Guest blog by: Lillian Craggs-Dino, DHA, RDN, LDN, CLT Metabolic and bariatric surgery is life-changing, but it also carries risks that require ongoing attention. One such risk is peripheral neuropathy, a condition that affects many after surgery.In this blog, we explore what peripheral neuropathy is and how you and your healthcare team can work together to prevent it. Understanding Peripheral Neuropathy Your nervous system consists of the central nervous system (the brain and spinal cord) and peripheral nerves, which extend throughout your body. Peripheral neuropathy is caused by nerve damage, which can significantly impact your quality of life. Nerve damage may result from various factors, including injury, medications, illness, surgery, or poor nutrition. After surgery, the risk of nerve damage increases due to changes in how your body absorbs nutrients. Why Bariatric Surgery Patients Are at Risk After surgery, you’re educated on diet and supplement recommendations. However, it’s not uncommon to drift from these guidelines for various reasons. It’s important to understand that taking vitamins and eating healthy is not always enough. You need to continually work with your bariatric care team to ensure you are meeting your long-term health goals.You’re at a greater risk for peripheral neuropathy because the surgery limits your food intake and affects nutrient absorption. Without proper nutrition and supplementation, you could experience nerve damage leading to peripheral neuropathy. Symptoms of Peripheral Neuropathy Peripheral neuropathy can be painful and disruptive to your life. Some common symptoms include: Burning pain Tingling or numbness in the extremities Poor balance Paralysis Slow-healing wounds Unfortunately, peripheral neuropathy is common in the United States, especially in people with obesity and diabetes, which are often related to those undergoing bariatric surgery. Preventing Peripheral Neuropathy Through Nutrition To prevent peripheral neuropathy, it’s critical to meet your specific post-surgery nutritional needs. Taking a general multivitamin won’t be enough. You should pay close attention to the following micronutrients, which are listed in the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines: Vitamin E Vitamin D Vitamin B12 Vitamin B1 (thiamine) Vitamin B6 Vitamin B3 (niacin) Folic acid Copper These vitamins and minerals are crucial for maintaining the health of your brain, spinal cord, and peripheral nerves. Deficiencies in one or more of these micronutrients could increase your risk of developing peripheral neuropathy.1 Recommended Micronutrient Dosages and Sources The table below outlines the recommended starting dosages for key micronutrients2 along with some common food sources: Micronutrient Dosage Foods Vitamin B12 350-1,000mcg dissolvable, daily OR 1,000mcg monthly injection All animal protein foods such as eggs, poultry, seafood, red meat Vitamin B1 (thiamine) At least 12mg, preferably 50-100mg daily Brewer’s yeast, pork, yogurt, milk Vitamin B3 (niacin) 20mg daily (no more than 35mg daily) Beef liver, shiitake mushrooms, chicken breast Vitamin B6 2mg daily (no more than 100mg daily) Cereal, salmon, garbanzo beans, cabbage Folate (folic acid) 400-800mcg daily OR 800-1,000mcg daily if pregnant or planning on pregnancy All green leafy vegetables, papaya, nuts and seeds, asparagus Vitamin E 15mg daily (no more than 1,000mg daily) Wheat germ, nuts and seeds, avocados Vitamin D 75mcg daily Salmon, eggs, cheese Copper 1-2mg daily (additional may be needed if taking zinc alone) take 1-2mg of copper per 8-15mg of zinc Oysters, lobster, crab, nuts and seeds, mushrooms While these dosages are a good starting point, your individual needs may vary. You should regularly have your lab work checked to monitor your nutrient levels and adjust your supplements as needed. Remember, this is a lifelong process. Work closely with your bariatric interdisciplinary team, including your doctors, dietitians, and specialists, to ensure you meet your nutritional and health goals. Conclusion Protecting your nerves after surgery requires paying close attention to your nutritional intake and working with your healthcare team. By following your supplement regimen and keeping up with medical supervision, you can reduce your risk of peripheral neuropathy and maintain a healthy, fulfilling life post-surgery. References 1. Staff NP et al. Continuum (Minneap Minn). 2014;20(5 Peripheral Nervous System Disorders):1293-1306.2. Mechanick JI et al. Surg Obes Relat Dis. 2020;16(2):175-247.