Iron deficiency

[BigSue 184]

My endocrinologist ordered some bloodwork last week and (surprise, surprise) I have Iron deficiency. I was slightly iron deficient before the surgery as well. I've been taking BariMelts iron + Vitamin C with 54 mg of iron per day. The endocrinologist suggested I take the iron supplements twice a day, and that makes me nervous because I know too much iron can be toxic. Google tells me the maximum recommended iron dosage is 45 mg per day, and I'm already over that. I realize some of the normal rules go out the window for bariatric patients, but my bariatric program only recommends 45-65 mg per day.

Dr. Matthew Weiner has a video on YouTube about supplements after bariatric surgery, and he said that the most important thing to learn from that video is that gastric bypass patients need to take chelated iron supplements. My bariatric program says nothing about that and specifies ferrous fumarate or ferrous fluconate (but they said the BariMelts, which are carbonyl iron, are fine). I purchased some chelated iron supplements (which are hard to find) and I plan to start taking those once I run out of BariMelts in a couple of weeks. I was told to take chewables for the first six weeks, and the chelated iron pills aren't chewable.

My surgeon doesn't do bloodwork until 3 months out, which is about 5 weeks from now. I sent my bloodwork results to the surgeon's office, but I'm not sure if they'll even look at them since they're apparently not concerned about bloodwork until 3 months out. I'm conflicted between following my endocrinologist's orders (who does not specialize in bariatric patients), or waiting until my 3-month appointment to see what the surgeon says, and also see how the bloodwork comes out after I've been taking the chelated iron.

Any advice?

[Foxbins 594]

I am taking 90 mg of carbonyl Iron and I am not worried about iron toxicity. Yes, iron is toxic in large quantities (mostly accidental ingestion by children and suicide attempts in adults) but it's likely that you'd have significant symptoms of gastrointestinal irritation before you got toxic. I am more concerned about iron-deficiency anemia, which has uncomfortable symptoms that won't go away if I don't take the iron. Besides, I'm only going to take these doses until I correct the anemia, and then I'll go back to 45mg. My surgeon said I could take any pills I could swallow, so I've been taking the Feosol carbonyl caplets. They aren't too big and don't seem to irritate my stomach. They are cheap compared to bariatric iron. Research seems to be mixed on the efficacy of chelated iron vs ferrous, though chelated seems to be easier on the digestive system.

I don't think anything bad is going to happen to you in the five weeks between now and your appointment--take the iron or take less, it takes a while for your iron levels to come up to non-anemic levels anyway, depending on how low you were when you started and whether your ferritin was depleted as well.

Best wishes!

[BigSue 184]

1 hour ago, Foxbins said:

I am taking 90 mg of carbonyl Iron and I am not worried about Iron toxicity. Yes, iron is toxic in large quantities (mostly accidental ingestion by children and suicide attempts in adults) but it's likely that you'd have significant symptoms of gastrointestinal irritation before you got toxic. I am more concerned about iron-deficiency anemia, which has uncomfortable symptoms that won't go away if I don't take the iron. Besides, I'm only going to take these doses until I correct the anemia, and then I'll go back to 45mg. My surgeon said I could take any pills I could swallow, so I've been taking the Feosol carbonyl caplets. They aren't too big and don't seem to irritate my stomach. They are cheap compared to bariatric iron. Research seems to be mixed on the efficacy of chelated iron vs ferrous, though chelated seems to be easier on the digestive system.

I don't think anything bad is going to happen to you in the five weeks between now and your appointment--take the iron or take less, it takes a while for your iron levels to come up to non-anemic levels anyway, depending on how low you were when you started and whether your ferritin was depleted as well.

Best wishes!

Thanks, that's good to know! The chelated iron is pretty cheap, too, and supposed to be easy on the stomach (and not cause constipation). Dr. Weiner said that chelated iron is best for gastric bypass patients because it can be absorbed anywhere in the intestine, while elemental iron is mostly absorbed in the first part of the intestine (which is now bypassed). But that video was from 6 years ago, so I don't know if there's any more recent research that says differently.

Do you take 90 mg at a time or split it up into two doses?

[Foxbins 594]

I take it in two doses, I figure less chance of stomach upset with only one caplet at a time, and more chance of absorption in two doses instead of one. I take one with food and one on an empty stomach, too.

[catwoman7 5,136]

you're right in that some of this stuff goes out the window when it comes to bariatric patients because we don't absorb a lot of things - or don't absorb them as well - as "normal" people.

re: endocrinologists vs bariatric surgeons: my endocrinologist has me taking half the Calcium that my bariatric clinic suggested, because she said I was excreting a TON of calcium, which is really hard on your kidneys. So I'm obviously absorbing it better than most bariatric patients do. So we've been playing around with the doses, rechecking bloodwork every couple of months, and then adjusting up or down as necessary. I do think this is more of an endocrinologist's bailiwick.

five weeks of taking too much or too little of something is fine. Usually when they increase or decrease your dosages of things based on your bloodwork results, they re-check in a couple of months to see where you're at and then adjust if necessary.

re: Iron - I take carbonyl. A lot of bariatric patients seem to take that since it's easy on the stomach. I take 100 mg a day (all at once), and my labs are good. I'd cut back at one time but my ferritin got too low, so now I'm up to 100 again. We don't absorb all the iron we take, so even if that amount would be toxic to normal people (and I'm not sure if it is, to be honest), it might not necessarily be toxic to bariatric patients.

[BigSue 184]

17 hours ago, catwoman7 said:

you're right in that some of this stuff goes out the window when it comes to bariatric patients because we don't absorb a lot of things - or don't absorb them as well - as "normal" people.

re: endocrinologists vs bariatric surgeons: my endocrinologist has me taking half the Calcium that my bariatric clinic suggested, because she said I was excreting a TON of Calcium, which is really hard on your kidneys. So I'm obviously absorbing it better than most bariatric patients do. So we've been playing around with the doses, rechecking bloodwork every couple of months, and then adjusting up or down as necessary. I do think this is more of an endocrinologist's bailiwick.

five weeks of taking too much or too little of something is fine. Usually when they increase or decrease your dosages of things based on your bloodwork results, they re-check in a couple of months to see where you're at and then adjust if necessary.

re: Iron - I take carbonyl. A lot of bariatric patients seem to take that since it's easy on the stomach. I take 100 mg a day (all at once), and my labs are good. I'd cut back at one time but my ferritin got too low, so now I'm up to 100 again. We don't absorb all the Iron we take, so even if that amount would be toxic to normal people (and I'm not sure if it is, to be honest), it might not necessarily be toxic to bariatric patients.

Good to know... I guess I'll start taking the extra iron now and see what the surgeon says when I go in for my next followup. The endocrinologist said to take it twice a day, but that will be difficult because I'm supposed to take calcium 3x per day, two hours apart from each other and two hours apart from iron, and my thyroid medication four hours apart from calcium and iron.

Thanks for the info on endocrinologist vs. surgeon. I've been wondering about that since this stuff is more in the endocrinologist's area of expertise, but she doesn't specialize in bariatric patients, so maybe she doesn't know all the specifics of bariatric post-op changes. The surgeon doesn't even do bloodwork until 3 months out, so his directions are just based on the general bariatric patient guidelines.

[waterwoman 103]

I had RNY 4 years ago and have tried a variety of supplements since. At one point I was diagnosed with very low Iron and Dr. just suggested taking iron tables.

I recently found attached from Kaiser which I thought was well laid out and, as current supplements were running low, decided to follow this plan.

So far, so good.

Bariatric Supplements - Kaiser.pdf

[catwoman7 5,136]

14 minutes ago, BigSue said:

Good to know... I guess I'll start taking the extra Iron now and see what the surgeon says when I go in for my next followup. The endocrinologist said to take it twice a day, but that will be difficult because I'm supposed to take Calcium 3x per day, two hours apart from each other and two hours apart from iron, and my thyroid medication four hours apart from calcium and iron.

Thanks for the info on endocrinologist vs. surgeon. I've been wondering about that since this stuff is more in the endocrinologist's area of expertise, but she doesn't specialize in bariatric patients, so maybe she doesn't know all the specifics of bariatric post-op changes. The surgeon doesn't even do bloodwork until 3 months out, so his directions are just based on the general bariatric patient guidelines.

yea you're right. Endocrinologists know a lot about various chemical balances but most of their patients wouldn't be bariatric patients - and bariatric surgeons are, of course, very familiar with bariatric patients but wouldn't be as well-versed in chemical balances. Although as long as they're re-running labs within a couple of months after making a change and then adjusting if necessary, it should be OK.

[BigSue 184]

10 minutes ago, waterwoman said:

I had RNY 4 years ago and have tried a variety of supplements since. At one point I was diagnosed with very low Iron and Dr. just suggested taking Iron tables.

I recently found attached from Kaiser which I thought was well laid out and, as current supplements were running low, decided to follow this plan.

So far, so good.

Bariatric Supplements - Kaiser.pdf

Thanks for the helpful info! Interesting that BariMelts are on the list of not recommended supplements. That's what I've been taking, but in addition to the Multivitamin, I'm taking separate supplements for iron, B-12, D3, and Biotin. I'm planning to switch anyway once I run out of Barimelts because I can take pills now and the Barimelts are pretty expensive.