Iron deficiency

[BigSue 525]

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 621]

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 525]

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 621]

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 6,045]

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 525]

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 114]

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 6,045]

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 525]

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.

[Minnie77 0]

I’m concerned that my ferritin levels are too high. I just got back my blood test results and b-12 and ferritin is high. I have not spoke to my doctor yet about the results. I take Iron 65mcg per day and I’m wondering if I should stop taking them daily and change the cadence. B-12 I take sublingual daily 5000 mcg. I need to ask my doc about stopping or changing cadence.

[BigSue 525]

1 hour ago, Minnie77 said:

I’m concerned that my ferritin levels are too high. I just got back my blood test results and b-12 and ferritin is high. I have not spoke to my doctor yet about the results. I take Iron 65mcg per day and I’m wondering if I should stop taking them daily and change the cadence. B-12 I take sublingual daily 5000 mcg. I need to ask my doc about stopping or changing cadence.

Definitely ask your doctor about this, but most likely, you'll just need to lower your Iron dose (I assume you are taking 65 mg, not mcg, right?). 5000 mcg of B-12 is a lot (I only take 1000 mcg), so your doctor may tell you to lower that as well. I think taking B-12 supplements can make your bloodwork show erroneously high levels. My bloodwork showed high B-12 levels, but my doctor was not concerned about it because you just pee out the excess.

[BigSue 525]

I figured I'd post an update here in case anybody comes across this post wondering about the same thing.

I took my endocrinologist's advice and started taking additional Iron. I now take a multivitamin with 45 mg of ferrous fumarate, plus a chelated iron supplement with 36 mg of iron, for a total of 81 mg of iron per day. I just got my 6-month bloodwork, and everything is great, so I think I'm taking the right dosage of iron (at least for now). I have no idea whether the chelated iron makes a difference, but it's certainly not hurting.

[Pdub8112 7]

On 9/5/2020 at 11:22 AM, BigSue said:

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?

Have you asked about iron injections?

[catwoman7 6,045]

On 1/8/2021 at 10:47 AM, BigSue said:

I figured I'd post an update here in case anybody comes across this post wondering about the same thing.

I took my endocrinologist's advice and started taking additional Iron. I now take a Multivitamin with 45 mg of ferrous fumarate, plus a chelated Iron supplement with 36 mg of iron, for a total of 81 mg of iron per day. I just got my 6-month bloodwork, and everything is great, so I think I'm taking the right dosage of iron (at least for now). I have no idea whether the chelated iron makes a difference, but it's certainly not hurting.

whoever said some of the traditional advice on Vitamins goes out the window when it comes to bariatric patients is right. Especially with RNY, since we malabsorb some nutrients. I'd go by your bloodwork and adjust as necessary. Going for three months at a dosage level that's a bit higher than "normal" (we're not talking 2-3 x more than normal - we're talking a few milligrams) shouldn't be toxic - they'd catch it before it became a problem.

I have a similar issue with Calcium. I evidently absorb it much better than most bariatric patients, because my endocrinologist noticed I was excreting gobs of it in my urine. She said I was at a huge risk for developing kidney stones at that rate. She had me cut my dosage in half, and then had me cut out calcium supplements altogether. I was a little freaked out about this because I have osteoporosis, but my levels on everything are fine. Balancing chemicals in bodies are an endrocrinologist's bailiwick, so yours should know what he/she is doing. And like mine, yours tests again after three or so months, so they can tell pretty quickly if the change is causing problems.

and yes - different forms of iron are absorbed differently. Sounds like you're good at this point!

[Darktowerdream 405]

I think the Vitamins can be confusing, at least to me. I studied Holistic health and nutrition and I understand it but not when it comes to my own blood test results 🤣 I have taken whole foods based vitamins since my gastric bypass surgery April 29th 2019. My Vitamin levels have done well. my previously very low Vitamin D even before surgery actually normalized. my Iron levels are within the normal range I try to get it from the whole foods based vitamin and food even the gentle iron supplement that claim no constipation cause severe constipation and I have too much problems for that. what is extremely low is my Ferritin. I am not sure it correlates with iron deficiency or is as simple as iron supplements. I know my hormones must be whacked since I went into surgical menopause after having my last ovary removed due to endometriosis. as well as existing metabolic disorders. but my doctor and my surgeon just assume it is that simple to just take iron. but my levels stay the same. and of course say speak to the nutritionist. but I could not afford an appointment since its no longer covered I paid for a set amount of visits they wanted the same amount for one appointment that it cost for what I needed to have before my surgery and the post op visits. I have a endoscopy today. so Im a bit distracted.

Sorry I cant answer your question. It just seems to vary so much between each person.