Hi all , I am 6 months out , on Bariatric Pal Multivitamin One chewable plus 45mg iron tablet , but it's still not doing it .I only had the tests done yesterday and first thing today the doctor texted and said you are very low on iron .She told me to get in touch with my dietician for her to decide what's to be done , but I only have her e mail so don't know when she'll reply .

Has this happened to you ? what did you get told ? please don't suggest including more fruit and veg or red meat into my diet , as I am struggling with "ordinary" food going down as it is .

Many thanks for reading x

I don’t understand why your doctor wants you to speak to your dietician about your low iron levels except to maybe review your current diet & see if something is missing or there is something extra you could add. Has your doctor has you to arrange an appointment to discuss your results & prescribe or recommend an additional supplement or an infusion if needed??? Unless your level isn’t that low & dietary changes should be enough??? ??‍♀️

I’ve heard it can take some time for your iron levels to go up again too.

Low iron levels seems to becoming more common these days for all women not just bariatric patients. I have several friends (none have had surgery) who need to take iron supplements or have transfusions because of low iron levels. Never knew one 10 years ago.

PS - I have a protein absorption issue thanks to my gall removal. Not related to my sleeve. (Also stopped me absorbing my HRT meds - God bless the patch.)

Hi all , thanks for your replies .I don't get this .My dietitian wanted me to take 4 Bariforce Liquid tabs which would have only given me 36mg iron .But I got the Baritriatric Pal chewable which has 45mg .Now my iron is showing low as we know and she's changed her tune and said you should be on 210mg .

On top of that I haven't got her number and now have to wait until the evening of the 6th March to speak to her .I paid privately for this op and it cost a mint here in the UK .I'm not sure she knows what she is doing ! I think I'll have to try and get in to see my G.P. to sort this out . How much iron was everyone else told they need ?

thanks x

I’m so sorry this happened to you Fedup. I have very low iron levels and was ordered to take more iron from my doctor who just said, “take it with some acid.”? My dietitian and I came up with a more detailed plan that seems to work for me, it’s only three weeks now.

I take 45mg in the morning every other day with 4oz v8 vegetable juice. I picked even days of the month to help me remember. I knew not to have anything with calcium, but she reminded me not to take PPI at that time either because of absorption issues. (I think that’s where I went wrong) stick to decaf drinks at the same time too because of irrigation. Some food prior can help with stomach irritation too.

So far I do feel better. My oxygen levels are up (I check due to asthma) three points. My resting heart rate (Fitbit) dropped from 67 to 62, which tells me my heart isn’t working so hard to keep my body oxygenated. The rest of my job, life, diet stayed the same. The blood tests won’t be for another 5 months but some empirical evidence suggests the new iron tablets are doing their job.

Wishing you well.

Hi Fedup, good luck low iron sucks! I have very very heavy periods and with that have continuously low iron so will dump a load of generic advice I have researched over a couple fo years, sorry in advance (and obvs take doctors' advice first!)

Firstly don't even bother trying/thinking about getting more in your diet, even iron-rich foods hardly have enough unless you eat liver or black pudding especially if you are already low. Supplement away.

Secondly, it is possible you have an absorption issue, but as you have a sleeve (which unlike the bypass don't skip the first bit of the intestines) I think it's much more likely that it's just the small amount of food combined with what sounds to me like way too little supplementation and possibly safe but low levels pre-surgery (NOT a doctor).

Things that help the absorption of iron: vitamin C, things that obstruct it, Calcium and caffeine. So when you supplement make sure it is not with caffeine or other supplements like calcium or magnesium, it should ideally be along with either fruit juice or a vitamin c pill or gummy. Multivitamins with iron combined often dont help as teh iron is just blocked. If your diet is anything like mine post-surgery... there was a lot of dairy! Also... im pretty sure i used to get most of my iron from chocolate, white bread and sugary cereal beofre surgery.

I also paid privately in the Uk so might have a slightly different perspective to those from the USA above. They won't just do infusions here the way alot of people have been discussing above, they arent covered privately with the cost of surgery, and NHS will supplement first and you need to be ILL. I used Nuffield so your package may differ, but the surgery cost covered the dietician for that year, but not costs from them, so they can ask your GP to prescribe stuff but cant directly. Hopefully its all sorted now but in teh future I would not rely on them to get stuff actioned, get on the phone to the GP get an appointment and get them to prescribe you what the dietitian recommended. I just demanded a repeat long-term prescription of iron pills.

As I say my deficiency is chronic (I prefer iron to birth control at the moment) but I have been on 305mg Ferrous Fumarate every other day for a couple of years, you can also ask for the more expensive ferrous compound if that gives you issues. Maybe try floradix if you can stomach it ?. But anything below 100mg or so a day just cant combat the deficiency.

I would up my dosage, check when/the combination of supplements, and keep on chugging, iron deficiency is really normal and very fixable and not down to your diet.

Ensure that you take your Iron at least 4 hrs after taking your multivitamin, my dietitian made sure to explain about absorption issues when taken to close to each other. Best of luck!!

I’m just here to add the idea of taking your iron supplement - whichever form and dose - with ascorbic acid or vitamin C to help break down the iron for better absorption.

On 2/23/2023 at 1:55 AM, fed-up said:

Hi all , I am 6 months out , on Bariatric Pal Multivitamin ONE chewable plus 45mg Iron tablet , but it's still not doing it .I only had the tests done yesterday and first thing today the doctor texted and said you are very low on iron .She told me to get in touch with my dietician for her to decide what's to be done , but I only have her e mail so don't know when she'll reply .

Has this happened to you ? what did you get told ? please don't suggest including more fruit and veg or red meat into my diet , as I am struggling with "ordinary" food going down as it is .

Many thanks for reading x

I had this problem a few years ago and had to get iron infusions for several years to get my levels back to normal. I went in to the infusion clinic (where most people are getting chemo, etc.) and sat with a drip for 1-2 hours a couple times a year. It really helped with my levels as well as my energy!

Hi All , thanks so much that valuable info .I dread trying to get an appointment with my G/P - as anyone in the UK will tell you - it's a miracle if you don't just get the nurse or pharmacist .

The dietitian told me that gentle Iron , Feraglobin , and Bariatric Vits won't do it for me and I need to get a treatment plan off my G/P .Yeah like that's easy .

She is sending me to be re-tested in a month .I have found it nigh on impossible to stomach ANY food that isn't soft ie I live on cottage cheese , shakes , Oatabix ( when it's soft ) and yogurt plus Protein water .I have really tried to digest proper food but it kills me going down .I can manage chocolate and am tempted to have some very dark chocolate every day to get my iron up .It doesn't give me the runs .

Memoryissues - you are so right .The dietitian will only do so much .I wish I could have an infusion but I'm likely just to be put on Ferrous Fumerate which hasn't worked so far .

Thanks for all the tips everyone re caffeine , spacing out my iron pills, the Vit C etc .I can't have V8 juice unfortunately as I have a stoma ( have a colostomy ) and veg juice would play merry hell with it .My stoma must be male 'cos it's very loud , embarasses me in front of people ,and never shuts up ??

Hi anyone who is interested ! I saw my G/P today and she listened and said there was iron supplement she could prescribe that hasn't been tried .She said she was going to call a department at the hospital whose job it was to give advice and guidance on the next step .She said infusions cost a lot - to the NHS - but it may be that's what is advised .Before the op I had great iron levels !! all that cereal and dark chocolate I expect .So I have to wait now and see what they advise .I'd love to feel energetic again , I just feel soooo tired .Will post when I hear if I am getting an infusion .I wonder how long an infusion puts you on for ?

thanks !

Hi All,

I have low Iron. I just received my 2nd infusion 2 days ago. I am happy to answer any questions

From my understanding, the low iron is a complication of the gastric sleeve, as it causes me to not be able to absorb enough iron. I tried everything I could think of, but it didn't help. I felt terrible for a longtime with significant fatigue.

After the infusions I feel rather weak and tired for a day, but overall feeling mucho better with increase physical energy and mental clarity-- but I also started keto a week ago, and that feels good ,too.

It sounds like my hematologist will redraw my iron levels in a about 2-3 months to see if I need more infusions.

Yes it was very expensive-- about $1700 per infusion (my insurance is covering it).

Hi Tink , thanks a lot .I do have questions about infusions .How often do we have to have them ? Are they painful ? how long does each infusion take ? She said there was sometimes side effects - did you getting apart from what you said ?

The NHS may or may not let me have an infusion/s , I don't know what the criteria is for it .The dietitian says it's nothing to do with them as it's not included in the private op I had .Sorry ,I meant to put in my post above - that my doc said there was NO iron supplement she could give me that I hadn't tried .

thanks everyone .

53 minutes ago, fed-up said:

I do have questions about infusions .How often do we have to have them ? Are they painful ? how long does each infusion take ? She said there was sometimes side effects - did you getting apart from what you said ?

Hi fed- up. So sorry to hear about your situation.

To answer your questions- I had one and then the 2nd infusion about a week later. No not painful at all- just an IV poke. The first infusion took an hour and a half- just to watch for side effects. The second infusion was about 20 minutes. No major Side effects. Kinda tired the day after. The infusion felt a little cold going in. Perhaps a little achy in the bones the night after the infusion- but all mild and transient.
However there are major adverse effects risks like low phosphorus in the blood that could lead to increase in fractures and other yucky stuff. By the way - The name of the medication was Injectafer.

Hope this helps you out.
Sincerely,

tink

Just found these two articles about iron malabsorption you may find interesting. Basically it’s more common with bypass than sleeve & with post menopausal woman. Also said one possibility as to the cause is your reduced diet after surgery while you are losing. To absorb iron you need a range of nutrients which you may not be getting. You are eating much smaller portions & many struggle with beef which is considered an easy source of iron. Worth a conversation with your surgeon & the experience of their previous patients & whether it will be a permanent issue for you

https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/risks-of-bariatric-surgery-anemia.html

https://www.hopkinsmedicine.org/health/wellness-and-prevention/iron-deficiency-after-gastric-bypass-surgery

Hi all , I am 6 months out , on Bariatric Pal Multivitamin ONE chewable plus 45mg Iron tablet , but it's still not doing it .I only had the tests done yesterday and first thing today the doctor texted and said you are very low on iron .She told me to get in touch with my dietician for her to decide what's to be done , but I only have her e mail so don't know when she'll reply .
Has this happened to you ? what did you get told ? please don't suggest including more fruit and veg or red meat into my diet , as I am struggling with "ordinary" food going down as it is .
Many thanks for reading x

Hi fed-up, I was told by dietician that iron should be taken with vitamin c as it helps the absorption. That iron alone is very difficult for the body to take in. I hope this helps!

Randomly recently discovered that caffeine can reduce your absorption of iron by up to 70%. Advice was not to drink coffee close to (before & after) a meal. Also that the iron used in iron enriched foods like breads & cereals isn’t absorbed easily & are of no real benefit. Also don’t take iron with calcium (including dairy products) or antacids/PPIs - leave 3 - 4 hours between taking/eating them.

Always seem to be discovering new information that are worth conversations with doctors.