Educate me about Iron

Hi All!  My ferritin levels are low.  This is not new for me as I have chronic kidney disease and mostlystopped eating red meat in 2005 after my  bout with colon cancer.  ( I have red meat maybe once a month or 6 weeks...)

Anyway, I have been taking an iron supplement.  The type varies.  I was taking the ferrous sulfate for a while.  For the past 3 or 4 months I was taking iron glycinate.   I have been taking iron ferranyl for a couple of days since I found out my levels are low. (Seems like the iron glycinate is doing nothing or my levels wouldn't be that low.  )  I am not a nutrition expert so I was wondering if anyone knew the differences between the irons and if there is a certain type that with better bioavailability?    Taryn said to just bring in whatever I am taking on Friday, so she will be going over that stuff with me.  I just wanted to get some education about the different types; I don't know if I am just not taking enough or the wrong kind.  I hate to be taking this stuff and it do nothing.  (Or is it just different for everyone and you just have to find the one that works for you personally?) Any thoughts or experiences appreciated! Melanie g.

Mel... this is a big problem for a lot of us. Unfortunately I went in to this with the gun all ready pointed at my head. It really depends on the person as to how they respond to the iron. The one that usually works the best is one that is given under a dr's care, whether it be the IV or a prescription pill. give me a minute to find a great post from DX and I wil post again with more info.

 ok I found the post ... here you go.remember this was written with guys in mind but a lot of the info about the supps would still apply. Iron- (a repost from  past...ignore if you've seen it.)

Some random-azzed info on ---- IRON! (skip if not needed) ______________________________________________ The Women are very aware of Iron needs. That whole menstrual cycle thing Causes so much iron deficiency among them That the typical "Women’s Formula" Vitamins Are usually just normal multi- Plus Iron. It’s an issue that they deal with as Non-Ops. But for men, it is very rare That we ever have Iron deficiencies- Except those of us Men, who have had Gastric Bypass, Specifically- RNY. Suddenly we go from a group that rarely if ever Experiences Iron Deficiency, to a group that Has a 33% to 50% occurrence rate. So, chances are somewhere between 1 out of 3 And half of the guys reading this Will experience an Iron deficiency at some point. That is unless- We take care of our business! Yes? So- Some Iron Man Talk!- Iron allows our blood to carry Oxygen in our blood. Not enough Iron, Oxygen is not efficiently Carried throughout our bodies. The symptoms can be- fatigue, headaches, weakness, Irritability, pale skin color, unusual cravings, And decreased resistance to infection. At Even, at more serious low levels- Heart palpitations, hair loss, low blood pressure, And Shortness of Breath. The causes for our Iron deficiency are two-fold. - Iron is primarily absorbed in the proximal jejunum (Upper small intestine) as well as the duodenum. Iron normally begins breaking down in the stomach With the acids and continues breaking down and Is absorbed in the upper intestine. With RNY patients, our lower portion of stomach Is bypassed, therefore missing the whole stomach acids Event needed to break down the iron, And also the upper portion of the small intestine is bypassed Thus skipping the primary absorption sites for iron. Lap-Banding doesn’t create either of these problems with iron But the DS, even though it keeps the lower stomach And acid production/interaction, it still bypasses and therefore Can result in reduced iron absorption. So, as a rule, we tend to have some degree of iron deficiency Inherent in the whole bypass business. So, to get more Iron? The easiest is to eat iron rich foods. Red Meat, Eggs, fish, Green leafy veggies, As well as Peas and Beans. There is also a high iron content in dried fruits Such as apricots, raisins, and prunes, As well as all of the "fortified" cereals and breads, Nuts and seeds. The dried fruits will also "keep you regular" But at higher amounts, may cause dumping in some. (me) But, with reduced intake, and not always making Your food choices based on- "How much Iron is in this?" It is probably just easier to take a supplement. Iron supplements come in- Ferric –Or- Ferrous forms. The FERRIC supplements need the stomach acids to Make them absorbable. So, The ferrous is considered better because it is Easily absorbed. Read your labels! These show up on the shelves and in multi-vitamins as- Ferrous Sulfate, Ferrous Gluconate, and Ferrous Fumarate. The AAMC’s Biochemistry page lists- "Oral administration of Ferrous Sulfate Is the Most Commonly used Iron Supplement" But, even though when taken with a mild acid such as juice It has acceptable "Bio-Availability," It’s Not the best. Although ferrous sulfate is often recommended to treat iron deficiency, Frequent problems with the drug including gastrointestinal discomfort, Bloating and other distress, make it unacceptable to many patients Second most common Iron Supplement? – Ferrous Gluconate, Which is roughly equivalent in cost, produces fewer problems, And is preferable as the initial treatment of iron deficiency. (it also happens to be the compound used to color or "dye" ripe "black" olives) (so a few of these now and then have the added perk of Iron.) (also dropping a little "Factoid" in here- Cooking in an Iron skillet or pot will add substantial Iron to the foods you eat. Just a thought) Ascorbic acid (Vitamin C) along with the supplement enhances the absorption. Combination tablets containing iron salts and ascorbic acid Are significantly more expensive than separate tablets for each, however. Ferrous Fumarate is the often the Iron of By-Passers choice because It has the highest % of absorbable iron "of the ferrous versions." The Office of Dietary Supplements At The National Institute of Health, Lists Ferrous Fumarate As containing twice as much absorbable iron as F-Gluconate, and 3 times as much as F- Sulfate. (before breaking into a discussion of-"My Iron is Better…" some more info) I don’t take the Ferrous Types because I take a prescription Iron supplement. My Doctor says to, and my insurance pays for it. My prescription is POLY-IRON 150. (POLY-IRON) The Generic Name: iron polysaccharide Also comes in the Brand names- Fe-Tinic 150, Hytinic, Niferex, and Nu-Iron 150 Polysaccharide-iron complex, (What I’m on) A replacement form of iron that differs from the iron salts, Is a more recent option. Most patients tolerate this form of iron better than the iron salts, Even though the 150 mg of elemental iron per tablet Is substantially greater than that provided by iron salts (50 to 70 mg per tablet). Still, According to- The Harvard Center for Sickle Cell and Thalassemic Disorders "No study exists comparing iron uptake from polysaccharide-iron complex and ferric salts." There’s also Iron Bisglycinate, often sold as "Gentle Iron" Because it is easy on the digestive tract. The only "non-Vitamin Sales Site" info I have concerning iron bisglycinate Is from The American Journal of Clinical Nutrition- http://www.ajcn.org/cgi/content/full/72/6/1592 Which found- "No advantage of using ferrous bisglycinate as an iron fortificant." It is an Older article however from 2000 A 2006 article from – U.S. National Library of Medicine, National Institutes of Health, & Human Service http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract &list_uids=15864409&query_hl=3&itool=pubmed_docsum Showed that when taken or administered along with Ascorbic acid, The relative bio-availability (RBV) of seven different commercially available Elemental iron powders (actual only 5 on the market, 2 in testing trials) ---No significant overall ranking was possible. All that to say? Ask your doc! And if the Ferrous Sulfate gives you Constipation or gas Try another. But by all means take what ever one you use Along with some Vitamin C. With Vitamin C? There’s not enough difference between them to be Measured by Current (2006) Technology. So, Do you need it????????????????????????????? Iron levels should regularly be checked Along with your normal blood tests. The Normal range for Men is – 75 to 175 (mcg/dl) micrograms per deciliter of blood And 65 to 165 (mcg/dl) micrograms per deciliter of blood for Women. Typically the test That is part of the usual Mal-absorption/Nutrition Screen For WLS Patients is not an Iron specific Test, but rather A simple blood test that measures the number of red cells And the amount of hemoglobin in the blood. The normal amount is at least – 13g/dl (13 grams of hemoglobin per deciliter of blood) for men And 11g/dl for women. This test can determine if you are anemic, But does not identify the cause of the anemia directly. The leading cause of Pernicious anemia is from low B12, Which is also a "red-flagged" concern Of mal-absorption in WLS folks, So unless your Doc is specifically looking at Iron levels It may be missed. What to do? ASK! Again, ASK! "Doc, are you checking my Iron levels specifically? Or just my Hemoglobin?" "Does that test break out testing for B-12 problems From other causes of Anemia?" Just write these two questions on your arm Where they are gonna stick the needle to draw the blood. Why do you need to be "all up in the Doc’s Business?" Cause, It’s Your Business! Pernicious Anemia is fairly common, among WLS folk. It can be, and is most often caused by low B-12, But all the B-12 in the world won’t help, If you are running low on iron. Yes? So, just start taking some iron supplements to be Safe? NO! -again- NO!:nono: Have your Doc check. If your B-12 levels are low, And this is also a common occurrence for By-Passers, And you have been taking Iron Supplements And have a high Iron level, It will completely skew the lab results looking at B-12 levels And could totally Screw You Up! So, Ask your doc! And make sure he/she is looking specifically at/for both. Also, if you are just getting labs done once every 3 months Ask if the numbers are going up or down- Even if they are in Normal range. If three tests in a row, the numbers are dropping on your Iron But are still within Normal range, The Dr. will look and say- "Great! Well within normal range! See you in 3 months!" But if for instance- Your Iron level has gone- Test one- 128(mcg/dl) in the normal range! 1 month later- Test two- 95(mcg/dl) in the normal range! 3 months later- Test three- 82(mcg/dl) in the normal range! By the time you get to test four, 6 months later, At this descending rate- You’ll have about 4 months of not doing well Before the test that determines that You’ve fallen below the 75 to 175 (mcg/dl) Normal range. Yes? So- ASK!!! And ASK if you can have your numbers, Photocopies of your lab results. As Great as your Doc is, he/she is looking to see If you are in Normal ranges. Unless your Dr. is "House" on TV Pulling off diagnostic miracles each week In a one hour episode, Chances are, they are not going to be looking at your Tendencies and movements within the normal ranges Anywhere as near as YOU would. Once you get past the first year of Post-Op, Lab tests are typically only twice a year. Don’t risk a few months of ill-health While waiting for another test to come around. With a B-12 deficiency, it is corrected fairly quickly with Some B-12 injections, and the "store-houses of B-12," Your muscles, can be replenished fairly quickly. But if you get behind on your Iron? Iron infusions through an IV A couple of days a week for a few weeks. That Bone marrow is a slow warehouse to get in and out of. The treatment Suks! So, all of this to say- Stay On Top Of Your Iron! Now, * stepping onto a lower soapbox *- A couple of other bits to know- Iron competes for the same "receptors" on your intestines as Calcium. If you take a Calcium Supplement (and you most definitely should) Make sure you don’t take it at the same time as your Iron. Each, will get in the way of the other’s absorption. Not that they "cancel each other out." They just "plug" each others pathways of absorption So you don’t get the Full benefit of either. Take your Calcium and Iron at least 3 hours apart And you should have no problems getting the full benefit of each. The acid of Vitamin C helps break down the Iron and make it More absorbable, so it is good to take these together. Other thing? When taking an Iron Supplement, and some of it is Not absorbed It passes on into the lower intestine, where for most of us It does a great job of "firming up" and in many instances, "locking up" Our Bowel’s Contents. This can make going to the pot- Like trying to pass a Dumbbell! A big one! When taking Iron Supplements, the more they are absorbed, The less this effect on the stool. So take the Vitamin C! Yes? Also up the 3 F’s- Fiber, Fluid and Fats, to keep your "Moves-Smooth!" One of the symptoms of Too Much Iron is in fact Constipation And this is one of the things that may crop up if you just start "Taking Iron Supplements, just to be safe!" Unlike the case with getting Too Much Protein, B-Vitamins, C’s and such- Those will just pass on through in feces and urine, Too Much Iron can cause Big problems ranging from the Constipation And even Diarrhea to Liver and Heart Damage. So don’t just Start up supplementing without Needing to. And Last- Don’t take Iron Supplements in a tablet form with an enteric coating. Enteric Coating is that Thick, Candy like Coating on some "Extended-Release" Meds. By the time the Coating has worn off, It’ll be ready to exit out the "End of the Line," And none of the benefits will see your insides, But rather, will arrive Intact, in your Toilet. In fact, don’t take anything with an Enteric Coating. Those are intended to get the stuff past The harsh corrosion of the stomach. Not an issue for By-Passers. Yes? So, that’s all the Poop on Iron That I could remember this evening! The whole- "I’m not getting enough Iron" Thing Is typically one that Men never face. But with having a Gastric Bypass, This is suddenly just as much an issue For Us -(33% to 50% of Us) As it is for those who get regular visits from Aunt Flo! Best Wishes- Dx

Hey melanie, I am so sorry I have been busy and didn't see the post until now. I do some consulting with Bariatric Advantage with patient education when I can.  With questions such the one you have here, it's important to go to professionals for help and answers, Dr.Sonnanstine and Taryn will work with you very closely on your iron levels. I went to the Dr. Jacques, Chief Science Officer for BA and submitted your question.  Here is her answer. Brenda – there are different types of iron and some are better absorbed than others.  Generally ferrous forms are preferred to ferric forms.  However, ferrous sulfate is notoriously hard to digest.  I like ferrous fumarate, ferronyl (carbonyl iron) and ferrous citrate.  Vitamin C improves the absorption of iron after gastric bypass, which is why we include it in our tablets. It is also important to know if she is treating herself or if she is working with a doctor, what she is calling “low” and whether she still has periods.  If she has a history of colon cancer and kidney disease , I think it is very important that she be working with a doctor on her nutrition.  Her iron deficiency could very well be a result of those conditions and less related to her weight loss surgery.  Potentially, she could do harm by supplementing high levels of iron on her own – especially if there is more than one cause. Hope this helps!!

Great post Brenda! That is what I was getting at when I said that the info I was posting was written with guys in mind. We all know my Iron problems. I'm just wondering if I will be getting another Iron IV or if it will fall to being the prescription for the Iron. Can't wait for August to get here to find out because I would like to stay ahead of it and not get to that level again. Not that I am planning on any more surgeries but still.......

Thanks Ryan, I will always try to answer post that are vitamin related if I can..I have the resources like Dr. Jacques who can answer most questions, especially since her life and job is studying bariatric patients. I take chewable iron tabs every day, I was taking 4 right after Dr. Sonnanstine operated on me in Dec for the infection due to plastic surgery,  I was anemic due to loss of everything while the wound vac sucked it out of me.  Dr. Sonnanstine felt with being as compliant as I am with my eating and vitamins I should be able to bring it back up without infursons, etc.   he was right, it was normal last he checked.  All I am working on now is Vitamin D ...he told me to add that to my vitamin intake.  I however, had a better idea.  A prescription for the Bahamas..LOL..he didn't fall for it though, I tried..Taryn even told me to tell him she felt I needed a private nurse (her) accompanying me..lol I am now getting out in the sun, best source of vitamin D.. it's awesome to study and learn this stuff.  As a RNYer.  I feel prevention is so much better than fixing it later...so anyone reading this..please don't forget to take your vitamins....make sure you take a good quality..leave the childrens vitamins for the children!!!.. take care Brenda

Thank you Brenda and Budda!

The iron I switched to is the Bariatric Advantage brand.  I probably am not taking enough, but I'll just let Dr. S let me know how many of these  I need.  (They come in 18 mg and 29 mg tabs.) I am taking 2 of the 18's or one of the 29's.  (The supplement I have been using for the past 3  months  was a 28 mg tablet and I am still low, so hopefully I just  needed a different formula.)  If they think I need more for a while that is fine with me; they are easy to take. All my nephrologist said was take an iron supplement; nothing specific  and he was not remotely concerned about the kind or anything.   My H&H has been low normal now (was low before the colon cancer surgery...bleeding!)  just the iron is low.  The renal disease would affect my H&H due to a hormone made by the kidneys (and the neph did not  think I needed epogen yet... years away!) , but my issue seems to consistently be the low iron.  Back in the day (before the CA!) I ate  red meat a lot and iron didn't seem to be an issue. Hubby took me on a riverboat cruise last night and we had roast beef,  so maybe that will help!!!! 

Thank you for the info!!! Melanie g.

Oh Brenda, I just saw your post where you said, "make sure you take a good quality..leave the childrens vitamins for the children!!!".  Wouldn't you know it, I've been taking children's chewable vitamins since surgery because I couldn't swallow the adult ones.  I can swallow now so maybe I'll try grown up vitamins now.  :-)  The multi-vitamin is the only one I was getting from the kiddie section though.  My iron is also very low.  My protein is quite low and my doctor (pcp) is quite concerned.  He had the nurse make a special appointment for me to discuss these issues.  Anyway, I have something to tell you but I'll post about it in a separate post to not take away from the poster here. I will be checking out the other forms of iron as well.  I was taking the one with the coating for months and months but accidentally bought the kind that has no coating at all the last time, which was about 6 weeks ago.  I didn't know there were iron pills without that coating before then.  My gums have already turned pink again so I'm thinking my iron is surely back up a little.  I've also gone from one pill a day to two.  The doctor wanting me taking two iron pills a day two years ago because of my anemia anyway and that was a year before wls and was my pcp who told me to do that as well.   Gale

Hi Gale, sounds like you are doing all the right things, keep up with your levels and never miss an appt with your surgeons office, ...remember what I said..prevention is the key..so get on the right track and have them work with you...then make sure you take a good quality multi.  Bariatric Advantage makes chewable multi as well as iron chewables.  they taste a little like a sweet tart, very small but pretty good..I don't get indigestion from them either. email me direct if you want more information, but certainly follow Dr. Knightburt's directions.. Brenda [email protected]