Iron Tablets

I had to go in to see my regular PCP yesterday (technically it's a clinic so I see whoever is on duty) and man... talk about leaving more ticked off than when I got there.

Near the end of my appointment, the NP (whom I've never met until this appointment) tells me that I should drink orange juice with my iron tablet so that citric acid helps break down the pill and process in my stomach better. Now, this is the first I've heard of this. I told him... I'll do a small wedge of an orange, but I don't do orange juice. Too much sugar and too high on the glycemic index for me. I also informed him that I didn't eat grains, flour, sugars, and most processed foods. 

He halls off and starts spouting, "That's a myth! All this MISINFORMATION that's spread out on the internet! blah! blah! blah!" He even argued that a diabetic (he's PRE-diabetic and taking Metformin; I'm taking Metformin for PCOS) could drink sugared soda if "he just worked it a certain way". 

He wasn't happy when I told him "Really, I'm not the taking meds for diabetes, buddy, you are!"

I came away more ticked off than having to wait half 40 minutes in the cold to get into the clinic in the first place!  

So... my question to all those taking a prescribed iron tablet... I take mine at night time before I go to bed with 8-12 ounces of water. SHOULD I nibble on one wedge of a navel orange? Or is he just blowin' smoke?

Vitamin C is what helps the iron absorb.  Also, many foods have way more vitamin C than oranges.  Red bell peppers would be superior to eating an orange, actually, as they have far more and are remarkably lower in natural sugar.  

You can also buy chewable iron or iron supplements that come with vitamin C for absorption. That is what I do.  You can also take it with your multivitamin if there is no calcium - you just can't take iron and calcium at the same time as absorption is impared.

So.... yeah.  You don't need to drink orange juice.  I think they suggest that because many folks have it lying around.

He's a dumbass, but partly right on the OJ. It's the vitamin C that helps absorption of iron, not the citric acid, so you don't need oranges or orange juice. Both of those actually have relatively little vitamin c, not enough to help much.

The guideline is 200 mg of vitamin C for every 30mg of elemental iron. Keep in mind that most 325mg of iron tablets have only 65mg of elemental iron in them. So if that's what you take, a 500mg vitamin c tablet has you covered.

It's good to take iron at night, as other things such as coffee, tea, soy, calcium, etc will interfere with absorption.

Grim has it right (as usual) -- Cleveland Clinic has me taking iron at night with 200 t0 500 mg of vitamin C.

I have to find a PCP that is more informed about WLS patients, also.  I searched the OH Physcian finder and there are no GPs in the entire northeast.

Good luck with that -- I have the very same issue.  I end up using my bariatric endocrinologist at the Cleveland Clinic as my primary care physician when possible-- but truthfully, I have had to research and advocate for myself any time I go to a local doctor because most of them are terribly uneducated about bariatric surgery, obesity and nutrition in general.  It's really frustrating.

I've been going to the same PCP for 20 years.  I'm lucky.  She actually takes notes from me and I give her links to studies that I have read. We are a team when it comes to my health.  I think the key is finding a doctor that will listen to you, who doesn't have a "God complex".  Doctors can be pretty full of themselves.

She has one other RNY patient, who almost died from severe vitamin deficiencies because her surgeon told her that all she had to do is take two Flintstone's vitamins daily (and I guess she wasn't very compliant with that either).  This woman refused to go to the doctor until she was VERY sick.  I have spoken with her.  I just don't see any ambition to advocate for her own health in this woman.  At least our PCP is informing herself and maybe that will trickle down to her.  You can't fix stupid.

You are lucky Rocky.  I had a fabulous PCP internist locally.  I credit him for helping to save my life -- he was the one who brought up WLS to me in the first place.  He was an excellent doctor.  Unfortunately for me, he retired a year after my surgery.  Since then, I have tried several new doctors -- the last being the most agreeable to me -- but she is completely uninformed about post-bariatric surgery.  At least she isn't rabidly promoting incorrect information, so she seems to be the lesser of the evils from the choices open to me.  

I've had to teach 4 PCP's so far and because they shut down our health co-op (f**k you Corey Gardner), Ive got to take on another student in January.

As long as they do as I ask, and leave everything else alone, I'm good!!

I take 2 Vitron-C tablets before bed. Those are iron pills with the Vitamin C built in. I've always had really low iron even before surgery and I am doing well so far with these tablets.