Fingernail indentations?

Hi all,

I'm 10 months out from surgery today and doing great, down form 253 to 165.  I have my next f/u with the surgeon in March when he will check my labs again (they were good at last check).  I have noticed one thing however and not sure if it's important - my thumbnails have horizontal indents on both of them, no discoloration that I see but you can definitely feel them.  My left ring finger also has this (but not the right).  I tried researching online and it seems this could be from a vitamin deficiency (I don't remember any traumas to my fingernails in the last 6 months) but I seemed to get different information on every site I looked on.  Anyone else experience this and learn anything more about it?

This may be unrelated but I've also noticed I'm very fatigued even though I get enough sleep. 

FYI I am current taking: B12 sublingual (1000), biotin, B1, calcium (2000), 2 chewable multi vitamins a day, ferrous sulfate (dose?) 2x/week, D (2000).  Additionally I am on fluoxetine 40 mg and birth control pill.

Thank you for any thoughts you have.  Just trying to see if this is a minor thing that is typical/resolves or if I should contact my doctor now.

Jessie

why do you only take iron twice a week?  you may be tired due to not getting enough iron.  that shouldn't be affecting your fingernails, though.

did you get your vitamin A checked when you had labs done last?  What was it?  What type of vitamin A is in your multi and how much of it?

Is there a reason you chose ferrous sulfate? That would be my last choice. The constipation that can come with it is not worth it. It also can be VERY rough on a pouch.

Have you tried carbonyl iron? Also, are you taking C with your iron? And that amount of D is far less than I take daily--are your numbers high with D? And are you taking dry D or wet? VERY important that you only take dry...otherwise it's just expensive poop filler. :)

Are you spacing your calcium out in 4 doses of 500 each time through the day? Are you taking a 'real' vitamin or a Flintstone type chewable? And the B12 is a LOT less than I take (5K a day) and my numbers are good, but not exceptionally high or anything. 

Those are my thoughts/feedback. :)

Most people don't need as much B12 as you're taking.  The ASMBS recommends just 500 mcg sublingual a day.

See, this is why I love this board?  You all ask me the questions about why I'm doing something and I realize that sometimes I don't know!  I feel I haven't gotten a lot of guidance from my surgeon's office about supplementation although they finally have hired a full-time dietician who I will see at my visit in March.

I've actually never been told to take iron, I just thought it was a good idea and went with the ferrous sulfate b/c that's what I found and I didn't think to question it.  As far as just taking it twice a week, I was specifically concerned about the constipation and my husband takes it twice a week for low iron levels as recommended by his doctor so I thought that'd be okay (not smart logic, I realize now).  I will take a look at carbonyl iron - is there a specific dosage that is recommended? 

Never had my vitamin A checked that I know of - will inquire about this...

Not sure what "wet" vitamin D would be... mine is just in a pill form so I'm assuming that means dry?

I do space out my calcium throughout the day.  Have a handy fitbit flex that I've set vibrating alarms to tell me thoughtout the day to take it.  Works well! 

My vitamin is chewable Centrum which was on the list of recommended by my surgeon.  I take one in the morning and one at night.

The ASMBS recommends 54 to 63 mg iron (that's elemental iron; ferrous sulfate is only 20% elemental iron, so 325 mg ferrous sulfate only gives you 65 mg elemental iron) for menstruating women and 36 mg for everyone else.  If you're taking regular Centrum, it has iron in it, I think 18 mg per pill.  Make sure you don't 'take your calcium with it, though, because calcium blocks the absorption of iron.

I like carbonyl iron because it's all elemental iron and it usually does not cause constipation.  What causes the constipation is all the iron salts in the ferrous sulfate and other ferrous types of iron.  The brands usually available in stores are Sundown Perfect Iron and Feosol, but Feosol also makes a ferrous sulfate one, so make sure you pick up the correct one.

Dry D3 just means it's not in oil.  So if it's a dry tablet or a capsule with dry powdery stuff in it, it's dry.  If it's one of those soft gels with oily stuff in it, then it's in oil.  The reason we want dry is because we malabsorb fats, and oil is a fat.  "Normal" people absorb D3 in oil well because it's a fat soluble vitamin.  But with our bypass, we don't absorb fat so well, so we don't absorb vitamins in oil so well, either.

Get your vitamin A checked when you get labs done.  You can always call and ask them to order it sooner than your appt if you're concerned about it.

I forgot to mention protein.  Are you getting enough protein?

Thank you so much!  I do get enough protein I think, a minimum of 60 a day although usually more around 80.  I keep protein shakes around in case I'm running low for the day and that will bump me over.

Since I'm actually taking 2 centrum a day, I think that means I'm getting 36 grams/iron/day already?  Is it bad to get too much iron - so if I added a 50 mg Sundown Perfect one, would that be too much?

It's bad to get too much iron but that wouldn't be too much.  The Sundown Perfect Iron is 50 mg for TWO pills, though.  So you could take just one or you could take two and either way would probably be fine for now until you get labs done.  Then if your iron is on the low side, you can add more.

Perfect, that's what I was thinking.  I will go get it after work.  :-)

Thank you so much!  I do get enough protein I think, a minimum of 60 a day although usually more around 80.  I keep protein shakes around in case I'm running low for the day and that will bump me over.

Since I'm actually taking 2 centrum a day, I think that means I'm getting 36 grams/iron/day already?  Is it bad to get too much iron - so if I added a 50 mg Sundown Perfect one, would that be too much?

I was told NOT to count the iron in my multi because it conflicts with the calcium you are likely taking at the same time. There are people who believe there should be a 2 hour difference between the two, others who say 4 hours. I subscribe to the 4 hour difference because I am worried that I'll find out too late that I am not getting all that I need until a lab check and getting iron back up can be a challenge for some.