Can't find my original post. I was talking to Poet-Kelly. I told the VA and provided a letter from Dr Kim but they still sent me ferrous sulfate.

I am going to fight them. Why is ferrous sulfate not as good? I will ask Dr Kim also. Does it have to do with absorbtion and pouch irritant?

Thank you  

325mg of ferrous sulfate is only 65mg of ferrous sulfate, so 65mg is all you count. I take carbonyl iron in 50mg tablets, and all 50mg is elemenral iron.

The biggest difference is that ferrous sulfate is very constipating, where carbonyl is not. Post-ops tend to have problems with constipation anyway, without iron adding to it. Ferrous sulfate can also cause some stomach discomfort.

You can try to fight it, but sometimes insurance only covers certain things, and don't budge. I get my carbonyl iron as Sundown Perfect Iron at my local grocery store, 200 50mg tablets for $4.99

First, you need a lot of stomach acid to break down ferrous sulfate for absorption and you don't have much stomach acid after RNY.

Second, ferrous sulfate causes constipation, which is already an issue for many people after RNY.  Carbonyl iron doesn't.

It is not as bioabsorbable (i.e you dont absorb as much) for the reasons that Poet_Kelly said.

The VA and people who dont like spending a lot of money on vitamins LOVE it because it is "cheap" compared to iron carbonyl.

So you got options.  Take more of the ferrous sulfate and risk stomach upset, constipation, etc etc and maybe have to check your blood checked MORE often (which is expensive..but if the VA is paying for it...well apparently they like to waste mney on tests).

What you could do is a cost analysis for them.

Find how much LESS iron a RNY'er absorbs.  Lets pretend it is 50% less to make the math easy. Then compare the  absorption of ferrous sulfate to iron carbony.  Lets pretend that 50% less compared to carbonyl iron. From the recommended dose for iron from the ASMBS, determine the amount of iron sulfate you wll need vs iron carbonyl (remember to account for the poor absorption).  The determine the number of pills needed to achieve that dose.  The calculate the cost per dose for each type of iron.

By calculating it this way, you may find that you are saving money with carbonyl iron vs ferrous sulfate even though on its face it looks more expensive because you need less pills.  

Good luck

SkinnyScientist- who hates math but uses it alot.

Carbonyl iron is not very expensive, either.  I usually pay $5 for a bottle of 200 pills, 25 mg each.  And I don't need as much Miralax or stool softeners or laxatives as I'd need if I was taking ferrous sulfate.

And even if the VA was paying for my iron and blood tests, I prefer to be able to poop.  I don't like being nauseous and having stomach pain.  They might not  mind if I was horribly constipated, but I mind.

When I was looking online, it was 3Xs the cost of ferrous sulfate.

Help me out?  Since I dont mind standing on the shoulders of giants (i.e. you), what brand do you use and where do you get it from?  Your tip on the Family dollar multi's was an excellent savings for my pocketbook.

I ultimately ended up getting mine from vitalady.  But it is near time for me to order more.

So, your disclosure will really help

It might be more expensive than ferrous sulfate.  I haven't priced ferrous sulfate since I don't use it.

I use Sundown Perfect Iron.  Sometimes I buy it from drugstore.com if they have it on sale.  Like sometimes they have sales, buy one get one half price.  Other times I buy it at my local Meijer.  I frequently have coupons for it.  I think they typically charge $5.99 a bottle but I often have $1 off coupons.  I find coupons for it on the Sundown Naturals website, on coupons.com, on the Meijer Perks website (digital coupons) and once a week where I live we get a bunch of coupons delivered door to door with all the store ads.  So if I have coupons, I buy it at Meijer since I can't use the coupons online.  Otherwise I buy it from drugstore.com when they have good sales.

Just got my letter from Dr Kim. He says my pouch does not produce enough acid to break down the ferrous sulfate.

I am to take ferrous fumarate or chelated iron which does not need acid to break it down.

Thank you all for your replies. 

The problem with chelated minerals is that they are absorbed in the first part of the small intestine, which has been bypassed in RNY folks.

Ferrous fumerate would be my second choice, after carbonyl.  I prefer carbonyl because it's all elemental iron.  Ferrous fumerate is only 33% elemental iron - so if you want to get 66 mg elemental iron a day, you need to take 200 mg ferrous fumerate.  The iron salts, which is what the other 67% is, can cause constipation.

I see Sundown Perfect Iron is sold at walgreens. I'll pick some up. Let me know if you can use a 90 day supply of ferrous sulfate 325mg. So far I have been unsuccessful in getting the VA to stop the order.