Ferritin dropping - possibly due to iron tablet coating?

Hi, everyone,

I've been dealing with ferritin issues for over a year now. Last January, it was so low (1.6 when 13 is minimum) that the hematologist prescribed IV infusions. We've been monitoring it all year and it was 35 in May, 12 in August, and now 7 in December. A big drop is expected but he said it should have leveled off around 12 by a year out. At this point he wants me to double my daily dose of iron and triple it on the weekend. 

Over the last year, I've used two different types of iron (carbonyl) tablets, Sundown's Perfect Iron and Feosol's Carbonyl Iron. Looking at when I switched brands, it was in May. Sundown doesn't have a coating on their tablets and they taste horrible while Feosol's has a red coating and no taste. So I asked the hematologist today if that may be making a difference and he said no. WHAT HAVE YOU ALL HEARD FROM YOUR DOCS ABOUT THIS? I NEED ADDITIONAL OPINIONS AND A MEDICAL RATIONALE.

Now, the hematologist NOT a bariatric specialist but has seen quite a number of bariatric patients. I have NO confidence in my normal bariatric followup doctor because she insisted the low ferritin wasn't a problem. I had to demand she do further investigation, resulting in the hematologist ordering the IV for the day following my appointment with him. Before you say, "Find a new doc!", I live in a country with all of two (2!) bariatric surgeons and ONLY ONE (1!) followup doc (the one I see). I have extremely limited options until I go back to America next summer so I would love a broader perspective that your experiences can give.

Thanks so much!

Kim

I have always taken the Sundown Perfect Iron.  I take three every night.  I just pop them in my mouth and swallow with water.  What difference does taste make.  I do not chew them ... Just swallow them along with three Sennekot and twice a week a big D3.  Again, why are youmtasting anything if you are not chewing them?  

I don't chew them but they make me burp with that iron flavor that makes me want to vomit. Ick! So I like the Feosol better.

I know the burping thing.  I eat 1/2 a piece of light string cheese, or some turkey slices and it's not an issue.  Neither lasts long in our pouch anyway.

I also take Sundowns Perfect Iron.

Some WLS patients will never be able to keep iron levels up with iron pills.  We just can't absorb them.  Some will have no problems at all.  I have had two iron infusions.  I started with a ferritin level of 10 and after the first infusion I was at 65.  Nine months later I was back at 13. The second infusion was a different type of iron and my levels were up to 315.  That was more than a year ago.  At my last physical my ferritin was at 165.  Thankfully I have been holding onto the iron for a little longer this time (but it is still dropping, slowly).  I will probably have to have infusions for the rest of my life.  I'm hoping for every three or four years.

I do take iron capsules from Vitalady's website.  It's 60 mg Elemental Carbonyl Iron with 400 mg Vitamin C.  I think the capsules probably work better since they dissolve quickly. I take double doses to try to keep my iron from dropping too fast.

Thanks. I may end up being one of those patients but when I didn't have any problems in the first 2.5 years, I thought I was in the clear. The type of infusion I had is supposed to last a year so this next three months will tell if I can keep it up with supplements or if I'll need the infusions again. Every three or four years isn't bad!! Maybe I'll get Vitalady's iron as I know it's designed for our systems instead of the Feosol. 

I went out to their website to see if it tells what the coating is (since we have trouble breaking down some types of coutings).  It doesn't, BUT it says the following (bolding mine):

Supplements that claim to have a slow release mechanism usually rely on a chemical coating to slow down the absorption. However, Feosol® Natural Release requires no additives or coating for a gradual and gentle absorption of iron. That’s because the type of iron itself is naturally regulated by your body which must produce gastric acid to help with absorption

That appears to be the only one of their three products that is carbonyl iron, so I assume that is the one you are taking.  Based on our shortened digestive tract and the info above, I am guessing that you are simply not absorbing enough of it because of the RNY.  What confuses me, though, is that I have never read/heard anything about carbonyl iron requiring gastric acid for absorption.  Maybe someone else cam chime in here...

I take the tender Iron from Vitalady (62mg of carbonyl iron) which is a capsule.  You might try those.

Lora

My understanding is that we do still produce some acid, just not much. Like you, I thought iron carbonyl was absorbable without the acid.

So maybe I just need higher doses of iron to absorb enough. Is there a limit to how much iron can be absorbed at a time like there is with calcium?

Oh and I am sure you already know this, but just in case... calcium can inhibit iron absorption, so avoid taking calcium and iron supplements at the same time of day.

Audrey

Yep! Thanks for making sure. 😊 I take the iron at night right before bed so there's no interactions.