The daily hustle and bustle was tiring in and of itself. Throw in the holiday season, complete with a family visit that included my high-energy 2-year-old granddaughter, and I was not at all surprised at just how exhausted I was feeling. Later I would learn this was the beginning of my battle with iron deficiency anemia.
Winter was upon us, and my summer bronze was long gone replaced by the snowy pallor of December and January. The holiday season passed and our visitors returned home, but my energy did not. The daily hustle and bustle turned into the monotony of getting out of bed to go to the office, then going straight to bed once I got home.
I had other symptoms in addition to exhaustion: Irritability, anxiety, confusion, dizziness, shortness of breath, tingling in my extremities, sallow complexion, and an upper respiratory infection that I could not shake. This went on for 2-3 months. So, when no improvements were in sight and I was left without an explanation. I visited with my primary care physician (PCP) who ordered blood work and urinalysis.
Iron Deficiency Anemia after Bariatric Surgery
My lab results showed iron deficiency anemia. In fact I was told that my reserves were nearly depleted. A normal range for iron in the blood, as reported by MedlinePlus, is 60mcg/dL to 170 mcg/dL. Iron in my blood was 21mcg/dL.
Of course my PCP understood that as a gastric bypass patient part of my anatomy that absorbs iron had been removed/bypassed. Iron deficiency anemia is fairly common in patients whom have had gastric bypass. This is why bariatric surgeons always recommend iron supplements to their patients post-bariatric surgery.
However, I had stopped taking an iron supplement a few years prior on the advice of a bariatric surgeon. Why did I stop? Because the iron supplementation was making me awfully constipated. The bariatrician said because my blood work showed normal levels of iron in my blood that I did not need to take an iron supplement. In hindsight, my iron levels were normal owing to the iron supplement. Discontinuing its use was very bad advice on the part of the bariatrician.
Preventing Iron Deficiency Anemia
Importance of Iron Supplements
Iron supplements are an important part of the post-bariatric surgery regimen. But unpleasant gastrointestinal side effects may cause patients to think twice about taking them. Here is what you need to know about iron deficiency anemia and why you should seek alternative solutions to discontinuing your iron supplementation — even if your blood work appears normal.
Consult your healthcare professional as I am not a doctor. Rather, I am a writer sharing information that hopefully is helpful to you in seeking treatment.
The American Society of Bariatric and Metabolic Surgery recommends at least yearly lab checks.
Symptoms of Iron Deficiency Anemia
According to the National Heart Lung and Blood Institute (NHLBI), iron deficiency anemia is when a lack of iron causes an insufficient number of red blood cells. Red blood cells are responsible for oxygenizing the tissues throughout your body. Some of the first symptoms you may notice if this process is not running smoothly are fatigue and shortness of breath. Read, “Chronic Fatigue after Bariatric Surgery.”
You also may notice any combination of the following symptoms consistent with iron deficiency anemia: pallor, weakness, headache, faintness, cold extremities, irritability, brittle nails, tongue inflammation/discomfort, rapid pulse or restless leg syndrome.
Complications of Iron Deficiency Anemia
Often, iron deficiency anemia begins mildly and you may not have any symptoms at all. This is why annual checkups with your PCP are important and should include blood work to screen for anemia. Left untreated, complications of iron deficiency anemia may include heart failure or an enlarged heart because the heart needs to pump more blood to compensate for the lack of oxygen in the blood. In turn, an enlarged heart puts you at risk for blood clots (which can lead to heart attack or stroke), heart murmurs or cardiac arrest, which occurs when the rhythm of your heart beat is disrupted.
How to Take Iron Supplements
While nausea, vomiting, constipation or diarrhea are unpleasant in their own right, comparatively they are the lesser of two evils. Please, stay on an iron supplement! Bariatric patients are at greater risk for developing iron deficiency anemia because the small intestine is bypassed in some surgeries and inhibits iron absorption.
If you are experiencing side effects, talk with your bariatric surgeon or PCP. My PCP recommended one iron supplement once per day, or preferably twice per day if I could “handle” it. She suggested that I take Vit. C to aid iron absorption, but that caused me to break-out with acne. She also recommended Metamucil before bedtime to combat constipation. However, years later my gastroenterologist said the fiber was feeding the bad bacteria in my intestines, so I discontinued use. Read, “Trust Your Gut? Bacteria and Weight Gain.”
I tried a great many things to get my iron levels optimized while maintaining normal bowel movements. It was extremely difficult. Through a long course of trial and error, the best solution for me was to take: Nature Made Iron 65mg 2x/day every other day for 4/days per week, and 3x/day on alternating days (3/days per week); drink 80-100 ounces of water with 2 tsp or more of Natural Vitality Natural Calm Magnesium citrate sipped throughout the day; take one Super Aloe 450 at bedtime. I do not state this as medical advice because what works for me will not necessarily work for you. Rather, I share it to illustrate how very unique individual needs can vary from the usual recommended dosage! On this iron-therapy regimen my bariatric plastic surgeon, upon reviewing my labs, commented that he’d never seen a bariatric patient with iron levels as good as mine.
I should have stayed on that regimen because once again I developed iron deficiency after using the bariatric vitamin patches with iron. And I twice had IV iron infusions to correct the anemia, which caused an inflammatory response and severe digestive distress that took a very long time to heal.
Taking iron supplements with folate and vitamin B12 are said to improve absorption of the iron. I take these supplements, as well.
Other approaches that your PCP might recommend include: Decreasing your iron dosage and gradually increasing the amount so as to help your body to adjust to the supplement and decrease side effects. You also can take multiple, smaller doses throughout the day instead of one larger dose, and take your supplement with food. While delayed release formularies may be appealing, the absorption is significantly reduced, so it is best to avoid this option.
Caution about Iron Overload
Remember, while iron is an important supplement, more is not necessarily better. Stay within the recommended dosage as excess iron can cause iron overload, damaging internal organs, especially the liver where iron is stored.
PLEASE EXPLORE OUR LIBRARY OF ARTICLES ON VITAMINS AFTER BARIATRIC SURGERY.
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