31st Aug 2022
Iron. What's the Big Deal?
Iron is a mineral that is frequently deficient in bariatric surgery. In sleeve gastrectomy, it is due to the decreased amount of stomach acid and lack of intrinsic factor that is needed for iron breakdown and absorption. In gastric bypass, it is a combination of decreased stomach acid AND the bypass of the intestines where iron is absorbed. Furthermore, iron sources are highest in red meat. This is often a food type that is not consumed in high volume in bariatric patients, furthering the risk of low iron.
Iron is vital for all living organisms because it is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport (energy generation inside all cells). Iron’s role in the body is to help make red blood cells, including hemoglobin, which carries oxygen all throughout the body. Iron oxygenates every tissue in the body!
Iron helps to preserve many vital functions in the body, including general energy and focus, gastrointestinal processes, the immune system, and the regulation of body temperature.
The benefits of iron often go unnoticed until a person is not getting enough. Iron deficiency anemia can cause fatigue, (sometimes severe) heart palpitations, pale skin, and breathlessness.
Some may find motivation to keep iron stores plentiful if they learn that iron deficiency causes weight gain. The mechanism for this is that iron is a key co factor in thyroid hormone production. So, low iron causes hypothyroid states which further decrease energy, and make it difficult to maintain weight, often causing weight gain!
Most people who have had bariatric surgery will need to supplement iron in order to prevent deficiency. The typical recommended dose is 30 mg of elemental iron. Women who menstruate or are pregnant need a minimum of 60 mg daily. In addition to iron supplements, it is important to integrate iron rich foods into your diet. While some vegetable do contain iron, these sources are not well absorbed in the body. Heme iron, from meat is the most absorbed source. Try to eat plenty of these heme iron rich foods:
Oysters, clams, mussels.
Beef or chicken liver.
Canned light tuna.
Foods and supplements that block iron absorption and should not be consumed within 2 hours of iron include:
- proton pump inhibitors and omeprazole, used to reduce the acidity of stomach contents
- polyphenols in cereals and legumes, as well as in spinach
- tannins in coffee, tea, some wine, and certain berries
- phosphates in carbonated beverages, such as soda
- phytates in beans and grains
Most people find it easiest to take their iron first thing in the morning or last thing at night in order to maximize it’s absorption. Adding extra vitamin C either with a vitamin, a squeeze of lemon in water, or a few bites of grapefruit will add benefit in its absorption.
Iron deficiency after bariatric surgery doesn’t happen over night. (unless you have a major bleeding episode!) It is a slow burn. But just because your levels are within normal range, doesn’t mean you don’t need iron! When you compare your levels to previous levels (from before surgery or the previous year) are they the same? Often times they will be decreased dramatically, but still in normal range. This will sometimes lead your practitioner to tell you they are normal. This is a missed opportunity to see that while they are still in normal range, you are indeed, on your way to anemia!! Once you are clinically low in iron, ferritin, or hemoglobin, it will take YEARS to get back to normal. (Just as it may have taken years to get there!).
The best treatment is good prevention. Don’t learn it the hard way, just take our advice. You are at high risk for deficiency based on MULTIPLE risk factors. Just prevent the problem by taking the iron and tracking your levels year to year!