Iron Deficiency After Bariatric Surgery

We need iron to stay healthy. 

Usually the amount of iron we ingest in our diet is enough to keep up with our needs.

The iron we ingest as food is absorbed very efficiently by the first part of our small intestine.

However, gastric bypass patients have reduced ability to absorb iron since the first part of the small intestine is bypassed along with much of the stomach.

Anemia, or decreased red blood cells, may be the result of not absorbing enough iron. Persons who are anemic often look pale and feel tired. If the anemia is severe the heart rate may increase to compensate for too few red blood cells to transport oxygen to the body. In some situations this increased heart rate can be dangerous.

Persons who are anemic often crave ice and eat ice frequently.

To prevent iron deficiency anemia we suggest a gastric bypass patient consider iron supplementation taken by mouth.

To check if someone has an iron deficiency anemia doctors check a ferritin level as a blood test. If this is low we know the person has low iron storage and iron deficiency is likely to be the cause of their anemia and we will place them on daily iron supplementation.

This supplement should be Ferrous Fumarate or Ferrous Glucanate since the usual form of iron supplementation, Ferrous Sulfate, will not be absorbed well since it needs acid to make the iron available for absorption and the new small gastric pouch formed at the time of the gastric bypass makes very little acid, Ferrous Sulfate is likely to pass out in the stool without being absorbed.

You any need to remind your family doctor about this since he or she are so used to writing for Ferrous Sulfate and may forget you need a different form of Iron.

Menstruating women are a particular risk for anemia since they may have difficulty keeping up with their monthly blood loss. In this situation a woman with iron deficiency anemia will be referred to her gynecologist for intervention like hormonal therapy, endometrial ablation or even hysterectomy. 

If these interventions are not acceptable she may need to be seen by a hematologist for periotic intravenous iron infusions.

Of course a thorough evaluation is often in order. This may require a colonoscopy since patients with a history of obesity have a higher risk of colon polyps and colon cancer.