June 2021
Jacqui Lewis - BHSc Nutritional and Dietetic Medicine

Iron Deficiency and Anaemia After Weight Loss Surgery

Different kinds of green vegetables

Iron is a relatively common deficiency after weight loss surgery.
Studies have shown that 20 to 49% of gastric bypass patients develop iron deficiency/ anaemia within 12 months.

What Causes Iron Deficiency?

1. Gastric Bypass and Gastric Sleeve surgery results in decreased stomach acid production. This affects the absorption of iron for life.
2. Changing tastes and restriction on food intake after surgery can reduce intake of iron rich foods.
3. Forgetting to take your Bariatric multivitamins daily.
4. Increased blood loss through heavier menstruation is not uncommon in WLS patients

How Much Iron Do I Need?

To maintain your current levels of Iron, including Ferritin or Stored Iron:
For menstruating women, the recommendation is 50 to 100 mg/day.
For post-menopausal women and men 18 to 27 mg/day.

Catch up using extra iron along side your BN Multi will generally take at least 3-6 months and requires regular monitoring to make sure your levels are improving Your dietitian or GP will manage this with you.
The daily catch up dose of supplemental iron is between 60-200mg and needs to be set by a professional - so having close contact with your team is key to recovery.

The recommended dose iron required to replete iron stores is in the range of 180 to 220 mg per day. The results of the present study suggest that taking two ferrous sulfate capsules daily, containing a total of 100 mg of elemental iron, will prevent development of iron deficiency after RYGB.
Eating iron-rich foods with vitamin C increases your absorption of iron.

Which Foods Will Help Increase My Iron Intake?

Iron Rich Foods - BN Healthy

Foods high in iron include beef, chicken, turkey, eggs, dried lentils, peas, beans, fish, liver, peanut butter, soybeans, iron-fortified cereals and breads, raisins, prunes, molasses and apricots.
High vitamin C foods include citrus, kiwi, strawberries, broccoli, sweet potatoes, mango and pineapple.

What Does Iron Deficiency Feel Like?

Symptoms that are often a sign of deficiency include:

Fatigue / lack of motivation
Shortness of breath
Irritability, sleeplessness
Anxiety / Depression
Poor memory / Brain Fog
Aching Muscles
Slow weight loss / Metabolism

As iron stores deplete further:

Brittle nails,
Spoon-shaped nails
Hair loss
Light-headedness when standing up,
Pale skin colour
Shortness of breath,
Heart palpitations,
Sore / swollen tongue.

What Can Be Done?

Additional daily iron supplementation is recommended for life after WLS (ASMBS 2016).
Once your iron is low after Bariatric Surgery, food alone will not be enough.
Catching up is hard - so prevention is the key with your daily BN Multivitamins.

If your ferritin is extremely low, your practitioner may suggest an iron infusion to correct levels more efficiently. Infusing the iron directly into the bloodstream bypasses the digestive process, so absorption is increased.
Up to 1000mg of iron can be infused and tolerated reasonably well which will have you on your way to feeling human again sooner.  

Extra iron will be needed daily and for some 3 - 6 months so that new healthier blood cells are formed. 

The recommended dose to treat diagnosed iron deficiency is 180 to 220mg of iron per day taken in divided doses plus 250 mg vitamin C. Iron levels should be rechecked in two months.

In gastric bypass patients, the bypass of the first part of the small bowel (duodenum) decreases absorption of iron, as the duodenum is the most efficient part of the small bowel for iron absorption.
Ideally, iron should be taken on an empty stomach if tolerated.

Coffee, tea, calcium, bran products, cocoa, and nuts can impair the absorption of iron.

Tips for Getting More Iron

The best way to increase your iron intake is to eat more foods that are rich in iron.
However, the following strategies can maximize your iron intake.

After Weight Loss Surgery of any kind refraining from drinking tea or coffee with meals (separated by about 2 hours) refraining from eating foods rich in calcium with those rich in iron eating iron-rich foods alongside those rich in Vitamin C cooking with a cast-iron skillet cooking foods for shorter periods

Iron From Meat V Iron From Vegetarian Sources

Food Sources of Iron - BN Healthy

Heme iron is derived from animal sources, and nonheme is vegetarian, Heme sources of iron are more bioavailable and are better absorbed by the body.
Non heme sources aren't as bioavailable.
It's actually dependent on some vitamin C, which helps to convert the nonheme iron into a more bioavailable form.

Checklist to Help Prevent Iron Deficiency From Disrupting Your Health 

  • Eat Foods that are rich in iron
  • Take a specific Bariatric Multivitamin
  • Include foods rich in Vitamin C with iron rich foods or supplements
  • Ensure you are taking in adequate B Group vitamins as they are key to iron status  
  • Regular blood tests will detect iron levels declining early - prevention is best.

Jacqui Lewis
BHSc Nutritional and Dietetic Medicine

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