I Have Iron Deficiency Anemia - My Bariatric Life

Patient Expert

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, and I was not at all surprised at just how exhausted I was feeling.   Winter was upon us, so my summer bronze was long gone, replaced by the snowy pallor of December and January.   The holiday season passed, our visitors returned home, but energy did not.

The daily hustle and bustle turned into the monotony of getting out of bed to go to the office, and 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 checked in with my primary care physician (PCP) who ordered blood work and urinalysis.

Gastric Bypass Iron Deficiency Anemia

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.

I told my PCP that I am a gastric bypass patient. So, of course she understood that 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 ago on the advice of a bariatric surgeon. Why did I stop? Because the iron was making me awfully constipated. The bariatrician said my blood work showed normal levels of iron in my blood and so I did not need an iron supplement. In hindsight, my iron levels were likely normal owing to the iron supplement. Discontinuing its use was probably bad advice on the part of the bariatrician.

Taking Iron Supplements

Iron supplements are a part of the post-bariatric surgery regimen, but unpleasant gastrointestinal side effects may cause you 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.

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. However you 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.

Annual Blood Test for Iron

Often, iron deficiency anemia begins mildly and you may not have any symptoms at all, which is why annual checkups with your PCP are important and should include blood work to screen for anemia.   Left untreated, iron deficiency anemia may lead to 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 all the lesser of two evils, so please, stay on your iron supplement   Bariatric patients are at greater risk for developing iron deficiency anemia because in some surgical procedures, the small intestine where iron is absorbed is bypassed.

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 recommended Metamucil before bedtime to combat constipation. She also suggested that I take Vit. C to aid iron absorption.

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.

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.

As for me, I've been following my doctor's regimen for several days now and recuperating slowly. As for my "plumbing," well let's just say there are no clogs in my drain.

References: National Heart Lung and Blood Institute accessed on March 24, 2012. MedlinePlus accessed on March 24, 2012.


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