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Iron deficiency and ANAEMIA after Weight Loss Surgery

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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 result in decreased stomach acid production.
This affects the absorption of iron for life.

2. Changing tastes and restrictions after surgery can reduce the intake of iron-rich foods.

3. Forgetting to take your bariatric vitamins daily.

HOW MUCH IRON IS REQUIRED AFTER WLS? 

For menstruating women, the recommendation is 50 to 100 mg of iron per day.
For post-menopausal women and men 18 to 27 mg/day.
Eating iron-rich foods with vitamin C increases your absorption of iron.

WHICH FOODS WILL INCREASE MY IRON INTAKE?

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 and apricots. High vitamin C foods include citrus, kiwi, strawberries, broccoli, sweet potatoes, mango and pineapple.

WHAT DOES IRON DEFICIENCY FEEL LIKE?

  • Symptoms of low iron or anaemia include,
  • fatigue,
  • shortness of breath,
  • irritability, sleeplessness
  • headaches and
  • poor memory.
As anaemia gets worse:
  • 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 (ASMBS 2016)
Once your iron is low after WLS, food alone will not be enough.
Extra iron will be needed daily and for some 3/6 months.

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 in the diet

The best way to add iron to the diet 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: 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. Nonheme 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.

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  • Roger Lewis Jacqui Lewis