Iron Deficiency After Bariatric Surgery

Iron Deficiency After Bariatric Surgery - Bariatric Fusion

Did you know that after bariatric surgery, iron deficiency affects up to 54% of individuals?1

Explore how gastric surgery for weight loss can deplete vital nutrients, like iron, and how evidence-based guidelines suggest specific nutrient dosages to replenish and support healthy vitamin and mineral levels.2*

In this blog, we discuss the importance of iron, uncover the root causes of this common deficiency after bariatric surgery, understand the symptoms of deficiency, and explore the purpose of different forms of iron.

What Does Iron Do?

Iron is a vital mineral with various functions in the body, but its primary role is in the production of red blood cells. These cells contain hemoglobin and myoglobin, crucial for transporting oxygen from the lungs to body tissues and muscles.*

According to guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS), most individuals should aim for 45-60mg of iron daily. However, this recommendation may vary depending on factors such as the type of surgery undergone, history of anemia, age, and gender.2

Why Is Iron Deficiency Common After Bariatric Surgery?

Bariatric surgery can lead to restriction, malabsorption, or a combination of both. Iron deficiency tends to be more prevalent among patients who have undergone gastric bypass compared to those who have had sleeve gastrectomy or gastric band procedures. This heightened risk of deficiency is attributed to:

  • Malabsorption—due to the bypassing of the duodenum and proximal jejunum. This area of the small intestine is where a majority of iron is absorbed, causing a higher risk of deficiency.
  • Decreased stomach acid—caused by surgical changes to make a smaller stomach pouch. Stomach acid helps to change iron into a form that is readily absorbed by the body.
  • Tolerance—with recommended iron supplements because of digestive discomfort caused by some iron forms and dosage.

To maintain iron levels within normal ranges, patients often need a form of iron that is easily absorbed by the body and a higher dosage than what's typically found in a standard multivitamin.

Iron is also obtained from dietary sources. It's crucial to maintain a diet rich in variety and essential nutrients, including iron, to ensure proper nutrition.

Symptoms of Iron Deficiency

It's important to find out if your body has low levels of vitamins and minerals or any deficiencies before having surgery. This helps make sure you have the best chance of recovering well afterward.

After surgery, there's a risk of not having enough iron in your body, and research has found that iron deficiency can happen a few years after metabolic and bariatric procedures.3

Symptoms of iron deficiency include:

  • Iron deficiency anemia
  • Brittle nails
  • Headaches and confusion
  • Constipation
  • Dizziness
  • Fatigue
  • Unusual cravings (pica)

Regular lab work and check-ups with your healthcare provider are essential to stay on top of your health and wellness after surgery.

Vitamin C and Iron Absorption

Foods and dietary supplements containing vitamin C can support the absorption of iron.*

Some food sources of vitamin C include:

  • Red bell peppers
  • Oranges
  • Broccoli
  • Strawberries

For bariatric patients, an iron supplement that includes vitamin C is recommended to help ensure the best absorption of iron.*

Food Sources of Iron

There are two forms of iron found in food—heme and nonheme iron.

Heme iron (readily absorbed by the body) includes:

  • Animal products such as chicken, eggs, ham, pork, salmon, and sardines

Nonheme iron (not as readily absorbed) includes:

  • Plant foods such as spinach, beets, kale, beans, lentils, peas, nuts, and seeds

There are also iron-fortified foods available that include breakfast cereals and grains.

Different Types of Iron Supplements

There is a wide variety of iron supplements to choose from. Below are three things to look for when choosing an iron supplement:

  • Elemental iron—refers to the total amount of iron that is available in a product to be absorbed by the body
  • Ferrous fumarate—offers the highest percentage of elemental iron, is readily available for absorption, and is less constipating than other types of iron*
  • Iron with vitamin C—vitamin C helps iron to be absorbed better in the body*

    supplemental iron forms


    Regular follow-ups and lab work with your healthcare provider are essential for maintaining healthy nutrient levels and overall health, especially after bariatric surgery.

    At Bariatric Fusion, we're committed to providing products that are not only delicious but also affordable and convenient. Our supplement options include chewable multivitamins without iron as well as multivitamins with iron, catering to different needs.

    Our multivitamin supplements are designed in accordance with the ASMBS guidelines to ensure proper nutritional support. It's important to note that bariatric supplements are typically recommended for life, and they should be specifically formulated for bariatric patients.

    Before adding any dietary supplement to your routine, it's advisable to consult with your healthcare provider to ensure it's appropriate for you.

    See our collections:

    We think you should consider our next blog, Gastric Bypass and Anemia as well.


    1. Steenackers N et al. Proc Nutr Soc. 2018;77(4):445-455.

    2. Mechanick JI et al. Surg Obes Relat Dis. 2020;16(2):175-247.

    3. Gowanlock Z et al. Blood Adv. 2020;4(15):3639-3647.

    *These statements have not been evaluated by the Food & Drug Administration (FDA). These products are not intended to diagnose, treat, cure or prevent any disease.

    This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.

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