Iron Deficiency After Bariatric Surgery

What does iron do for the body?

Iron is a mineral that plays many roles in the body, but its main function is in the production of red blood cells. Without iron, your body cannot produce enough hemoglobin and myoglobin (components in red blood cells) to carry oxygen from your lungs to body tissues and muscles. The American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines recommend that most patients get 45-60mg of elemental iron daily. The recommendation can differ based on the surgery performed, history of anemia, age and sex of the patient. 

Why is iron deficiency so common after weight loss surgery? 

Weight loss surgeries result in restriction, malabsorption or a combination of both. Iron deficiency is usually more common in Gastric Bypass patients than in Sleeve Gastrectomy and Gastric Band patients. The increased risk of deficiency is caused by:

  • 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 after surgery. Stomach acid helps to change iron into a form that is readily absorbed by the body.
  • Tolerance and compliance issues with iron supplements

To prevent iron deficiency, patients usually require a bioavailable form and high dose of iron that may not be found in a typical multivitamin. It is still important to consume a wide variety of foods containing essential nutrients, like iron, to ensure proper nutrition. 

Signs of iron deficiency

It's important to correct any low vitamin/mineral levels or deficiencies before bariatric surgery to prevent complications post-op. Studies have shown that iron deficiency can appear a few years after malabsorptive weight loss surgeries. Iron deficiency can cause:

  • Anemia
  • Brittle nails
  • Headaches and confusion
  • Constipation
  • Dizziness 
  • Fatigue
  • Unusual cravings (Pica)

To further prevent deficiency, it is necessary to obtain lab work regularly and follow-up with your healthcare provider. 

The importance of vitamin C and iron absorption

Foods and dietary supplements containing vitamin C can help the body absorb iron. Some food sources of vitamin C include: 

  • Red bell peppers
  • Oranges
  • Broccoli
  • Strawberries 

An iron supplement that contains vitamin C is ideal for a bariatric patient to ensure optimal iron absorption. 

Food sources of iron

There are two forms of iron found in food, heme and non heme iron. Heme iron (readily absorbed by the body) includes:

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

Non heme 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.

Forms of iron to look for in a supplement 

There are a wide variety of iron supplements to choose from. You want to look for:

  • Elemental iron (refers to the total amount of iron that is available in a product to be absorbed by the body)
  • There are different forms of iron that can offer various amounts of elemental iron. Ferrous fumarate tends to offer the highest percentage of elemental iron, is readily available for absorption and less constipating than other types of iron. 
  • A product that contains vitamin C 

Bariatric Fusion offers multivitamin products that contain iron, but for those needing an additional iron supplement, we offer iron soft chews with vitamin C. Our soft chews contain 45mg of elemental iron in the form of ferrous fumarate, so you are receiving a highly bioavailable form along with vitamin C to aid in absorption. Bariatric Fusion focuses on creating products that are great tasting, affordable, and follow an easy daily regimen so that bariatric patients can avoid problems regarding tolerance and compliance.