X-Post: VSG, PPIs, Gluten, Iron Absorption - my research & experiment

Background:

I have been faithfully taking my supplements and tracking my labs since I had surgery, and have continued to see my Ferritin numbers drop, although for the time being, my other iron counts are good. Ferritin is stored iron, so it appears that my body is drawing down on this "savings account"  and I can anticipate that if it continues to fall, that I will likely end up with some degree of iron deficiency anemia. Bleh.

I have always been mildly anemic and have been taking heme iron for more than a year, and was taking carbonyl iron + Vitamin C since surgery until I switched to the heme. Even so, my numbers have dropped by half.

I also have been unable to stop taking a PPI - within about 36 hours off meds (Nexium) I am in a lot of pain and discomfort from reflux.

My research:

I have been doing a lot of reading in medical journals about iron absorption and have found 3 things that may be contributing to my ongoing problem - thought this might be useful info for others.

1) Poor iron absorption is a common side effect of gastrectomy, partial or full
2) Nexium, by reducing acidity, decreases iron absorption, even with heme iron and iron polysaccharide, which shouldn't require much acidity. (Ferrous salts are VERY poorly absorbed in a non-acidic stomach environment). It also reduces calcium absorption, again because of the reduction of stomach acid.
3) Gluten intolerance may contribute to poor absorption, although the evidence I have found is a bit mixed - some say that damage to the intestine would be the only cause of malabsorption. my doctor disagrees and has suggested that I try a gluten free diet.

I have also been reading about trying to discontinue the Nexium and it seems that some people who stop taking it cold turkey experience some rebound reflux - or worse sypmtoms than they had in the first place.

My Plan:

So - I am motivated to get OFF of the Nexium - it is expensive and seems to be contributing to an incipient case of anemia. For now we have lowered my daily dose by half and I have commenced with a gluten-free diet (as if I weren't already working hard at low-carbing it!)

After two weeks of this I will try to reduce the Nexium to every 1 1/2 days, and then to every two days, and continue to try and reduce until, hopefully, I can eliminate it.

I will continue with my iron supplementation, taking iron polysccharide daily with 1000mg of Vitamin C to increase absorption, and at least 12 hours after taking the Nexium.

Plan to run labs again in a couple months and see how it goes. Will report back!

Gluten:

Regarding the gluten free - I had been leaning toward the suspicion that this might be a good idea, but was SO resistant to giving up even the small amounts of gluten-containing food that i do eat. I have been reading a LOT about paleo/primal eating and finding the literature pretty convincing, so I suppose my doctor's suggestion came at a good time.

Upon giving up wheat I did immediately dump about 4 pounds of bloat, and it appears to be staying off, so maybe this will contribute to my weight loss maintenance in a positive way. Anyone else celiac or eating wheat or gluten-free?

You may want to look at a yeast culture and probiatics as well if you're going gluten free.

I do take probiotics already - could you tell me more about a yeast culture?

Something you might find intresting from the harvard medical journal.

http://www.health.harvard.edu/healthbeat/HB_web/getting-out-the-gluten.htm

Thanks for posting this! I don't have celiac disease, but the doc thinks I might be gluten sensitive, so recommended trying a full month gluten free, then try reducing the meds while remaining gluten free to see how it goes. Other than the reflux, I have no gastro symptoms at all other than occassional constipation due to the new iron supplement.

 VERY INTERESTING INFO.  ALL MY LABS HAVE BEEN GOOD AS OF ONE YEAR OUT FROM VSG.  HAVEN'T HAD ANY RUN LATELY AS I DON'T GO BACK FOR FOLLOWUP TILL MAY.  BUT I HAVE BROKEN A BONE IN MY HAND (THUS TYPING WITH ONE HAND) WITHOUT SERIOUS TRAUMA.  

SO THAT HAS ME CONCERNED ABOUT LOW CALCIUM.  I AM HOPING THIS IS JUST A FLUKE IN MY CASE.  

Good luck! My bone density is actually in very good shape (98th centile) so that at least isn't a problem, although I continue to supplement with calcium citrate and vitamin d. Hope your hand is better soon!

I hope you can get things figured out, I am battling something similar. 

Also, I am sure you know it but you didn't mention it, that you cant take most iron supplements within at least an hour, 2 is better, from when you had calcium or will have calcium, otherwise the iron is not properly absorbed...

My results are weird and they / I don't know why..

iron=38 way low
iron sat=12 way low
TIBC=324 way high
Ferritin= 384 way high

Those are strange values! I do follow the "iron rules" and should have mentioned it in the post, in case anybody doesn't read the whole thread. Thanks for reminding me.... and iron should also be separated from dairy, whole grain and caffeine intake, along with calcium supplements.

I have also read that it is ideal to take Vitamin C with the iron to improbe absorption...

Good luck in figuring out YOUR iron - it seems to be a case of trial and error for many folks.

Going gluten free is SOOOOO much easier than when we had to tackle it 6 years ago.

There are so many things out there and so many resources available.  I have a mild gluten intolerance, but my children were completely gluten free (as well as casein free) for 5 years.  My Mother also has issues with gluten.

If you ever have any questions, please do not hesitate to message me.