The importance of educating yourself...

Hi gang I hope you are all doing well! I thought I was doing pretty good until I found out about the low iron thing that I told you about a week or two ago. I'm in the position of trying to correct a pretty serious iron deficiency that I feel I could have been better advised about preventing. It is looking like I now need to get some I.V. iron infusions to get my levels to where they need to be. Not only has it been affecting my energy level and causing symptoms, but now I don't feel safe to go to the gym and really push myself until this is corrected. I don't want to damage my heart, etc. On the other hand, I don't want to stall out my weight loss because I have to get out of my exercise routine. There is so much conflicting info out there on all this stuff, several kinds of iron, calcium etc. I knew that I was supposed to take my vitamins, calcium and b-12, and get enough protein. But it is far more complicated than that. There is so much to learn about post-op nutrition, and if you think it wont affect you, then I want to just alarm you all a little bit to stay on top of things yourself and don't wait for a problem to be uncovered to find out that you were doing it wrong all along. I'll post again soon with a list of nutritional things I've learned recently. Some of you probably do know all of this, but I was shocked how much I didn't know with as much as I read about wls. For example, many people avoid caffeine, but did you know it's the tannins in coffee and tea, not the caffeine, that can prevent you from absorbing iron? {decaf still has the tannins} Did you know that an innocent little bran muffin can keep you from absorbing iron? Or any dairy? We have to space out our iron supplements two hours apart from any of these foods. Not only was I not advised to take iron in the first place, but I had no idea that I was preventing the absorption of what little iron I did get in my diet. By the way, if you are NOT iron deficient, and you take unnecessary iron supplements, you can also cause disease processes to begin in your body, so we have to stay on top of things and not just throw supplements down our throats and assume all is well. Thanks for listening to my rant today guys, I will post more info on this stuff soon. There is so much more info out there. BTW thanks to those who answered to my original post about this, I learned alot from you guys, thanks for sharing your knowledge and concern. love, Sue

Thank you so much Sue. Gosh, I hope you are doing better. I was thinking about you today. Please post what you can, when you can. This is how we learn. WE all need to stay on top of things. As my PCP said to me once, that I am a "special" patient now. I have to be cared for in a whole new way. I love my PCP because if she doesn't know, she calls people who do know. Please take care and get your iron levels up. Hang in there and please post what you know. (((HUGS)))) Erin

Sue - I hear ya. I am in a bit of a panic mode myself about what I'm taking, when I'm taking it, and what to combine and not combine. Some days I feel so confused and overwhelmed that I end up taking nothing, which is NOT the answer. Sue, can you or someone else who is knowledgable tell me about combining the following (Beth Ripley, are you out there? You seem to know ALOT about the vitamin thing!). I'm supposed to take the following each day: 3 multivitamins, 6 calcium citrates, 1 Vitron C (iron), 1 B complex, 1 acid reducer, biotin (I take 3/day for hair loss). Someone (Beth?) already told me not to take the multivitamin with calcium so I no longer do that, my doctor never told me that! The acid reducer is called Ranitidine and says to take it after meals at night. I don't really know anything about combining the others. A relative who is a pharmacist told me to take everything with food and he said it is even OK to take everything at once! I feel skeptical about that though. And the calcium bottle doesn't say it has to be taken with food so I've been taking that in between meals. ANY advice would be SO appreciated PLEASE!!! Thanks in advance! Hugs, Sandy P.S. Thank you so much Sue for raising awareness about these issues!!! Good luck with your iron, thank goodness it was caught! Please keep us in the loop about what's happening!

Hi Sandy, Beth does seem to know alot, as does Lynn I believe, so jump in here ladies! As far as your question goes, I know nothing about biotin, but I know that the acid reducer definitely needs to be kept away from your iron sups also, because iron supplements need acid to be absorbed properly. I think the calcium is ok between meals, away from the multi or the iron.. Those of you taking calcium carbonate, from what I keep reading, you really should reconsider and take the calcium citrate. I've read that we don't have enough stomach acid to properly absorb the carbonate and believe me, it's awfully late once you find this out the hard way. One more thing, to clarify from my earlier post, it's the iron SUPPEMENTS that are not well absorbed, dietary iron from MEAT, {called heme} IS absorbed without the same concerns, and in fact aids the absorption of non-heme iron found in supplements, veggies and supplemented grains. Just wanted to add that. Thanks for the good wishes Sandy and Erin, I know I'll be ok, just impatient to be back up to 100% Love, Sue

Hi, Sandy! Please go by what your doctor or nutritionist advises!!! I just recently put in a message to my own surgeon's office regarding his instructions. I'm supposed to take a total of 4 calcium supplements a day---but the number of milligrams aren't listed!!! Our bodies have been altered but a "normal" person can only absorb about 600 mg at time of calcium. As far as the Ranitidine (also known as zantac) I couldn't find where it would cause absorption problems. Here's a thought for us all to think about....Sandy, perhaps your doctor prescribes your supplements this way for a reason. We may may not absorb ALL the iron or calcium if it's taken together but surely SOME it will?? And I'm no expert, believe me!!!! Nutrition and vitamins are like trying to learn chemistry! I wish there was a self-help book "Nutrition/Vitamins for RNY Dummies"! I'd buy one for home AND work!!! Sue--thanks for the reminder about coffee!!!! I had gotten into the habit of taking my mulitvitamin with my decaf in the morning! I thought I was being a good girl not doing caffeine. Hmmmmmmmmm.... Life is good. Isn't it wonderful spending our time, thoughts and energy on ways to be MORE healthy instead of what we were doing a year ago??? Beth

Sandy, I take my calcium with my multivitamin. I don't take anything with food because I don't drink while I eat or for 30 min. after I eat. I take my iron and Vit C as soon as I get up and I don't have anything excep****er for 2 hours. I only take iron once a day. For the calcium citrate, we only absorb 500mg at a time so I take it throughout the day and separate each time with 2 hours. You also have to be careful to look at the bottle of calcium citrate to make sure you are getting 500mg of elemental calcium with each dosage. If the label reads 500mg Calcium (as calcium citrate) or 500mg Calcium from Calcium Citrate or 500mg calcium (calcium citrate), then you are getting 500mg of elemental calcium. But if it reads 500mg calcium citrate, you are only getting 125mg of elemental calcium. I don't know about the acid reducer. I would ask a nutritionist about taking that with supplements. Lynn J., lap RNY 9/29/04 -105 lbs

This has always been my concern. I take my Tums (carbonate which I always said I wanted to take the citrate but my nutritionist said that the TUMS is OK....)1 in the AM, then I drink for an hour, take 1 multivitamin a day, I wait about an hour or two then I take my second tums. I think I am going to switch to calcium citrate once my TUMS are gone. I have been debating this off and on and both my nutritionist as well as my surgeon say that the TUMS is OK. But I will take the calcium citrate instead. What do you take for your Calcium citrate?? I am so paranoid about not getting enough vitamins, B12 (which I also take ama once a day), and the correct calcium. I also have to take 1 Prilosec a day as well. I don't know if I am coming or going sometimes and its very frustrating. But please keep us posted Sue. Erin

My doctor must have the most comprehensive program ever. We get a book with everything in it that we should know. We have to see the nutritionist 4 times in our first year. This is what my bible says about supplements. 1. multi vitiman-once a day(adult multivitamin) They also suggest vista vitamins or bariatric advantage. They are made specifically for us. I take bariatric advantage. They are chewable and orange flavored. 2.Calcium-1500mg per day calcium citrate. 3. Iron-ferrous citrate-90mg per day. (slo-fe)It is gentler to your GI system. Do Not take Iron and Calcium together. Take them at least 4 hours apart. Do not take with tea, coffee or cola(which we are allowed anyway) This goes for all vits and minerals. 4.B12-500mcg sublingual(under your tongue as they are better absorbed. 5. Protein-at least 64 grams a day. I usually get at least 100 grams of protein a day. I drink Unjury chocolate with skim milk. I also take biotin every day. my hair has never fallen out. Least not any more than usual

Sorry to hear about your iron deficiency. Thanks for ALL the information too. I was beginning to think I was iron low but had labwork last week and found out I was tired b/c I NO LONGER needed my medicine for Hypertension. (my bp was way too low) I feel better now that I stopped it. Ive gone from 30 pills daily down to 1 since wls. I do take prenatal multivitamins, B12, Bcomplex, biotin and calcium but I dont need to take iron (as of yet). Thanks for sharing. I wish you continued success. Leslie 312/190/170?

Leslie, Taking iron is very important. I know not everyones doctor says the same thing but take it from Sue, Take some iron before it becomes a problem. I have heard of people whodidn't take iron and years later they become deficient. It is so easy to just take it now and avoid the headache later. At least thats my opinion.