Iron supplements?

I understand the ADEK vitamins and also changing to Citrucal, but do DS patients need to take extra iron? I just see a lot of people do. I don't it regularly now and don't have a problem with anemia or my iron levels. Do you absorb Iron differently with DS? 

thanks.

I did not start taking iron until a few months ago after having had several plastics procedures.  I have never had a problem with anemia and am past "that" age.  I am taking a prescription iron and I do not seem to be having any problems with it.

Red

I do, to be proactive instead of reactive.  I don't want to get anemic. 

Some people seem to have big issues despite supplementing, some people have no issues without supplementing.  Luck of the draw, I guess.

Seems like more people tend to need it than not need it, though.

Your labs will tell your surgeon if you need to take Iron or not. I've been anemic all my life and the DS didn't change that. I'm used to needing Iron.

It did change my Synthroid absorption, though. I went from needing 100mcg to needing 175mcg, but no big deal there.

Labs generally dictate.  Personally, I started at 14 months post-op, to be proactive.  My labs weren't low, but there is definitely room for improvement.  I prefer to see if I can have a positive effect before I have to react to a problem.

Let your labs be your guide

I have been recommending to BPD/DS patients that they not take iron unless they have to. Unlike gastric bypass, with BPD/DS there is exposure of iron in the diet being exposed to a small cuff of duodenum, which is where maximal iron absorption occurs. Also, in contrast to gastric bypass, the stomach sleeve holds a larger volume of stomach acid to process iron for absorption, and is generally capable of handling red meat quite freely. There is something about the iron in red meat that makes it more "bioavailable", meaning, more easily assimilated into the body. About 30-40% of gastric bypass patients will show signs of iron deficiency despite their taking iron supplements; this is improved, however, in those that can tolerate red meat. With BPD/DS, this is generally not a problem.

The reason I have become fairly conservative about oral iron is because of its reported interference with calcium absorption. The consequences of calcium malabsorption are much more grave than those of iron malabsorption; there is no really good way to reverse osteoporosis, while iron-deficiency anemia can be corrected with an iron infusion.

John D Husted, MD

It's really nice to see you posting, Dr. Husted!  Now that you're in Kentucky, you're my neighbor!!  Well kind of anyway!  Maybe someday our paths will cross, from what I understand you trained my surgeon, Dr. Inman.  Glad to have you here, would love to see more of you when you have time!  Welcome!!!!!!

Lori

Your surgeon will advise you if you need to take them and based on your bloodwork if you need to take them. As you can see Dr. Husted is a DS surgeon and will recommend his patients not to take them. My DS surgeon does suggests iron supplement and with criteria that is based on bloodwork too, and the amount of dosage, which was 18mg that I started off at 2x a day.

At 2 yrs out, it has increased due to my age, being female and having very heavy menstruation. Only your DS surgeon will medically advise what is best for you. Just do not take iron on with your own judgment to whatever amount you think or see others take because it can cause more harm than good if you have a normal range right now. Ask your DS surgeon who knows and responsible for you care and has background of your medical situation. I have worked receiving instructions and medical advice ONLY from my DS surgeon and PCP regarding the iron dose I need for myself and it is directly related to my bloodwork, age and other reason to the amount I need. 

Do you absorb Iron differently with DS? 
Each Dser is different based on their stomach size, limbs configuration and common channel length. All I want to say about this is, DSer absorb iron very different than a person who has the RNY, whether proximal or distal. We are not the same, even if a distal RNY has something that is similar to a common channel, it is still not the same as a switch. Their entire digestive system is not the same as ours. They have their stomach and duodenum bypass and different configuration of their jejenum to ours and therefore malabsorbs differently than we do of vitamins and other supplements, especially iron.

Iron is absorbed in the higher parts of the small intestine, which is the part (mostly - they kind of divide the duodenum in about half) that's brought up to the pancreas and becomes the bileopancreatic limb of the DS.  So the iron that you eat/take isn't in contact with very much of the main absorber of iron.

I'm exactly 4 weeks out from my DS.   My DS surgeon gave me a prescription for Foltrin, which is an iron and intrinsic factor combination capsule.   I have had anemia for years, and I take ProCrit injections and B12 injections every few weeks.

I spoke with my hematologist about the iron question today, and told her that some people seem to be taking two different kinds of iron and I asked how much more than they take would I need?   (Before my DS, I was on 350 mg of Iron sulfate three times a day!!!)    She said that, looking at my new plumbing, she couldn't imagine that I'd be able to absorb enough iron for my needs, and will have to go back to iron infusions.   She had the lab draw iron and ferritin levels today and has tentatively scheduled an infusion for my next visit.  

Which, to tell the truth, does not upset me.   Taking such huge quantities of iron has always had one effect or another on my digestion.   Plus, I've been taking a Vitamin C with each iron, and that concerned my renal doctor, who said he'd prefer I only took one Vitamin C per day.

Hematologist told me to keep taking the Foltrin one a day, which goes with the one Vit. C per day, so it sounds like the whole thing is working out for me.   I hope so, anyway.

I'm sure you will and have already gotten lots of good advice and interesting information from people who were more hematologically normal before surgery.   I just thought I'd add my 2 cents worth, as a semi-interesting anomaly.

Dennie