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Iron- (a repost from  past...ignore if you've seen it. Paul, ther's a much 'slicker' version f this I can e-mail.  It's one of my handouts from Lexington with graphics and such...)

Some random-azzed info on ---- IRON! (skip if not needed) ______________________________________________ The Women are very aware of Iron needs. That whole menstrual cycle thing Causes so much iron deficiency among them That the typical "Women’s Formula" Vitamins Are usually just normal multi- Plus Iron. It’s an issue that they deal with as Non-Ops. But for men, it is very rare That we ever have Iron deficiencies- Except those of us Men, who have had Gastric Bypass, Specifically- RNY. Suddenly we go from a group that rarely if ever Experiences Iron Deficiency, to a group that Has a 33% to 50% occurrence rate. So, chances are somewhere between 1 out of 3 And half of the guys reading this Will experience an Iron deficiency at some point. That is unless- We take care of our business! Yes? So- Some Iron Man Talk!- Iron allows our blood to carry Oxygen in our blood. Not enough Iron, Oxygen is not efficiently Carried throughout our bodies. The symptoms can be- fatigue, headaches, weakness, Irritability, pale skin color, unusual cravings, And decreased resistance to infection. At Even, at more serious low levels- Heart palpitations, hair loss, low blood pressure, And Shortness of Breath. The causes for our Iron deficiency are two-fold. - Iron is primarily absorbed in the proximal jejunum (Upper small intestine) as well as the duodenum. Iron normally begins breaking down in the stomach With the acids and continues breaking down and Is absorbed in the upper intestine. With RNY patients, our lower portion of stomach Is bypassed, therefore missing the whole stomach acids Event needed to break down the iron, And also the upper portion of the small intestine is bypassed Thus skipping the primary absorption sites for iron. Lap-Banding doesn’t create either of these problems with iron But the DS, even though it keeps the lower stomach And acid production/interaction, it still bypasses and therefore Can result in reduced iron absorption. So, as a rule, we tend to have some degree of iron deficiency Inherent in the whole bypass business. So, to get more Iron? The easiest is to eat iron rich foods. Red Meat, Eggs, fish, Green leafy veggies, As well as Peas and Beans. There is also a high iron content in dried fruits Such as apricots, raisins, and prunes, As well as all of the "fortified" cereals and breads, Nuts and seeds. The dried fruits will also "keep you regular" But at higher amounts, may cause dumping in some. (me) But, with reduced intake, and not always making Your food choices based on- "How much Iron is in this?" It is probably just easier to take a supplement. Iron supplements come in- Ferric –Or- Ferrous forms. The FERRIC supplements need the stomach acids to Make them absorbable. So, The ferrous is considered better because it is Easily absorbed. Read your labels! These show up on the shelves and in multi-vitamins as- Ferrous Sulfate, Ferrous Gluconate, and Ferrous Fumarate. The AAMC’s Biochemistry page lists- "Oral administration of Ferrous Sulfate Is the Most Commonly used Iron Supplement" But, even though when taken with a mild acid such as juice It has acceptable "Bio-Availability," It’s Not the best. Although ferrous sulfate is often recommended to treat iron deficiency, Frequent problems with the drug including gastrointestinal discomfort, Bloating and other distress, make it unacceptable to many patients Second most common Iron Supplement? – Ferrous Gluconate, Which is roughly equivalent in cost, produces fewer problems, And is preferable as the initial treatment of iron deficiency. (it also happens to be the compound used to color or "dye" ripe "black" olives) (so a few of these now and then have the added perk of Iron.) (also dropping a little "Factoid" in here- Cooking in an Iron skillet or pot will add substantial Iron to the foods you eat. Just a thought) Ascorbic acid (Vitamin C) along with the supplement enhances the absorption. Combination tablets containing iron salts and ascorbic acid Are significantly more expensive than separate tablets for each, however. Ferrous Fumarate is the often the Iron of By-Passers choice because It has the highest % of absorbable iron "of the ferrous versions." The Office of Dietary Supplements At The National Institute of Health, Lists Ferrous Fumarate As containing twice as much absorbable iron as F-Gluconate, and 3 times as much as F- Sulfate. (before breaking into a discussion of-"My Iron is Better…" some more info) I don’t take the Ferrous Types because I take a prescription Iron supplement. My Doctor says to, and my insurance pays for it. My prescription is POLY-IRON 150. (POLY-IRON) The Generic Name: iron polysaccharide Also comes in the Brand names- Fe-Tinic 150, Hytinic, Niferex, and Nu-Iron 150 Polysaccharide-iron complex, (What I’m on) A replacement form of iron that differs from the iron salts, Is a more recent option. Most patients tolerate this form of iron better than the iron salts, Even though the 150 mg of elemental iron per tablet Is substantially greater than that provided by iron salts (50 to 70 mg per tablet). Still, According to- The Harvard Center for Sickle Cell and Thalassemic Disorders "No study exists comparing iron uptake from polysaccharide-iron complex and ferric salts." There’s also Iron Bisglycinate, often sold as "Gentle Iron" Because it is easy on the digestive tract. The only "non-Vitamin Sales Site" info I have concerning iron bisglycinate Is from The American Journal of Clinical Nutrition- http://www.ajcn.org/cgi/content/full/72/6/1592 Which found- "No advantage of using ferrous bisglycinate as an iron fortificant." It is an Older article however from 2000 A 2006 article from – U.S. National Library of Medicine, National Institutes of Health, & Human Service http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract &list_uids=15864409&query_hl=3&itool=pubmed_docsum Showed that when taken or administered along with Ascorbic acid, The relative bio-availability (RBV) of seven different commercially available Elemental iron powders (actual only 5 on the market, 2 in testing trials) ---No significant overall ranking was possible. All that to say? Ask your doc! And if the Ferrous Sulfate gives you Constipation or gas Try another. But by all means take what ever one you use Along with some Vitamin C. With Vitamin C? There’s not enough difference between them to be Measured by Current (2006) Technology. So, Do you need it????????????????????????????? Iron levels should regularly be checked Along with your normal blood tests. The Normal range for Men is – 75 to 175 (mcg/dl) micrograms per deciliter of blood And 65 to 165 (mcg/dl) micrograms per deciliter of blood for Women. Typically the test That is part of the usual Mal-absorption/Nutrition Screen For WLS Patients is not an Iron specific Test, but rather A simple blood test that measures the number of red cells And the amount of hemoglobin in the blood. The normal amount is at least – 13g/dl (13 grams of hemoglobin per deciliter of blood) for men And 11g/dl for women. This test can determine if you are anemic, But does not identify the cause of the anemia directly. The leading cause of Pernicious anemia is from low B12, Which is also a "red-flagged" concern Of mal-absorption in WLS folks, So unless your Doc is specifically looking at Iron levels It may be missed. What to do? ASK! Again, ASK! "Doc, are you checking my Iron levels specifically? Or just my Hemoglobin?" "Does that test break out testing for B-12 problems From other causes of Anemia?" Just write these two questions on your arm Where they are gonna stick the needle to draw the blood. Why do you need to be "all up in the Doc’s Business?" Cause, It’s Your Business! Pernicious Anemia is fairly common, among WLS folk. It can be, and is most often caused by low B-12, But all the B-12 in the world won’t help, If you are running low on iron. Yes? So, just start taking some iron supplements to be Safe? NO! -again- NO! Have your Doc check. If your B-12 levels are low, And this is also a common occurrence for By-Passers, And you have been taking Iron Supplements And have a high Iron level, It will completely skew the lab results looking at B-12 levels And could totally Screw You Up! So, Ask your doc! And make sure he/she is looking specifically at/for both. Also, if you are just getting labs done once every 3 months Ask if the numbers are going up or down- Even if they are in Normal range. If three tests in a row, the numbers are dropping on your Iron But are still within Normal range, The Dr. will look and say- "Great! Well within normal range! See you in 3 months!" But if for instance- Your Iron level has gone- Test one- 128(mcg/dl) in the normal range! 1 month later- Test two- 95(mcg/dl) in the normal range! 3 months later- Test three- 82(mcg/dl) in the normal range! By the time you get to test four, 6 months later, At this descending rate- You’ll have about 4 months of not doing well Before the test that determines that You’ve fallen below the 75 to 175 (mcg/dl) Normal range. Yes? So- ASK!!! And ASK if you can have your numbers, Photocopies of your lab results. As Great as your Doc is, he/she is looking to see If you are in Normal ranges. Unless your Dr. is "House" on TV Pulling off diagnostic miracles each week In a one hour episode, Chances are, they are not going to be looking at your Tendencies and movements within the normal ranges Anywhere as near as YOU would. Once you get past the first year of Post-Op, Lab tests are typically only twice a year. Don’t risk a few months of ill-health While waiting for another test to come around. With a B-12 deficiency, it is corrected fairly quickly with Some B-12 injections, and the "store-houses of B-12," Your muscles, can be replenished fairly quickly. But if you get behind on your Iron? Iron infusions through an IV A couple of days a week for a few weeks. That Bone marrow is a slow warehouse to get in and out of. The treatment Suks! So, all of this to say- Stay On Top Of Your Iron! Now, * stepping onto a lower soapbox *- A couple of other bits to know- Iron competes for the same "receptors" on your intestines as Calcium. If you take a Calcium Supplement (and you most definitely should) Make sure you don’t take it at the same time as your Iron. Each, will get in the way of the other’s absorption. Not that they "cancel each other out." They just "plug" each others pathways of absorption So you don’t get the Full benefit of either. Take your Calcium and Iron at least 3 hours apart And you should have no problems getting the full benefit of each. The acid of Vitamin C helps break down the Iron and make it More absorbable, so it is good to take these together. Other thing? When taking an Iron Supplement, and some of it is Not absorbed It passes on into the lower intestine, where for most of us It does a great job of "firming up" and in many instances, "locking up" Our Bowel’s Contents. This can make going to the pot- Like trying to pass a Dumbbell! A big one! When taking Iron Supplements, the more they are absorbed, The less this effect on the stool. So take the Vitamin C! Yes? Also up the 3 F’s- Fiber, Fluid and Fats, to keep your "Moves-Smooth!" One of the symptoms of Too Much Iron is in fact Constipation And this is one of the things that may crop up if you just start "Taking Iron Supplements, just to be safe!" Unlike the case with getting Too Much Protein, B-Vitamins, C’s and such- Those will just pass on through in feces and urine, Too Much Iron can cause Big problems ranging from the Constipation And even Diarrhea to Liver and Heart Damage. So don’t just Start up supplementing without Needing to. And Last- Don’t take Iron Supplements in a tablet form with an enteric coating. Enteric Coating is that Thick, Candy like Coating on some "Extended-Release" Meds. By the time the Coating has worn off, It’ll be ready to exit out the "End of the Line," And none of the benefits will see your insides, But rather, will arrive Intact, in your Toilet. In fact, don’t take anything with an Enteric Coating. Those are intended to get the stuff past The harsh corrosion of the stomach. Not an issue for By-Passers. Yes? So, that’s all the Poop on Iron That I could remember this evening! The whole- "I’m not getting enough Iron" Thing Is typically one that Men never face. But with having a Gastric Bypass, This is suddenly just as much an issue For Us -(33% to 50% of Us) As it is for those who get regular visits from Aunt Flo! Best Wishes- Dx