calorie counts

Hello everyone:
       I am semi new member meaning I've been here before but it was a long time ago.  I have a question for anyone in the same problem area, Can anyone tell me if there is an acceptable calorie count limit for a gastric bypass patient with an iron defiency that is keeping me away from plastic surgery? I had surgery four years ago and am at the stage where plastic surgery is needed but I have an iron defiency and the surgeon won't let me go for it  because my iron counts are too low. I am trying to get them back up with supplementation and diet but I am gaining weight and like all of you I never want to be back there again.  I have gone to nutritionists but they won't give me a number count for calorie limits all they want to talk about is protein limits and I know that already. If anyone can help me I would greatly appreciate it. I am getting
frustrated

Hello:

I would suggest a few things to cinsider.

ALthough I am not sure what your CBC, Ferritin (iron stores), TIBC or iron levels are (if you have them post numbers and normal ranges) if not consider getting a copy for yourself.

Based on these results I may seek help of a hemetologist, as if severely low all the food with iron and pill supplementation may NOT help many of us can not absorb oral iron, some need differnet forms, ferrous sulfate is a pouch burner and constipator and really is less absorbable, ferrous gluconate or ferrous fumarate seem to be more tolerable and absorbable for some as is chelated iron or polysaccharide (like Vitaladies tender iron www.vitalady.com ) there is also carbonyl iron...vitamin C is usually taken with iron to increase oral absorbtion, nevr take iron with: Eggs, fiber, calcium, caffeiene, dairy, protein all can decrease absorbtion, it is best with Vit c and on empty tummy, if it hurts then a saltine can be ok to buffer the blow to the gut!

It is so hard to know what to recommend if you do not know how low you are..if your iron has tottally tanked the plastic doc is doing you a favor by holding off as plastics are very harsh on the system and a major trauma! Healing is imperative and w/o iron that is an issue. How is your protein levels? (prealbumin, albumin etc?) when we have low protien iron can be low as a result.
Many gastric bypassers need iron infusions!

Now as for calories there is no one size fits all, it is trial and error for eachof us individually, notice perhaps what a 1500 cal diet with exercise will do fow you over a month or two. if gain then drop it a hundred calories or so andup exercise....

Age, medical conditions and your activity level all play a role!

Gastric Bypass Surgery and Iron Deficiency

Approximately 33% of gastric bypass patients develop iron deficiency and up to 30% develop anemia.The primary site of iron absorption is the duodenum,which is completely excluded in gastric bypass patients. Iron absorption is enhanced by gastric acid secretion which is greatly reduced in the remaining pouch. In addition, dietary iron usually in the form of meat, is often poorly tolerated in this group. In two separate studies, Brolin found that multivitamin supplements did not consistently protect against iron deficiency, especially in menstruating women.


want more guidance email me off list! [email protected] i have this article in PDF form I can send:

Iron Absorption and Therapy after Gastric Bypass
Authors: Rhode, Barbara1; Shustik, Chaim1; Christou, Nicolas1; MacLean, Lloyd1
Source: Obesity Surgery, Volume 9, Number 1, February 1999 , pp. 17-21(5)

Abstract:

Background: Iron deficiency anemia is a common complication of gastric bypass. The authors assessed the value of taking vitamin C with oral iron in correcting deficiencies in iron stores and anemia postoperatively. Materials and Methods: Iron absorption tests were performed on 55 patients 3.2 ± 2.0 years after isolated gastric bypass to identify those at higher risk for the late development of anemia. Twenty-nine of this group agreed to a therapeutic trial of iron alone or with vitamin C over a 2-month period. All 55 patients were followed up for 27.1 ± 1.0 months following the study. Results: The iron absorption test identified patients with low iron stores, as indicated by low serum ferritin, and those with sufficient absorption surface to benefit from oral iron. The addition of vitamin C appears to enhance the therapeutic effect of iron by correcting ferritin deficits (P < 0.01) and anemia (P < 0.05). Differences in intestine length bypassed by the operation (10 vs. 100 cm) did not affect late ferritin and hemoglobin values. Conclusion: This study suggests but does not prove that the addition of vitamin C to iron therapy after gastric bypass is more effective in restoring ferritin and hemoglobin than iron alone. These results are in contrast with the outcome 22.8 months later, when ∼50% of study patients were again anemic. Closer follow-up of patients is urgently needed.
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I became anemic after plastics.. iron deficiency anemia affects much more than just wound healing and energy level! If left to go too low it can have serious cardiac effects!....

http://www.thinnertimes.com/weight-loss-surgery/gastric-bypass/gastric-bypass-complications/iron-deficiency.html



http://www.cdc.gov/NCCDPHP/dnpa/nutrition/nutrition_for_everyone/iron_deficiency/index.htm

http://www.mayoclinic.com/health/iron-deficiency-anemia/DS00323

http://www.nhlbi.nih.gov/health/dci/Diseases/ida/ida_whatis.html

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IRON ISSUES
Here are a few groups specifically for iron/vit issues
http://health.groups.yahoo.com/group/ossg-anemia/
http://health.groups.yahoo.com/group/OSSG-vitamins-minerals/
http://health.groups.yahoo.com/group/BariatricSurgeryandIronDeficiency/


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http://bariatrictimes.com/2008/03/10/micronutrient-and-macronutrient-needs-in-roux-en-y-gastric-bypass-patients/
for full article use the lin here is part on iron:
Iron. Iron functions in hundreds of human proteins, most commonly known for its role in hemoglobin carrying oxygen. Iron deficiency is relatively common in RYGB patients.14 Patient risk for iron deficiency is due to the decrease in stomach HCl and decreased intake, and individual risk is associated with heavy menstruation. Symptoms of iron deficiency include anemia, fatigue, hair-loss, feeling cold, pagophagia (significant chewing and eating ice), and decreased immune function. Lab tests for determining iron deficiency should include serum ferritin levels, serum iron, transferrin saturation, total iron binding capacity (TIBC), (MCV), and hemoglobin (Hb). Typical presentation of iron deficiency with anemia will show elevated TIBC and all other results will be low. In the absence of anemia, Hb and MCV can be normal. Treatment and resolution can be difficult secondary to outside factors affecting absorption and patient noncompliance because of constipation and stomach irritation. A commonly suggested recommendation is to give 100 to 200mg of iron per day to treat deficiency.1 Some studies have shown greater outcomes and compliance with doses given every 5 to 7 days.15 Iron taken with vitamin A may be more effective in resolving iron deficiency, even if there's been no vitamin A deficiency identified.16 There is no agreed upon protocol for prevention or maintenance largely because of the risk of iron toxicity. The UL for iron has been set at 45mg per day for adults. Symptoms of toxicity include gastrointestinal (GI) irritation, nausea, vomiting, diarrhea, or constipation. Chronic toxicity can present with heart palpitations, fatigue, joint and muscle pain, and depression.