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?

BOo, I am sorry girlie.

I have also started using the iron "rules" for the heme-iron too, even though, according to the glossy brochure :} we ought not *have* to, so we shall see.

I get my labs drawn next Friday and will go meet with the hematologist on the 29th, so I will share what I find then too. 

Good on you for taking good care and keeping a good eye on yourself, Margo!!

Thanks Brandilynn - I look forward to hearing what you find out - I also followed the rules even though I was taking the heme-iron and continue to do so with the polysaccharide, so we shall see how it goes.

I found it illuminating how much I wanted to stamp my feet and eat a bunch of gluten free, (but not nutritious), crapola at the very notion of any restriction of any food item in my daily eating. Major internal tantrum, and I even bought some white rice bread, (and I NEVER eat white carbs)! Waaa!

Well, I am pretty much over it, in about a week, so am back on track for the time being!

Take care - and hope all is good news with your labs! Good on you also for being on top of this stuff!

*chuckle*

Sadly I know what you mean about how illuminating it is to feel insanely rebellious about having to "give food back" (the gluten free spree). I felt the same way when I realized I had to "give food back" and drink those calories in shakes. 

Go us go!!  We can learn and do good by us!

And hey, I *really* appreciate your reporting this stuff back, its so important and the more we can learn and share (think I) about lab stuff, the better prepared we are when things go a bit wonky.

Or maybe misery loves company.
WHATEVER!

:}

Oh well.  At least corned beef and cabage are gluten free.

NACKIN O THE IRISH TO YE, ME LASSIE!

**also of an interesting note on my labs, my saturations, even when my ferritin AND H&H have been low, have always been borderline high, or even over high normal. 

Weird, more conversations with the hematologist in order as to what the hell that means.

ALSO ABOUT THE GLUTEN!  My niece, we found out a few years ago, when she was 14, has gluten issues.  They found out because they were trying to find out why she had not grown much (although she is from leprechaun stock, so I am not sure how they figured she want growing "normally" she fits the profile of all the women from both sides).  Anyway - the gluten issue was keeping her body from absorbing CALCIUM and at 14 - she had osteopenia, so full well on her way to osteoporosis at 14.

14.

booo. 

Yeah corned beef and cabbage - in my fridge all ready to be cooked!

Hey Margo, I too have the ferritin issues and have been taking proferrin for about 6 months now.  I also take a PPI and can NOT live without it due to severe acid after more than 2 day without it.  All other iron numbers are okay, just that dang ferritin.  Although it was never really high, it was like 69 at one time and is now 20.  I just had labs drawn last week and don't have my results yet.  I will post when I get them.  Thanks for bringing this up cause the newbies think their labs are fine and these things start showing up much later.

Laura

Hi Laura, it will be interesting to see how it goes for you - I took the proferrin for about the same and still saw a drop (to 22 from 44 last time), and like you, my other numbers are good, so my doc isn't feeling the same sense of alarm. I just really do not want to be trying to catch up once the other iron numbers drop - and also don't want to have the symptoms that would accompany that drop!

I'll let you know how dumping the gluten goes in terms of being able to drop the ppi. I was very hesitant to do it because I really just don't want to be one of those folks who is constantly focussed on what I am and am not eating, but like post WLS eating, I suppose it could just become a normal part of my routine.

Good luck with your iron!

Yeah, my doc isn't too alarmed with the ferritin drop either and the good news is that although the ferritin dropped a year ago, the other numbers have not.  But lets see what the current labs say.  Keep us posted on the gluten free thing.  That would certainly suck to have to do but whatever it takes, right??

I may have something to add to this. My surgeon told me to get off the PPI as soon as I could, but that I would have rebound reflux for up to two weeks and could supplement with Tums as needed until it passed. I was able to get off them, but it took more like three weeks and I went to every other day first as well. Hope this helps.

Good luck with this. Never had the problem so I don't have much to offer. I assume you are getting b 12  too.     Diane