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Iron Deficiency After Gastric Bypass Surgery

What is iron deficiency after gastric bypass surgery?

Iron deficiency and anemia are common after a gastric bypass or other weight-loss surgery, especially in women. In fact, iron deficiency can occur in more than half of women who are premenopausal who have this surgery.

What causes iron deficiency after gastric bypass surgery?

Iron deficiency is a side effect that results from the changes made during the surgery. Most of the iron from foods, like meats, legumes, and iron-fortified grains, is absorbed in the first part of your small intestine. This is your duodenum. But after a gastric bypass procedure, food bypasses this part of your body before minerals and vitamins can be absorbed. This can lead to iron deficiency and other nutrition problems.

The Roux-en-Y gastric bypass, or RYGB, is the most common type of gastric bypass. Studies say that the amount of iron in a standard multivitamin (18 mg) may not be enough to prevent anemia if you have this kind of surgery.

What are the risks for iron deficiency after gastric bypass surgery?

Iron deficiency can occur in more than half of premenopausal women who have this surgery.

What are the symptoms of iron deficiency after gastric bypass surgery?

Iron has many important roles in your body. It’s important for the health of your hair, skin, and nails. It also helps create hemoglobin. This is  the substance inside red blood cells that carries oxygen throughout your body. When you are anemic because of iron deficiency, you may notice:

  • Lack of energy
  • Weakness
  • Headache
  • Rapid heartbeat
  • Hair loss
  • Brittle nails
  • Pale or yellow skin
  • Shortness of breath
  • Chest pain
  • Strange pounding sensation in your ears
  • Craving for ice or clay (known as pagophagia)

How is iron deficiency after gastric bypass surgery diagnosed?

Your health care provider will note any of the above symptoms. He or she will also order blood tests to find out if you have iron deficiency or anemia. In its early stages, iron deficiency begins to use up the stores of iron in your body. This can be seen by testing your levels of ferritin, a protein that stores iron in your body. If your ferritin levels are low, iron is likely low.

If your iron deficiency has advanced to iron deficiency anemia, a complete blood count will show some problems. These include low hemoglobin, lower numbers of red blood cells, and smaller red blood cell size.

For men or postmenopausal women, iron deficiency anemia is usually not related to the gastric bypass surgery. Your health care provider will need to be certain that you are not anemic from blood loss elsewhere, such as from your intestine. He or she may suggest a colonoscopy to look for a source of blood loss from your large intestine. 

How is iron deficiency after gastric bypass surgery treated?

Many people can raise their iron levels by making some changes to their diet. If your iron deficiency is related to a gastric bypass procedure, your health care probably will prescribe iron supplements. This extra iron should come from a prescription from your provider, not from an over-the-counter (OTC) supplement you pick yourself. The exception to this is if your health care provider recommends a specific OTC iron product for you.

If you are a teen boy or girl, or a woman of childbearing age, you may need 2 multivitamins plus 50 to 100 mg of elemental iron each day. Vitamin C supplements, among others, is also recommended to increase the amount of iron your body is able to absorb. Your health care provider will determine the right amount of iron for you.

Iron supplement can cause side effects. Many people have constipation and nausea, among other problems.

For some people, usually women with heavy menstrual periods, supplements aren’t enough. You may need iron through an intravenous( IV) line, blood transfusions, or even surgical revision of your bypass to increase the amount of iron absorbed.

Can iron deficiency after gastric bypass surgery be prevented?

You should have a thorough blood workup before weight-loss surgery to find out about any existing vitamin or mineral deficiencies, such as iron, vitamin B12, and folate. Studies suggest that treating these deficiencies before your operation will improve your outcome and quality of life after surgery.

After gastric bypass surgery, you will need to monitor your level of iron and other nutrients for the rest of your life. You can develop iron deficiency and anemia years, and even decades, after your gastric bypass surgery. Your health care provider should measure your serum iron 6 months after weight-loss surgery and at least once a year after that, along with doing a complete blood count.

Red meat, poultry, seafood, leafy greens, legumes, iron-fortified grains, and other iron-fortified foods are all good sources of iron. Drinking more than 16 to 24 ounces of milk each day may decrease how much iron you absorb. But remember that dietary measures alone may not be enough to prevent or correct an iron deficiency related to a gastric bypass procedure. Work with your health care provider to find the right iron supplement plan for you.

Key points

Iron deficiency and anemia are common after a gastric bypass or other weight-loss surgery, especially in women. Iron deficiency is a side effect that results from the changes made during surgery. Iron helps create hemoglobin that carries oxygen throughout your body.

  • Symptoms of iron deficiency anemia may include:
    • Lack of energy
    • Weakness
    • Headache
    • Rapid heartbeat
  • For men or postmenopausal women, iron deficiency anemia is usually not related to the gastric bypass surgery.
  • Your health care provider will probably prescribe iron supplements.
  • Iron supplement can cause side effects such as constipation and nausea.
  • You can develop iron deficiency and anemia years, and even decades, after your gastric bypass surgery. You will need to monitor your level of iron and other nutrients for the rest of your life.
  • You should have a thorough blood workup beforeweight-loss surgery to find out about any existing vitamin or mineral deficiencies.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Fincannon, Joy, RN, MN
Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Last Review Date: 1/29/2014
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