Iron Deficiencies After Bariatric Weight Loss Surgery

Iron Deficiency and Weight Loss

Graphic from, a fantastic resource for iron information


Iron deficiency is the most common cause of anemia after bariatric surgery and can be found in 20-49% of patients.


The severity and type of nutritional deficiencies experienced by post-op patients varies based upon the type of procedure performed. As can be expected, malabsorptive procedures cause the most impact to vitamin and mineral absorption and result in deficiencies much faster, while restrictive procedures limit food (and therefore nutritional) intake, but do not bypass any part of the intestine.


Supplementation is recommended for all procedures at the levels and frequencies specific to each patient’s surgery type, loss rate, sex, age and medical history.  The inherent malabsorptive qualities of RYGBP, BPD and BPD/DS bring about a strong requirement for daily iron supplementation. Iron deficiency has been reported in many studies to be present in up to 50% of RYGBP patients, and most frequently in women.1


Amino Acid Chelate
The form of iron can make a huge difference in both absorbability and stomach irritation.  Iron as Amino Acid Chelate, is a water soluble, highly absorbable form of iron, equally as soluble as ferrous ascorbate and as absorbable as ferrous sulfate. This form of oral iron, by virtue of how it is absorbed, with iron dissociating from the chelate as it enters the nonheme pool in the same manner as other nonheme iron compounds, benefits patients with enhanced absorption and fewer side effects.1


Iron is an essential component of proteins involved in oxygen transport.
A deficiency of iron limits oxygen delivery to cells, resulting in fatigue, poor work performance and decreased immune system function.2,3  Bariatric patients post surgery, especially in the first few weeks as healing is still occurring, will need full immune function, and as much energy as possible to recover from surgery and successfully transition to daily home maintenance.


Gentle Supplementation – Ferrous sulfate is inexpensive, but many patients experience unpleasant side effects from its use, particularly gastrointestinal intolerance, which for a bariatric patient can be detrimental to supplement compliance. Symptoms such as constipation, nausea, vomiting and diarrhea, are all common, especially when ferrous sulfate is taken on an empty stomach. Comparatively, Iron bisglycinate chelate has a much lower incidence of gastrointestinal issues, and in a double-blind crossover study comparing side effects of ferrous sulfate with iron bisglycinate chelate, 61% of study participants preferred the use of the chelate for that reason.1


It is imperative that you have your blood levels checked at each follow-up visit after weight loss surgery to check for possible anemia.  If Iron supplementation is needed, a liquid iron from amino acid chelate is a great option due to high absorbability and ease of taking.  Dosage can be easily adjusted according to recommendation from your health professional.


1. Coplin, M.; Leichtmann, G.; Lashner, B. 1991 Clinical Therapeutics 13:5.
2. Miret S, Simpson RJ, McKie AT. Physiology and molecular biology of dietary iron absorption. Annu Rev Nutr 2003; 23:283-301.
3. Haas JD, Brownlie T 4th. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship.
J Nutr 2001; 131:691S-6S.



Healthy Energy – Who May Benefit from a B-Complex Supplement?


Want more energy without the added sugar and caffeine and crash later on?  A B-Complex supplement may be the answer for you.


no more energy drinks


Though many drinks on store shelves claim they give you energy, they typically contain caffeine so you temporarily feel “awake.” But, a food or beverage that really provides more energy must have calories, typically from carbohydrates and fats – the two primary sources of energy in our diets. In addition to calories, there is another necessary component to the energy equation – B vitamins


The B vitamins help convert carbohydrates and fats into energy your body can use to move, think and perform. In addition, certain B vitamins help form red blood cells – the cells that carry oxygen to tissues throughout your body.


B vitamins are prevalent in our diets. They are found in a wide variety of protein-rich foods including fish, chicken, meat, eggs and dairy foods. Leafy green vegetables, beans and peas also contain certain B vitamins. In addition, some cereals and breads are fortified with B vitamins (look at the Nutrition Facts panel to see which B vitamins a cereal contains; if none are listed then the cereal probably isn’t fortified). And while B vitamins are prevalent in the diet, you need to consume them on a consistent basis because there’s only one that is stored in the body – B12. The rest are water-soluble meaning that they leave the body in your urine.


What Are The Best Sources of B Vitamins?


So how do you know if you need more B vitamins? You may not know unless you have a registered dietitian take a thorough look at your diet and determine which nutrient-rich foods you aren’t eating on a consistent basis or by having your blood levels checked by a doctor. Keep in mind that most physicians will only test for folate and B12.


Another clue may come from your overall energy levels. If you are dragging from day to day, you may not be getting enough of certain B vitamins.


Will taking a B complex supplement help? If your intake of certain B vitamins is below recommended daily values than yes, a supplement may help. Or if you have certain conditions or have had surgery that causes decreased absorption of key nutrients like B12 and folic acid, a supplement may be needed. Consult with your healthcare professional to be sure.



Are You Exercising Too Much?

Are you exercising too much?


Really…is that a real question? Yes, over-training can really occur and it happens more than you realize! You start exercising and finally start to see results. You are ecstatic but think, “Hey, if that got me these results, what if I exercised every single day?” This happens for awhile and you are feeling great, energized, and strong but it doesn’t last.


Fast forward a week or two and that “new car smell” is gone. You are feeling sluggish, can’t concentrate and it’s hard for you to even finish workouts. What happened? A week ago you were feeling on top of the world but now you have no motivation to even workout. Are you exercising too much?


We all know our bodies need rest because it can help our muscle recoup and grow and it can help us mentally recharge. In fact, even if you aren’t training daily, you can still be over-training your body. It is all relative to age, genetics, type of workout…etc. While there are several tell-tell signs of over-training – like decreased immune system, decreased performance, depression, mental blocks, fatigue…etc. – here are a few of common signs:


Your Enthusiasm To Exercise is Gone  

You were once so excited to exercise and break a sweat – you looked forward to it during your work day – but now you don’t really care if you workout at all. That spark is gone. Your body and mind are telling you that they don’t need exercise today. In fact, they are telling you that they need to rest!



This is a sort of counter-intuitive sign of over-training – sleeplessness or insomnia. This is normally caused by an elevated resting heart rate, loss of focus, or your sympathetic nervous system being stressed. These can all lead to chronic excitability and sleeplessness!


You Aren’t Getting Results

You are working harder than you ever have (even if it is like pulling teeth to actually exercise) but your body isn’t changing at all – you’ve plateaued. This is a sign from your body that you need to rest. Your metabolism has pretty much shut down and you aren’t building any muscle anymore – your body needs to recoup and recover!


More Frequent Injuries

This is the most obvious sign of exercising too much – frequent injuries! Because your body doesn’t have the time to properly recover, you are more prone to injuries such as muscle pulls or sprains. Plus, old nagging injuries that you thought were long gone start to come back!


The Road to Recovery

This is not a call to give up exercise forever but if you experience the symptoms of exercising too much then it is time to take a break from your routine – we need you to get healthy. It could be anywhere from a few days to a few weeks – depending on how long your body needs to recover. The most important part is that you do give your body ample time to recover!


To prevent this from happening again, make sure to rest at least 1-2 days after an intense workout. In fact, we would like you to have 3 rest days a week from very intense exercise (walking and movements of that nature are okay).


Apart from the obvious nutrition recommendations like eating plenty of muscle building lean protein and drinking plenty of water, it’s important to sleep at least 7 hours a night!

If you do think you are exercising too much, it’s time to let your body recover! There’s no point of doing more harm than good with exercise. Be healthy mentally and physically!


For the latest and greatest at-home fitness, nutrition, and motivation advice visit Josh at Always Active Athletics: Your #1 Source For At-Home Fitness!