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.



Lets Talk About Iron

On September 8th, my husband and I were sitting on opposite couches watching television together. He made a joke, looked over, and thought I was laughing.  When he looked harder, he saw me shaking and thought I was choking.  My arms had been crossed over my chest, and he picked me up (!)  and tried to give me the Heimlich.  I guess when he saw my face, he realized that I was having a seizure.  He called 911 because I wasn’t breathing, blood was coming out of my mouth, I had bitten straight through my tongue, and they talked him through everything and sent the ambulance within minutes. (Sidebar:  apparently I was VERY belligerent to the firemen who showed up.  I don’t remember this at all, and feel awful that it even happened.)


Other than that, I don’t remember a thing about it.  It was mostly traumatic for my husband, who really took the brunt of all of it.  I did end up with some battle wounds:   I bit almost clear through my tongue, twisted my ankle, and tweaked my back.  I tried to nurse all of those yesterday, but I’m really feeling the brunt of the pain today.

Not being able to sing, talk, or practice trumpet is KILLING ME. 

They say that the mouth heals faster than any other part of your body, so hop to it, body!  I can deal with the back and foot (although they are pretty damn painful), but the tongue is just really an inconvenience for everything:  the above mentioned plus eating, drinking, or brushing my teeth.


I went to rehearsal and tried to sing, which quickly frustrated me:  I sounded like a lisping Cindy Brady every time I sang a work with an “S’s” in it. Playing trumpet was even more traumatic because you use the tip and front of your tongue almost all the time.  Right now, it feels like my tongue has been given Novocaine and over a week later, it is still numb.


I’ve never had a seizure before and have no family history.  The ER tests couldn’t pinpoint why this has happened, so we’re kind of on the hunt for what’s going on right now.


The reasons they are focusing most on:


  1. My low iron levels
  2. That I may have bleeding ulcers again


I don’t feel like I do, but they are doing an upper GI next week to be sure, and I have a consultation with a neurologist as well.

But the moral of the story here kids is DO NOT SKIP YOUR VITAMINS!  



I am a well-known proponent for Wellesse and all it’s liquidy awesomeness.  I’m usually pretty good about my multivitamins, but if I’m being honest, I’ve been slacking on the iron.   So from this point on, I carry my little travel bottles with me EVERYWHERE.  Low iron for me no more!


Diva Taunia is a professional musician and music educator in the Greater Los Angeles area.  She had RNY gastric bypass surgery on 03/25/2008 and has maintained a loss of almost 150 lbs.  You can visit her website at


Health Tickets to Minimizing Breast Cancer Risk

A few nights ago I was talking to my mom about breast cancer and she interrupted me and started naming the women she knew on nearby streets who were breast cancer survivors. There’s a reason we are hearing so much about this disease and you too many know many women who have had it – breast cancer is the most common cancer in women worldwide. But here’s the good news: there are steps each of us can take to decrease our risk.


Maintain a Healthy Weight

Being overweight increases one’s risk of developing breast cancer and leads to a poorer prognosis if you have breast cancer as well as an increased rate of recurrence, particularly in post-menopausal women.


Make Time for Physical Activity 

According to the most comprehensive report on food, nutrition and cancer prevention from the World Cancer Research Fund and American Institute for Cancer Research, greater than 3 hours of physical activity per week reduces risk of breast cancer. Get your calendar out and schedule periods for exercise. If you are having trouble finding time, get an activity counter (Nike and several other companies make them and there are apps on your phone that you can use as well) and measure your physical activity each day (aiming for at least 10,000 steps per day). Activity counters make you accountable. Being overweight increases one’s risk of developing breast cancer and leads to a poorer prognosis if you have breast cancer as well as an increased rate of recurrence, particularly in post-menopausal women.


Minimize Alcohol Consumption

One or more drinks per day increases your risk of developing breast cancer. And, the more alcohol a woman drinks, the greater her risk of breast cancer.


Eat a Nutrient-Rich Diet

Eating a healthy diet rich in vitamins, minerals and fiber will help you feel better and keep your weight within normal limits. Also, diets that contain plenty of vitamin C rich foods including citrus fruits (oranges, tomatoes, grapefruit), potatoes and strawberries may help protect against certain types of cancer including lung, breast and colon cancers. And, be sure to consume vitamin D rich foods as well including fortified milk or a milk substitute, fortified yogurt (check the container since only a few have added vitamin D) and fatty fish. And, get your vitamin D levels checked and if you are having trouble maintaining them within normal limits through diet alone, take a supplement. The latest research shows patients with the highest levels of vitamin D in their blood had approximately half the death rate from breast cancer as those with the lowest levels of vitamin D in their blood.


SEE ALSO:  Calcium, Vitamin D & Weight?  and  Can Calcium & Vitamin D Supplements Reduce Breast Cancer Risk?




Food and Nutrition Board. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press, 2000. Website:


Anticancer Res 2014;34(3):1163-1166.