A major complication after gastric bypass surgery is malnutrition caused by the smaller quantity of food consumed and the decreased ability to digest and absorb certain nutrients. It is recommended that individuals who have had gastric bypass take vitamin and mineral supplements every day for life to prevent malnutrition. Iron is one of the minerals affected by the surgery.
A study published in the "American Journal of Clinical Nutrition" in 2009 found that gastric bypass surgery reduces both iron absorption and iron status. Researchers followed 51 patients for 18 months after surgery. Iron absorption from both supplements and food at 6 months decreased to between 32.7 and 40.3 percent of the initial values, with little change by 18 months. Thirty-eight percent of subjects were anemic at 18 months compared with 1.5 percent initially.
The serum ferritin level is directly related to the iron stores in the body and is a common test for anemia. Normal levels range between 12 to 150 ng/mL for women and 12 to 300 ng/mL for men. According to the National Institutes of Health, signs of low iron levels include feeling tired and weak; decreased performance; difficulty maintaining body temperature; decreased immune function; an inflamed tongue; and pica, a craving for non-nutritive substances such as ice, dirt and clay.
Most physicians recommend taking an iron supplement after gastric bypass surgery in addition to the iron available in a multivitamin after solid food can be consumed. Ferrous fumarate and ferrous gluconate are available over the counter and are the most absorbable forms of iron, according to the West Penn Allegheny Health System. Iron and calcium supplements should be taken at least two hours apart. Vitamin C helps the body absorb iron, so iron should be taken with vitamin C supplements or foods that contain vitamin C, such as fruits and vegetables. Ask your doctor about recommended brands and amounts that are right for you. Supplements specifically formulated for bariatric patients are available.
Potential Side Effects
Large doses of iron can cause gastrointestinal upset, including nausea, vomiting, constipation, diarrhea and abdominal distress. Take iron with meals to increase absorption and prevent stomach upset. You may also find it beneficial to take the prescribed dose in two to three equally spaced doses because the Office of Dietary Supplements reports the amount of iron absorbed actually decreases with larger doses.
- “American Journal of Clinical Nutrition”; Iron Absorption and Iron Status are Reduced After Roux-en-Y Gastric Bypass; Manuel Ruz, et al.; September 2009
- Pubmed Health: Ferritin
- National Institutes of Health’s Office of Dietary Supplements: Dietary Supplement Fact Sheet: Iron
- West Penn Allegheny Health System: Bariatric Surgery Dietary Guidelines