016 Iron Anemia, Avoiding Weight Regain, & My New Year Wish

by reeger on January 17, 2014

Do you know your ferritin level?
Anemia is a catch-all term for low red blood cells and/or low hemoglobin levels on the red blood cells
What is hemoglobin? It is protein on our red blood cells that binds and carries Iron.  Iron in turn binds and carries oxygen. Iron is the reason our blood is red.
Think of it this way:
The Red Blood cell is the mini-van. The seats are hemoglobin, and sitting in those seats is Iron, ideally lots and lots of iron.
And on the the lap of Iron, Sits OXYGEN.
Oxygen is constantly getting in and out of the mini van as it drives around but the iron generally stays put.
Hemoglobin + Iron + Oxygen = Energy = Life!
There are many different types of anemia but there are only three main reasons anemia can develop:
Blood Loss
Low red blood cell production
High red blood cell destruction
Iron deficiency anemia
Common around the world in general

Why Does Someone Develop Fe Anemia: 6 reasons 
WLS because of reduced Iron absorption especially in the case of the malabsorptive procedures: RYGB and BPDS. Iron is best absorbed in the duodenum.
Diet low in iron-containing foods
Chronic blood loss: Females with heavy or irregular menstrual bleeding or anyone with internal or gastrointestinal bleeding: bleeding ulcers or lesions anywhere along the GI tract or bleeding hemorrhoids),
Long-standing obesity has been shown to lead to iron deficiency anemia because of chronic inflammation
Iron absorption can also be reduced by taking oral calcium, PPI or H2 Blocker, Antacids, high intake of coffee or caffeinated teas
Symptoms iron deficient of anemia make a lot of sense when you consider we are ultimately talking about chronically reduced levels of oxygen available to cells: Fatigue, weakness, irritability, dizziness, worsening exercise intolerance, worsening shortness of breath, heart palpitations, headaches, pale skin, RLS, cold hands and feet. Sometimes people can have craving for or actually consuming non-food items such as dirt, paint, starch, and ice. This is a condition called Pika.
“I’m always anemic” This statement drives me crazy. It is not healthy to be always anemic. It is hard on your heart, your brain, your muscles, your resiliency, and vitality for living.
Iron deficiency is what we call a chronic condition. It does not develop over night and generally speaking one does not recover from iron deficiency over night.
RBC Life span: 90- 120 days. Baby red blood cell: only has 1-2 weeks to absorb Iron. Once that baby red blood cell has developed past 1-2 weeks, it can no longer absorb iron. If it did not absorb enough iron during this first 1-2 weeks it will live out the rest of it days low on iron.
Diagnosing: Checking stool for occult on invisible blood. Blood tests: CBC (Hgb will be low), Iron studies, Ferritin (what is the trend? 20-200) Reticulocyte count (baby red blood cells), and looking at the RBC under a microscopic .
FERRITIN: I watch ferritin like hawk. Normal level- 20-200. Ferritin is our iron stores, our iron “in the bank.”
Education. It is not ok to “always be anemic.”
Heavy menses: see your licenses medical provider to discuss treatment options.
Internal bleeding: determine where it is happening, why, and treat it. Your medical provider can order the appropriate tests and make any referrals to specialists as needed.
Iron Supplements: Severe iron deficiency may require blood transfusions, iron injections, or intravenous iron therapy.
Iron pills: There are many forms of iron supplements but the most common are Ferrous Sulfate, Ferrous Gluconate, and Ferrous Fumerate. Of these 3, Ferrous Fumarate provides the highest amount of elemental iron. In general, for my patients I recommend they take an iron supplement that is specifically formulated for someone who has had bariatric surgery. I am partial to Bariatric Advantage’s Iron, but I am flexible on which brand so long as it bariatric formulated for a person who has had Bariatric surgery and the persons Iron levels are going up. What is going to be the right dose for each person is a great conversation to have with your bariatric provider.
Ideally Iron is taken 2-3 hrs apart from calcium because they bind to each other when taken together, this reduces the amount available for your to absorb.
Vitamin C can also be taken with Iron, helps absorption.
Iron containing foods: beef, chicken, turkey, eggs, dried lentils, peas, beans, fish, liver, peanut butter, soybeans, iron-fortified cereals and breads, raisins, prunes and apricots.

Office of Dietary Supplements: National Institutes of Health



1) Increase Fat fighting Foods:
Quality proteins of soy, fish, chicken, turkey, eggs, pork, mild, cheese, grass-fed beef.
Foods High in calcium:Fresh fruits, vegetables, whole grains, Legumes

2) Decrease (STOP) Fat-storing foods:
Processed grains
Sugar (sucrose)
High-fructose corn syrup
High Saturated Fats
Processed Meats.

3) Increase Omega-3 Fatty Acid Intake (1g/day)
Foods rich in O3FA: Salmon, sardines, herring, mackerel, tuna, halibut, anchovies, avocado, kale, spinach, mustard greens, sesame seeds, pumpkin seeds, tress feed beef.
Oils: Flax seeds, grape seed, hempseed, walnut, wheat germ

4) Increase Sources of Probiotics:
Live culture Yogurts (Greek Yogurts), Kefir, Cottage Cheese, Sauerkraut, Pickles, Miso, Tofu, Tempeh, Buttermilk, Soy Yogurt/
Acidophilus supplements
Pre-Biotics: Barley, beans, garlic, fruits, onions, leeks, whole grains.

5) Increase Dietary Fiber (30+g/day)
Whole grains, Fruits, vegetables, nuts, legumes.

6) Reduce Intake of Pollutants and Toxins
Wash fruits and vegetables
Peel Root vegetables
Remove Skin from fish and chicken
Remove visible fat from meats

7) Reduce Stress
Relaxation and Mindfulness, especially at meal times. Eat slowly. Eat only when you are physically hungry. Stop when you are no longer physically hungry.
Attend Support Group
APostOp and A Doc at www.spreecast.com/channels/a-post-op-a-doc
Surround yourself with optimistic, supportive people
Practice Deep Breathing and Meditation

8) Daily Exercise
Dedicate 30-60min per day of moderate activity (you break into a sweat, your breathing, and heart rate go up but you can still hold a conversation) above and beyond your usual busy life.

9) Increase Sleep Duration and Quality:
Strive for 7-8 hrs/night. Turn off your devices 1-2 hrs before sleep, journal before bed, mediate, reduce external noise and light.
10) Lastly:
Stop snacking and grazing between meals
Avoid and all fast-foods
Take your vitamins
Drink 64 oz water daily

My New Year Wish
Life can be complicated. And many of us seek answers to our problems. But more often in life what we desire from each other is not the perfect answer to solve all our problems, but rather someone who can listen and be there for us when we need them. My wish for the new year is that you have someone you can turn to, who supports you, and is there for you. I also encourage to reach out to others to be that person for someone else. It is through connection and caring that we all are healed from what troubles us.
In Peace and with Connection,

Reeger Cortell, FNP-C




{ 3 comments… read them below or add one }

Suky Behm July 23, 2016 at 11:29 pm

Have people had any success with the vitamin transdermal patches?


reeger July 30, 2016 at 3:51 pm

Suky, According to my very trusted sources, transdermal patches have zero proof that they work. Reeger


reeger September 11, 2016 at 10:46 pm

Suky, Please listen to episode 75. The question of transdermal patches is discussed. Kindly, Reeger


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