Foodie-sentials: Iron – Why Eating Your Spinach Isn’t Enough

(Check out last month’s article: The Sunshine Vitamin.)

By Kelly Morris
Despite non-op opinions to the contrary, luck doesn’t get you very far after weight loss surgery. If you want to be healthy and have energy, you need your vitamins and minerals, including iron. 

We need adequate iron in order for our blood to carry oxygen to all our vital organs, for our muscles to store and use oxygen, and for our bodies to make various enzymes that we need in order to digest our food. Spinach is a good source of iron, as is red meat, oysters, pumpkin seeds, and white beans, but food alone won’t provide enough iron after weight loss surgery.

The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends that all weight loss surgery patients take iron, including men and post-menopausal women. The recommended amounts vary depending on the type of surgery you had. They recommend 36 mg elemental iron daily for all lap band and sleeve patients, 36 mg daily for male and post-menopausal female gastric bypass and duodenal switch patients, and 54 to 63 mg daily for female gastric bypass and duodenal switch patients that menstruate.
Iron Deficiency
According to the Centers for Disease Control and Prevention, iron deficiency, also called anemia, is the most common nutritional deficiency in the U.S. Symptoms include weakness, fatigue, dizziness, headaches, feeling cold all the time, an inflamed tongue (called glossitis), bruising easily, and restless leg syndrome (those annoying, involuntary jerky movements of your legs, usually when you’re falling asleep). Iron deficiency also prevents your immune system from working properly.
Different Types of Iron
There are many different types of iron supplements and different types contain different amounts of elemental iron. For instance, ferrous sulfate contains only 20% elemental iron, so 325 mg ferrous sulfate only gives you 65 mg elemental iron. Keep in mind that the ASMBS makes recommendations for iron supplementation in terms of elemental iron, so if you take a supplement that is not all elemental iron, you’ll need to do some math to figure out how much elemental iron you’re getting.
  • Carbonyl iron is 100% elemental iron. Therefore 100 mg carbonyl iron = 100 mg elemental iron.
  • Ferrous fumerate is 33% elemental iron. Therefore 100 mg ferrous fumerate = 33 mg elemental iron. 
  • Ferrous gluconate is 12% elemental iron. Therefore 100 mg ferrous gluconate = 12 mg elemental iron.
  • Ferrous sulfate is 20% elemental iron. Therefore 100 mg ferrous sulfate = 20 mg elemental iron.

Side Effects of Iron Supplements

The most common side effects of iron supplements, according to the University of Maryland Medical Center, are constipation, nausea, heartburn, and an upset stomach. Iron can also make your stool darker in color. There are many different types of iron supplements, however, and some are more likely to cause unpleasant side effects than others. Carbonyl iron is all elemental iron and therefore is less likely to cause constipation than some other kinds of iron.
Iron and Calcium
Calcium blocks the absorption of iron, so take your calcium and iron supplements at least two hours apart. Don’t take your iron with foods high in calcium, either, like milk, yogurt, or cheese.
Iron and Vitamin C
Taking vitamin C with your iron will aid in the absorption of iron. According to Andrea Ulberg, author of the Lab Tracker Workbook, you need 200 mg vitamin C for every 30 mg elemental iron in order to enhance absorption. While many iron supplements contain some vitamin C, most don’t have enough to actually help with absorption, so read the label to see if you need to take additional vitamin C with your iron.

Kelly had gastric bypass in November 2008 when she weighed about 270 pounds. Just over four years later Kelly is now about 135. She says, “My knees don’t hurt anymore, my blood pressure is on the low side, my blood sugar is good, and I feel pretty well. The journey hasn’t always been easy and I’ve had some complications. It’s all been worth it though! I really feel like this surgery gave me my life back.”(Check out last month’s article: Calcium: It Does A Body Good)

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