Why Are Bariatric Patients At Risk for ID & IDA?

This past Saturday I had the honour of speaking with a group of amazing people, The Coalition of Bariatric Patients of Southern Ontario (CBPSO), at their annual meet and greet held this year in Paris, Ontario.  This is the second year I have been asked to speak on the topic of iron deficiency and how it relates to the Bariatric patient.  This is a topic near and dear to my heart, not only because I have a specific interest in patients with iron deficiency related to malabsorption, but because I am one of them.

Studies have found that as many as 49% of bariatric patients develop iron deficiency. What’s the reason for this? There are actually a few factors at play that lead to iron deficiency and iron deficiency anemia following bariatric surgery, which I will discuss here.

How Bariatric Surgery Affects Your Iron

Bariatric surgery can include several types of surgeries made to help obese patients lose weight in combination with a healthy diet and lifestyle changes. They alter the digestive tract which not only changes the way your body processes food, but also the way it absorbs nutrients from food.

Bariatric procedures fall under the following categories:

  • Restrictive
  • Malabsorptive with some restriction
  • Combination of restrictive with some malabsorption

With restrictive procedures, the size of the digestive tract is reduced so that you can only consume a limited amount of calories. By drastically limiting your food intake, you also limit the amount of iron-rich foods you eat which can lead to iron deficiency.

Malabsorptive procedures alter the way your stomach and intestines absorb the food. Unfortunately, this also limits how your body absorbs nutrients from the foods you eat, and can very quickly lead to deficiencies, including B12, folate, and yes, iron deficiency and iron deficiency anemia.

Other Factors

Along with eating considerably less because of bariatric surgery, most patients also find it difficult to “stomach” food after surgery. This is not only because of the surgery itself and getting accustomed to your “new” digestive tract and diet, but also because of the medications that are commonly prescribed after the surgery which can cause side effects on top of everything else, such as nausea, vomiting, and diarrhea.

Content and advice provided on The Iron Maiden is for information purposes only and should not serve as a substitute for a licensed health care provider, who is knowledgeable about an individual’s unique health care needs

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9 thoughts on “Why Are Bariatric Patients At Risk for ID & IDA?

  1. Sylvia scouten says:

    I had the privilege of hearing you speak in Paris this year. I am having surgery November 14th I would like to avoid iron deficiency.I received a sample of Feramax but am unsure how to use. Do I ask my Dr for a script for them? Thanks

  2. Leona, RN & Blood Specialist says:

    Hi Sylvia – I am happy to hear that you were in attendance in Paris and hope you found my discussion useful!

    Unfortunately I can’t give specific dosing information… Your private physician or bariatric clinic can give you patient specific information. I will remind you that while on the liquid stage of your journey FeraMAX capsules can be opened and dissolved in warm liquids. FeraMAX is available over the counter (no prescription required) from any pharmacy.

    Best wishes on your journey to a healthier YOU!


  3. Adrienne Wong says:

    Hi there,

    If an individual has is without the lower half of their stomach and 1st part of small intestine, will supplementation with Feramax be a suitable option? Will absorption be adequate? I understand that the body does adjust with the absence of these parts to still be able to absorb iron…how long does it take for the body to adapt?

    Thank you

    • Leona, RN & Blood Specialist says:

      Hi Adrienne,

      Thanks for your question. Yes, FeraMAX is an excellent choice in this scenario. Iron Salts (like ferrous sulphate, ferrous gluconate, Palafer, Eurofer, etc) would not be as effective because they are absorbed in the first section of the small intestine. FeraMAX is a great option, and similarly for this situation, Heme iron (like Proferrin) would also be another option over iron salts.


  4. Sue says:

    I have a question about the right type of iron supplementation for people who have had gastric bypass. I thought I read in one of your articles that after a gastric bypass a person can’t absorb non-heme supplements so heme iron supplements like Proferrin are the one to take. I have searched again and now I can’t find that statement. Which supplement do you recommend?


      Hi Sue,

      Patients who have had gastric bypass surgery should avoid “iron salt” supplements because the section of small intestine where they are absorbed is the section that has been bypassed.

      I recommend that my Gastric Bypass patients use “Non-Salt” iron supplements, specifically a Polysaccharide iron such as FeraMAX (open the capsule to increase it’s bioavailability) or a heme polypeptide such as Proferrin (crushed to increase its bioavailability).


  5. Ali says:

    Hi Leona…
    I was wondering if you may have some suggestions on how I could ingest my Feramax when I am opening the capsule (post WLS) ..apple sauce? just small amount of water? just “shoot it back”?
    Thank you for all the info you provide.

    • The Iron Maiden says:


      What a fabulous question! I tell my clients to drop it into a hot beverage or mix it with yogurt or soft food.

      The great news is that the new FeraMAX vegetable based capsule actually dissolves on its own when dropped in hot liquids so no more struggling to open it. I do not know if this is true of other polysaccharide irons available on the market.

      Just as a note of interest – While it is safe to open the polysaccharide iron supplements, this is not true for all medications. Please be safe and ask your pharmacist if it is safe to open capsules or crush other medications you are taking. It is recommended that bariatric patients maximize bioavailability and subsequent absorption by opening capsules and crushing tablets when it is safe to do so.

      Finally, please note that the contents of the FeraMAX capsule is odorless, flavourless and won’t stain your teeth. It does however, darken the colour of the food and/or beverage you are mixing it with…so if mixing it with water consider adding some water enhancer or use an opaque container because it really doesn’t look appetizing!


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