HELP! 4 -1/2 years out, low ferritin and iron levels

Hi, it's been forever since I've posted. I had RNY in 2/13, got down to about 165, and unfortunately am now at about 225. I had blood work done a couple weeks ago and was told my iron and ferritin are low. My ferritin is at a 6 (Im going to try and attach a pic of the lab history). I haven't been taking any extra iron over thr last couple years

, just what was in my multivitamin, but I think maybe it was the wrong kind of iron? I was told to start taking iron supplements and retest my levels in 3 months, and if they weren't up if have to maybe get a fecal blood test as low levels could be a sign of something more serious like cancer. I have somewhat of a cancer phobia, so have been freaking out sense. She was concerned because of how fast the levels dropped. My stools are normal and I don't notice anything off with that.

I started taking 325 mg ferrous sulfate a day, per her recommendation, but on my own have doubled that. I'm attaching my iron and ferritin level history, hoping to get your recommendations and to see how concerned I should be it's something more serious. I'm 43 years old, if that makes any difference. I have been really tired the past year, but attributed it to the weight gain, a new job, and the fact I have no thyroid. Now my brain keeps thinking, "oh, you're tired because you have cancer." This is how a person with health anxiety thinks.

I saw some recommendations about iron patches from PatchMD? What do you think of that? Any recommendations will be appreciated.

P.S. Here is my level history. Thoughts or suggestions?

This is really, really common for someone with WLS. Especially for someone who has been taking very little iron, as you have.

With ferritin this low, you will absolutely feel run down. You will not feel better until your ferritin comes up. Many of us feel like crap when ferritin gets below 50. Yours is almost nonexistent.

Unfortunately, oral iron supplements won't make a dent. If it were me, I would see a hematologist ASAP, preferably one who has worked with WLS postops. You should be getting iron infusions.

325 mg ferrous sulfate actually only has 65 mg of elemental iron. It may be enough for most people, but not a WLSer. And that type of iron, or anything with ferrous salts as the active ingredient, are going to be constipating. Heme iron or carbonyl iron would be better choices.

Calcium, tea, coffee, abd many other things will keep you from absorbing iron. You should be taking extra vitamin C with iron to help absorption.

Using the patch iron is a good idea. Many have great results with it, but some don't.

Whatever you take for iron supplements, stop them a few days before your next labwork. Recent supplements can make your lab results higher than they truly are.

Stop fretting about cancer. By all means, get checked out. But this is very normal for someone 4 years post WLS who hasn't been vigilant about supplements and labs.

Thanks so much for your reply. The nurse I spoke with made it seem like my levels weren't always low, just within the last year, but personally looking closer at my labs and looking at this board, they really have been pretty low the entire time, it's just now getting extreme. I do drink a lot of coffee, so I'll try and reduce that as well. I wonder why that has such an impact?

from everything I've read, you can still drink coffee (and tea) - you just can't have it within two hours (before or after) taking your iron, because it interferes with iron absorption. I just take my iron before I go to bed and refrain from eating or drinking anything two hours before I take it.

Do you think it's more a caffeine thing and Iron? I've depended on caffeine too much lately because of the exhaustion. Maybe that only Make a things worse? My mom had the RNY later in the same year I did and very rarely has caffeine because she was told we need to stay away from it.

I think some surgeons tell patients to stay away from it because it can cause stomach irritation. As far as iron goes, I think it's fine as long as you don't have the caffeine within two hours of taking the iron.

Caffeine is fine. It's the tannins in tea and coffee. Just don't drink either within 2 hours of taking iron. The 2 hour rule also goes for calcium supplements, or calcium in food, such as dairy products. Soy products also inhibit iron absorption.

Take an extra 200 mg of vitamin C for every 30 mg of elemental iron, to help absorption.

Just be aware that a lot of WLSers just don't absorb oral iron, no matter what. Heck, regular folks can have issues too. I grew up watching ads for Geritol, for "iron poor blood."

Thanks! Looking at my iron and ferritin levels over the years, it's no wonder why I always feel run down. Is it normal for if ferritin is low, then iron is low? I guess I always thought they were the same thing. Really, they look like they've always been on the low side. From what I've read on OH, many people start feeling bad when their ferritin is on that low end. I did like the nurse I talked to after getting my blood work done. She seemed like she had some good nutrition and medical knowledge, but never seemed to address the WLS aspect of my issues. All she did was tell me to take 65 mg of elemental iron a day, making it seem like this should solve my issues and if it doesn't something else is probably wrong. I had no clue many WLS patients had a difficult time absorbing oral iron, and as low as it is, it probably won't help much.

I'm glad I have found my way back to OH. While I hate to see so many others have this same problem, I'm glad to know I'm not alone and really it's not uncommon at 4 years out. Her main concern was how much they'd dropped in the past year. Does it seem that drastic to you, especially since they were already low? I did order the iron patches from Patch MD. I'm going to give things about a month, see how I'm feeling, and if I'm not noticing much improvement, then I'll look at getting the iron infusions. Does that seem reasonable? My insurance is Kaiser Permanente, I'm not sure that they have a hematologist who specializes in WLS patients :(

Ferritin is a protein that stores iron. Think about iron as money in your pocket, and ferritin as money in the bank. You need that iron that ferritin is storing, otherwise you will be constantly tired. And if something were to happen that causes a loss of blood, you could be in serious jeopardy.

Losing too much blood during your monthly cycle can contribute to this problem. A few women here have had ablations to end their periods, and that has helped with anemia. I don't know if this is an issue for you.

Good explanation! You have a lot of knowledge on the subject, and I appreciate all your insights! I still get my period and may have just finished it, or even have been on it, when I had my blood work done, I don't remember, but they are fairly normal.