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Is there a relation between hypoglicemia and anemia?

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Hi everyone, 

I'm 4.5 years post-op and my blood work had always come back perfect until 45 days ago. It turns out my red blood cells, hemoglobin and hematocirt values were low but my iron was ok. My nutritionist told me to increase my red meet intake and I did (ate some almost every day with green leaf veggies, sea food, seeds, etc., for 30 days). When I repeated the test, the values had gone down even further and the iron was now low. I've been having some hypoglicemia in the past few months and was thinking that may have something to do with it? What do you think?

I've also had two separate incidents of severe stomach pain in the early morning. Constant pain in the center of my chest and back that subsides on its own after approximately 10 minutes.

My weight is still within the normal range and I excercise regularly (I do get tired more easily now though).

If you have any suggestions, ideas or articles I can refer to, please share. Also do you know what the best iron supplement type is for us RNY people? Your advice will be much appreciated.

Thanks.

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Iron levels can be up and down depending on many things....one being inflammation. My doctor actually told me to stop having iron tests until I can get rid of whatever is causing my ferritin levels to run sky high. I don't take iron supplements at all due to genetic hemochromatosis but did need an iron infusion about 9 months post surgery. My iron levels have been fine since then but I do expect that over time they'll drop back. @cinwa is an iron supplements guru and I'm sure will be along a some stage to give you advice on them. As someone that isn't allowed to take any supplements containing iron I'll steer clear of giving advice on them. I do know that that trying to eat your way out of an iron deficiency even when taking supplements takes many months to achieve if you even can. My iron level was 7 when I had my infusion....it was 16 two weeks later...great result with minimal fuss and zero abdominal distress which iron supplementation can cause.

I also have in intermittent intense lower abdominal pain. I'm not certain what it is but it does occur when waste or air is in that part of my (pretty sure it's) lower bowel. I had pelvic and abdominal ultrasounds late last week to look for some answers. I do have reactive hypoglycemia and take medication to try to prevent the severity of the episodes. I determined very quickly by keeping a diary (as instructed by a gynaecologist) that my abdominal pain directly ties in with thrush, which also absolutely correlates with hyper/hypoglycemic episodes. I initially thought it might be related to low iron as it was about the time I needed an infusion that the pain and the thrush all started to intensify and become unbearable. I know now it isn't tied in with my iron.

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First, what level are you referring to when you say "iron level"?  Circulating iron (transferrin) or stored iron (ferritin)?  Some even use "iron level" when they mean hemoglobin but you differentiated that already :) 

I can keep my hemoglobin and transferrin up to normal with "Gentle Iron" supplements, which are vegetarian in source and are much easier on the stomach.  My ferritin stays low though, and I need it to be high normal for my Restless Legs Syndrome, so I've switched to a brand of Iron supplement called "Integra".  It has both Ferrous Fumarate and Polysaccharide Iron Complex plus Vitamin C to help absorption.  Also be sure you're not taking you're iron near any calcium or dairy consumption which will impede absorption.  The Ferrous Fumarate helps with circulating iron (transferrin) and the Polysaccharide Complex Iron helps with ferritin (stored iron).  I've only been on it a month and haven't had my ferritin rechecked so don't know if it's doing the job but still having RLS so I assume it's not up to 75 yet which is where they want it to be (last checked at 16).

As to the abdominal pain, I doubt that is related.  Sounds like if it continues you should have it investigated. 

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12 hours ago, msmarymac said:

First, what level are you referring to when you say "iron level"?  Circulating iron (transferrin) or stored iron (ferritin)?  Some even use "iron level" when they mean hemoglobin but you differentiated that already :) 

I can keep my hemoglobin and transferrin up to normal with "Gentle Iron" supplements, which are vegetarian in source and are much easier on the stomach.  My ferritin stays low though, and I need it to be high normal for my Restless Legs Syndrome, so I've switched to a brand of Iron supplement called "Integra".  It has both Ferrous Fumarate and Polysaccharide Iron Complex plus Vitamin C to help absorption.  Also be sure you're not taking you're iron near any calcium or dairy consumption which will impede absorption.  The Ferrous Fumarate helps with circulating iron (transferrin) and the Polysaccharide Complex Iron helps with ferritin (stored iron).  I've only been on it a month and haven't had my ferritin rechecked so don't know if it's doing the job but still having RLS so I assume it's not up to 75 yet which is where they want it to be (last checked at 16).

As to the abdominal pain, I doubt that is related.  Sounds like if it continues you should have it investigated. 

All of my iron levels are always low (due to heavy menstruation) and my dr has me scheduled for a hematologist for an iron transfusion which i hope will help (I think @Aussie Bear gets them).  I am hoping that helps.  When my iron is very low, i get terrible leg cramps (which my dr calls RLS, although i never heard of cramps, just fidgets), and by leg cramps, i don’t mean the standard “Charlie horses” but the kind that you can’t uncramp and i have to jump out of bed but can’t straighten my foot regardless and the pain is unbelievable (my husband wakes up to my whimpering).  And that is night after night so i know then to up up up my iron.  

@msmarymac, thanks for the info, I am going to look up that integra and see if I can get some and try it too.  

(One other thing I get when my iron is super low is pica...but fortunately it is only eating ice uncontrollably and not anything else! :) )

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Iron infusions are super easy @CheeringCJ. The quickest way to bring iron up. They just shove in an iv and the iron is pumped straight into your vein. They are so common now in Australia that most specialist centres and medical practices can do them. I expect that the ease with which you can get these, that iron supplements will eventually become a thing of the past for the majority of people that really need supplementation. Why bother taking a poorly absorbed supplement that can have some very harsh side affects when you can get six months to a years worth in your system in about 15 minutes? You do have to hang about for around 30 minutes after in case of a reaction, but the infusion is pretty quick.

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To add to the conversation, something worth remembering is that not all iron is created equal.

I'd recommend carbonyl (and/or polysaccharide iron) because they're the least abdominally distressing (for me and most bariatric patients I know) and are 100% bioavailable so if you take 60 mg of carbonyl or polysaccharide iron, you'll get 60 mg of iron (unlike other forms of iron - see the list below).
 
Carbonyl and Polysaccharide has 100% elemental iron.
Ferrous fumarate has approximately 33% elemental iron.
Ferrous sulfate has 20% elemental iron.
Ferrous gluconate has 12% elemental iron.from milk, calcium an

And remember to keep your milk/yogurt etc., calcium and antacids away (a good 2 hours) from iron supplements because it inhibits iron (Fe) absorption.

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18 hours ago, CheeringCJ said:

One other thing I get when my iron is super low is pica...but fortunately it is only eating ice uncontrollably and not anything else

Me too!  But only when my hemoglobin is low, not when my ferritin is low.  We are such strange creatures :)  (Humans, not just you and I lol).  When it's bad I buy Sonic ice by the bag and have considered buying my own sonic ice maker.  Fortunately my levels usually rise before I can act on that impulse...

 

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12 hours ago, cinwa said:

To add to the conversation, something worth remembering is that not all iron is created equal.

I'd recommend carbonyl (and/or polysaccharide iron) because they're the least abdominally distressing (for me and most bariatric patients I know) and are 100% bioavailable so if you take 60 mg of carbonyl or polysaccharide iron, you'll get 60 mg of iron (unlike other forms of iron - see the list below).
 
Carbonyl and Polysaccharide has 100% elemental iron.
Ferrous fumarate has approximately 33% elemental iron.
Ferrous sulfate has 20% elemental iron.
Ferrous gluconate has 12% elemental iron.from milk, calcium an

And remember to keep your milk/yogurt etc., calcium and antacids away (a good 2 hours) from iron supplements because it inhibits iron (Fe) absorption.

Putting this in my back pocket for future iron purchases. Thanks, @cinwa. What would we do without you?

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On 12/19/2018 at 9:36 PM, Jen581791 said:

Putting this in my back pocket for future iron purchases. Thanks, @cinwa. What would we do without you?

Agreed!!!  Such a wealth of information!!! 

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Thanks everyone for all the tips. I appreciate your taking the time to share. 

On 12/18/2018 at 12:02 PM, msmarymac said:

First, what level are you referring to when you say "iron level"?  Circulating iron (transferrin) or stored iron (ferritin)?  Some even use "iron level" when they mean hemoglobin but you differentiated that already :) 

I can keep my hemoglobin and transferrin up to normal with "Gentle Iron" supplements, which are vegetarian in source and are much easier on the stomach.  My ferritin stays low though, and I need it to be high normal for my Restless Legs Syndrome, so I've switched to a brand of Iron supplement called "Integra".  It has both Ferrous Fumarate and Polysaccharide Iron Complex plus Vitamin C to help absorption.  Also be sure you're not taking you're iron near any calcium or dairy consumption which will impede absorption.  The Ferrous Fumarate helps with circulating iron (transferrin) and the Polysaccharide Complex Iron helps with ferritin (stored iron).  I've only been on it a month and haven't had my ferritin rechecked so don't know if it's doing the job but still having RLS so I assume it's not up to 75 yet which is where they want it to be (last checked at 16).

As to the abdominal pain, I doubt that is related.  Sounds like if it continues you should have it investigated. 

I'm in Argentina so the stuff measured in blood tests might be named differently. The value "iron" is listed under Chemical Analysis while "hematocrit, hemoglobin and red blood cells" values are listed under Hematology. 

Transferrin includes two values, the first is still normal and the value with the % symbol is low (concentration %). Ferritin is still normal but on the lower side of the range.

Folic Acid and vitamin B12 are normal.

On 12/19/2018 at 11:22 AM, cinwa said:

To add to the conversation, something worth remembering is that not all iron is created equal.

I'd recommend carbonyl (and/or polysaccharide iron) because they're the least abdominally distressing (for me and most bariatric patients I know) and are 100% bioavailable so if you take 60 mg of carbonyl or polysaccharide iron, you'll get 60 mg of iron (unlike other forms of iron - see the list below).
 
Carbonyl and Polysaccharide has 100% elemental iron.
Ferrous fumarate has approximately 33% elemental iron.
Ferrous sulfate has 20% elemental iron.
Ferrous gluconate has 12% elemental iron.from milk, calcium an

And remember to keep your milk/yogurt etc., calcium and antacids away (a good 2 hours) from iron supplements because it inhibits iron (Fe) absorption.

The iron drops I've started taking are made of "hierro polimaltosato (polimaltosato férrico)" which I 've been told is the most gentle option for your stomach. Could not find out if this is the same as carbonyl and polysaccharide. What confuses me is that the instructions leaflet says it does not interact with food and can be taken with milk... I'm taking 20 drops twice a day which means I'm taking in 100 mg of elemental iron.

My multivitamin (centrum woman silver forte) contains both the vitamin C that I need and some calcium. Should I take it with the iron drops or 2 hours apart? If the latter, should I take another vitamin C supplement with the iron? 

The RnY procedure and all bariatric surgeries are relatively new here and not as wide-spread so doctors and nutritionists are not as fimiliar with the requirements as they are in the US. I do a lot of research online but trust what's on this formum a lot. 

On 12/19/2018 at 5:54 AM, Aussie Bear said:

Iron infusions are super easy @CheeringCJ. The quickest way to bring iron up. They just shove in an iv and the iron is pumped straight into your vein. They are so common now in Australia that most specialist centres and medical practices can do them. I expect that the ease with which you can get these, that iron supplements will eventually become a thing of the past for the majority of people that really need supplementation. Why bother taking a poorly absorbed supplement that can have some very harsh side affects when you can get six months to a years worth in your system in about 15 minutes? You do have to hang about for around 30 minutes after in case of a reaction, but the infusion is pretty quick.

If my levels don't go up or at least stop going down in the next 45 to 60 days, I will talk to a hematoligIst to get an iron infusion. 

For my hypoglicemia, I have started following these rules (http://blog.joslin.org/2017/03/dealing-with-post-bariatric-surgery-hypoglycemia/):

-Low carb meals with only low-glycemic index carbohydrates 

-Include heart healthy fats in every meal

-Eat every three hours

-Get adequate protein intake

-Avoid consuming liquids with meals and chew slowly

-Avoid alcohol and caffeine (I'm still in denial about caffeine....I love my coffee so much!)

 

I knew my experience with RnY was too good to be true. I lost all the overweight and made it to the normal weight range, I felt much more energetic and happy than before the surgery, I had virtually no dupmping (except from bananas), my labs were perfect....it couldn't last forever. I will face each issue as it comes up but still swear by the surgery which saved my life. 

Thanks again.

 

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I am 7 years out and have had iron infusions three times now. My last round was back in November. I did 3 and my labs are normal now. Having a hysterectomy 4 years ago did not solve my anemia issues. It is no longer something I worry about though. 

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