Iron and Other Minerals

Low iron stores (hypoferritinemia) and iron deficiency anemia may occur in up to 50% of RYGB patients and less commonly in SG patients [9, 10]. Menstruating females are at higher risk. Common signs of iron deficiency include fatigue or lethargy, ice chewing, pallor, shortness of breath, and restless legs. Postsurgical hypochlorhydria associated with the RYGB and to a lesser degree the SG inhibits the reduction of ferric iron (Fe3+) into the more readily absorbed ferrous state (Fe2+). The RYGB surgically bypasses the duodenum and proximal jejunum, which are the preferential sites of absorption of iron and other nutrients.

In addition, dietary sources of well-absorbed heme iron, such as red meat, are often poorly tolerated by postsurgical patients. For some patients (men, postmenopausal women), iron needs will be met by the recommended multivitamin supplement that includes iron. Other patients will require additional iron supplementation up to 150-200 mg/day of elemental iron. Ingestion of iron and calcium supplements should ideally be separated by 4 h to avoid competitive inhibition of absorption. For patients who do not respond to oral supplementation, alternative treatment, such as IV iron infusion, should be considered.

Zinc, copper, and selenium deficiencies have been reported in post-RYGB patients though the incidence is lower than that seen with iron. Routine screening for zinc deficiency has been suggested after RYGB. Screening for copper and selenium should also be considered based on symptoms such as poor wound healing and unexplained anemia [8].

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