Did you know that without a stomach you cannot properly absorb naturally occurring iron? Maintaining proper iron levels is very important. Therefore, iron supplements become a necessity to avoid becoming anemic. Iron is essential for blood production, transferring oxygen from lungs to tissues, metabolizing some proteins and enzymes. Iron deficiency or anemia symptoms include:
· Pale or yellowish skin
· Irregular heartbeats
· Shortness of breath
· Dizziness or lightheadedness
· Chest pain
· Cold hands and feet
Visit Anemia – Symptoms and causes for more information.
It’s tricky because anemia symptoms are some of the same that a person without a stomach can have from early or late dumping syndrome. The fatigue symptom really resonates with me because right after a total gastrectomy (TG) you cannot consume enough calories, your brain has to exert energy thinking about eating all the time, and your body is learning to digest food without a stomach. It’s a lot of work not having a stomach, physically and mentally! The good news is that iron deficiency happens over time and with a properly skilled medical team, they should be able to catch a downward trend before it dips into the deficient range and you start to feel the anemia symptoms. If iron deficiency is not caught in time to correct through supplements, the treatment for iron deficiency is iron infusions, which are administered in a clinical setting over several hours.
Without a stomach, there’s so much to pay attention to in regards to nutrition and digestion. Vitamin supplements must be tailored for people without stomachs and that includes iron. Before my TG, my medical team at the National Institutes of Health (NIH) did a bloodwork baseline and my iron and transferrin levels were normal. My levels were holding normal at 3 months and normal again at 6 months post TG, but they were trending down and my % saturation was less than normal at 17% (normal range is 20-50%). My dietician discussed the downward trend and asked me some questions like which vitamin I was taking (ProCare Health multivitamin with 18mg iron), how regularly I was taking it (every day, maybe missing a day every two weeks), and the time of day I was taking it (evening with dinner).
The red flag for my dietician was the time of day I was taking the iron (oops!). Iron does not absorb well in the presence of calcium so the optimal time to take iron is in the morning with something high in vitamin C which improve absorptions. Immediately after TG I was taking my multivitamin with iron in the morning (probably because that’s what my medical team advised after surgery), but I had minor nausea starting around 3weeks after TG. Because iron supplements can cause nausea, I switched to taking it in the evening in an attempt to avoid nausea. I knew to separate my iron supplement from my calcium supplements (I take Celebrate 500mg calcium citrate & 500 IU of vitamin D three times a day, at least two hours apart), but I forgot about the calcium in the food I eat and that it can cause iron absorption issues. Plus, there is always something with calcium in my dinner (often its cheese!).
Based on the discussion with my dietician, they recommend I switch from 18mg to 45mg of iron daily. I am now taking my multivitamin with 45mg iron right after I wake up with applesauce. Then I wait to eat anything containing calcium for about 2 hours. The NIH will check my iron and transferrin levels again at my 1 year post-TG appointment. We’ll reevaluate then. It might be that switching from night to morning causes my iron levels to become and remain normal. Hence, hopefully then I can return to 18mg of daily iron. Either way, I appreciate the proactive approach of my medical team to fix a negatively trending lab result rather than waiting for me to be outside the normal levels.
Being without a stomach for eight months now, my body is still adjusting to absorbing supplements and food. It is critical to have a medical team proficient in CDH1 mutation or patients without stomachs to ensure proper medical monitoring and to allow for making adjustments along the stomachless journey. It’s quite a significant change from before TG when I didn’t need to pay attention to my bloodwork levels; I rarely had them checked because I had no reason to do so. I ate fine, maintained a healthy weight, was active, and was happily living my life. Now I have to think about everything I eat. On the bright side, it’s getting easier month by month (I am 8 months post TG now).