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A week ago, I was diagnosed with Anemia secondary to Iron Deficiency. My symptoms of headaches, extreme fatigue and difficulty concentrating came out of nowhere, hence my trip to the doctor. My ferritin was extremely low -- 3.4 out of a range of 4.6-204 and my hemoglobin was slightly low -- 11.3 out of a range of 11.7-16.0. (Everything else on the CBC was OK.)

My folate levels were also low...I don't recall the actual numbers.

Oddly enough, my B12 numbers were fine.

My doctor has me supplementing iron 3X daily, vit. C once daily, and folic acid once daily.

A couple of days ago, my Vitamin D came back as low (23...should be at least 30 per the doctor's office). They have me taking 50,000 units twice weekly.

I saw the hematologist on Monday and he said that my symptoms _could_ be from my gastric bypass, which I had in July 2011. However, he said that it generally takes 2 years or more for people who has this surgery to have these symptoms and that he was going to consider all possibilities.

Wednesday, I spoke to the hematologist's office and they said my iron levels were within range. I asked why I was having these symptoms and the lady said she did not know and that the doctor would tell me at my appointment on Wednesday next week.

Just out of curiosity, does anyone here have any insight into why I would be experiencing the symptoms of anemia, with concurrent folate deficiency, especially with normal B12 levels? I had a hysterectomy with one ovary removal in July of this year and can exclude the possibilities of pregnancy and menses as a cause. Everything I've read online seems to lump B12 and folate deficiency info together. The text also centers around pregnancy. However my B12 levels are fine and it is now medically impossible for me to be pregnant.

I'm just wondering why this came on so suddenly and why the two deficiencies came together. Also, why did my iron came back as normal so quickly, yet I am still feeling so lousy? FYI: My celiac testing came back negative.

Additional symptoms: frequent thirst (especially upon waking), frequent urination, and deep pain behind the left rib/breastbone (in the side/back) upon lying down and on certain movements.

My blood sugar and thyroid are normal.

Thanks a bunch!


I disagree with your doctor. People's iron levels have dropped quickly after surgery and were anemic in just a few months. That's why it's so important to supplement and check labs regularly. Also 30 is NOT normal for vitamin D for us. Optimal levels are 80. You can try the prescription, but it's D2 and oil based. We malabsorb oil, therefore we malabsorb D2. And even D3 in oil. You need DRY D3. Low levels of vitamin D prevent calcium from being absorbed too. No calcium, no bones. Osteoporosis is rampant in the RNY community.

What is "fine" for B12? Most PCPs don't understand gastric bypass patients needs. The lab ranges are wrong for us, ours needs to be over 1000. Why? It's better for our health AND we can drop SO quickly.

Also if your folate is low, that will interfere with iron absorption as well. So will low B12, low copper, low zinc, low protein intake. So... everything! It all matters. Ferritin and Hemoglobin are proteins... think about your protein intake. If you did a metabolic panel recently, there's a serum protein entry on there. It should be above 7. Less than that, and you're not getting enough everyday.

Likewise, you need to take vitamin C every time you take iron. Not just once a day, some other time during the day. That's not how it works. We don't have an acidic stomach anymore its all alakaline and the place of absorption for iron is bypassed now, so it must get absorbed elsewhere. You need 200mg of Vitamin C for every 30mg of elemental iron. Elemental is different from the actual mg of the pill you're taking if you're taking one of the ferric salts -- ferrous this or that. 325mg of ferrous gluconate is 65mg of elemental iron. Even 3 times a day that's not even going to cut it for us. I've been taking 300mg of elemental iron (using carbonyl iron which is the purest non-heme you can find and also non-constipating) and my numbers are rising only slowly. *I* just might not absorb iron anymore, no matter how good.

Ferritin can be hosed while other things are ok because its only after your stores are zapped that hemoglobin and all that goes down. A level of 3 is depletion. There's nothing left.

The bottom line is that probably the gastric bypass is the culprit. Do you take a multi-vitamin with at least 200% RDA of everything? My folate was just a tiny bit low and I take 800mcg a day. I've had to bump it up to 1200mcg a day. If you're not supplementing, low numbers aren't at all surprising and I bet there's others too.

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