6 month labs are back and some values are low

[Foxbins 625]

I know little about labs so if somebody does, please chime in. My two-month labs were great. Now at six months, my ferritin is 7 (should be above 30) my serum Iron is 42, down from 84 in February, my parathyroid has decreased to 14 from 36, and my prealbumin is 17.2, normal is 18-41. My hematocrit, hemoglobin, and other indicators for anemia are low normal.

From my interpretation, it looks like I am drawing on my Iron stores and soon will exhaust them and become anemic. I think the prealbumin level means I need more Protein ( I eat 60-70 gms a day). I don't know what the parathyroid drop means--something related to Calcium, I think. All Vitamin levels were fine or above normal and other blood chemistries were normal.

I take a Centrum multi with 18 mg of iron daily, 1200 mg of calcium citrate, 1000 mg of D3, and B-12. I have Kaiser and wonder if they will address this or if I should start taking more iron. Have a call into the doc but this is worrying me.

[SeattleSue 25]

I know little about labs so if somebody does, please chime in. My two-month labs were great. Now at six months, my ferritin is 7 (should be above 30) my serum Iron is 42, down from 84 in February, my parathyroid has decreased to 14 from 36, and my prealbumin is 17.2, normal is 18-41. My hematocrit, hemoglobin, and other indicators for anemia are low normal.

From my interpretation, it looks like I am drawing on my Iron stores and soon will exhaust them and become anemic. I think the prealbumin level means I need more Protein ( I eat 60-70 gms a day). I don't know what the parathyroid drop means--something related to Calcium, I think. All Vitamin levels were fine or above normal and other blood chemistries were normal.

I take a Centrum multi with 18 mg of iron daily, 1200 mg of calcium citrate, 1000 mg of D3, and B-12. I have Kaiser and wonder if they will address this or if I should start taking more iron. Have a call into the doc but this is worrying me.

Nothing to add but a thanks for posting. I have been low on iron for-e-v-e-r, so as I'm now headed into my 3rd week post-op, this is a good reminder that I need to start figuring out a way to get back on my iron. I was 650 mg/day pre-op!

Thanks again...and good job being pro-active!

[MeMeMEEE 206]

You might want to consider a Vitamin made for bariatric patients. Your nutritionist should address the labs if not your doctor.

[wishes 125]

Does your Multivitamin also have Calcium? If it does, you pretty much aren't getting any of that Iron. Iron and calcium bind to the same receptors in the body. Calcium is a lot bigger than little old iron, so it pushes it out of the way. You might need to start taking them two hours apart so that the iron can properly bind. Also just a side note, Vitamin C improves the absorption of iron.

[AutumnLily 77]

I know little about labs so if somebody does, please chime in. My two-month labs were great. Now at six months, my ferritin is 7 (should be above 30) my serum Iron is 42, down from 84 in February, my parathyroid has decreased to 14 from 36, and my prealbumin is 17.2, normal is 18-41. My hematocrit, hemoglobin, and other indicators for anemia are low normal.

From my interpretation, it looks like I am drawing on my Iron stores and soon will exhaust them and become anemic. I think the prealbumin level means I need more Protein ( I eat 60-70 gms a day). I don't know what the parathyroid drop means--something related to Calcium, I think. All Vitamin levels were fine or above normal and other blood chemistries were normal.

I take a Centrum multi with 18 mg of iron daily, 1200 mg of calcium citrate, 1000 mg of D3, and B-12. I have Kaiser and wonder if they will address this or if I should start taking more iron. Have a call into the doc but this is worrying me.

Are you taking your Calcium and Iron within 2 hours of each other? As they do not play well together and you really need to have your calcium and then 2 hours later your iron. Also, you should be taking your Calcium in 500 mg doses through out the day as your body only absorbs approx 500mg at a time.

Parathyroid has a major role in calcium, phosphate, calcitonin and Vitamin D levels. Did the lab give you the normal range for the parathyroid?

Low prealbumin levels can be an indicator that the person is malnourished.

Ferritin is the Water soluble and temporary storage form. This is the newly absorbed iron from your diet and not from the longer term storage (our body recylces iron with very little lost daily) form hemosiderin (water insoluble storage).

So a decreased absortion of iron is seen in total or partial gastrectomy patients and it can lead to a iron deficiency anemia if you are constantly depleted in your newly formed iron. You will see an effect on iron stores going to zero and serum iron and transferrin saturation decreased with a increased total iron binding capacity.

That all being said iron is mainly absorbed by the mucosal cells in the duodenum and depends on the serum iron (low serum iron increased absorption from intestine if available), amount in your diet and the pH in your gut (acid pH will enhance absortion).

Vitamin C will enhance absorption

phytates (in whole grains) and oxalates (in spinach) will chelate (alter) iron and decrease its absorption.

Alcohol will enhance absortion by stimulating HCl secretion by gastric (stomach) cells.

Have a talk with you doctor on what you can do to increase your iron stores and ask about the parathyroid as he/she will be able to look at the full picture and assess your needs.

[kellyw74 258]

If you have Kaiser, in the pharmacy they sell Ferrous Gluconate pills over the counter. I take them because after surgery I became anemic. I take 325mg two times a day in addition to my Centrum that has Iron in it. My levels are much improved after 2 months and I am to continue this until my 6 month labs in November.

I would ask your dr. first, but they are like $4.00 for a box of 100.

Good luck.

Kelly

[Foxbins 625]

Thanks, all, for your replies. My nutritionist is the one who told me to take Centrum. I take liquid calcium citrate in two 500 mg doses and one 200 mg dose spaced two hours apart. I don't take the Calcium until after lunch and I take the multi-vit with Iron in the morning; since we don't absorb calcium carbonate well, I assumed that it would not impede the Iron absorption in the multi-vit. I'll give some additional Vitamin C a try even though the multi has C in it.

@Kellyw74: Are you having any stomach issues or Constipation with the ferrous gluconate? I heard it was hard on the tummy.

[KellyL 173]

Is the B12 you're taking sublingual? I wonder what dosage Iron we need, I just noticed my multi doesn't have Iron in it so I need to pick some up.

[Foxbins 625]

Is the B12 you're taking sublingual? I wonder what dosage Iron we need, I just noticed my multi doesn't have Iron in it so I need to pick some up.

Yes, it's sublingual. My values are above 1000 pg/ml. I take 2500 mcg on M, W, & F. Might drop down to 2x/wk. The multi with iron I am taking has 18 mg of iron, that's supposed to be 100% of the RDA for me as a post-menopausal woman.

[SuperMom 33]

Hey just wanted to chime in here (lab rat going on 25 years this next year).....look on your CBC (cell blood count).....the MCV (Mean Cell Volume) is a better indicator of Iron stores. When your Iron stores get low your body starts producing SMALLER red cells. Your MCV should be 76-100. When you see it less than 75 you have tiny (microcytic) cells. This is due to low iron. You can look up "iron deficient anemia" to see symptoms. Your ferritin is directly linked to your low iron.

Your body only makes new red cells around every 120 days.....so you have to take iron for MONTHS to get your stores back up (hard to explain this to people...they take iron for one week and wonder why they don't feel better - it takes MONTHS)

Prealbumin is also directly related to diet. Malnourished SEVERE is less than 8. Mild is 12-15. Moderate is 8-10. So yours at 17 is fine. Yes it is on the lower side but I think if someone did a study the general population of sleevers normal is prob alot lower than the population of people who are eating alot more.

Also....serum iron of 42 is wonderful especially for females. I run them all day long and most females run in the 30's. Make sure you don't take iron the night before or the morning of your lab tests and are measuring what is really in your bloodstream and not what you just ate .

Parathyroid is on a NEGATIVE feedback loop with Calcium. Calcium goes up parathyroid goes down. Calcium goes down parathyroid goes up.

Normal parathyroid is 10-60.

My doc has me on:

Bariatric Advantage Vitamins....Folic Acid 800 mcg, iron 18 mcg - plus alot of the B Vitamins

Plus B complex Vitamin which has more folic acid, Biotin (yea helps with loosing hair) more vit B 12 and more b vitamins

Plus chewable iron 29 mcg a day

B12 sublingual 1000 twice a week

so far my labs look great. good luck. No worries your labs are ok.

[Heatherr 149]

I take a Centrum multi with 18 mg of Iron daily, 1200 mg of Calcium citrate,

^^^^ Didn't read ahead, so I'm not sure if someone posted this or not, but you need to take Iron and calcium citrate at different times, hours apart for best results. I'm not even sure why they put them in the same pill.

[Heatherr 149]

I should have read ahead. You ladies are a wealth of knowledge. <shrug>

[Heatherr 149]

While we're on the subject....I have never had an issue with low Iron. IN fact, mine is always well above what it needs to be. We have well Water which has a lot of iron in it and I always wondered if that was helping. Because of that, I have been lazy about taking my iron daily as I did not want to over do it. I am still pre op, but now I wonder if I should be more diligent about taking the extra. Ideas or comments?

[kellyw74 258]

No, it does not bother my stomach at all. I don't have Constipation or any upset. I also take Ester-C for better absorption of the Iron.

I take one of the Iron pills when I get up, my Centrum with Breakfast and another iron pill before bed. I also have the iron chews from Bariatric Advantage and i eat a couple of them a few times a week. Hopefully, I won't o.d. on iron!! LOL

Kelly

Thanks, all, for your replies. My nutritionist is the one who told me to take Centrum. I take liquid calcium citrate in two 500 mg doses and one 200 mg dose spaced two hours apart. I don't take the Calcium until after lunch and I take the multi-vit with iron in the morning; since we don't absorb calcium carbonate well, I assumed that it would not impede the iron absorption in the multi-vit. I'll give some additional Vitamin C a try even though the multi has C in it.

@Kellyw74: Are you having any stomach issues or constipation with the ferrous gluconate? I heard it was hard on the tummy.

[klus263 9]

I was told by my office to take 2 of the Multivitamins a day....my schedule is Vitamin at Breakfast, Calcium at break, Vitamin A (my only deficiency at my 6 month check-up), 2nd calcium at afternoon break and 2nd Multivitamin at supper. The week days go better for me as I have set schedule breaks and lunches due to phone coverage. I was taking the baiatric advantage but has recently switch to the Centrum Silver for Women.