Iron + Vitamin C

About Iron
The role of iron in your body is to help create hemoglobin, the substance inside your red blood cells that carries oxygen throughout your body to produce energy and form antioxidants. It is also important for the health of your hair, skin and nails.

Iron Deficiency After Bariatric Surgery
Bariatric surgery can result in an iron deficiency because of the changes that are made to your digestive system during surgery. In malabsorptive procedures such as the Roux-en-Y, most of the iron from foods bypasses the first part of your small intestine (the duodenum). This is the part of intestine where some vitamins and minerals are absorbed, including iron. Additionally, after the sleeve gastrectomy and gastric bypass, the decrease in stomach size, and this stomach acid makes iron more difficult to be broken down into a usable form. All bariatric procedures cause a dramatic decrease in food intake, which reduces the likeliness that they will take in the needed iron through food alone. Furthermore, many bariatric patients have intolerance for iron-rich foods such as red meats. This can lead to iron deficiency in many patients, most commonly premenopausal women.

Symptoms of Iron Deficiency
Iron supplementation can play a very important role in your diet post bariatric surgery. It is important to know the symptoms of iron deficiency, and have a discussion with your doctor is you experience these signs. Indications of an iron deficiency include:

  • Lack of energy & lethargy
  • Memory loss and difficulty concentrating
  • Weakness
  • Headache
  • Rapid heartbeat
  • Hair loss
  • Brittle nails
  • Pale or yellow skin
  • Shortness of breath
  • Chest pain
  • Pounding sensation in your ears
  • Desire to eat ice or clay (known as pagophagia)
  • Severe iron deficiency anemia can lead to heart attack due to lack of oxygen in the blood.


Why Iron + Vitamin C?
When digested together, vitamin C combines with iron to form a compound that is more easily absorbed. The acid in the vitamin C helps to break down the iron into a form that is easily absorbed by the body. This is a key benefit for bariatric patients who may already have challenges with absorption.

When Should I Take My Iron?
While it is recommended to take Iron supplements on an empty stomach, for many patients it causes uncomfortable side effects. In instances such as this, it is recommended that the patient take their iron with food to avoid those side effects. The chart below shows the best time of day to take your iron supplement in combination with your other supplements. It should not be taken within 2 hours of antacids, synthroid medications, or calcium supplements.

Daily Regime Sleeve & Bypass

It should be noted that all over the counter iron may not be absorbed by bariatric patients. Iron should be in a ferrous fumarate, sulfate, or gluconate formulation and it is recommended that it also be in a chelated form.



  1. Iron absorption and therapy after gastric bypass, Rhode BM, Shustik C, Christou NV, et al. Obes Surg. 1999;9:17–21
  1. Anemia Following Weight Loss Surgery, Dorothy T. McFadden MA, RD, LDN, Bariatric Dietitian, St. Luke’s Bariatric Services
  1. Iron Deficiency After Gastric Bypass Surgery, Fincannon, Joy, RN, MN, URMC Health Encyclopedia