If you're taking anything to reduce stomach acid (Zantac, Prilosec, etc.) that could reduce iron absorption. Also, bleeding always has to be ruled out, especially in males who usually need very little iron to keep up with normal red blood cell recycling. 

Thanks Scott, I'm not using any acid reducing meds now, and I'm not bleeding now either.

Scott Randall posted:

The reason I ask is because I just read that "iron enters the stomach where it is exposed to stomach acid and changed into a form that allows it to be absorbed. The portion of the small intestine called the duodenum is the chief area where iron absorption takes place. There may be a second minor absorption site near the end of the small intestinal tract."

OK it is absorbed through your small intestine, and I still have that but still my iron count is below normal. 

My iron levels have been high all my life. Until I had my colon removed. End ileo now. 

Anyway. I was feeling fatigued all the time. I would tire easily and explained it to my surgeon who sent me in for a complete blood work up. Only thing that came up was my iron levels were low. Low enough to cause my fatigue.

I was surprised to say the least.  I thought it may be some other deficiency. Certainly not iron. She asked me to take an iron supplement so I did. And within a week I noticed a difference in my stamina especially at work. After four hours of work beforehand I was tired and weak. Now. I can make it eight hours easily. 

No explanation why it was low after being high all my life. It's just the way it was. And it had a simple cure. 

Sorry. Long story. 

I would only hope your iron level is an easy fix as mine was. 

Richard. 

My doctor told me to take an iron supplement too, and then he told me to cut back on it for fear of cancer.   After hearing that I'm not so hot about taking iron supplements.    But that still doesn't explain why we're iron deficient when we still have our small intestines whose job it is to absorb iron?

Most J-pouchers aren't iron deficient. Those that are are in a very similar situation to non-J-pouchers. While iron has some theoretical cancer risk, that's probably just as true of the iron in red meat or iron infusions (for example) as it is for supplements. If you're low in iron then you need supplementation, IMO, and the hypothetical cancer risk is a poor reason to fail to supplement a true deficiency.

Bleeding is sometimes "occult," and can't be detected just by looking. Like a leaky faucet, a fair amount of blood can be lost this way over time. Other ways of losing blood (and iron) are more obscure - usually only a hematologist will look for them.

OK, well my iron count has been low for years now.   My doctor just believes it's pouch related.  I haven't heard any other explanations for it.  Just for the hell of it here's what my last blood test that I took last week looked like;

Oh, you're not anemic at all! Heck, your iron might have always been low, even pre-pouch. I wouldn't supplement it, and I'd personally ignore it. If you really want expert advice about this a hematologist is your guy. I don't think it's "pouch-related."

Scott but my iron count is at 60, that's below the normal range.  Also take a look at my Ferritin it's just 12 or way below the normal range.   There have been times where my red cell count and hemoglobin were below normal too.   I never had a doctor inform me until I got my pouch that any of these readings were below normal too.

The iron tests wouldn't have been done unless someone was trying to figure out anemia. "Abnormal" iron results aren't particularly meaningful or helpful unless there's a clinical condition they may help explain. Your iron levels appear to be just fine for you; the job is getting done.

I don't understand what you're talking about Scott since my iron level is below the normal range and so is my Ferritin,  which could be why I my energy level feels low. By the way I have already been diagnosed with anemia too.

An abnormal blood test is not a disease. It often doesn't mean anything at all. The way the abnormal thresholds are determined leads to many tests being clues rather than answers. I don't know why your energy level feels low, but it's not because of anemia you once had but don't now.

 When I had low iron and ferritin levels, during the time I had a J pouch, I would get iron infusions on a regular basis. They made a tremendous difference in  improving my energy level and minimizing headaches. My levels would get lower than what you are at now, but I was barely functioning at that point. Your crit and hemoglobin levels are normal, which is contrary to what I experienced as they too would get very little.The hematologist worked with my G.I. doctor.  Have you gone to a specialist?

At the time I didn't give much credence to the doctors' opinions that the cause was chronic inflammation– – Caused by pouchitis.  Nearly 2 years ago I had my J pouch removed and now have a k pouch. I have only had low iron levels after a surgery, but no more need for iron infusions. Do you have pouchitis or other information?   What is your SED rate?  I was also on antibiotics at the time, Which I mentioned because it may be another variable.  That said I still face some amount of exhaustion, but  could be my age or could be  other physical problems 

have you taken iron supplements, the type over-the-counter? You might want to try a liquid form as it's better digested

One other thought is whether your B 12 has been checked. When you lose your colon you lose your ability to absorb B12. I give myself a B 12 shot every month to six weeks.

 It's terribly frustrating to go through the exhaustion and have abnormal blood work and not know what to do. I've been there, I was there for years and years. Sorry that you aren't feeling well and I hope you can get some relief.  Keep us posted to the resolution. Janet

Yesterday after all these years of living with a J Pouch I discovered bleeding too.   It was pretty bad but has stopped for the time being.  That's all the more reason to explain my lack of energy.  I try to push myself too and exercise everyday I can but at the same time too I'm fighting with myself since my body is so low on fuel.

I just put up with it.  I have always had low iron even pre pouch.  I had 3 iron infusions and my ferritin went from 5 to 7.   I am having 3 more over the next 3 months hoping to increase my ferritin a bit more.  They are a pain in the neck because it takes 4 hours in the hospital and I am a very tough stick for an IV.  Oh well.  C'est la vie.

I've seen my Ferritin go down as low as 3 too.  It's always a guessing game where it will be next.  Either way you cut the cake, I'm a mess. 

Now that I'm bleeding I doubt supplements are going to do me any good.  If anything I'd like to know why I'm bleeding?  Nobody seems to care.  I've had this pouch for 29 years and I can't remember bleeding before.  

One of my doctors told me if I'm anemic and iron is low, my body is leaking blood from something in my body somehow.  Just little enough so it's not visible in my stool.  I've been getting iron through iv with a slow drip for about 6 years now every 6 months.  I recently went 13 months having a stable iron level and attribute it to one change I make in this time.  I started taking a year ago ProBio 5 plexus priobiitics that has digestive enzymes in it to break down food for me so it's easier on my small intestines/jpouch. I take one twice daily after a meal.  I can't live without this now and during this I only had one small flare. I eat low gluten diet and no dairy and no red meat.  

15 years with jpouch 

I am also anemic after 15 years with BCIR pouch. I was told it's because my ilieum is gone and that is what helps  absorption. I have been getting IV iron for 14 years and now I only have to get it once a year ( ferraheme). My hemotologist wants my ferritin to be above 100. I have been taking forvia vitamins for 4 years and i think that has helped my iron levels. Forvia vitamins are for people with absorption issues--check out their website--inovera.com

I take the chewables.

Wow, given how low my ferritin level has been now for several years.  I wonder if it's possible to jack it up 100 or more?  I think the highest I've seen so far is 30 something.   I definitely have a bleeding issue now, so that's not going to help.  Perhaps I had this issue before and just couldn't see it.

Just a tip...to help boost your iron, when you are taking iron supplements or eating foods high in iron, have a glass of orange juice or a serving of fruit high in vitamin C.  Vitamin C helps the body to absorb iron.  It can make a big difference.  

 Scott – – from my experience it is the iron level that should be at 100 and not ferritin. 

I do take vitamin c supplements and drink my share of orange juice too, since I have heard that vitamin c helps the body absorb nutrients more effectively.