First and foremost, We apologize for the confusion and last minute change with the webinar.  It was set to go and logged in then the internet dropped the group meeting.  The meeting site automatically marked the meeting as over.  We sent out e-mails with the new URL for the group meeting but it took time.  Thank you for your patience with this new platform.  Although far reaching, it comes with downsides and hopefully we can make this a long term way to reach our patients.  Lesson learned, don’t rely on wireless internet access for webinars.  The Anemia slides will be added to our website dssurgery.com soon.

Ferritin is a protein that acts like your savings account.  It’s like a holding tank. When you have a blood loss your body goes to Ferritin stores for iron to increase red blood cell production. Iron is like money in your pocket.  For small and daily building of red blood cells. Transferrin is a protein transport that carries the iron.  Copper is also needed to transport iron. Iron can be readily available but will not be utilized unless your protein levels are adequate.  The protein level on laboratory studies needs to be at least 6 gm/dL & Albumin 3.2 gm/dL for adequate iron utilization.  Vitamin B12 also is needed for iron utilization.

Iron metabolism in the DS patient is limited due to several factors.  In unaltered anatomy Iron enters the stomach where it is exposed to acid and changes into a form which allows it to be absorbed.  Then it enters the duodenum which is the chief area of the small intestines where iron absorption takes place.  There is possibly a second minor site of absorption near the end of the ileum.  However,  after the DS there is a small portion of the duodenum that is left after the pyloric value for iron absorption.  Below is a list of iron rich foods.  Also remember to take Vitamin C with your iron supplements and when eating plant based iron rich foods add a food that is high in Vitamin C.

There was a brief discussion regarding Calcium oxalate kidney stones.  That talk can be found on our website.  Treatment is limiting oxalate containing foods and to increase calcium supplements to 3,000mg daily but to take half with food and the other half without food.  Also Vitamin K2 can also decrease kidney stones.

Fissures where also briefly discussed.  Fissures are most likely caused by the unopposed bile salts entering the colon after DS.  Bile is alkaline and causes irritation to the mucosa.  Treatment is liberal use of barrier type creams/ointments, controlling loose stools by watching if certain food items cause them or by using fiber with half the liquid mixed with it.  The fiber with less liquid acts as a sponge to give more form to the stool.

We had anemia themed snacks at the live group meeting.  Pate, Southwest ground Bison, and a Mayan Pumpkin seed dip. Here is the information on the nutritional value of Bison versus other meats.  It is higher in iron and Vitamin B12 and lower in fat and cholesterol.

Iron Content of Common Foods

This chart shows the amount of total iron in food. Iron from most animal sources (heme iron) usually is more readily absorbed than iron from plant sources of food (non-heme iron). Include a source of vitamin C or heme iron to improve the absorption of non-heme iron.
Sources of Predominantly Heme Iron