Iron and B12 Deficiency with an Ileostomy

Hi all, does anyone else on here have problems with their iron and B12 levels? I have an ileostomy, and my recent blood test shows this deficiency.

Yes, Rubie, very common but easy to fix. You can often add vitamin D to that as well.

Yes, I take a B12 tablet twice a week now. I used to take one a day as prescribed by my surgeon, but it was too much.

Regards, IGGIE

Yes, B12 after having an ileostomy for 37 years. My recent blood test found it low, so I'm on B12 jabs now.

Yes, Rubie, I have been on the B12 shots for about 14 years, and mine still runs low. And vitamin D still runs low… Have a blessed day. 🙏

My Ostomy Journey: LeeAnne | Hollister

I take iron every day to deal with anemia. It keeps my iron at a healthy level. I don't have an issue with B12; actually, when I took a supplement of B12, my B12 went too high. But I was on B12 for a long time before this happened, for the first like 2 years of my ostomy.

B12 yes, vitamin D yes, and now iron studies. I have an ileostomy too. It seems the part of the intestines they removed processed those things. If you eat clean, it's worse. Lots of vitamin B supplements in junk food for some reason.

Hiya Rubie rubie

I have had this problem ever since my operation in 2011, and it causes me a lot of fatigue because of this. I can't tolerate oral supplements, and iron infusions are too far in between. I am now considering paying for a private iron drip. In the last 5 weeks, I have been injecting myself with vitamin D and folate, as I am deficient in this too. My fatigue is not reduced, but I have been feeling better, more alert, and my skin and scalp are no longer dry. It's early days, as it can take several months for vitamins to be fully absorbed, so I still have hope, lol.

I have never had a problem with my B12 levels, but I read that it is not active if you don't have enough folate in your body.

I found the NHS and GP are not very proactive in any help, so I have to try on my own as the fatigue is starting to ruin my life.

Sorry to be so blunt and miserable about it, lol.

Sarah

I forgot to say I take vitamin D as well. To keep up my levels, they are near perfect now with the supplement, but without it, they would be low.

Interesting what you said about junk food. I find I can only eat bland, stodgy foods and try to add rice and pasta to everything. I also eat tinned fruit and vegetables as they don't come out whole like fresh food does. Sugary things are not my friend either.

My husband's hemoglobin has been a little below normal since surgery. But everyone is okay with that. However, I do give him monthly B12 shots.

Yes, I take cyanocobalamin (might not be spelled right) twice a day for B12 deficiency. Some B12 tablets are not as strong as others, so check with your pharmacist.

I use methylated b complex vitamin.  They seem to be better absorbed 

🔒 Login to see image

I have the same issue, so my doctor put me on B12 and iron once a day. I also take potassium daily.

I've used methocobalamin (B12) injected for years. Most people past 50 are low, let alone with an ileostomy or colostomy. Don't use cyanocobalamin; it's cheap and a waste of money. I use Empower Pharmacy (the least expensive I've found). My doctor sends them a script, then I get my bottles and syringes sent to me. My insurance doesn't pay for the B12, but I do have to use a doctor prescription. I only had a problem with iron before my surgery because I was anemic all the time from blood loss due to colitis. You might want to discuss the iron deficiency with a doctor.

The reason I use injectable is that B12 is usually destroyed by gastric juices before it reaches your small intestine. Also, B12 is supposed to be absorbed at the end of your small intestine, so having the end of mine coming out of my stomach, there is no way for it to get into my system.

I did B-12 injections for years until they came out with sublingual, which I tried, and it works great for me.

I had low B12, too, so my doctor told me to take sublingual B12, and that has helped. I also take iron and have been taking D3 for years. The doctor cut me back on my iron as my levels were better. I take it 3 times a week, so I will see how that is working next time I have blood work.

Hello, Peabody here. I was diagnosed with a B12 deficiency recently and am now taking a B12 supplement (B12 1000 mcg). I hope it's helping, and I don't know why the deficiency occurred. Right now, I have no clue about the status of this deficiency and won't until blood tests are taken again. Good luck... what's one more pill!!!

If you have an ileostomy, B12 deficiency is a very common and serious risk. It is not a matter of if but when it will occur without proactive management.

IGGIE, you must have a lot of your ileum remaining to be able to take B12 tablets, since B12 is absorbed in the ileum. Or are you taking sublingual tablets?

What were the problems you had with cyanocobalamin?

B12 is not normally destroyed by gastric juices. The absorption of vitamin B12 is a complex process that requires several steps and specific proteins produced by the body. It's often described as the most intricate absorption mechanism of any vitamin. The following is a brief explanation of the B12 absorption process:

1. B12 is freed from food in the stomach using stomach acid and pepsin.
2. Freed B12 binds to R-protein in the stomach using R-binder (from saliva).
3. B12 is handed off to the duodenum using intrinsic factor (from the stomach).
4. The B12-IF complex is absorbed in the ileum using receptors in the ileum.
5. B12 is transported to cells in the bloodstream using transcobalamin II (TC-II).

Some causes of B12 deficiency are:

1. Pernicious anemia — An autoimmune condition where the body attacks the parietal cells in the stomach, destroying its ability to produce intrinsic factor. This is a classic cause of B12 deficiency.
2. Low stomach acid (achlorhydria) — Common in older adults, acid-reducing drugs (PPIs, H2 blockers), and certain conditions. Without sufficient acid, B12 cannot be freed from food proteins in the first place.
3. Pancreatic insufficiency — If the pancreas doesn't secrete enough enzymes, it cannot break down the R-binder-B12 complex, preventing B12 from binding to intrinsic factor.
4. Ileum problems — Conditions like Crohn's disease, celiac disease, or surgical removal of the ileum can destroy the absorption sites.
5. Dietary lack — Strict vegans who consume no animal products whatsoever can become deficient over time, as plant-based foods are not a reliable source of active B12.

So you can see you need the gastric juices for B12 absorption. You are correct that most of B12 is absorbed in the ileum.

G-Day Traveler,

Yes, I have most of my ileum left, except for the last few inches, and it's the last part of the ileum that absorbs the B12. So I take B12 tablets twice a week.

Regards, IGGIE

Iron pills can cause constipation because they slow down your processing speed. You may want to try using a “Lucky Iron Fish.” It allows you to increase the iron in the food you eat. You might want to check it out!

https://luckyironlife.com/?srsltid=AfmBOooNwAIe0igTPslZdn942bBMeY0XvV5uG3c0ipwGe-uWYGPp-_yh