Maintaining iron levels became a problem within two years of my j-pouch surgery. I am aware from previous posts on the forum that it is not an uncommon complication.
Cooking with iron skillets, eating spinach, eating red meat, chicken livers, copious amounts of eggs and adding ascorbic acid (vitamin c) Oral supplements have only caused pain and discomfort. The only thing that has worked are iron infusions however these are not without side-effects.
After listening to haematologists say that I may have had too much bowel resected to absorb iron and gastroenterologists finding that all my inflammatory markers are within 'normal' ranges I became frustrated with my inability to absorb iron.
From reading I have learned that it is the duodenum that is responsible for the uptake of iron in food. I still have that part of gut.
Hepcidin is a hormone that was only discovered in 2000 that is excreted by the liver that controls the amount of iron absorbed in the gut. It turns out that Hepcidin is excreted during chronic disease which can lead to Anemia of Chronic Disease (ACD) but it is also referred to as anemia of inflammatory response.
Even having mild inflammation in your pouch (or anywhere else in your body for that matter) will disrupt your iron metabolism as Hepcidin is produced.
Given this knowledge I insisted on being scoped and sure enough inflammation in the j-pouch was seen and also elsewhere in my ileum. The endoscopist was not surprised about the j-pouch having inflammation and commented 'oh we expect to see some inflammation in the pouch, that is normal'.
Chronic iron deficiency will likely damage your immune system and lead to further inflammation.
Here are some references so you can do your own reading:
Hepcidin is a key mediator of anemia of inflammation in Crohn's disease.
Iron, anaemia, and inflammatory bowel diseases
Hepcidin and iron regulation, 10 years later.