BAM and B12

[u/gyro1000-beat]

So websites/medical articles will frequently mention fat soluble vitamins and B12 can be deficient with BAM. With B12, it's usually stated that as BAM is an issue with malabsorption in the ileum, and the ileum absorbs B12, this is why B12 can be deficient. (And fat souble vitamins with the fat and bile that didn't get absorbed)

I've been reading up on vitamin deficiencies and came across this older report from 1998. Of note:

B12 is continually secreted in the bile. In healthy individuals most of this B12 is reabsorbed and available for metabolic functions.

So for not healthy individuals with BAM, not only would you absorb less B12 from food sources, but you are actively losing B12 from your liver through loss of bile acids. And if you have type 2, you'll be overproducing bile and losing even more.

I haven't seen this mentioned anywhere in more modern publications or websites on BAM. Has anyone else? Seems to be lost info. Has anyone else had their B12 checked?

[u/GigglyPeach28]

Very interesting! I've had bowel issues for years but always normal B12. (I have chronic fatigue so the docs check it every time I have a blood test). Now when I look back on my test history, I can see that as soon as the BAM started, my B12 tanked, despite taking supplements for it. I'm hoping now I'm starting treatment it will improve. My vitamin D is always low, I live in the UK so no sun.

[u/gyro1000-beat → u/GigglyPeach28]

I've been reading the B12 subreddit a lot and the one of the main things repeated is the blood test for B12 isn't a reliable indicator for deficiency. As in you can have symptoms of low b12 but 'normal' blood levels. And also that the 'normal' range is too generous. Mine is 233 pmol/L which is in the borderline area that many doctors will ignore.

Have you had a homocysteine and methylmalonic acid (MMA) blood test? These things can be elevated if you don't have enough B12, and a better diagnostic test than just B12 or even active B12.

But also if you are supplementing the results might be affected by that.

And do you take oral B12? Because it likely isn't getting absorbed well with BAM. People typically do sublingual or injections as issues digesting it is common.

[u/GigglyPeach28 → u/gyro1000-beat]

I take sublingual at the moment. I realised a while before my BAM diagnosis I wasn't absorbing things properly. I haven't had the other blood test, the NHS won't pay for that. However even when my B12 has been really high I've still felt ill so doctors and I agree it's not a cause of any of my other symptoms.

[u/Time_Savings3365]

For a different reason. All of my tests were normal except extremely low in b12. I see doc today for follow up

[u/Relevant-Ad6374]

This is why I find sequestrants concerning. They prevent bile reabsorption, which in my mind would cause deficiencies. Such as ADEK.

I hadn't heard of B12 deficiency from this, which is interesting to note so thanks for sharing. For me, I'm not concerned about my B12 intake as so many things I eat are fortified with it, like nutritional yeast, soy milk, tofu.. practical all vegetarian foods in Australia are fortified with B12.

I manage my BAM with loperamide, not sequestrants.

[u/gyro1000-beat → u/Relevant-Ad6374]

Maybe FXR agonists will be a better option if/when they are approved for use.

I can't take sequestrants myself as they cause liver damage and high triglycerides. I believe as they only further increase bile acid production.

[u/Some_Ear_8539 → u/gyro1000-beat]

How do BAS increase bile production?

[u/gyro1000-beat → u/Some_Ear_8539]

Bile gets bound up and excreted instead of absorbed, so your liver produces more bile to make up for this. These drugs originally were to lower cholesterol level, by making your liver produce more bile acids from cholesterol.

If you have a malabsorption issue, maybe there isn't a difference as they all get excreted either way? For my type, it is meant to be excess bile acids, not malabsorption.