Is it true that with PA you can’t sto... - Pernicious Anaemi...

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Is it true that with PA you can’t store b12 in the liver?


Does anyone have any good research to read on this topic? Based on my experience, I’m inclined to believe this myself, but how could that be? I thought we just couldn’t absorb b12

14 Replies

PA doesn't stop you storing B12 in your liver it just means that the fact that you can do this is somewhat irrelevant as the mechanism for releasing the B12 relies upon the B12 being reabsorbed in the ileum - which is a mechanism that is bust in people with PA. The amounts involved would be unlikely to be enough for passive absorption elsewhere in the gut to have any material impact and your stores would be quickly depleted.

Xena2202 in reply to Gambit62

Wow, I’ve done some reading and found a couple sources repeating this. Apparently stored b12 is released into the small intestine from the bile duct, so the liver has no efficient way of transferring stores to the bloodstream if you have no intrinsic factor. You’d think it could just release it into the blood. It’s interesting bc everything I read about PA treatment references building up the stores of b12

fbirder in reply to Xena2202

Yup, that's right.

It's a mystery as to why the body uses two types of carrier protein for B12 in the body.

Xena2202 in reply to fbirder

We should have a limited ability to store it however, right? Since some of it is stored in tissues?

fbirder in reply to Xena2202

It depends on what form is stored in the tissues. If it’s bound to haptocorrin, like the stuff in the liver, then it will be of little use.

I’m going to have try to find if there is an enzyme that cleaves the haptocorrin-B12 binding. If there isn’t then that would explain why the stored stuff is inaccessible. I know there are peptidases in the liver, but I don’t know how specific they are.

Damn, I’ll need to learn some more biology.

Xena2202 in reply to fbirder

I definitely want to hear if you figure that out 😁

Nackapan in reply to Gambit62

Does this also apply for b12 deficiency. ? I've not a PA diagnosis. It would make sense as I'm needy more frequent I jections.

fbirder in reply to Nackapan

Anybody who cannot absorb B12 from the gut will not be able to access the B12 secreted in the liver.

Nackapan in reply to fbirder

Okay. Thankyou

HRH8591 in reply to Gambit62

So injections get B12 to where it needs to go...simply. Is that right? Taking B12 orally just doesn't do it. Would this also be the reason that I have high levels of uric acid i.e. bile ducts not working effectively? Or am I on completely the wrong wavelength?

And does having hard gallbladder removal make it impossible due to lack of recirculatation ?

Gambit62Administrator in reply to Survivorette

the gallbladder is a reservoir of bile but doesn't mean that you have no bile if it is removed

(note: site is linked to Merck & Co so has a connection to a drug manufacturer rather than being completely independent.

gallbladder surgery can damage the ileum though, which would affect B12 absorption and could leave you in the same position as someone who has PA

I have PA. Due to delayed DX I had severe gallbladder disease. On another newsgroup head of it is always saying you will never store again in your liver without gallbladder—or that’s what I understood.. v

How big is your water butt?

In your garden, you have a water butt with a tap. The butt itself is behind a wall but you can access the tap.

You would like to know how much water the butt could contain.

You put a 10 litre bucket under the tap and fill it up. When it is full, you empty the bucket and fill it up again and again.

After filling the bucket ten times, there is no water left in the butt. Therefore you have shown it has a capacity of at least 100 litres.

Ever so simple.

Now repeat the whole process with one difference. Instead of you emptying the bucket, someone keeps taking each full 10 litre bucket round behind the wall and you get another empty bucket.

You carry on. And on. 10. 20. 30. 100 buckets.

Is the butt 1,000 litres? Or is someone behind the wall pouring the 10 litre buckets back into the butt?

If you carried on long enough, the level drops because of spillage, etc., but it would superficially appear that you have a water butt with a capacity of at least a thousand litres.

The first approach is what happens if there is no recirculation.

The second approach is what happens if there is recirculation and there really is someone pouring the buckets back into the water butt.

Trouble is, without understanding that there is recirculation, it is almost indistinguishable from having a gigantic water butt.

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