B12 absorption post gallbladder surgery

[lambuth_eagle]

I know certain gastrointestinal surgeries can lead to an absorption issue with B12. Has anyone had this happen from “just” gallbladder surgery?

[wedgewood]

I haven’t heard that gallbladder surgery causes B12 deficiency.

Removing part of the stomach that contains the parietal cells causes B12 deficiency . The parietal cells produce the intrinsic Factor and stomach acid , both of which are essential for B12 absorption. Pernicious Anaemia is caused by the destruction of these cells by Intrinsic Factor antibodies . These antibodies can be detected by a test ( IFAB) If found , this proves that the patient has Pernicious Anaemia. BUT. unfortunately, in about 50 % of P.A. patients , they do not appear . Many doctors assume that non-appearance of these antibodies means that the patient doesn’t have P.A. , and they don’t get treatment . …… Awful ……

Sorry , this isn’t what you asked about .. I get carried away when I think about the many injustices that P.A, patients have to endure . I hope someone has some knowledge to help you . Best wishes .

[lambuth_eagle in reply to wedgewood]

Thank you…yes, I have had the IF test and it was negative but the hematologist still thinks I have PA. I was just curious about if anyone has linked gallbladder removal to B12 issues.

[Stransky]

Yes! I'm convinced having my gallbladder removed has caused my PA, the bile normally stored in the gallbladder to be released in the event of a large meal to break it down, whilst now the bile is a constant flow into the stomach.

[Gambit62 Administrator]

gallbladder surgery can affect the terminal ileum and lead to B12 absorption problems. I have a friend who has to have B12 injections as a result of gallbladder surgery.Please note that a negative IF test does NOT rule out PA as the cause of B12 absorption problems. The test is not very sensitive and gives false negatives 40-60% of the time. The chances of a false positive are vert small though which is what makes it a useful test in the absence of another more sensitive test.

[waveylines in reply to Gambit62]

Thanks Gambit. I didn't know this. Surgeons are ignorant of this too as was told there would be no consequences. I had my gall bladder removed. Now I know why my b12 level dropped. It explains why despite being gluten free for a year & my guts have completely settled down now but Ive still need the b12 jabs. My IF test result was negative. Would this also explain the need for high frequency jabs?

[Gambit62 Administrator in reply to waveylines]

none of this would explain need for high frequency jabs - reason for that just isn't known.My friend didn't start getting B12 injections until he collapsed in the street and it was the paramedic that identified the problem.

[waveylines in reply to Gambit62]

Thanks Gambit. Hopefully one day they will find out..... Ive assumed Ive lost the ability to store it as I cant think of any other reason. Im lucky cos at least it works!

How is your friend now?

[Gambit62 Administrator in reply to waveylines]

They are okayIf you have an absorption problem then you won't be able to access stores of B12 in the liver because that involves the same mechanism as you use to absorb B12 from your food. Again, that wouldn't explain the need for frequent B12 injections.

[waveylines in reply to Gambit62]

Why wouldn't it? I was told that the body clears excess b12 in 12hrs? If I cant store or access stores (presumably I cant store if the mechanism is interupted) then sure it would make sense to need more frequent jabs as I cant access/retain stores?

[Gambit62 Administrator in reply to waveylines]

There is no way that your body can clear the B12 in a jab within 12 hours. The mechanisms that clear it - mainly the kidneys just cannot cope with that amount in that time. A month is the average time taken with cyanocobalamin and 2 months the average time with hydroxocobalamin, that's why the normal treatment intervals for maintenance doses are one month for cyano and 2 (possibly 3 for hydroxocobolamin).There is a huge variation and there are some people who can take years to clear the B12 - and that's not to do with the efficiency of kidneys it's more to do with the complicated biochemistry of B12. There will be some that are shorter but if you genuinely clear it in 12 hours then you are something of a medical anomaly, and you would need injections every 12 hours.

It is more likely that your serum B12 levels continue to be high but like others of us that doesn't mean that you are okay. The PAS did research n the past and found out that the average level at which PA patients found they were okay after loading doses was 1000 - which is above the normal range. I don't feel okay with only injections even though my levels are off the measurable scale.

[waveylines in reply to Gambit62]

Am confused by this Gwmbit.......any excess is excreted through the urine and thhe link below says excess is excreted within 48hours. (So am wrong on the 12hrs). It doesnt appear to be months. I guess if you are storing it takes a long time tp use up ypur store but thats not what Im referring to. .

b12vitaminstore.com/default...

[Gambit62 Administrator in reply to waveylines]

I am not sure which bit of the article you are using to say that excess is removed in 48 hours. The article says this about removing B12

How quickly is a B12 injection absorbed?

Injections bypass the need for the vitamin to be absorbed by the intestines so the body can begin using it within minutes. Vitamin B12 given through subcutaneous or intramuscular injections is rapidly absorbed and used by the body as needed. Studies show that between 50% to 98% of injected B12 is found in the urine just 48 hours after the injection is administered, meaning it may have a half-life of up to 24 hours.

During the time it is in your body, your body sends and uses it where it is needed, and if you are able to store it and there is any excess it helps tops up your liver reserves.

The statement 'may have a half life of up to 24 hours' isn't correct because if 50-98% is removed in 48 hours that would be giving a 'half life' that was more than 24 hours.

Even if it was correct it wouldn't mean that the excess would be removed in 12 hours - quite the opposite.

A 'half life' in this context is the time taken to remove half of the excess B12. So if half

is removed in the first 48 hours, a half of a half in the next 48 hours (one quarter) and then an 8th in the third - this is taking the 50% figure. So that means that at the end of 6 days you would still have 1/8th of the excess remaining ... and the 'excess' following an injection is a really big number.

if you took the 98% figure then you would still have 1/8 left at the end of 3 days.

This is a very simplistic model and we know that it doesn't represent reality, because the variation in removal rates is actually much larger than stated and doesn't really follow a half life mode. Some people can and do retain excess B12 in blood for years and although much of it may be removed in the first 24-48 hours the rates of removal don't see it halving every couple of days but see it becoming more of a plateau.

Also we know that serum B12 isn't a useful way of monitoring when treatment is needed for a B12 absorption problem (though it can be a useful part of the diagnostic tool set for identifying a B12 absorption problem if used and interpreted correctly). It is just telling you how much B12 is in the blood - it isn't telling you anything about how effectively that is being transferred into cells for use in the huge number of processes that need it.

[waveylines in reply to Gambit62]

Thanks Gambit. Am not doubting you but I am worried now that injecting twice daily could poison my system as if its not being excreeted quickly it must be building up in my system somewhere.. Where on earth will it all be going? A blood vitamin B12 test showed 2000 so am guessing that simply means its not measurable as its above the upper range of 1800. .

[Gambit62 Administrator in reply to waveylines]

unless your symptoms say you need to be injecting 2x a day I would recommend you stop, keep a diary of symptoms and not do another injection on the symptoms start to return.B12 isn't toxic

[waveylines in reply to Gambit62]

I've done all that Gambit which is how I arrived at 2xs per day which I check periodically. When I drop to daily I get bowel & urine incontinence within a few days, tremors and numbness in my toes spreads across ball of foot within 48hrs of drop. Am trying to reduce to daily & progress down but so far no joy. I just don't understand if I am retaining it as much as you describe then technically it should not impact on me like it does when I reduce frequency. I do si injections. There has to be another reason.

[Gambit62 Administrator in reply to waveylines]

you have an issue because the problem isn't the amount in your blood it is the amount that is getting from your blood to your cells - which is a whole different story and currently isn't fully understood, so there isn't an answer at the moment as to why some people with high serum B12 still need much more frequent injections of B12.Reality is that biology is extremely complex. It involves biochemistry and many of the reactions involved in biochemistry involve things called enzymes and most of those seem to work by using effects from quantum physics and the cross over between quantum physics and biology - quantum biology - is a very new field but I suspect the answers will come out of studies in quantum biology - but it has only been an area of study for about 17 years, still in its infancy and definitely off-topic for this forum.

[Gambit62 Administrator in reply to waveylines]

the report probably said >2000 - which it would do immediately after an injection anyway.The treatment for cyanide poisoning is 5g administered intravenously over 15 minutes with a repeat 30 minutes later if needed - I know cyanide poisoning is an extreme situation - but that is the equivalent of doing 5000 injections in 15 minutes.

The risk factor for this treatment is hypertension from the introduction of the amount of fluid required to deliver that amount of B12.

[waveylines in reply to Gambit62]

Thanks..... What you are saying does not fit with my experience. You're right a blood test doesn't explain how much is getting into cells etc but there is no test for that. That isn't what I'm talking about though. I'm asking about the excretion rate of b12 not required by the body when injecting it. There appears to be nothing in the public domain on this that I've found. Do you have research on this? I think I need to set up a separate post. Apologies for hijacking this post somewhat! Lol....

[Gambit62 Administrator in reply to waveylines]

waveylines, blood serum levels are irrelevant. There is a huge variation in the time taken for levels to fall after injections and most of the work on this is 40+ years old so some available as pdfs if you are lucky.onlinelibrary.wiley.com/doi...

ncbi.nlm.nih.gov/pmc/articl...

The removal of B12 from blood is as dependent on enzymes (albeit different ones) as the processes that B12 into cells and the processes that use B12 when it is in cells.

[WildyWiley]

I think they might correlate. I had my gallbladder removed and it affected my pancreas leading eventually to EPI (malabsorption). Long term use of PPI’s doesn’t help either.

[MoKayD]

I'm pretty sure my B12 deficiency is a result of my gallbladder being removed. I've read studies that say bile is involved in the B12 absorption process. The gallbladder is the organ that sends bile into the stomach so that process is affected. I wish my doctor had warned me about possible vitamin deficiencies at the time my gallbladder was removed.

[jillc39 in reply to MoKayD]

Once my gall bladder was removed I needed more frequent B12 injections (getting them was a medical pantomime in itself) but I have now settled to once every 10 days and that fits me perfectly.

[MoKayD in reply to jillc39]

I've found once every 3 weeks works for me. Once a month just wasn't enough.