b12 liver stores

[brenanddave]

Hi everyone, Just a quick question for those of us with PA. When we have b12 loading doses I have read this replenishes liver stores. Can anyone tell me does this b12 always successfully make it into the liver stores? I ask because my body does not reflect this. Loading doses did nothing to alleaviate my exhaustion or other neurological symptoms. It took daily SI to start making any headway with these. I am now on twice daily b12 injections and any less and I am suffering and can not function properly. I am nearly a year into treatment. Thank you in advance for info!.

[topazrat]

Excess B12 gets stored in the liver, and then when blood levels drop, it is released into the gut for absorption into the body. The problem with P.A. is that we cannot absorb B12 from the gut very well, if at all. So when the liver does release its B12, we can't absorb it, so it goes through the gut and out the other end without doing its job, which is why we need a constant supply of injected B12.

A good analogy is trying to fill the bath with the plug out. Its never going to fill, as the water just flows straight down the drain.

[brenanddave in reply to topazrat]

Thank you so much! That is what I thought but I read articles about it on health cites and they say we are injected and that goes to our stores and then we release it as we need it. If that was the case, it isn't doing it for me. I can see how little correct info is fed to doctors and people. I will carry on doing what works for my body. x

[brenanddave in reply to topazrat]

So when we inject that is straight into our blood from the muscle and anything that is surplus goes to liver and cant be used when released. Did I get that right? x thanks sorry! I have to understand when the doc asks the question.

[wedgewood]

If you have Pernicious Anaemia , you cannot absorb Vitamin B12 through the stomach .The stored vitamin b12 in the liver is discharged into the stomach , so therefore is not absorbed , Sorry , Just noticed that topazrat has answered your question. .

Just to illustrate the ignorance of some GPs re Pernicious Anaemia. I had to go to a private GP from whom I obtained the Intrinsic Factor AntiBodies test which was positive. So got my loading doses ( just 5 as I’m in Gloucestershire. )from my GP. who told me that I now had stores of B12 in my liver which would last me for several years . So one injection every 3 months was very generous indeed . End of story . ……… …

[brenanddave in reply to wedgewood]

OMG! It's enough to drive you mad at time I swear lol Thank you for that info. So when we inject it is just used for the body then and pee'd out if we don't use it all. Can't make it to stores? xx

[helvella in reply to brenanddave]

It doesn't get peed out in that circumstance. It is released into the digestive tract and not re-absorbed.

[brenanddave in reply to helvella]

Thank you helvella ! So when we inject it gets absorbed instantly from ou muscle to our cells to use then and when it is used its time to inject again? Sorry. My brain struggles with stuff like this especially when docs try to convince you otherwise x

[Gambit62 Administrator in reply to brenanddave]

B12 from injections gets into your blood stream without going through the gut. Some will go to the liver for storage but that doesn't help if you have an absorption problem because the release mechanism is, at best, very inefficient.

This means your cells are dependent on B12 circulating in your blood - it is only transferred into the cells when it is needed by the cells.

For some individuals this transfer process also seems to become inefficient if they have very high serum B12 levels so they can need to maintain very high serum B12 levels.

Excess B12 in the blood is filtered out by the kidneys - the amount of time this takes varies considerably from individual to individual - on average it is 1 month for cyanocobalamin and 2 months for hydroxocobalamin ... but it can be much shorter in some people and in others it can take years.

[brenanddave in reply to Gambit62]

Thank you so much for your detailed explanation Gambit62 x

[Wwwdot in reply to helvella]

Hi Helvella

I am intrigued by the comment “It doesn't get peed out in that circumstance. It is released into the digestive tract and not re-absorbed.“

I was told by my B12 consultant that excess from a SC injection is peed out. There was a podcast recently where I am sure they said this … but I will need to listen again.

My urine cover has significantly changed colour since I have been taking B12. It used to be almost clear and I have always been “into” urine colour since working in a chemist in the 80’s when that’s how you did a pregnancy test! The pharmacist always did a running commentary on the colour!

My urine is now much yellower regardless of how much fluids I drink, my friend who is a nurse was alarmed at the colour of my pee (we had no water so couldn’t flush the loo … I am house trained!)

So two things come to mind - could the excess be going to the liver which is already full but can’t release to gut anymore (system broken) and so it goes into overflow system which is kidneys to pee out?

Or does the excess go to the gut and as beetroot juice affects both stool and urine colour, B12 does the same to yellow?

I hope I don’t come across as disagreeing, I am just interested to understand what my body should do as is doing!!

🤗🤗🤗

[helvella in reply to Wwwdot]

The excess that is injected might well get peed out! (The word "excess" being a misnomer. It is B12 that is needed but cannot be retained because very high levels in the blood do indeed get passed through the kidneys. But it isn't excess as in "more than needed" overall - just more than can remain in the bloodstream.)

But what gets released from the liver is part of the entero-hepatic system which is broken in PA!

The amount stored in the liver is far less than many think. Let us accept the claim that we have, say, enough B12 to last two years in our livers. But that misapprehends how it works. It might last two years in someone who very efficiently recycles B12. But far shorter time in someone who cannot absorb the B12 from their gut.

Read around and you see that in optimum health we might need as little as 3 micrograms of B12 a day (some say even less). So the liver only needs to store 3 * 2 * 365 micrograms = 2180 to provide daily top ups for two years!

(Some suggest that a healthy adult could have stores that are much greater.)

If recirculation is broken, we would find that amount lasts far shorter time.

But what gets released from the liver and should be recirculated - doesn't in PA. So you are not absorbing enough that would colour urine. Though this is clearly possible after an injection. I never notice any change to urine colour however much B12 I take orally.

The

Enterohepatic

Circulation of

Vitamin B 12

b12info.com/wp-content/uplo...

[brenanddave in reply to helvella]

Thank you so much for that helvella x

[brenanddave in reply to Wwwdot]

Thats what I had thought! x

[Nackapan in reply to brenanddave]

It makes it to your liver stores but you cant utilise it .As used the same process as eating food. .

That system is broken b12 Injections bypass that by delivering the b12 directly into your blood stream..

The blood levels of b12 are kept high to be able to use it .

This is in the case of PA and many other unexplained absorbtion issues .

[brenanddave in reply to Nackapan]

Thank you Nackapan That really helps explain it. It is when doctors have a fixed idea what is going on which is incorrect and you start questioning your own understanding of it.

[tomdickharry]

Please read "THE ENTEROHEPATIC CIRCULATION OF VITAMIN B12" by Kevin Byrne, 2010.

There is no such thing as a liver store. B12 is NEEDED by the liver in large quantities in order for its role in metabolism.

[brenanddave in reply to tomdickharry]

Thank you tomdickharry! I will try to get it and read. x

[tomdickharry in reply to brenanddave]

b12info.com/wp-content/uplo...

[Oneash in reply to tomdickharry]

Ooh very good. Thanks for this.

[tomdickharry in reply to Oneash]

b12info.com/wp-content/uplo...

[Bellabab]

You also need to have enough folate because it works hand in hand with B12. Folate is readily available from beans and dark green vegetables however we must eat these regularly to get enough. I was surprised when I did not take note of this how little I was actually eating so I started growing my own French, runner and broad beans because I like them fresh. That became impossible and I crashed again. I started buying fresh veg from my local supermarket then the shortage of vegetable due to no one to pick them & Brexit shortages. I now take 5mg folic acid tablets daily as the consultant who saved my life from a B12 shortage told me to do. I am going to reduce from 1mg. B12 EOD and when I do I will take 5mg. folic acid every other day as well. I can find no evidence of any danger from a high folate diet.

[brenanddave]

Thanks for your reply. Yes! I take 5mg of folic acid too. I believe it is water soluble like b12 so no worries about too much. I'm sorry to hear you were so dangerously ill from b12. I was pretty close to there too when finally diagnosed. I am planning to continue with tablet form of folic acid, just because I am regularly taking high b12 and that way I can be sure I have enough to utilize that b12. x

[helvella in reply to brenanddave]

Water solubility alone is NOT sufficient to say no worries about too much of anything.

I offer Vitamin B6 as one example. Very definitely causes issues in excess.

Maybe even consider potassium cyanide? Very soluble in water...

[brenanddave in reply to helvella]

sorry! Should not shouldn't !

[Technoid in reply to helvella]

I don't think it's completely clear that long-term, very high dose folic acid has no safety concerns. In my opinion, there are some valid concerns raised by this narrative review:

mdpi.com/2072-6643/15/21/4699

Many people regularly inject high dose B12 without needing massive amounts of supplemental folate alongside.

[brenanddave in reply to Technoid]

Thanks Technoid I have been personally following protocol from another PA group that I have found works for me. It has given me my life back. This includes amongst other cofactors EOD b12 with 5mg folic acid. I have had to up my b12 to daily sometimes twice daily . I am guided by my body's response. I take folic acid to activate the b12 to assist absorption

[Technoid in reply to brenanddave]

Folic Acid doesn't activate B12 or do anything to affect B12 absorption but it sounds like this group have been very convincing to you. I've never seen them support this 5mg daily requirement with any evidence and I doubt they ever will. I do wish you well and I hope this protocol does not cause harm.

[brenanddave in reply to Technoid]

There are 43k people in this particular PA b12 def group following this protocol and it has been running for over 20 yrs and saved many lives from what I read from those in the group. Pat Kormic one of the founders of it helped with the development of the latest NICE guidelines. Its working for me!

[brenanddave in reply to Technoid]

efsa.europa.eu/sites/defaul... you may be interested in reading this Technoid

[Technoid in reply to brenanddave]

Thanks, I'm aware of the EFSA Tolerable Upper Limits research. That was from 2006 and the narrative review is from last year so I think it's possible that the UL research may be updated/revised based on some of the newer research from the review. In terms of form, folinic acid seems to be the safest but I still don't see a good reason to exceed the UL.

[helvella in reply to Technoid]

This is a list of citations of a 2020 paper:

europepmc.org/search?query=...

The 2020 paper:

Knowledge gaps in understanding the metabolic and clinical effects of excess folates/folic acid: a summary, and perspectives, from an NIH workshop.

europepmc.org/article/PMC/7...

There definitely seems to be concern over high intake of folic acid. Seemingly because folic acid supplementation appears to increase unmetabolized folic acid (UMFA). (Which wouldn't seem a surprise!)

A number of members of this forum have reported they suspect issues with high folic acid intake (e.g. 5 milligrams a day) but that would surely be dismissed as anecdotal.

No - I have not read them all!

[brenanddave]

Thank you helvella, That is true. I shouldn't have thought before writing that comment.