Malabsorption of drugs?

[Chickens44]

I am still awaiting a diagnosis of PA, but do suspect I do have it. My stomach pH level was recently 8.1, so very low stomach acid, which is why I am not absorbing/processing B12, iron and folate. I also did a test which showed I have very low diamine oxidase in my gut so have histamine intolerance.

My question is regarding my medication. I currently take 100mg sertraline, two blood pressure pills and a statin. Are these not getting into my system either? I wondered whether I should taper off these, as if they are not being absorbed they are not working, so I don’t see the point in continuing them. I am also on HRT, but I use patches. Although I suspect my flushes are more to do with PA than menopause which I should be well through by now.

Your thoughts would be much appreciated.

[Nackapan]

I personally wouldn't come off your drugs .B12 has a specific route of absorbtion.

You are absorbing most things otherwise you wouldn't be surviving.

Wait until you have a clearer picture

[Narwhal10]

Hi Chickens44,

It is rather difficult to ascertain the definitive and gold standard PA diagnosis mainly because both the vitamin B12 test is not very good* and the Intrinsic Factor test is only 50 % reliable.

Apart from feeling unwell, it can feel like you are wandering around a minefield with PA/B12D. So, the best thing you can do is organise and collate your Medical Data. I recommend joining the PA Society to have accurate information and pass information to your NHS GP. if you have not already.

Please know your Family History. Anyone who had gut problems ? Autoimmune Diseases ? Low Iron. Had B12 injections ? Or possible misdiagnoses.

Know your own Medical History when you can say the time, date, name of doctor, their position and where (GP Practice, Clinic or Hospital), investigation, diagnosis and treatment including dosages of drugs, frequency, the Clinician you are interacting will respond very differently to you.

Have all your blood results in Hard Copy and spend some time writing out the aforementioned in a Word document.

From previous posts, I can see that you have had 2 Microbiome Tests. Now, as far as I am aware, they are more geared to looking at the bacteria in the gut. So, it should be a lengthy report with weird names such as Saccharomyces cerevisiae. The report is to show you have Good Microorganisms, Neutral ones and the Baddies.

To date you have established (privately) the following :-

1) Hypochlorhydia - you have discussed taking Betaine HCL.

2) Low DiAmine Oxidase - I recommend a low histamine diet and a DAO enzyme is available on Amazon. See diet :-

histaminintoleranz.ch/downl...

3. Symptoms diary

4. Food diary

5. On your blood results is the cut-off and range for the vitamin B12 test in your CCG/Trust is. This is another huge problem, different areas, have different cut-offs. So, anywhere between 130 mg/L or 210 mg/L.

6. You have seen 2 private gastroenterologists but did they test serum (blood) gastrin levels ? Endoscopy ?

7. Anyway, the most important aspect is you have a forthcoming appointment with ‘The Doctor’. He will get you on the right track.

Please know that doctors are not trained in Nutrition, so discuss a referral to a Dietician . With regards to your current Medication, as Nackapan said it is definitely not recommended. Although, in a previous post, the Private GP ‘suggested you stop taking statins for a month to see if that helps with the fatigue.’

All different Medications have different ways of absorption, distribution, metabolism and excretion. The posh name is pharmacokinetics. The gastrointestinal tract is approximately 9 metres long and so many interactions happen along it. One of the most important indicators is the end product our stools. Frequency, urgency, shape, size, colour, odour. Please do not be afraid or embarrassed discussing this.

Lastly, you may or may not have Small Intestinal Bacterial Overgrowth which is diagnosed via a breath test which your NHS GP may be able order. This is the pathway. ‘The Doctor’ most probably knows all this but your NHS GP will not.

clinicaleducation.org/docum...

For reasons of confidentiality, we do not name doctors on the main page. Private messaging is absolutely fine. The Doctor is the Go To Person. 👍🏻

Hope this helps.

🐳

* Wildly inaccurate as the NHS B12 test measures both active and inactive B12 and between 40 and 70 % can be inactive.

[Chickens44 in reply to Narwhal10]

Thanks for advice. I have dates and docs/consultants visits, also tests and all results. I am very good at record keeping. I have low diamine oxidase so am taking Betaine HCL. I have also started taking Apple Cider Vinegar, a very good one with the mother. I haven’t had Gastrin test. Both gastroenterologists (which I saw privately) couldn’t diagnose what was causing my pain, bloating and other symptoms. They didn’t seems keen on doing more investigations like endoscopy (which I’m not sorry about as I hate them). I did a low FODMAP diet for six weeks with no change to symptoms. I consulted a dietitian through this and even she agreed after six weeks she didn’t think it was food related. I have also done allergy and intolerance tests, and nothing jumps out as affecting me.

The gut microbiome tests were useful in the fact that they showed I have high pH, which at first I didn’t know what it meant, but on further research it brought me to PA answers to so many questions.

I seem to recall my mum saying my grandmother had pernicious anaemia, but I’m not certain. And my sister has rheumatoid arthritis. Both my mum and my sister were on B12 injections, so they obviously had some issues. Unfortunately they are not here now, so I cannot ask them.

I was waiting for the intrinsic factor antibody results from my GP, but after waiting 5 weeks, it appeared my specimen got lost! So have just done another blood test. I’m not pinning any hopes on it being positive, but you never know.

And as to my B movements, since I stopped taking omeprazole in December last year, they have been much better. I was going 3 - 4 times a day, and loose, but now once or twice in the morning. And they look great!!! 💩

[FlipperTD in reply to Chickens44]

Hi. Scientist, not medic. Purely observing that the pH 8.1 you state is actually alkaline. Below 7.0 is acid, above 7.0 is alkaline. I appreciate this isn't much help.

[Chickens44 in reply to FlipperTD]

I’m working on it. Taking Apple Cider Vinegar and Betaine HCL.

[B12life]

What was your b12 level before any supplementation?

[Chickens44 in reply to B12life]

Active B12 was 48 (range 37.5 - 188), GP test was 213 (range 150 - 771)