Every time I think I have a handle on how this essential vitamin works, I read something and have to adjust my understanding.
Has anyone read this? Enough to have a discussion about it?
The Enterohepatic Circulation of Vitamin B12
My takeaway quotes were:
“The reabsorption of bile cobalamin explains why it takes approximately 20 years to get cobalamin deficiency after ending consuming dietary cobalamin but only 1-3 years if one stops absorbing cobalamin due to diseases in the stomach, pancreas or ileum….PA patients - along with other sufferers of conditions inhibiting digestive secretions - tend to “crash” far more quickly than people who….simply starve themselves of B12. Digestive secretions are the clue.”
“To view the liver as simply a “B12 store” is to be profoundly misled. The liver is the core of an elegant B12 recycling machine, and the process is fundamentally different the extraction and replacement of, for example, skeletal calcium.”
That is also why the idea of injecting once every three months is so incredibly misconceived.
1000 micrograms every 90 days - call that 10 a day.
And our need is often suggested to be just 3 micrograms a day. Superficially that looks like three times as much as we need.
But 3 micrograms is based on only replacing what is typically lost daily in someone who has no impairment of their enterohepatic recirculation.
And it ignores that some of the 1000 gets lost very quickly after injection. Possibly quite a lot.
I always go back to one of those garden water features which pumps water up either in a small fountain or to the top of a waterfall. It gives every impression of being an almost never-ending process. But even a small leak will see it fail very quickly.
Thanks Helvella! It’s so interesting (now that I’m not arguing with my doctor for more injections).
When our bodies work well, it’s incredible (like the fountain) but yes, one small fault puts the whole thing out of whack very quickly and very messily.
Do you have any other med journals or similar that supports the paper I’ve shared?
Others are far more involved in B12 than me. (I'm more of a thyroid person who happened to be walking by...) I really don't collect B12 references but try to add incrementally to the little I know.
I even had a doctor (not my GP, she’s been wonderful) contradict themselves - I’d asked about more regular injections and they said “oh no, you won’t need more than this. You’ll just pee out any excess, so it’ll be an expensive wee (side note, 3 vials in Aus costs me $8.50).”
5 minutes later, she says “And your liver will store it all anyway so you’ll be set for a few months.”
I just sighed internally. Both of these can’t be right!
indeed! The ignorance of GPs is incredible. They ´resist’ learning about the importance of B12 generally but more so for those who are deficient and/or have been undiagnosed PA. B12 ampoules cost peanuts compared to most other medication. I had to fight tooth and nail to obtain a prescription a few years ago. I was passing out. It made a big difference.
Interesting, thanks! So if I’ve understood the article that I shared, then the liver is important, not for b12 storage, but rather for the recycling of B12. So can we infer that the high B12 and fatty liver disease link is that the liver isn’t properly recycling and is instead discarding (abandoning) the b12 in the bloodstream?
Without reading beyond the abstract, I want to shout!
NAFLD and raised liver enzymes are more common in hypothyroidism. As is relatively low B12. Often attributed to reduced stomach acidity, digestive enzymes, and possibly reduced intrinsic factor.
Could this operate in the opposite direction and maybe even confuse and confound other studies?
Yes, read many times. Sadly, doctors don't accept it. They still say 'B12 is stored in the liver' like it was a surplus ready to be taken as needed. The liver NEEDS that B12 even though it circulates it through the body. In malabsorption the body doesn't get it from food but still loses it through faeces. That's why sufferers get sick fast.
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High b12 & elevated liver enzymes
High liver levels and low B12
Does the liver store B12 after loading? 
Can too much B12 damage the liver?
Is it true that with PA you can’t store b12 in the liver?
