Bile Acids and Collagenous Colitis

[tex]

What's New In GI
July 2000
Volume 95, Number 7
Pages 1625-1626


Bile Acids and Collagenous Colitis
J. K. DiBaise, M.D.

Ung K-A, Gillberg R, Kilander A, et al. Role of bile acid binding agents in patients with collagenous colitis. Gut 2000;46:170-5.
Collagenous colitis is an increasingly recognized condition characterized by chronic watery diarrhea with a normal or near-normal appearance of the colonic mucosa and typical histological changes of lymphocytic inflammation of the lamina propria, intraepithelial lymphocytes, and thickening of the subepithelial collagen layer. Although the pathogenesis of this condition remains unknown, a luminal factor has been proposed as a possible etiological agent. In the study by Ung et al., the role of bile acids in collagenous colitis is investigated.
Over a 3-yr period, 404 patients with chronic, noninfectious diarrhea prospectively underwent upper and lower gastrointestinal endoscopy with biopsy and the selenohomocholytaurine test (75SeHCAT) for bile acid malabsorption. Treatment with a bile acid binder was then given, irrespective of the results of the 75SeHCAT test, to those with collagenous colitis. Twenty-eight patients were diagnosed with collagenous colitis—27 of whom had persistent diarrhea and completed the study. Of those 27, 12 (44%) were found to malabsorb bile acids. Bile acid binding treatment was followed by rapid improvement in 11 (92%) compared with 10 of the remaining 15 (67%) patients with normal 75SeHCAT tests. No information was presented regarding histological changes that occurred during treatment. The authors suggest that bile acid malabsorption is an important pathophysiological factor in collagenous colitis and further propose that bile acid binders should be considered first-line treatment of this condition.
On the basis of this information, it would seem unlikely that bile acid malabsorption would be the main pathophysiological mechanism of collagenous colitis for several reasons. First, other diseases associated with bile acid malabsorption are not associated with microscopic colitis. Second, bile acid malabsorption, at least in some circumstances, is a consequence of chronic diarrhea rather than the cause. Third, the response to bile acid binders may be nonspecific and related to the binding of substances other than bile acids. Histological changes produced by treatment will add important information to the bile acid-collagenous colitis story.
Should bile acid binders be the first-line therapy in these patients as the authors propose? This therapy clearly seems to have a high response rate and low toxicity; however, treatment may need to be continued indefinitely to maintain its effect. In my opinion, the best initial therapy remains another well-tolerated and low-risk medication with excellent efficacy when given over a finite period as demonstrated in an open label study (and my personal experience)—bismuth subsalicylate. Bile acid binders and other potential therapeutic choices would then be used when bismuth therapy fails.

Copyright ©2000 the American College of Gastroenterology
Published by Elsevier Science Inc.

American Journal of Gastroenterology

[Joseph7179]

Can you take Axid with microscopic colitis?

[tex]

I apologize for giving an ambiguous answer, but my response to that question would have to be "maybe". The reason has to do with the fact that Axid is an H2 blocker, and for a few of us, H2 blockers can trigger MC symptoms.

On the other hand, for some of us who have issues with excess histamine in our stomach and intestines (which is common with MC), H2 blockers can help to control our symptoms almost as well as a corticosteroid (if histamine is a problem). IOW, you would have to try it to see if it helps, or causes symptoms.

One thing is for sure, taking an H2 blocker is much, much safer (for our long-term health) than taking a proton pump inhibitor (PPI).

If you are considering taking it to control acid reflux or GERD, please be aware that acid reflux/GERD is common with MC, and it's typically caused by either a vitamin D deficiency, or a magnesium deficiency, or both. We have found that large doses of vitamin D (8,000—10,000 IU daily) for several weeks, plus supplemental magnesium, can often bring amazing relief in a matter of a few days, for many of us in that situation. Since large doses of magnesium act as a laxative, it's best to keep oral supplements under 400 mg daily. Topical applications (to the skin) of magnesium (dissolved in oil or water), or soaking in Epsom salts, allows a much higher level of safe supplementation, and works very well for most of us.

I hope this is helpful.

Tex

[Gabes-Apg]

I was able to resolve Gerd issues via Vit D3 and Magnesium.

I was also able to negate the need for H1 and H2 blockers (took them 5-6 days out of 7 for a couple of years) with high doses of Vit C, Magnesium and Zinc.
As Tex mentioned there are good Magnesium products that will not cause a Laxative effect.

when magnesium is deficient, gastric acid production is diminished, hindering magnesium absorption even more

[nerdhume]

tex

We have found that large doses of vitamin D (8,000—10,000 IU daily) for several weeks, plus supplemental magnesium, can often bring amazing relief in a matter of a few days, for many of us in that situation.

Is it safe to take that much vitamin D? I have been supplementing with 4000 IU daily. Haven't had my blood tested yet.

[C.U.B. girl]

The article quoted in the original post must be the data my GI is using to defend the script for colestipol he gave me. I notice the date on it is 14 years ago, which makes it ancient as far as medical studies go. But then few doctors take the time to read anything current, and it certainly shows in their outmoded treatments and recommendations….

Like Theresa, I'm also questioning the wisdom of taking such high doses of vitamin D. I've read several articles lately that suggest that vitamin D supplements, when taken without the appropriate amount of vitamin K2, will do more harm than good by directing calcium to the walls of blood vessels rather than to the bones, thereby increasing the risk of atherosclerosis. Unfortunately, all the K2 supplements I've found contain soy, which is contraindicated for most of us.

It would be a great irony to die of a heart attack at the expense of being GERD-free…..

Any info on this?

[JFR]

There are soy free K2 supplements

http://www.vitacost.com/douglas-laborat ... n-capsules

Jean

[tex]

Is it safe to take that much vitamin D? I have been supplementing with 4000 IU daily. Haven't had my blood tested yet.

Yes, in general, regardless of your vitamin D level, it's safe to take 5,000 IU daily, as long as you do not have hypercalcemia. The reason for this is because the body generally uses about 5,000 IU of vitamin D daily, on the average. This is the daily dose that the Vitamin D Council recommends as a safe starting dose, and then your vitamin D level should be checked at about 6 months or so, to see if the dose needs to be adjusted up or down, or left where it is.

Hypercalcemia is a condition associated with excess serum calcium. Hypercalcemia is typically caused by parathyroid malfunction, but vitamin D can make the condition worse, and vitamin D toxicity can also cause hypercalcemia (this is a risk if 25(OH) D blood levels reach 150 mg/dL, or greater).

Tex

[tex]

The article quoted in the original post must be the data my GI is using to defend the script for colestipol he gave me. I notice the date on it is 14 years ago, which makes it ancient as far as medical studies go. But then few doctors take the time to read anything current, and it certainly shows in their outmoded treatments and recommendations….

Yes, you're quite correct. I posted that article about 2 months after this board was opened to the public, over 9 years ago. I should have mentioned in my response that I disagree with the position advocated in the article, now that we know much more about treating MC. One of the big problems with medical literature, is that old articles that have become obsolete, and even articles that have been shown to have reached totally incorrect conclusions, are never removed from the libraries. Most of us here recognize that, and take that possibility into consideration when reading old articles, but many doctors seem to have a more simplistic attitude and they assume that if it was published in a peer-reviewed medical journal, then it must be the truth, and they never seem to worry about glaring discrepancies.

Like Theresa, I'm also questioning the wisdom of taking such high doses of vitamin D. I've read several articles lately that suggest that vitamin D supplements, when taken without the appropriate amount of vitamin K2, will do more harm than good by directing calcium to the walls of blood vessels rather than to the bones, thereby increasing the risk of atherosclerosis.

Before using vitamin D at higher doses, one needs to learn a bit about it, in order to stay safe. In general, at nominal doses (say, below 10.000 IU daily), vitamin D is just a supplement, helpful for maintaining desirable blood levels of 25(OH)D. At doses above roughly 10,000 IU per day, vitamin D becomes therapeutic. IOW, at higher doses it acts more like a medication, than a vitamin supplement.

When I thought I was coming down with the "swine flu" a few years ago, on the second day I began taking 50,000 IU of vitamin D each day. It never developed, and after the 4th day I dropped back down to my regular dose. If I thought that I were developing a virus as serious as ebola, I would be taking about 150,000 IU each day, for at least a week or 10 days, or until the symptoms reduced.

Here's a quote from chapter 6 of my book on Vitamin D and Autoimmunity, but of course this version may be revised before it's published:

In general, someone taking 5,000 IU of vitamin D daily, for example, may or may not gradually increase their blood level of 25(OH)D, but they are not likely to ever reach a toxic condition at that dosage rate. By contrast, someone who takes 40,000 IU each day, for an extended period, will almost surely reach a toxic condition after a few months of taking such a high dose. In between these extremes is a broad gray area.

Too much vitamin D tends to cause excess calcium absorption, so high blood levels of vitamin D can lead to a dangerous condition known as hypercalcemia. To date, it appears that all known cases of vitamin D toxicity with hypercalcemia have been associated with daily vitamin D intakes of over 40,000 IU.3 Therefore, in cases where vitamin D deficiency or insufficiency needs to be corrected, a daily dosage in the range of 5,000–10,000 IU for several weeks or so would not seem unreasonable, provided that the blood level is tested occasionally in order to monitor the progress of the treatment. Beyond that though, higher doses taken for extended periods of time can be risky. Taking for example, 15,000–20,000 IU daily for a few weeks probably would not cause any problems, but taking that much for several months could be asking for trouble. Unfortunately the medical literature is severely lacking when it comes to specific information on vitamin D toxicity It mostly consists of case studies and speculation.

Here is reference #3 in that quote:

3. Vitamin D Overdose. (2013, September 7). News-Medical.Net. Retrieved from http://www.news-medical.net/health/Vita ... rdose.aspx

Therefore, to treat GERD aggressively, one needs to take doses at least at the bottom of the therapeutic range 8,000-10,000. If I recall correctly, that's exactly what Gabes did, in order to bring her GERD under control relatively quickly. Once the immediate problem is resolved, then the dosage should be reduce to a more normal range. That avoids any risk of a toxic overdose. As mentioned in the quote above, overdoses don't normally occur due to short term dosing — they occur due to very large doses taken daily for months and months. The only known short-term overdose cases have been due to industrial accidents, and outrageous pharmaceutical labeling errors (where the dosage may be understated by a factor of 10,000, for example. We had one member who had that happen to her with her thyroid supplement — it contained 10,000 times as much thyroxine as it was labeled to contain.

Tex

[MBombardier]

This is the one I take which has no soy or anything else I can't have:

Nutricology Vitamin D3 Complete with Vitamin A and K2 Capsules
http://www.amazon.com/gp/product/B003YQ ... UTF8&psc=1

[C.U.B. girl]

Thanks for the clarification, Tex. When I think about it, none of the articles I read mentioned a "safe" vs. "therapeutic" dose; it was more of a "if-you-take-vitamin-D-you-need-to-take-vitamin-K2-as-well" kind of approach. At 5,000 IU a day, I guess I'm in the "safe" range….

And thank you Jean and Marliss, for the K2 recommendations! Most of the ones I've looked at derive the K2 from natto, which is fermented soybeans. I will definitely check in to the ones you mentioned, especially if I should need to raise my vitamin D intake significantly.

[nerdhume]

Thanks Tex for your usual quick response.

I found these Vitamin D gummies at Walmart a while back (no allergens). I've been taking one with each meal and another D2 1000 IU once per day.
http://www.walmart.com/ip/Spring-Valley ... t/16935791

[Gabes-Apg]

If your body has any type of inflammation, not just the gut, joint, muscle, adrenals, nervous system, etc you use more Vit D3.

Vit D3 levels can deplete quickly if you are going through periods of stress and magnesium deficient.
Correct the magnesium deficiency, and the vitD3 will be more stable and useful.

The RDI, for most nutrients and minerals are outdated, not in line with the needs of our bodies in this era.
My research thus far on cells, cell health, nutrients and minerals, anyone with any sort of medical condition uses more of the essential nutrients/minerals.
Anyone with an IBD needs way more, as nutrient/mineral absorption via the gut is reduced.
An option to overcome this is to use lingual products where possible as this bypasses the gut.

Small doses through the day also works well.
For things like magnesium, calcium, zinc, taking small doses each snack and meal replicates how it would have been absorbed 60-80years ago.

[Joseph7179]

Thanks so much for the suggestions. I will boot up my vitamin D and try the other thing too.

Now he wants me to take protonix once a day. Same risks I presume?

[tex]

That's even worse. Protonix is a proton pump inhibitor. PPIs are known to be a major cause of MC, osteoporosis, C. diff infections and an increased risk of other intestinal bacterial infections. also.

H2 blockers are much safer if you're trying to reduce stomach acidity (reducing stomach acid is the main reason why PPIs are prescribed).

Tex