After trying several medications for my MC which did not help much if at all, last summer I tried cholestyramine after reading Polly's post. It seemed to be the first thing (aside from diet, which I was controlling 80% of my symptoms with) that helped me in terms of medication. I have an issue though which is that I routinely have low cholesterol and am worried about it going too low being on the cholestyramine. I have read that Bile Acid Malabsorption can cause more cholesterol to be carried out of the body and it can result in a lower LDL number and sometimes a higher HDL number which is exactly what my lipid tests show. My total cholesterol at last check was around 139 with an HDL of 95 and LDL of 40, triglycerides 22. I know that cholesterol is necessary in the body for many reasons including making hormones. Does anyone else with supposed Bile Acid Malabsorption have this problem or have any insight on the issue? Also I am really trying to understand what causes the BAM. I also have SIBO which can cause bile issues but I can't figure out if the BAM causes the SIBO or the SIBO causes the BAM.
Any insight is greatly appreciated. 3
Thank you!
Robin
Bile Salt Malabsorption question
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
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robinc2525
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- Posts: 75
- Joined: Sat Jun 08, 2013 7:29 am
Hi Robin,
I don't have any insight to share on the cholestyramine, because I have never taken it. But I did take a statin for a while after having a couple of TIAs 5 or 6 years ago. My cholesterol level was declining anyway because a few months earlier I had emergency surgery that including removing part of my terminal ileum (where as you are probably aware, bile acids are absorbed for recycling). But by adding a statin on top of the loss of part of my terminal ileum it didn't take long for my cholesterol level to plummet to the level you mentioned. Fortunately a few months later the statin caused my finger joints to lock while I was sleeping, so I was able to drop the statin without any nagging from my doctor.
Most doctors would insist that your cholesterol level is great, but I disagree (of course I ain't no doctor
). Many/most doctors seem oblivious to the fact that low cholesterol levels are associated with an elevated mortality risk during traumatic health events (such as a bad accident or major surgery), and they actually believe that the lower the total cholesterol level, the better. They haven't done their homework. Low cholesterol also is not associated with longevity in general. In fact, after the age of roughly 65 or so, optimum longevity is associated with a cholesterol level at least twice as high as the number you mentioned, or higher. And there are other undesirable effects of low cholesterol levels, including neurological issues (cholesterol protects the myelin sheaths that protect nerves from drying out and dying, for example). A form of cholesterol is also the feedstock used by the body to make vitamin D in the skin, upon exposure to sunlight.
As an interesting observation I mention that my HDL level was always too low, and no matter what I did (or what I ate), I was unable to increase it. It was always in the 30s, usually the low 30s. My doctor shrugged and blamed it on inherited genetics. This went on for decades. But at some point after I doubled my magnesium supplementation last spring, my HDL broke into new territory. For the first time in my life my last test showed my HDL level to be in the 40s — 44 mg/dL, to be exact.
The bottom line appears to be that for younger people, low cholesterol may be a good thing (up to a point), but that advantage fades away as we age. Most doctors haven't updated their thinking to incorporate that information though, unfortunately.
No one knows what causes BAM. If someone ever figures that out, it will be beginning of some substantial progress in understanding the human digestive system.
Tex
I don't have any insight to share on the cholestyramine, because I have never taken it. But I did take a statin for a while after having a couple of TIAs 5 or 6 years ago. My cholesterol level was declining anyway because a few months earlier I had emergency surgery that including removing part of my terminal ileum (where as you are probably aware, bile acids are absorbed for recycling). But by adding a statin on top of the loss of part of my terminal ileum it didn't take long for my cholesterol level to plummet to the level you mentioned. Fortunately a few months later the statin caused my finger joints to lock while I was sleeping, so I was able to drop the statin without any nagging from my doctor.
Most doctors would insist that your cholesterol level is great, but I disagree (of course I ain't no doctor
). Many/most doctors seem oblivious to the fact that low cholesterol levels are associated with an elevated mortality risk during traumatic health events (such as a bad accident or major surgery), and they actually believe that the lower the total cholesterol level, the better. They haven't done their homework. Low cholesterol also is not associated with longevity in general. In fact, after the age of roughly 65 or so, optimum longevity is associated with a cholesterol level at least twice as high as the number you mentioned, or higher. And there are other undesirable effects of low cholesterol levels, including neurological issues (cholesterol protects the myelin sheaths that protect nerves from drying out and dying, for example). A form of cholesterol is also the feedstock used by the body to make vitamin D in the skin, upon exposure to sunlight.As an interesting observation I mention that my HDL level was always too low, and no matter what I did (or what I ate), I was unable to increase it. It was always in the 30s, usually the low 30s. My doctor shrugged and blamed it on inherited genetics. This went on for decades. But at some point after I doubled my magnesium supplementation last spring, my HDL broke into new territory. For the first time in my life my last test showed my HDL level to be in the 40s — 44 mg/dL, to be exact.
The bottom line appears to be that for younger people, low cholesterol may be a good thing (up to a point), but that advantage fades away as we age. Most doctors haven't updated their thinking to incorporate that information though, unfortunately.
No one knows what causes BAM. If someone ever figures that out, it will be beginning of some substantial progress in understanding the human digestive system.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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robinc2525
- Adélie Penguin
- Posts: 75
- Joined: Sat Jun 08, 2013 7:29 am
Robin,
The "secret" to reducing cholesterol levels is to eat a high-fat, low carb diet. I use the term "secret" because physicians choose to ignore this research so that they can prescribe drugs to lower cholesterol levels rather than to recommend a high-fat, low-carb diet. Doctors love to prescribe drugs and they have little use for dietary treatments, since dietary training is not part of their education.
So I would postulate that the secret to raising cholesterol levels should be to eat less animal fat and more carbs. However, since eating animal fat is not only healthy in general, but protects against heart disease, nerve and brain damage, and other important aspects of long-term health, the best solution seems to be to eat both animal fats and carbs. The article at the first link below supports (by verified medical research data) the claim that eating a high-fat low-carb diet lowers serum cholesterol, and the article at the second link sort of sums up the observation that eating animal fats protects against heart disease (with or without an increase in cholesterol level). IOW, eating plenty of animal fats helps to protect against the damage that is typically caused by carbs in the diet.
So if we compare both articles, we can conclude that:
1. Eating a high-fat diet is much healthier than eating a low-fat diet.
2. A higher cholesterol level is healthier than a cholesterol level that is too low (provided that one's diet contains plenty of animal fat).
3. Carbs in the diet (especially grains) increase cholesterol levels.
Reducing the serum cholesterol level with a diet high in animal fat.
How To Raise Your Cholesterol
My advice for a long, healthy life is to eat plenty of animal fats, and if low cholesterol is a problem, then add a significant amount of grains to help increase your cholesterol level. There is some evidence that dairy products can help to increase cholesterol levels, also, for those who are not sensitive to casein. Even if you're unable to raise your total cholesterol level significantly, added fat in the diet (especially animal fat) will help to reverse the bad effects of low cholesterol.
The main thing is to avoid a falling cholesterol level over the long term — that seems to be the key to mortality risk. As we age, it's desirable to have an increasing cholesterol level. Even if our cholesterol level is numerically low, as long as it's increasing we can probably side-step the increased risk that's traditionally associated with a low cholesterol level, and we should certainly be able to avoid the risk associated with a declining cholesterol level. As evidence of what I'm suggesting, consider this quote from the second article that I cited above.
You're very welcome, of course.
Tex
The "secret" to reducing cholesterol levels is to eat a high-fat, low carb diet. I use the term "secret" because physicians choose to ignore this research so that they can prescribe drugs to lower cholesterol levels rather than to recommend a high-fat, low-carb diet. Doctors love to prescribe drugs and they have little use for dietary treatments, since dietary training is not part of their education.
So I would postulate that the secret to raising cholesterol levels should be to eat less animal fat and more carbs. However, since eating animal fat is not only healthy in general, but protects against heart disease, nerve and brain damage, and other important aspects of long-term health, the best solution seems to be to eat both animal fats and carbs. The article at the first link below supports (by verified medical research data) the claim that eating a high-fat low-carb diet lowers serum cholesterol, and the article at the second link sort of sums up the observation that eating animal fats protects against heart disease (with or without an increase in cholesterol level). IOW, eating plenty of animal fats helps to protect against the damage that is typically caused by carbs in the diet.
So if we compare both articles, we can conclude that:
1. Eating a high-fat diet is much healthier than eating a low-fat diet.
2. A higher cholesterol level is healthier than a cholesterol level that is too low (provided that one's diet contains plenty of animal fat).
3. Carbs in the diet (especially grains) increase cholesterol levels.
Reducing the serum cholesterol level with a diet high in animal fat.
How To Raise Your Cholesterol
My advice for a long, healthy life is to eat plenty of animal fats, and if low cholesterol is a problem, then add a significant amount of grains to help increase your cholesterol level. There is some evidence that dairy products can help to increase cholesterol levels, also, for those who are not sensitive to casein. Even if you're unable to raise your total cholesterol level significantly, added fat in the diet (especially animal fat) will help to reverse the bad effects of low cholesterol.
The main thing is to avoid a falling cholesterol level over the long term — that seems to be the key to mortality risk. As we age, it's desirable to have an increasing cholesterol level. Even if our cholesterol level is numerically low, as long as it's increasing we can probably side-step the increased risk that's traditionally associated with a low cholesterol level, and we should certainly be able to avoid the risk associated with a declining cholesterol level. As evidence of what I'm suggesting, consider this quote from the second article that I cited above.
But I have a hunch that cholesterol levels are not nearly as important to health as plenty of fat in the diet and the long-term direction in which our cholesterol level is changing. It doesn't necessarily have to be increasing — we just don't want it to be decreasing after we are in our "golden years".For example, here is another quote from the Framingham study on the impact of cholesterol levels themselves. There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years. 11% overall and 14% CVD death rate increase per 1mg/dl per year drop in cholesterol levels.
In short, once your cholesterol level starts to fall, you are much more likely to die from heart disease. A 150% increase in relative risk for every 10 % fall, approximately. Add this to another very big study of the elderly, published in the Lancet: Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol levels, and show that long term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations the greater the risk of death.
You're very welcome, of course.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Bearcat,
My HDL is very high, too.
November 2012: LDL 56, HDL 87, TG 54
December 2013: LDL 51, HDL 116, TG 65
I switched primary care physicians in fall last year and the new primary care physician ordered a ton of blood tests when she first saw me, including a lipid panel. I really like my new PCP. However, the computers of her hospital system and the local hospital system where I need to get the blood tested in order to be covered by insurance do not seem to communicate with each other at all. So the results never automatically show up in my online file. They need to scan the fax with the results from the other hospital and I cannot look at my own blood results. I did not think to ask her when I last saw her what my most recent HDL was, she just said all the lipids were fine. I will have to ask her next time.
Not a single physician so far brought it to my attention that my HDL was that high, though, or thought anything of it!
Love, Patricia
My HDL is very high, too.
November 2012: LDL 56, HDL 87, TG 54
December 2013: LDL 51, HDL 116, TG 65
I switched primary care physicians in fall last year and the new primary care physician ordered a ton of blood tests when she first saw me, including a lipid panel. I really like my new PCP. However, the computers of her hospital system and the local hospital system where I need to get the blood tested in order to be covered by insurance do not seem to communicate with each other at all. So the results never automatically show up in my online file. They need to scan the fax with the results from the other hospital and I cannot look at my own blood results. I did not think to ask her when I last saw her what my most recent HDL was, she just said all the lipids were fine. I will have to ask her next time.
Not a single physician so far brought it to my attention that my HDL was that high, though, or thought anything of it!
Love, Patricia