Bile Acid Malabsorption?

mle_ii · Post by **mle_ii** » Fri Oct 27, 2006 3:21 pm

Anyone here diagnosed with bile acid malabsorption?

Liz · Post by **Liz** » Fri Oct 27, 2006 4:16 pm

Not so much as malabsorption but 30 or so years ago when they did not know anything about MC & were at a loss to know what was wrong with me they said that I had 'Non Specific Colitis' & that I over produced bile salts. Don't know what signifigance this has.

Cheers

Liz

mle_ii · Post by **mle_ii** » Fri Oct 27, 2006 4:23 pm

Liz wrote:Not so much as malabsorption but 30 or so years ago when they did not know anything about MC & were at a loss to know what was wrong with me they said that I had 'Non Specific Colitis' & that I over produced bile salts. Don't know what signifigance this has.

Cheers

Liz

Thanks! Not sure what significance this has either, but I ran across bile acid malabsorption and Microscopic Colitis in a few articles and wondered how many folks here have bile acid issues.

Mike

mle_ii · Post by **mle_ii** » Fri Oct 27, 2006 5:39 pm

On additional related question. Anyone here have or has had gallstones? Or even eleveated bilirubin?

Post by **tex** » Fri Oct 27, 2006 8:39 pm

Mike,

I believe at some point in the past, we've discussed the fact that an unusually high number of MCers have had gallbladder surgery.

Tex

mle_ii · Post by **mle_ii** » Sat Oct 28, 2006 12:00 am

Ah, I'll have to look for those posts.

artteacher · Post by **artteacher** » Sat Oct 28, 2006 11:17 am

Hi there,
The fact that I take Caltrate 600 +, and it helps my D, led me to believe that I had a bile salt problem. I asked my doctor if there could be something wrong with my gallbladder, he sent me in for the test where you swallow the radioactove stuff and they track it's progress through the gallbladder (gee I hope that's correct). Anyway, they said I looked normal.
But, I don't know if there are other tests that should have been done. I think "things" irritate the lining of my intestinal walls, and bile acids are just one of them.
By the way, if you do a search on Caltrate and gallbladder, you will find sites that say many people who had their gallbladders removed find relief from the D by taking Caltrate: apparently it absorbs the bile acids, making them less irritating.

Love, Marsha

mle_ii · Post by **mle_ii** » Sun Oct 29, 2006 9:38 am

Yes, indeed fiber and calcium help absorb bile acids.

There are some other tests, but have to do more research first. One of which has to do with a type of cholesterol that's not normally tested for and another has to do with what the bile acid content is. Supposedly these two can have an effect but still get "normal" results due to the lack of specifity of the basic tests.

cludwig · Post by **cludwig** » Sun Oct 29, 2006 10:20 am

Hi Mike,

I have had stones that went away on their own and grannyh and I were chatting on my dr appointment post that we both have sediment in our gall bladders.

Love,
Cristi

artteacher · Post by **artteacher** » Sun Oct 29, 2006 10:30 am

Hi Mike,

I guess I don't really know what bile acid or bile salts are, other than irritating. Now I have to do research, too. Thanks for opening up this line of thinking . .

Marsha

mle_ii · Post by **mle_ii** » Tue Oct 31, 2006 12:00 pm

Well, well... look what else helps with bile acid malabsorption:
Human ileal bile acid transporter gene ASBT (SLC10A2) is transactivated by the glucocorticoid receptor
http://gut.bmjjournals.com/cgi/content/full/53/1/78

Background: Patients with Crohn’s disease suffer from intestinal bile acid malabsorption. Intestinal bile acid absorption is mediated by the apical sodium dependent bile acid transporter ASBT/IBAT (SLC10A2). In rats, ASBT is induced by glucocorticoids.
Conclusions: Human ASBT is induced by glucocorticoids in vitro and in vivo. Induction of ASBT by glucocorticoids could be beneficial in patients with Crohn’s disease who exhibit reduced ASBT expression. This study identifies ASBT as a novel target of glucocorticoid controlled gene regulation in the human intestine.

Comments on this study:
http://gut.bmjjournals.com/cgi/content/full/53/1/10

mle_ii · Post by **mle_ii** » Tue Oct 31, 2006 12:17 pm

It appears that bile acids take part in the negative feedback for the activation of glucocorticoids.
http://www.ncbi.nlm.nih.gov/entrez/quer ... s=16123152

So perhaps the body produces too much bile acid that cannot be regulated by the bodies version of glucocorticoid.

mle_ii · Post by **mle_ii** » Tue Oct 31, 2006 12:30 pm

It gets more and more interesting. Guess what else promotes bile acid uptake...
Transactivation of rat apical sodium-dependent bile acid transporter and increased bile acid transport by 1alpha,25-dihydroxyvitamin D3 via the vitamin D receptor.
http://www.ncbi.nlm.nih.gov/entrez/quer ... s=16481392

Here we go again with Vitamin D!

What is even more interesting is that Bile Acid, Cholesterol, Vitamin D, Glucocorticoids and other sterols are all involved in the same path.

Here's a diagram of the pathway:
http://www.jlr.org/content/vol43/issue1 ... 163f1.jpeg

harvest_table · Post by **harvest_table** » Tue Oct 31, 2006 1:54 pm

Whoa, I'm learning here.

Okay, the prednisone I used years ago at the height of my imflamation (found immediate relief) is a synthetic steriod, a glucocorticoid which our bodies make naturally. Pred is an anti-imflamatory drug which reduces the imflamation without acting on the cause of it. Long term use of Pred of coarse is not a very good option because of it's side effects.

So, in laymans terms, bile acids affect our glucocorticoid levels which are also regulated by vitimin D...or something like that.

Noticed you have been mentioning vitimin D lately, do you believe taking it as a supplement might possibly help improve bile acid malabsorption problems? I don't seem to have BAM problems but vitimin D is the only thing I'm not getting naturally from my diet. I saw a post where Polly was considering supplementing with it.

These data support a regulatory role for the VDR in the protection of colon cells from bile acid toxicity through regulation of the Mrp3 expression.

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=15824121

I vote we nickname you "Mikey, Our Resident Mad Scientist" and start a collection for a nice lab kit to send you for Christmas. Thank you!

Love,
Joanna

mle_ii · Post by **mle_ii** » Tue Oct 31, 2006 2:27 pm

harvest_table wrote:Whoa, I'm learning here.

Okay, the prednisone I used years ago at the height of my imflamation (found immediate relief) is a synthetic steriod, a glucocorticoid which our bodies make naturally. Pred is an anti-imflamatory drug which reduces the imflamation without acting on the cause of it. Long term use of Pred of coarse is not a very good option because of it's side effects.

Right, prednisone is a synthetic version of our bodies own glucocorticoid. I think that one of the problems with prednisone is that it is systemic, meaning it effects more than just the GI tract. It is an immunosupressant, so via that mechanism it would indeed be anti-inflamitory.

Budesonide, or Entocort is supposedly more directed towards the ileum and right (ascending) colon. And thus would have less of the side effects the prednisone would have.

harvest_table wrote: So, in laymans terms, bile acids affect our glucocorticoid levels which are also regulated by vitimin D...or something like that.

Well, I was saying the opposite, but the article you linked shows that it would have an effect on Vitamin D. So in laymans terms what I was saying is that both glucocorticoids and Vitamin D have an effect on bile acids. Either to absorb bile acids when these steroids are present, or perhaps to not absorb well enough when they are not present. But it also looks like from the article you linked that bile acids when present in the colon would switch on the VDR and thus have a similar immunosupressive effect in the colon.

Given that might some folks be lacking in this receptor or have a malformed receptor and thus inflammation isn't regulated? Or might there just be too much bile acid and thus it overwhelms the receptor? Or perhaps we don't produce enough bile acid and thus the VDR never gets switched on? I have no idea.

harvest_table wrote: Noticed you have been mentioning vitimin D lately, do you believe taking it as a supplement might possibly help improve bile acid malabsorption problems? I don't seem to have BAM problems but vitimin D is the only thing I'm not getting naturally from my diet. I saw a post where Polly was considering supplementing with it.

Given the recent thoughts/readings on bile acid I'm not so sure that supplementation is a good idea. In fact perhaps the opposite is the right idea, and that we get Vitamin D more from the sun instead. Why might that be the case? Well, if you look at the pathway for bile acid production, what might have an effect? Perhaps supplementing with Vitamin D or not getting enough sun is causing more production of the other things derived in that pathway. Namely Steroids, Bile Acids and Membrane biogenesis.

Honestly I have no idea so I wouldn't say do one thing or another. But it is very interesting that all of these things that might have something to do with IBD and Microscopic Colitis are all part of the same path. Perhaps some part of the path is not quite right.

But let's also take a look at this idea. Who statistically is more likely to have this disease? Older women, at least from the stats thus far, perhaps this might change. Ok, and guess what older people (and even more so with older women) produce less of. Sterols and Vitamin D. So we have less of that path going towards Vitamin D and Sterols then where might it go? Perhaps bile acids? Again I have no idea, just writing down a thought.

harvest_table wrote:
These data support a regulatory role for the VDR in the protection of colon cells from bile acid toxicity through regulation of the Mrp3 expression.
http://www.ncbi.nlm.nih.gov/entrez/quer ... ctplus&db=
pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15824121

Wow, thanks for the article. Enlighting indeed.

harvest_table wrote: I vote we nickname you "Mikey, Our Resident Mad Scientist" and start a collection for a nice lab kit to send you for Christmas. Thank you!

Love,
Joanna

LOL Thanks! :)

Mike