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Gallbladder removal and vitamin D deficiency

It appears that

  • Gallbladder surgery is very common: 500,000 - 750,000 in US each year
    roughly 3% of adults have had gallbladder surgery
    • (20 years * 500,000 = 10 million, US population = 300 million)
  • Low vitamin D may cause gallbladder stones to form
    • Vitamin D appears to prevent gallstones - along with Vitamin K2
  • Gallbladder removal may reduce vitamin D and Magnesium levels (mixed opinions/evidence)
  • Bile from the gallbladder aids the processing of vitamin D in the gut: see  PDF from 1933

Many ways to get vitamin D if gallbladder had been removed or is functioning poorly
Gut friendly Vitamin D, sublingual, topical, from the sun, from UV lamps, etc
Perhaps also water soluable Vitamin D, such as from Bio-Tech
Click on chart for details
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A 2010 bulletin published by the Ontario Provincial Programs Branch explains that individuals who have had gallbladder removal may also experience a vitamin D deficiency due to absorption problems. Additionally, if you have gallbladder disease or gallstones, you may also be at risk for a deficiency of this vitamin.
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Demographics: Overweight, middle-aged females

Gallstones are approximately two times more common in females than in males. Overweight women in their middle years constitute the vast majority of patients with gallstones in every racial or ethnic group. An estimated 10% of the general population... has gallstones. The prevalence for women between ages 20 and 55 varies from 5–20%, and is higher after age 50 (25–30%). The prevalence for males is approximately half that for women in a given age group. Certain people, in particular the Pima tribe of Native Americans in Arizona, have a genetic predisposition to forming gallstones. Scandinavians also have a higher than average incidence of this disease.

Strong genetic correlation

There seems to be a strong genetic correlation with gallstone disease, since stones are more than four times as likely to occur among first-degree relatives. Since gallstones rarely dissolve spontaneously, the prevalence increases with age. Obesity is a well-known risk factor since overweight causes chemical abnormalities that lead to increased levels of cholesterol. Gallstones are also associated with rapid weight loss secondary to dieting. Pregnancy is a risk factor since increased estrogen levels result in an increased cholesterol secretion and abnormal changes in bile. However, while an increase in dietary cholesterol is not a risk factor, an increase in triglycerides is positively associated with a higher incidence of gallstones. Diabetes mellitus is also believed to be a risk factor for gallstone development.
(Note: weight, pregnancy, diabetes, high blood pressure are associated with gallstones and are associated with low levels of vitamin D)
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Gallstones affect approximately one in ten Americans, and are associated with approximately 3,000 deaths annually.
More than 800,000 hospitalizations each year are caused by gallstones that are large enough to cause significant pain.
Over 500,000 people undergo surgery for gallstones annually.
Obesity is one of the strongest risk factors for gallstones.
Rapid weight loss diets significantly increase the risk for gallstones.
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Gallbladder concentrates the bile from the Live so that it can be used to digest fats in the colon. Gall stones are made of cholesterol.

Diarrhea (and poor digestion of Vitamin D, Magnesium, etc) after gallbladder removal varies from 1 in 3 to 1 in 100

Mayo http://www.mayoclinic.com/health/gallbladder-removal/AN00067
Studies have found as few as 1 in 100 people undergoing gallbladder surgery or as many as 1 in 3 develops diarrhea.
In most cases, the diarrhea resolves soon after the surgery. Rarely, it may last for years.

Rats without any bile had virtually zero vitamin D absorption - 1987

Bile salt deficiency and the absorption of vitamin D metabolites. In vivo study in the rat.
Isr J Med Sci. 1987 Nov;23(11):1114-7.
Maislos M1, Shany S.

We studied the effect of the absence of bile salts on the absorption of vitamin D metabolites in vivo, in the biliary duct-ligated rat. The mesenteric, lymphatic absorption of the metabolites studied (vitamin D3, 25-hydroxyvitamin D3, and 1,25-dihydroxyvitamin D3) was almost completely abolished in the experimental animals. These results differed significantly (P less than 0.001) from those of the control rats. The 1,25-dihydroxyvitamin D3 absorption into the portal vein system was unaffected by the lack of biliary salts. The absorption of 25-hydroxyvitamin D3 was decreased and that of vitamin D3 was negligible, under the same experimental conditions. These data show that the more polar vitamin D metabolites, like 1,25-dihydroxyvitamin D3 and to some extent 25-hydroxyvitamin D3, are absorbed directly into the portal blood without the involvement of bile salts and micelle formation. Thus, the use of polar vitamin D metabolites should be considered in correcting hypovitaminosis D and osteomalacia in cases of chronic biliary salt depletion.

PMID: 2830204

Note to those with poorly functioning guts:

There is a form of vitamin D for those with poor gut functions
There is a form of vitamin D for adsorption under the tongue - never getting to the gut
There is a form of Magnesium topically as well: both Magnesium Chloride liquid and Epsons salts

All items in category Gut and Vitamin D 102 items

There is a free and instant test for vitamin D deficiency

If you are thus confirmed to be very deficient of vitamin D

Overview Deficiency of vitamin D has a chart - the following is a portion of that chart - showing vicious cycles


Seem strange that I have never noticed Vitamin D studies asking if participants still had gallbladders.
Gallbladder removal reduces vitamin D levels and will probably result in poor bio-availability of most (fat soluble) vitamin D supplements

A study in 1967 found that absorption fat-soluable vitamins was not a function of amount of bile salts

 Download the PDF from VitaminDWiki
This does not appear to be a consensus view

See also VitaminDWiki

See also web

  • Journal of Pediatric Gastroenterology and Nutrition as reported in US News.] Aug 2012
    Moderately Obese kids 4X more likely to have gallstones, Extremely obese kid 6X
    No mention in US News article of vitamin D
  • gallbladderattack.com nice description of reasons to avoid surgery AND what to do if you have had surgery
  • Vit­a­min D and Neu­ro­logic Disorders Dr. Gominak
    Pregnancy ==> low vitamin D ==> gallbladder problems ==> gallbladder removal often during pregnancy
  • Gallstone Surgery NYT good summary of types, when to get surgery, etc. from A.D.A.M.
  • Implications of vitamin D deficiency in lithiasic patient and in general population May 2015
    Found a strong association between stone formation and low vitamin D
    Recommends that stone formers be tested for low vitamin D - publisher wants $31 for the PDF
  • The Throwaway Organ You Can't Live Without GreenMedInfo Nov 2016
    "Consider this: without bile, you lose the lubricating benefits of those fat-soluble nutrients. Vitamins A and E lift your estrogen levels and help maintain mucous membranes. Omega-3, omega-6 and omega-9 fats help keep vaginal tissues healthy and encourage your body to produce the hormones necessary for preventing vaginal dryness."
    "Without your gallbladder, there’s a continuous trickle of bile from your liver directly into your intestine—regardless of whether you’ve consumed fats. The problem comes when you need a large bolus of bile to process a fatty meal. Without a gallbladder, you have no bile reserve, and this has adverse effects on fat digestion and nutrient absorption."
    "Without a gallbladder, your risk for weight gain increases substantially as oversized fat globules make their way into your bloodstream, and because they’re not broken down into a usable form, your body has no other option than to store them as fat— along with fat-soluble toxins."

Attached files

ID Name Comment Uploaded Size Downloads
5210 Bile salts and fat absorption - 1967.pdf admin 22 Mar, 2015 16:42 361.53 Kb 707
3496 Bile - 1933.pdf PDF admin 07 Jan, 2014 19:54 1.06 Mb 2227
1314 gallbladder.jpg admin 08 May, 2012 13:31 39.62 Kb 46687
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