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 oil-based vitamin D in the gut: see  PDF from 1933
  • Water-based and other forms of Vitamin D are probably OK with poor gallbladders

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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Vitamin D level was 25 percent lower if lack a gall bladder – March 2018

25-Hydroxyvitamin D levels and bone mineral density evaluation in patients with cholecystectomy: a case-control study.
Arch Osteoporos. 2018 Mar 2;13(1):14. doi: 10.1007/s11657-018-0435-7.
Ekiz T1, Yeğen SF2, Katar MK2, Genç Ö3, Genç S3.
1 Department of Physical and Rehabilitation Medicine, Elbistan State Hospital, Karaelbistan, 46300, Kahramanmaraş, Turkey. timurekiz at gmail.com.
2 Department of General Surgery, Elbistan State Hospital, Kahramanmaraş, Turkey.
3 Department of Internal Medicine, Elbistan State Hospital, Kahramanmaraş, Turkey.

This study compared the 25-hyrdoxyvitamin (OH) D and bone mineral density (BMD) values of patients with and without cholecystectomy. Although 25(OH) D levels were significantly lower in the cholecystectomy group (12.1 ± 6.2 vs. 15.6 ± 6.6 ng/mL), no significant difference was observed between the groups in terms of BMD measurements.

INTRODUCTION:
Although 25 (OH) D levels were studied and found to be lower in patients with cholecystectomy, the data is scarce as regards the BMD. Therefore, the aim of this study was to compare the 25(OH) D and BMD values of patients with cholecystectomy and without cholecystectomy.

METHODS:
This study was a single-center and case-control trial. The cholecystectomy group comprised the patients with a history of cholecystectomy. In addition, a healthy control group without history of cholecystectomy was defined. All patients were selected consecutively from the patients who admitted to the outpatient clinics of physical and rehabilitation medicine or internal medicine between the June 2016 and August 2016. The patients were ambulatory and did not receive any osteoporosis treatment before. Chemiluminescence microparticle immunoassay method was used for 25(OH) D measurements. Dual-energy X-ray absorptiometry was used for the BMD evaluations.

RESULTS:
There were 46 patients in the cholecystectomy group with a mean age of 58.6 ± 14.1 years and 64 patients in the control group with a mean age of 59.2 ± 13.3 years. Although 25(OH) D levels were significantly lower in the cholecystectomy group (12.1 ± 6.2 vs. 15.6 ± 6.6 ng/mL) (p = 0.010), no significant difference was observed between the groups in terms of BMD measurements (p > 0.05). While there was a weak positive correlation between the BMI and BMD measurements (all p < 0.05), linear regression analyses showed that the models were not valid (femoral neck R = 0.092; femur total R = 0.170; and lumbar total R = 0.199). No significant difference was observed between the BMD measurements and time after cholecystectomy in the cholecystectomy group (p > 0.05).

CONCLUSION: In the light of our results, cholecystectomy patients seem to have lower level of 25(OH) D levels in comparison with healthy subjects, but both groups have similar BMD values. Further studies in cohort designs taking into account the bone formation and resorption markers are awaited.

PMID: 29500745 DOI: 10.1007/s11657-018-0435-7

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Demographics: Overweight, middle-aged females

http://www.surgery.com/procedure/gallstone-removal/demographics
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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http://womenshealth.about.com/cs/gallbladder/a/gallstonessymtr_5.htm
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.

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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.

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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

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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 168 items

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

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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

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See also Vitamin D Life

• Overview Obesity and Vitamin D
• All items in Obesity and vitamin D 352 items
• Overview Gut and vitamin D
• Gut-Friendly Vitamin D especially good for those with gut problems
  Probably also good if had gallblader removed
• Eskimos evolved to get and limit Vitamin D from food perhaps gallbladders have evolved differently

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."
• Why does Vitamin D sometimes give me body aches? Feb 2018
  5,000 IU a day + Magnesium + Vitamin K2 - but recently had Gall Bladder removed
  "however sometimes 20 minutes after taking the Vitamin D I start getting body aches. I would describe it as all over body aches you get when you have a bad cold/flu. They usually go away within 12 hours,"