Are Gall Bladder Removal and Gout Related?

[Junior GoutPal]

Gall Bladder Removal and Gout

I had my gall bladder removed a few years ago and since then I have noticed the gout creeping in.
Is there any significance with that? Because of the digestion changing (no gall bladder).

That message from a lapsed GoutPal member started a long discussion about gout and gallbladder. Keith concluded:
Is there a link between gall bladder removal & gout? You need to look at all the circumstances. Is it just surgery that is the problem, or is there a gout link?

Several gout sufferers joined the discussion to say they had gout after gall bladder removal (cholecystectomy). But, nobody supplied any useful, relevant facts. We rarely got the time difference between surgery and gout symptoms starting. We never got any uric acid blood test results.

One member introduced the related topic of gallstones. Lea and son both had a history of gallstones. And both developed gout. They wondered if they had done something to start their gout problems. Brian, a GoutPal regular back in 2008, responded:
“The tendency to have gout runs in families so it is very possible that you didn’t have to do anything. There is no gout gene but there seems to be genes that predispose people to develop hyperuricemia, too much uric acid in the blood. For many gout sufferers, the hyperuricemia precedes the gout often by as much as twenty years. You and your son might have these genes.

Though younger men do develop gout, it is far more common in men over forty. Bile is produced in the liver and stored in the gall bladder. There it becomes more concentrated. The bile does several things including carrying substances (including uric acid) from the liver into the intestines where the uric acid is eliminated. About ninety percent of the hyperuricemics are termed “under secretors” because they do not secrete enough uric acid from their bodies. This lets the uric acid build up in the blood and contribute to gout attacks. About thirty percent of the uric acid is secreted through the intestines in the feces. The body guards the bile very jealously. When the bile has finished transporting the uric acid and other substances, the body reabsorbs the bile through the intestinal lining into the blood. The bile is extracted by the liver and then restored in the gall bladder. Any substance that the body guards jealously is important to the body.”

Keith’s conclusion is:
There is little evidence to suggest a link between gall bladder removal, and gout. Without detailed case histories, including uric acid blood test results, it is impossible to say. The significant points are:

• “Cholecystectomy does not significantly increase the risk of fatty liver disease” has significant information, though it is not a gout study. Over 34,000 subjects were analyzed. People who had gall bladder removed showed no significant change in uric acid levels.
• There are several reports of surgery increasing uric acid level, but this is short term, and not conclusive.
• Where gallstones are present, they should be analyzed for uric acid content.
• There are “between the lines” suggestions that some people who are susceptible to gall bladder problems, might also be susceptible to gout, through poor eating habits.
• Uric acid deposits in the gall bladder might cause damage that necessitates surgery.

As with all aspects of gout, gall bladder involvement has to be investigated on an individual basis. I’ve included this in the Secondary Gout Group, as there is a suggestion that gall bladder removal might cause gout. However, all the evidence suggests that a connection is unlikely. Therefore, gout sufferers who suspect gall bladder problems need to discuss their situation with their doctors. If problems that led to gall bladder removal have been resolved, but uric acid is still high, then they must decide which form of uric acid control is best.

What is your experience with gall bladder removal and gout?

Are Gall Bladder Removal and Gout linked?

[Carolyn Poulter]

I can’t say anything beyond my own experience I had my gall bladder removed when I was 31. I was Female but I as not ‘Fair Fat and Forty’ In fact I was red head, thin and 30 and a bit. But I had a whopping big gallstone – looked like a Suchard Easter Egg – and it had destroyed my gall bladder so out it went. Scroll forward 27 years and I had my first bout of gout though at the time it was not diagnosed because it wasn’t in the ‘normal’ place, the toe, but in my heel.

I have a funny feeling all of this is somehow related but I am not sure how. Clearly my body has some issues with getting rid of various chemicals/compounds – uric acid, whatever the heck it is that turns into gall stone, etc. So yes, I do think that it could well be related.

[GoutPal Victim]

My situation is very similar to Carolyn’s. My gall bladder was removed in 1983, and I too was 31 years old. I had my first gout attack in 2016 – 33 years later – but I did not know it was gout because, like Carolyn, it started in my heals. When I was finally diagnosed last year with gout, I was told to cut out meat and alcohol, (I don’t use either), so it’s been very confusing.

Now, of course, I better understand the nature of purines and uric acid. From the very beginning though, I felt it was connected to not having a gall bladder. I still believe that to be the case. I have an almost permanent discomfort/soreness in my heals, and I’ve had two gout flareups just recently. I hope more study can go into this – and other effects of gall bladder removal.

[Carolyn Poulter]

Hi Christine, I haven’t been here in ages, life gets in the way! Interesting that our expierience is pretty much identical. I veer between that pain you mention in the heels and then again a strange kind of numbness. Drives me nuts at night.

I just got out of hospital and unfortunately it would appear I am heading back early next week. I was popping pain pills because of the arthritis and gout like Smarties and of course I paid the price with 3 whopping ulcers – 2 bleeding for ages apparently – and a thing in my oesophagus. #3 ulcer and the oesophagus thingie decided to burst and I was fairly spectacular at home, and in the ambulance, but the third event in the Emergency Room I aced the audition for the Linda Blair part in the Exorcist – OK without the head spinning but the rest, over a litre of black blood down me, across the gurney, the floor and over the poor nurse who was in the line of fire.

I was bunged in another ambulance to another city for emergency surgery, then back to the first hospital and after 5 days of whining and complaining was sprung from Alcatraz. Unfortunately the gains I had made during the stay seem to be dropping. Last Tuesday my haemoglobin was 101 (in Canada we measure it that way, in the US I think there is a decinimal point) but by Thursday it was down to 95. I have to call my GP first thing Monday to try to get in for another blood test and from what he said Friday probably into hospital again for a transfusuion and try to find out what’s going on.

Apparently my heart is skipping a beat too and I promise it has nothing to do with the thought of George Clooney, naked, dipped in chocolate and carrying a nice glass of Benedictine…… where was I again? Oh yes…. anyway I have to have a stress test and of course have been battling yet another gout flare up, this time in my knee, so that’s going to be interesting. Perhaps they will write me a pop song

Hopping on the Treadmill!

Heh

Carolyn

[nobody]

Hi,
I hope these ulcers will heal well. But what were those “pain pills” if I may ask? It sounds like they were anti-inflammatories (the Irfen type of drug) but if other drugs can have that effect as well, others here taking the same pills might want to know.
In case they were indeed anti-inflammatories and you never tried colchicine, that drug doesn’t hurt my stomach in that way.

[Keith Taylor]

I think that “funny feeling” is possibly early stages of “confirmation bias”.

But, what do I know? 🙂

[Keith Taylor]

An interesting addition to the gout-gallbladder debate was published a year ago. “Сhronic cholecystitis and gout -an unfavorable tandem with dangerous consequenсes.” is an investigation into bone degeneration when gout sufferers also have inflammation of the gallbladder (cholecystitis).

Unfortunately, the published gout research is a translation from Ukrainian. However, I think the meaning is clear:

Due to common pathogenic mechanisms of both diseases, one of the dangerous consequences of such a tandem can be osteodeficit. Both the chronic
diseases of the gallbladder and gout arthritis significantly associated with
osteoporosis. The negative impact of osteoporosis on quality and duration of
life, significant economic costs of treatment and social adaptation of patients make this problem as topical for doctors of any specialties.

Don’t ignore gallbladder or gout problems. Both can lead to significant bone loss, if not treated early enough.

[Feedback Form]

The body’s production of bile salts is controlled to the circadian rhythm of the body. More during the day and less at night. Bile salts help to suppress the liver’s production of xanthine oxidase, the enzyme that converts purines to urates. The level of xanthine oxidase is tied to the circadian rhythm. During the night, the level of bile salts is down, the level of the xanthine oxidase and therefore the uric acid is up. That is why so many gout attacks occur at night.

If you have medication or a natural product that inhibits xanthine oxidase, you should time it for right before you go to sleep. You need it most then.

The study is “Periodic Variation in Bile Acids controls circadian changes in uric acid via regulation of xanthine oxidase by the orphan nuclear receptor PPAR alpha”. I found it at http://www.jbc.org/cgi/doi/10.1074/jbc.M117.7912.85. The research was published from Kyushu University on 11/3/2017.

[Keith Taylor]

That “Bile and Uric Acid” report is very interesting to me. So thank you to the anonymous reader who supplied the information. Unfortunately, the link doesn’t work. But the report is easy to find (http://www.jbc.org/content/292/52/21397). Also, it’s my first candidate for a new way to share gout research information. So keep watching the email updates!

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I’m guessing that the logical link to the main question in this topic is:
Bile salts limit xanthine oxidase activity. Therefore after gallbladder removal, this natural alternative to allopurinol is no longer available. So gout occurs?

Anyway, that’s my current working hypothesis. But I still can’t find good data linking urate levels before and after cholecystectomy. So this is still a topic that creates more questions than answers.

[nobody]

I don’t think it’s right that bile is no longer available after gallbladder removal since that organ only stores the stuff.
Also, I had more acute arthritis before mine was removed than afterwards. I didn’t get before/after SUA tests but over the years, my SUA did diminish. Dietary changes and so forth also affected my uric acid but I suspect bile production might actually be stimulated by removals before it kind of (and very slowly) reverses to the mean. Anecdotally, as far as arthritic symptoms are concerned, I had a pretty good year following my removal.

[Keith Taylor]

I don’t think it’s right that bile is no longer available after gallbladder removal since that organ only stores the stuff.

Of course! Basic high school biology forgotten already. Thanks for that and your experiences.

Looking back, I started this discussion with

Is there a link between gall bladder removal & gout? You need to look at all the circumstances. Is it just surgery that is the problem, or is there a gout link?

and

There are several reports of surgery increasing uric acid level, but this is short term, and not conclusive.

So I had another look at this and found a study showing that uric acid usually decreases after surgery. But it increases for some patients.
Snaith, M. L., and J. T. Scott. “Uric acid excretion and surgery.” Annals of the rheumatic diseases 31, no. 3 (1972): 162.

PLASMA URIC ACID (Table II).
In neither group of patients was any consistent pattern of change discernible. In cases 5, 9, 10, and 11 there was a slight decrease in postoperative levels, in Cases 3 and 8 a slight increase, and in Cases 1, 2, 4, 6, and 7, very little change. In both groups mean levels tended to be lower during the postoperative period; the mean basal plasma uric acid for all patients was 4.5 mg./ml. and the mean level during the six postoperative days was 4-2 mg./ml.

In all patients, uric acid excretion increased after surgery. So the mechanisms are clearly complex. Also, there are insufficient data to determine how the results are affected by:

• Pre-op meds
• Anasthetic type
• Post-op meds
• Type of surgery

Interestingly, the report suggests that gout flares after surgery might be similar to those experienced by patients taking uric acid meds when old crystals start to dissolve (see Allopurinol Medication: Why It Hurts To Get Rid Of Gout
All in all, the only conclusion seems to be that surgery is likely to affect uric acid. But we don’t know if it will go up or down. Also, to get back on topic, that applies to gallbladder removal as much as it does to any surgery.

So, if you are a gout victim with uncontrolled uric acid, it is wise to get uric acid under control before surgery if possible. If not possible, then it seems wise to discuss preventative or as-required gout pain relief with your doctor.

For other people, it is wise to monitor uric acid after surgery to ensure it does not get too high.

[nobody]

The amount of fat in one’s post-surgery diet might also have an effect on bile production and absorption.
The surgery will in any case encourage people to change their diets which can in turn affect uric acid, either directly or through weight loss/gain.

[jess]

I don’t believe the removal leads to gout. I have had gout since 2006 when I started undergrad and in 2010 I found out I had gallstones. I opted to skip the surgery and was able to dissolve the gallstones. However my digestive issues, and resuming my previous diet, have caused the gallstones to resurface. I am able to manage my gout but my foot has never gone back to its “normal” size.

[Keith Taylor]

Thanks for sharing your experiences with gallstones and gout, Jess ( @jessica-jackson ).

Also, I’m intrigued by your final sentence:

I am able to manage my gout but my foot has never gone back to its “normal” size.

Does that mean you are currently being treated for gout? If so, are you working with your doctor to be sure your uric acid is safe? I’d love to know more. But as it’s probably not related to gallbladder, perhaps you could share your swollen foot story in a new topic?

[Anthony]

Major Surgery and Gout

Good morning,

I am about a month away from having open heart surgery to repair a valve and was wondering if anyone here has had to have a major surgery and what if any complications would arrive from having Gout.

[Keith Taylor]

Though I don’t have personal experience, we’ve discussed surgery and gout before. Particularly in the gallbladder thread. But there was no real conclusion.

However, there are some significant factors that we need to know about:

• What is your uric acid level?
• What treatment(s), if any, are you taking for gout?
• What have your doctors said about your gout and surgery concerns?

So please, Anthony, can you let us have this information? There’s no need to join the forum. Unless you want to. Because you can just reply to the forum update list, as you did earlier. Then, I’ll add your replies here.

Also, I’ll take another look at that gallbladder topic. So I can see if there are any more recent reports. Then I will summarize the key points here.

[Author]

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