Pernicious Anaemia Society
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B12 deficiency and the role of the gall bladder

Just occurred to me, I had y gall bladder removed several years ago, and various articles including some threads on here mention the 'storage' of B12 in the liver and the gall bladder recovering bile at the end of the digestive tract.

So, in the absence of said organ does anyone know if how I manage my deficiency should be different than 'normal' lol

Has anyone here had their gall bladder removed and is 'on top of' their PA/B12 deficiency, what, if any, problems did it present that caused you to vary your B12 or other vitamins dosage?

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In a person with a gall bladder and without PA, B12 (bound to haptocorrin) stored in the liver is secreted into the bile, which is stored in the gall bladder. When signalled (by the presence of food in the duodenum) the gall bladder empties into the duodenum where enzymes remove the B12 from the haptocorrin, allowing in to bind to Intrinsic Factor. The IF-B12 complex moves down to the ileum, where it is absorbed.

In somebody with a gall bladder, but with PA, it's just the same up to when the B12 is removed from the haptocorrin. With no IF to bind to the B12 carries on past the ileum, through the colon and into the toilet.

In somebody without a gall bladder HC-B12 is still secreted into the bile. But the bile is continuously dribbled into the duodenum. The enzymes in the duodenum are secreted when food enters the duodenum. So much of the bile will dribble in while there's no enzymes to split the HC-B12.

However, I have no idea how long it would remain in the duodenum with no food. I would have thought that peristalsis wouldn't happen without food, so the bile (with its HC-B12) would hang around.

But it's probable that some (for some unknown value of 'some') will not be split and will not be able to bind to IF and will not be able to be absorbed. Eating small and often would mitigate the problem.

Of course, if you have PA then it's all moot, as there will be no IF for free B12 to bind to. And, therefore, no absorption.

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Nice explanation.

I'm off PPI's after 20 years and this is day 3 of that and eating better sources like more dairy and liver and beef, small portions.

I'm hoping the parietal cells will recover and go back to normal IF production and that I can not be B12 shots reliant (waiting for the to arrive in post as GP follow-up for blood results is 8 days away yet).

We'll see but thanks for clearing up the role of the gall bladder in all this!!

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It's probably coincidental but I had my gallbladder removed about 4 year ago, two yeasr later I was diagnosed with low B12. I also wonder if the two are related.

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