Simulation of the defect of bile acid metabolism associated with cholesterol cholelithiasis by sorbitol ingestion in man
Duane, W.C.
Journal of Laboratory and Clinical Medicine 91(6): 969-978
1978
ISSN/ISBN: 0022-2143 PMID: 650061 Document Number: 131859
The possibility that shortening small bowel transit time by administration of the nonabsorbable alcohol sorbitol might reproduce the defect of the bile acid metabolism associated with cholesterol gallstone disease was tested. Nine normal volunteers were studied by isotope dilution techniques after a 2 wk control period on a metabolic ward and again after 2-3 wk of sorbitol ingestion. Sorbitol dose was low enough to preclude diarrhea but sufficient to reduce mean small bowel transit time from 86-44 min. Sorbitol ingestion lowered the total bile acid pool in all subjects with an average reduction of 27% for the group as a whole (P < 0.005). This reduction in total pool included significant reductions in the pools of all 3 bile acids, cholic, chenodeoxycholic and deoxycholic, without disproportionate reductions for any of the 3. Reductions in primary bile acid pools were a result of both an increase in fractional turnover (cholic only) and a small decrease in synthesis (both primary bile acids). These changes in bile acid metabolism, which approximate those found in subjects with cholesterol gallstone disease, were accompanied by a significant increase in the relative cholesterol content of bile from 6.69-7.81 molar percent (P < 0.01). In addition to providing a model for the defect of bile acid metabolism associated with cholesterol cholelithiasis, these data may have practical implications for a group such as the American Indians of the Southwest whose high prevalence of cholesterol gallstones may be aggravated by ingestion of nonabsorbable carbohydrates known to be present in unusually large amounts in these Indians' diet.