Gallstones and Low Carb


Gallbladder in pink

Do gallstones improve or worsen on a low carb / high fat diet? It’s a common question with an interesting answer.

The gallbladder stores bile, a yellow-green fluid manufactured in the liver. The bile is used to digest the fat you eat. The question is: Is it good or bad for the gall bladder to eat fat?

The conventional fat phobic answer

The usual medical belief today is that fatty food can result in gall stones. This is because what happens if you already have gallstones in the gallbladder and eat fat: A gallstone can get stuck on the way to the intestines and give you a gallstone attack (pain in the top right part of your stomach).

The conventional advice is thus to eat low fat – and take pain killers if you get a gallstone attack. If the attacks continue the gallbladder is removed by routine surgery and the problem usually goes away. Probably with the side effect of slightly decreased ability to absorb fat and nutrients from what you eat (there is a reason we have gallbladders).

The conventional low fat advice rarely makes gallstone disease go away. Instead it often gets worse with time, until surgery is necessary. That is hardly a coincidence.

How to get gallstones

If you eat low fat less bile is needed to digest your food. More bile thus stays in the gallbladder. Long enough, perhaps, for stones to form. It’s been shown that people who (instead of fat) eat more carbohydrates are at increased risk of gallstones.

It all sounds logical. And there is even better evidence. The risk of low fat diets have been tested at least three times:

Studies of extreme low fat diets


  • In a study of 51 obese people using an extremely low fat low calorie diet (just one gram of fat a day!) the gallbladder was examined by ultrasound before the diet and after one and two months. After one month four of the 51 participants had developed new gallstones. After two months more than one in four (13 people) had new gallstones! This on an almost fat free diet. Three participants needed to have their gallbladder removed during the study.
  • A similar study examined 19 people eating an extremely low fat low calorie diet over 16 weeks. At the ultrasound examination at the end of the study five people (again about one in four) had new gallstones.
  • A third study compared an extremely low fat diet with a diet slightly higher in fat during 3 months. More than one in two (6 of 11 people) in the group eating extremely low fat developed new gallstones. Nobody in the group eating more fat did.

Conclusion: Do you want gallstones? Avoid fat.

What happens if you do the opposite?

What if you were to do the opposite of the usual advice? Regularly eat food with fat in it? Then more bile will be used to digest the food. The bile ducts and the gallbladder will be flushed through regularly. Probably no stones will have time to form, and pre-existing stones might (if you are lucky) be flushed out into the small intestine.

The risk is that you will get gallstone pain in the short term – if you already have gallstones.

The question is: Do you want to think short-term (low fat) or long-term (higher fat)?

Does high fat food work?

It’s logical to think that food higher in fat can result in a gall bladder free from gallstones. But as far as I know no study has tested high fat food to people with gallstones.

On the other hand I know quite a few people who have experienced that their gallstone disease disappeared on a LCHF diet. Sometimes at the expense of initial gallstone attacks though.

A Swedish low carb site conducted a survey of its members. 145 people who used to have gallstones answered what happened since they started eating LCHF. Take the result with a huge pinch of salt as this kind of survey gives very unreliable answers:

Gallstone survey

This survey gives some support to the theory that high fat food can cure gallstone disease.

Gallstones and kidney stones

Patients with kidney stones get better advice. They are told to drink a lot of fluid, increasing the production of urine, so that stones do not have time to develop. If you already have kidney stones this advice could give you a painful kidney stone attack initially – but you are still advised to drink a lot.

The reason why we give the opposite advice when it comes to gallstones might be the obsolete fear of fat. If we were afraid of water instead patients with kidney stones might have been advised to avoid drinking to avoid kidney stone attacks. If they did not improve their kidneys would be surgically removed.

What do you say?

Have you had gallbladder problems? Have you tested a LCHF diet? What happened?


Other health problems

LCHF for beginners


Another common question is if you can eat LCHF if your gallbladder is already removed. The answer is that this seems to work fine.

Some people without a gallbladder might have to increase their intake of fat gradually to allow their body time to adapt. Otherwise the body might not have time to digest the fat which could result in loose fatty stools initially. However this rarely seems to be a problem.


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  1. Catherine
    Glad to find this article. My fiancé, male, white, 43 years old, 1m85 and 83kg with slightly high LDL Cholesterol had a very bad pain attack 2 weeks ago with vomiting. He went to hospital and they found one gallstone (2.8cm). The gallbladder is in good condition, his liver has a small amount of cholesterol on it. The Dr recommended to remove the gallbladder, briefly mentioning dissolving stone medication but said they usually only give that to older people as it takes a long time.

    He generally eats a varied diet, small amount half fat milk with cereal or porridge oats in morning or toast with nutella. Lunch a sandwich with wholewheat bread, meat and salad and then dinner meat (generally chicken) with either potatoes, pasta or rice and veg. With fruit in between. Then in the evening he has full fat ice cream sometimes and yoghurts or cookies as a treat. So he was not really on a low fat diet, but I guess high in carbs. Why do you reckon he could have developed a gallstone?

    He gets a lot of headaches and has a fairly stressful job but keeps on top of it. The Dr has said to remove the gallbladder. Since the attack 2 weeks ago I cut out fats from his diet to try and avoid an attack, lots more veg and fruits with vit c and green apples. Meals with wholewheat pasta, brown rice or brown bread for the increased fibre... he has had no pain with this so far. I have made some salad dressings with extra virgin oil and cooked sugar free cookies with coconut oil (shredded coconut, coconut oil, oats, flax seed, maple syrup). I do not want more stones to appear without adding enough fat but I also do not want to cause any pain.

    My question is am I doing the right thing with his diet and what more should I do with his diet?
    Would you recommend asking the DR for Ursodil medication to dissolve the stone as we do not want to have his gallbladder removed? Have you any experience if it is possible to dissolve a large stone with just diet or how long it can take to dissolve if taking Ursodil?

    He is also taking milk thistle tablets and dandelion tablets. We also want to reduce his cholesterol levels, I read that low bile production increases cholesterol levels in blood, is this the case? I totally understand you can not give medical advice but I would really appreciate your thoughts as I can not find a Dr that is open minded yet. Thank you very much.

    Reply: #152
  2. sten
    By cutting out fat the gall bladder removal will eventually become inevitable. The "full fat icecrem" is a mere sugar bomb what I understand, not much fat today! The side effect of a low fat diet is stagnated bile flow resulting in thick bile and more stones. Cut out sugar and increase fat SLOWLY to increase the bile flow that will clean up the liver, the "most important" organ in the body. Full fat Cream is good fat, Coconut oil and real butter too.
    Sugar makes things to stick in our bodies, just like in the pan Glycation is the name for it. Google it and see why sugar or high blood sugar is bad.
    Read the comments above in the thread. All the needed advise is already there. Good Luck!
  3. Phil
    1. Has the Chinese gallstone removal technique published in 2012, wherein the gall bladder is not removed but simply opened using special laparoscopic instruments and methods, been given much press?
    2. If a "high" fat diet is now seen as desirable, should one consider the toxic residues in animal fat, and choose, for example, organic butter? Certainly, the advice to eat fish has caused problems with mercury residues in large species fish, so there is "fish" and then there is fish.
    3. If the medically endorsed low fat diet is "wrong" and even harmful, then why are we not taking a class action against those in authority who encouraged it?
    4. How are our arteries doing on our now higher fat diet - it was our clogged arteries, not our gall bladders, which caused the low fat era. I want to keep my gall bladder, but will sacrifice it for my arteries, if need be. Arteries too can be easily easily scanned.
    Reply: #156
  4. sten
    1 ??
    2 -Absolutely yes. Especially since conventional animal feed also in EU is sold as "rations", with unknown percentages of GMO grains, including Bt toxins. Bt toxins weakens intestional walls and insects eating such grains die from burst intestines. GMO is allowed as animal feed in the EU and is here not sold directly for human consumtion except in some unchecked(?) US made packaged products.
    But the buck stops att the top of the food chain. Toxin concentrations also tend to increase higher up in the food chain, as we know well. GMO feed applies at least to beef, pork and eggs and poultry sold in all EU standard food stores, so most of us are accumulating it (and glyphosate residues ) by the day.

    3- It is only a matter of time for a class action the way I see it. When less people stop beiieve they had the bad genes or bad luck things will change. The focus on genetics seem to have a hidden agenda protecting the food industry as our genes haven't, but our foods have changed as the new diseases exploded.

    4- It seems that apart from industrial transfats (made from vegetable oils) , high blood sugar is one proven agent to cause heart disease. High LDL cholesterol may have a role, but only for small LDL-particles. If it is due to easier oxidation or glycation (high blood sugar again), it is not known, but large LDL particles have never been implicated. High blood sugars cause the liver to produce triglycerides and also small LDL particles and palmitic acid (saturated fat). The last one is the only saturated fat implicated in heart disease, What happens is not clarified 100% but it seems to me that as oon as high bloodsugar is taken out of the equation calcification stops and can even reverse!
    And high blood sugar is known to cause inflammation in the artey wall, reason it is dangeous and a necessity for diabetics to get it down to avoid to die earlier than otherwise, in just heart disease; Lifespans up to 10 years shorter than average is typical for diabetics type 2.

  5. Phil
    Re: 1.??
    Here is the reference:
    Rev Sci Instrum. 2012 Jan;83(1):015115. doi: 10.1063/1.3673472.
    Design and application of a new series of gallbladder endoscopes that facilitate gallstone removal without gallbladder excision.
    Qiao T1, Huang WC, Luo XB, Zhang YD.
    Reply: #157
  6. Zepp
    Its nothing new.. they can do it on any western hospital with sugery clinic.. but they think that one surgery is better then many.

    And if one got one stone one get others becuse people dont change there lifestyle.

    And a few is geneticaly predominante to be stone builders.

  7. sten
    There is one single problem:
    one must do it time after time on a low fat diet as too little fat in the diet
    creates sludgy concentrated bile which eventually forms gall stones.
    It is a bit like smoking and get some kind of a lungwash once in a while, if it was available.
  8. Phil
    1.Recurrence of gallstones after any measure to prevent them reforming, is always a possibility. 2.Not all gallstones are associated with low fat diet I'm pretty sure. Weight loss regimes, for eg.,which more or less involve the individual using their fat reserves for energy are strongly associated with gallstones for example. That, is not what one might call a "low-fat" diet. Rather, the reverse. Although, the fat being consumed in that case is not arriving via the usual route of the mouth.
    3.Agree with Sten that repetative stone removal while preserving the gall bladder, would be "extreme". But with ultrasound monitoring, corrections to prevent recurrence would seem a better way. Radiologists seem to be in the box seat.
    4.Ultrasound monitoring seems the only sensible approach, as it takes little time or resources, is virtually harmless and painless, is non-invasive, and respects the individual.
    5.Zepp says "they can do it now in any Western hospital" - I'm not sure that's right. The Chinese designed their own instruments for the technique, and have published a further paper more recently.
    6.In Australia, you can get your gall-bladder removed without any symptoms, so keen are doctors to do laparoscopic cholecystectomies(LCs). But you cannot get Ursodeoxycholic Acid dissolution for less than about 40 dollars a week(the capsules), because the government only subsidies UDCA if being used for primary biliary sclerosis - despite people on waiting lists for LCs having taken UDCA and dissolved their stones completely.
    7. Are LCs the "training exercise" for intending surgeons? What a notch in the belt for a beginner to be able to say....."I've done a lap-chole!"
  9. Yep
    I lost 80 pounds, gained 30 lost 30 ad nauseam, started eating healthy - low fat, started having pains, diagnosed with gallstones after ultrasound. Was put on an SSRI for depression, started Binge eating, tons of pizza, drank a lot of soda - gallbladder worsened and I had it removed.
  10. Phil
    Yep. Sounds like, from what you say(159), that we all should pick a suitable weight for our height and build, and set that weight as a target. How many people actually go to a nutritionist and get a proper meal plan to maintain a target weight? We are not hibernating bears - they eat five kilos of pine nuts a day to gain weight before going into winter hibernation. Seems not surprising that bear bile would be special stuff. And hence the reason it has been produced synthetically and marketed. We don't need a diet - we need meals. And meals based on our local affordable foods, not special foods which cost a lot and are hard to prepare.
  11. Loren
    Since starting a low carb diet I have had some discomfort in my abdomen on the right side. Its a dull sensation, not exactly pain but more of an awareness of that area or mild discomfort. Typically occurs after eating. In searching about this online there are many people asking questions about this same discomfort/pain, but I do not see any clear responses to this issue other than questioning if it could be gallstones. For some people it is on the left side. Seems to be a fairly common issue, but most responses act as though the person asking is having an unusual response to a low carb diet. I am vegetarian so know it is not a question of too much protein as some suggest, and I have never had any issues with my gallbladder prior to now. I dont know that it is the gallbladder as there is no soreness in that area when pressing and as stated it is just a mild discomfort. But it is concerning considering I have never had this before. I am enjoying the low carb diet but this makes me question how healthy it is for me. At first I had fairly strong pains in my entire lower back. Have also seen that many people experience this as well but it is not addressed as a sympton/consequence of low carb in all the searches I have done. I started supplementing with magnesium and potassium and that got better, but then the discomfort in the side started. So about 2 months into doing low carb. It seems strange that there are so many people with this same issue yet I cannot find any clear information of what is causing this. Anyone know anything about this? Thank you
  12. Phil
    Re Loren(response 161):

    1. Without knowing why you chose a low-carb diet to begin with, and the possibility you went low-carb to address a nagging health problem, it is difficult to make even a layman's suggestion about what the problem is.
    2. But it does sound like you could get an abdominal ultrasound which will cover areas like; liver and gall-bladder, and other organs in the area. And a full-blood count etc. Not much expense or risk with those two tests. And they can tell a lot.
    3. The concurrence between the problem and the start of the low carb diet may be coincidental, or it may prove to be partly the cause. If you have gall stones they will likely show up on ultrasound.
    4. Being vegetarian is no insurance against health problems, when applied to a given individual. I'm vegetarian, but I still get things go wrong.
    5. For me, I tried a low-carb diet for a couple of months and found I was less energetic, a bit constipated, and generally not great.

  13. sten
    What we eat in LCHF is not low carb but low carb with high fat. By living for years on a low fat diet sludgy bile and gall stones often result.
    Galls stones and sludgy bile that could pass painfully is caused by slow bile flow, as bile flows to make it possible to digest dietary fats.
    Being a vegeterian makes it difficult but there are fats like coconut oil, avocados and butter since you are not a vegan at least. Avoid vegetable oils except guaranteed olive oil.

    But increasing bile flow by eating more fat too fast means that first the built up sludge must get out and then lighter normal bile can flow. Too much fat in one go can mean gall bladder pain !

    This is what I would do, and in no way doctors advice:
    Increase fat intake, but carefully. Ideally pain increases a few hours after each meal and then reduce. Temporarily eat fat between meals to quicker help dissolve the blockage with less or no pain. There is a lot of more useful information in this thread !

  14. J.B
    I don't agree here I had my gallbladder out in 2006 before this I would eat a bit of fat in my diet but often I would suffer reflux and any oily food would just come right back up within 30 minutes of me eating, to the point that if I could physically see oil in a dish I would opt not to eat, gall bladder was taken out by an open procedure as it was adheared to other organs including the bowel, 2011 I had a gastric sleeve so now I cannot tolerated any fat at all I avoid the chippy and any kind of deep fried food, any thing that I can see oil in even bacon is out of my diet, post sleeve one of the problems was a fall on gall stone attack! I said to the consultant how is this possible as I do not have a gall bladder? I was then informed that I have a residue part of the gal bladder as it was not all removed and yes I do have stones in it, at this stage I said the last thing I wanted was more surgery especially if it would risk damanage to my bowel to which he agreed and started me on medication to hopefully reduce the size of the stones over the following 6 months. Since then the stones have reduced and I'm on a basically fat free, high fibre diet there has been no issues with the residue gall bladder and stones. In fact any food that is slightly oily I either end up with heart burn for hours and hours or it comes back so why would one want to put oneself through that?

    Though even after a cholecystectomy it is possible to get stones traped in the bial duct which can be just as painful.

  15. Daniel
    @ J.B - Hi, I assume when you say "chippy" that you are talking about white potatoes and breaded/battered items fried in vegetable oil. I'd love to find a chippy that offered sweet potato fries fried in lard but I think that's 20 years and a whole paradigm shift away. Most folk here would recommend you avoid conventionally fried and breaded products like your life depended on it; because it does.

    The LCHF lifestyle embraces healthy fat which is practically all natural fats that can be obtained without a processing plant / refinery, including saturated fat rendered from animals.

    And if you are as truly "fat free" as you say I can only wish you luck maintaining your physical health in the long term and your mental health into old age, because you NEED fat in your diet to survive, let alone thrive. The more "fat free" your meals are the less fat-soluble vitamins your body can absorb from those meals, also I assume this means you eat more carbohydrates, both compounding problems that were killing me before I discovered LCHF.

    Then there's the whole issue with cholesterol. Yes, overall you probably have lower total cholesterol but I should think your ratios will be terrible and your triglycerides through the roof.

    Possibly the state in which your gallbladder was left after the surgeon stitched you up could be quite specific to you whilst keeping this article agreeable to everyone else. I didn't comment to have a dig at your situation, I wish you well.

    My dad was always on antacid tabs until he discovered the LCHF in the form of the primal blueprint.

  16. Olivia
    Daniel, I don't know where you live or if there is a location near you, but Smashburger has sweet potato fries that are fried in beef lard. You can get them with or without rosemary and garlic (why any one would want them without I will never understand) and come in a very reasonable portion size.
  17. Phil
    Here in Australia we have seen the LowCarbHighFat trend for sure - it's everywhere with Paleo cafes etc. We have not yet seen the outcome of the inevitable clash between the parties with vested interests LCHF versus HCLF. For me, I count calories - regardless of where they come from. I weigh and do % body fat each day. I find it easy to maintain a weight plus or minus 1 kg this way. For gallstones prevention, I am only interested in me, not what everyone else is doing - ultrasound tells me all I need to know about whether my gallbladder is ejecting bile properly when provoked with a fatty meal, whether stones are forming, whether my bile ducts are dilated, whether I have a fatty liver. And it tells me in ten minutes without invading my body. Doctors, god bless them, would much prefer to knock me out with a drug, put a hose in my rear end, (colonoscopy) and charge me a small fortune - because the medical funding supports that procedure. They aren't in the least interested in common sense.
  18. Linda
    I had my gallbladder removed oct 2012. Started LCHF great, the the fatty stools came. Not to mention RUNNING to the bathroom right after eating HF. What can i do? I have high blood pressure so i need to slow down on salt. Besides that weight loss is good, eating is great. What can i do about my fat and running to bathroom?
    Replies: #169, #170
  19. Zepp
    You can eat smaler portions more often!

    Its your liver that make gall/bile, but the bladder store it and concentrats it for those times you eat a lot of fat!

    Now your liver have to make it whituot any help of the bladder!

    And mayby dont eat the moste high fat, lower fat till you dont need to run anymore, then make some conclusions about the future!

    Try it out!

  20. sten
    With a much wider return to high fat eating we may also see "gall bladder transplants" in the not too distant future when research about this "unnecessary" organ become accepted again and both gall bladder removal and GBP surgeons have to look for new projects.
    Zepp says very well what you can do in between!
  21. Zepp
    And to that.. many thats eat LCHF is former obese persons desperat enough to eat low fat to lose some weight and hade there gallbladder removed as a result!

    There are very few reporting steatoree.. rather there are others that not removed ther bladder that report fatty stools!

    So, its not a very comon side effect.. and in some cases we do think they eat to much fat.. type MBC and things!

    They have sometime missunderstand the concept, thinking the more fat, the more weight loss!

    HF is high as ones energy demand.. not a lot on the plate.. its a lot in E%!

    And thats easyely done by eating eggs.. 60 E% fat, pork, salmon, sardines, avocado, minced meat, the same and enough ty fry in.. and then its often goes up to 80 E%, thats enough!

    The moste comon side effect is constipation!

  22. Phil
    The matter can easily be tested independently of medicos. Just ask people to report the results of their LFHC diets and their HFLC diets, as evidenced by repeat ultrasound. You will inevitably find that some got rid of the gallstones with LFHC, and some got rid of stones with HFLC. So you must always get into the detail of individual cases to give good advice. Quoting stats is irresponsible, as is quoting physiological probabilities. Blind trials are not needed - doctors are already blind. By the way, stones do get passed naturally. And, stones can form without a gallbladder. And, exercise must have an effect on abdominal pressure, and hence internal organs - you cannot even begin to say before know all the facts. There's no such thing as "the" gallbladder. Only "your" gallbladder.
  23. Sue
    Hi, I had my gal bladder removed just over a year ago. I am now considering the LCHF diet because I still have issues with digestion. In fact I meet with my gastroentronologist (sp?) today. My question is, I no longer have a gall bladder so how will this diet affect me?
  24. Zepp
    The bladder is for storage and concentration of bile/gall!

    Its your liver that produce bile.. so you still have bile for digestion of fat!

    Some few need to eat more often and smaller portions, but they are few.

  25. C.M.
    I just started this low carb high fat journey. I am in the middle...or nearing the end...of a gallbladder attack as we speak. The pain always starts in my back and it's god awful.

    I had my first gallbladder attack when I was pregnant with my first child. That was over 6 years ago. I have had about 50 gallbladder attacks since then, one that put me in the ER getting morphine. They are no treat. They are the worst pain I have ever felt for sure. That said, I absolutely refuse to get my gallbladder removed. I got myself into this mess by eating poorly, I can get myself out. The human body is incredibly resilient---but you have to treat it right. Surgery, modern medicine, while it is a wonderful thing, is not a cure. Gallbladder surgery doesn't cure your terrible eating habits.

    There are things that both dissolve gallstones and prevent them. Look on Amazon for something called stone breaker. Also, ACV tablets. I have taken about 20 of those tablets and I'm starting to feel better. They dissolve stones and keep them at bay.

    The thing about stones is this: until you fix your diet, they are never going to go away. The only thing that keeps the gallbladder functioning correctly is FAT. A terrible SAD is what causes gallstones. Therefore, if you're going LCHF, and you know you have stones, you're probably going to suffer a few attacks in the process of healing your body. There are casualties, this is one of them. THE ONLY WAY OUT IS THROUGH. Stock up on ACV pills or if you can tolerate it, Braggs ACV with the mother.

    As for LCHF, I've only been on it 3 weeks, and I feel AMAZING. I have so much energy I don't know what to do with myself. I can finally keep up with life, my house, my kids. I am sleeping like a baby. I am doing this to fix my hormones (PCOS/Endo). My liver was swollen, my spleen was swollen, I was a mess. I've already lost weight and the swelling is gone. This is not a diet, it's a lifestyle. I don't see myself ever going back to eating the old way. Good luck everyone! :)

    Reply: #176
  26. SMO
    C.M. (And others) Congrats on your changes! I started LCHF in Jan and have experienced my first 2 attacks, end of January and then last week. I don't know how you've made it through 50! I too have PCOS and am looking to balance my hormones. An ultrasound shows I have a large 3.2 cm stone and other smaller mobile stones. I'm taking ACV, a supplement mix with milk thistle, probiotics, multivitamin, vit D....I'm considering the Stone Blocker and also chanca piedra drops. I've been to a naturopath and was only given a cleanse, which I did this past weekend, but no help with herbs/supplements, so I'm educating myself. My primary care dr was not comfortable recommending ursodiol, but I'm interested and may follow up with a gastro dr. Eating LCHF has made me feel so great, that the thought of surgery, aside from just being scary, makes me worry that I'll backslide in my weight loss. Here's to fewer attacks for all!
  27. Niki
    I wish I had this information when I first started having weight problems. 20 years of weight problems. I say problems, because first the weight came on, and then I had gradually harder time running and cycling. Then stomach problems. So low fat diets went from short to long term. At the end I had severe gallbladder disease and it almost killed me. After gallbladder surgery I was told to go on a low fat diet as supposedly people without gall ladders could not deal with fat anymore. So I did and gained more weight. Then a friend of mine mentioned about the paleo diet, and I just about went through the roof. How could that be good for you? After all, I have hundreds of diet books and had gained 100 pounds, and I knew everything there was about losing weight. So because I respect my friend, I started reading and eventually made my way through most of the experts on LCHF. And I am still losing on a LCHF food regime. I have a question. I was concocting a glucose high fat marathon refuelling for running marathon, and I tasted some just to see whether it was palatable. Not for my own running might I add as I am practising ketosis. Within 20 minutes my cravings for the stuff went through the roof. Fortunately I was cognitive of the effects, whereas before I would have fed the hunger with carbs and low fat. It was obsessive cravings for the stuff. Could that be signs of Insulinhypertrophy?
    Reply: #178
  28. Zepp
    Its more probably a sign of addiction!

    Ones an addict.. always an addict.

    Ask an alchol addict.. if they stay sober they can handle it, but if they taste a small glas its no return.

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