The Gallbladder

The gallbladder is one of the most important organs in the body for good health. 

A pear-shaped, hollow structure located under the liver and on the right side of the abdomen. Its primary function is to store and concentrate bile, a yellow-brown digestive liquid produced by the liver. It is also the collective point for many of the toxins and waste the liver filters from the bloodstream, such as cholesterol particles, which are also delivered into the intestines along with the digestive bile to be eventually expelled from the body. 

The gallbladder's absorptive epithelial lining concentrates the stored bile. When food enters the small intestine, a hormone called cholecystokinin is released, signalling the gallbladder to contract and secrete bile into the small intestine through the common bile duct. The bile helps the digestive process by emulsifying fats and neutralizing acids in partially-digested food. An excess of cholesterol, bilirubin or bile salts can cause gallstones to form.  Biliary cholesterol concentration and serum cholesterol levels do not seem to correlate but there is a link between high triglyceride levels and gallstone formation.  Constipation has been linked to the risk of gall stones.

The gall bladder can be affecgted by gall stones, inflammation and infection.

Gall stones are four times more common in women, especially after 40.  If the gallbladder is removed, the body will struggle to metabolize fats.  A high saturated-fat and sugary diet with insufficient fibre, or those who are obese and are constantly dieting but rapidly gain weight, or suffer Crohn's Disease, are at a higher risk.  

Multiple preganancyies, the contraceptive pill and HRT are contributing factors, as the increased hormone level thicken the bile.  Chronic stress is also a contributing factor.  Most gall stones consist primarily of cholesterol, bilirubin and bile salts and can cause stagnation.  

Different forms of gallbladder disease:

• Gallstones without symptoms. (c. 20% of women and c.8% of men) often do not require treatment.
• Biliary colic - occurs when a gallstone intermittently blocks the duct that drains the gallbladder (cystic duct) usually causing severe, steady pain that lasts from 15 to 60 minutes to up to 6 hours.
• Inflammation of the gallbladder (acute cholecystitis) occurs when a gallstone becomes stuck in the cystic duct, causing severe abdominal pain that lasts longer than 6 hours.
• Chronic cholecystitis - long term (chronic) inflammation of the gallbladder. The wall of the gallbladder may be thickened and rigid.
• Common bile duct stones (choledocholithiasis) - occurs when a gallstone passes through the cystic duct into the common bile duct. (c.8-15% of people who have gallstones also have common bile duct stones often without symptoms). It can lead to life-threatening complications i.e. infection and inflammation of the bile duct or pancreas.

Gallstones:

Formation of gallstones occurs in three steps:

1. Increase in the concentration of a bile component
2. Formation of a small solid mass (the gallstone)
3. Enlargement of the gallstone by accretion 

An increase in cholesterol secretion or a decrease in bile acid or lecithin secretion along with either a decrease in the bile flow, infection and increased mucin secretion by the gallbladder lining will begin the formation of a gallstone, which is composed of cholesterol and mixed stone formation.   Once formed the stone enlarges year on year and symptoms typically occur eight years after formation begins.

Symptoms:   Ongoing pale, loose stool.  If gallstone is large enough to obstruct the bile duct – pain on the right side under the ribcage; jaundice; inflammation; intense pain and vomiting.  Symptoms tend to be worse after a high fat meal or consuming foods that cause sensitivities. 

Causes:

The major risk factors for the development of cholesterol and mixed gallstones include the following:

• Diet –
  • low fibre and high fat diet
  • coffee – can prevent gallstone formation but can exacerbate the symptoms
  • sugar – refined carbohydrates and sugar increase cholesterol concentration
  • Obesity – increases cholesterol manufacture in the liver. Active weight reduction can promote gallstone problems; initially when losing weight bile acid secretion decreases, thereby increasing cholesterol concentration.  Prolonged dietary fat reduction can promote a condition called biliary stasis, increasing the risk of gallstone formation.  Studies show that at least 10g of fat per day is necessary in order to ensure proper gallbladder emptying.
• Gender – 2/4 times more common in women. (Oestrogen can suppress the production of bile acids)
• Race – 70% of Native American Women are predisposed to gallstones.
• High caloric intake
• Oestrogen - oral oestrogen (HRT) use in postmenopausal women is associated with gallbladder disease
• Gastrointestinal tract diseases (Chrohn’s and cystic fibrosis)- due to malabsorption of bile acids from the small intestine.
• Drugs – Tamoxifen, HRT, contraceptive pill and statins
• Age – reported in all ages but the average patient is 40 – 50 years old.

Therapeutic Considerations:

Gallstones are easier to prevent than to remove or reverse.  Primary treatment involves avoiding aggravating foods and employing measures that increase the solubility of cholesterol in bile and possibly help dissolve the stones.  Gallstones are a risk factor for gallbladder cancer.  If symptoms persist, surgery may be required.

 

To prevent gallbladder problems:

Foods to avoid:  High fat, fried foods, coffee, alcohol, chocolate, animal fats, low fibre foods (white bread, cakes, biscuits, ice cream, puddings, pre-packaged meals), foods that may trigger an attack include: eggs, pork, onions, pickles, spicy foods, peanuts and citrus fruits.

Foods to increase:  Beans, lentils, celeriac, artichokes, beetroot, celery, chicory, radicchio, dried beans, linseeds (flaxseeds soaked overnight). Lecithin granules sprinkled over cereals. 

To prevent problems developing further include unrefined extra-virgin olive oil, walnut or linseed (flax seed) oil in small amount on salads.  6-8 glasses of water a day, very lean meats, brown rice, peas, pears, broccoli, porridge, wholemeal bread, lentils, rice and potato flour.  Fresh fish, chicken without the skin, plenty of salads and fresh fruit. High fibre foods to reduce constipation: beetroot, artichoke.

Juices: Celery, artichoke, parsley, raw beetroot, apples, carrots and any green vegetables plus a cup of organic aloe vera  - to aid detoxification of the liver and support the gallbladder.

Nutritional Supplements:

B Vitamins - are required for enzyme production and liver function.

Lecithin – can have a direct effect on cholesterol solubility by emulsifying LDL cholesterol (bad cholesterol) but will show no significant effect on gallstone dissolution.  100mg x 3 times a day

Vitamin E and C – a deficiency has shown to cause gallstones in experimental studies.  Vitamin C is required to convert cholesterol to bile acids.  Take 2 grams of Vitamin C daily with food and 200-400iu full spectrum natural source vitamin E.

Fish Oils – improves bile acid content and increases the solubility of cholesterol in the bile and lower triglycerides.

Lipotropic Factors – (hasten the removal of fat from the liver) include choline, methionine, betaine, folic acid Vitamin B12

Botanical cholagogues - stimulate gallbladder contraction to promote bile flow

 

Herbal choleretics –

• Dandelion (stimulates bile flow) – dried root: 4g x 3 times a day. Fluid extract: 4/8ml x 3 times a day
• Milk thistle (liver detoxification) – 70 – 210mg of silymarin (active ingredient) x 3 times a day
• Artichoke – 500mg x 3 times a day
• Turmeric – (not to be used for gallstones) active ingredient curcumin 200-400mg x 3 times a day
• Boldo – (may help to treat gallstones and reduce their negative impact on the gallbladder) dried leaves (infusion) 250 – 500mg x 3 times a day. Tincture 2-4ml x 3 times a day

Swedish bitters (aloe vera, angelica root, carline thistle root, camphor, manna, myrrh, rhubarb root, saffron, senna, theriac venetian, zedoary root) aids the liver by enhancing the flow of bile.  A few drops in water before each meal.

L-methionine is an amino acid that greatly aids detoxification of the liver. Take 500mg twice daily an hour before breakfast and dinner.

Magnesium Malate: 750mg per day to dissolve gallstones

can dilate biliary ducts, but care is needed that stones don’t move and get stuck.

Chemical dissolution of gallstones:

Ursodeozycholic acid and tauroursodeoxycholic acid (bile acid treatments) are effective in dissolving small, uncalcified cholesterol stones.

For Gallbladder removal and aftercare, please send me an email to anne@slaintewellness.ie