Facts About Gallbladder Disease

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Gallbladder disease is one of the leading causes of problems with digestion that result in hospital admissions. Did you know that around 10% of the population (on average) in most Western countries has gallstones? Most of these are “silent” but about 4% of patients with stones develop symptoms each year. For about half of them, the symptoms reoccur within 12 months. More men than women suffer from acute gallbladder inflammation (cholecystitis), whereas more women than men experience gallstones (men have more kidney stones), and married women with children have more gallstones than unmarried women. The term “gallbladder disease” is in one sense a misnomer, for it is the liver, bile ducts and gallbladder that form the system that enables your body to digest fats and all are likely to participate in gallbladder problems.

I have always said that doctors generally see health problems as conditions with symptoms requiring drugs, whereas surgeons see health problems as conditions requiring the knife, and when a patient is admitted with abdominal discomfort surgeons are often keen to remove the gall bladder as it is believed that it ‘serves very little purpose’ and that the patient can “live comfortably without it”. This is a ridiculous and very untrue notion however, and I want you to think twice about having your gallbladder removed, because over half of people I have seen who had their gallbladder removed still had the same digestive problem they started with in the first place unresolved, yet now without their gallbladder. Once it is out that is it, it does serve a purpose like every organ you were born with and having your gallbladder removed will affect your health to some degree. For some patients, the removal of their gallbladder had a major consequence on their health down the track. For others, it was a minor consequence.

A surgeon I once spoke to many years ago mentioned that the gallbladder operation was one frequently performed in larger hospitals by the younger surgeon to “bring them up to speed” in the operating room. He said that it was a relatively easy operation lasting from thirty to forty minutes enabling them to gain surgical experience before they move onto “bigger and better things” as far as abdominal surgery is concerned. I can’t help wondering if all the gallbladder operations performed are really that necessary, because they are so quick to take it out these days. The apprentice mechanic will first be introduced to the engine by learning to replace the spark plugs before he is allowed to work deeper into the engine. If the plugs were removed, carefully cleaned and then replaced they generally last a long time. But then again, today more than half the stuff we buy is made in China and it is “chucked” as soon as it is even slightly defective!

What is the gallbladder’s function?

Your gall bladder’s main function is to collect and concentrate bile produced by the liver that the body uses to digest fats. Think of bile a bit like you would dishwashing liquid. Have you ever tried to wash dishes with fat or grease on them in water without dishwashing liquid? Not really effective is it? Not at least until you squirt a little dishwashing liquid into the warm water then they are clean in no time. Your gallbladder makes plenty of its own type of “degreasing liquid” called bile. Bile becomes up to twelve times more concentrated in the gallbladder (and hence much more effective) than it was in your liver. Think about this, with your gallbladder gone, your liver now has to produce, store and secrete bile. It can do this but not as effectively as it can without that little purse called the gallbladder hanging by its side.

The liver makes between 600 – 900 mls of bile each day, and what is not sent during meals to the duodenum (beginning of your small bowel) directly via the liver’s main duct to emulsify fat, it is diverted through a smaller duct (branching off the main liver duct) to the gallbladder for storage until required. When fat in a meal reaches the duodenum (where most of the food you eat is digested and absorbed), hormones enter the circulation and along with nerve signals, stimulate the gallbladder to contract. This contraction, assisted by the small intestine’s contractions, induces the gallbladder’s small round muscle and the stored bile is propelled into the duodenum where it mixes with food from your stomach and pancreatic juices from the pancreas by way of the pancreatic duct. If you eat a fairly fatty meal (fish and chips for example) your gallbladder can empty completely within one hour. It is this combination of bile and fats that can make one feel “queasy” at times after a fatty meal.

Bile itself is made up of water, salts, fatty acids, lecithin, cholesterol, bilirubin, and mucus and has two main functions. The first function is to help in the absorption and digestion of fats, and the second to eliminate certain waste products from the body, especially excess cholesterol and the haemoglobin from worn out red blood cells, which have an average lifespan of 3 months.

In particular, the bile

(1) increases the solubility of fat-soluble vitamins, fats and cholesterol to assist in their absorption,

(2) stimulates secretion of water by the colon to help move its contents along,

(3) is a medium for excretion of bilirubin (the chief bile pigment) as a waste product of destroyed red blood cells, other waste products, medical drugs and their degradation products, and other toxins.

Bile salts are in fact re-absorbed into the small intestine, and re-secreted into the bile after extraction by the liver. All bile salts in the body re-circulate some 10 to 12 times a day by means of this so- called enterohepatic circulation. In each circulation small amounts of bile salts enter the colon where bacteria break them down for excretion with the feces.

Who is the greatest at risk of gallstones?

o Female gender: women outnumber men at least 2:1.

o Family history

o Forty or more years of age

o 3 children or more

o Diet: low calorie, low cholesterol, low fat. (especially a diet like this after a diet high in fat)

o Diet: previously high in refined carbs, alcohol, chocolate, chips, etc.

o Smoking

o High cholesterol history

o Constipation history

o Rapid weight loss

o Obesity

o Food allergy history

o Dehydration due to not enough water

o Liver problems like cirrhosis or past hepatitis infection

o Sensitive to penicillin antibiotics

Signs and symptoms of gallbladder problems

I have seen many women in the clinic who have for years on and off never felt quite well in terms of their digestion. Many have experienced a low grade ill feeling, a digestive discomfort which was put down to indigestion, constipation or diarrhoea or even a “grumbling appendix”. They go on for years and years with digestive symptoms and never realise that they may be related to a gallbladder problem. That’s because they are so inter-related with other digestive symptoms and too easy for their doctor to say: “You are fine; there is nothing to worry about”. Constipation is one of the most commonly missed complaints, and so is farting. Don’t be embarrassed here, we all fart, some men (and plenty of smallish children) enjoy boasting about it but women do it too and are generally totally embarrassed. Flatus is most common in bed when you first lie down, during the night or when you get up. This is because your bowel changes its position and gas more easily escapes through the anus with the large intestine in a horizontal rather than in a vertical position. Don’t laugh, but do you sometimes feel fat, frumpy and farty and at times “sicky” after eating a fatty meal like fish and chips or chocolate? Does your partner joke about how much you “let off”? Then you may very well have a gallbladder issue.

The Four F’s

Have you heard about the four f’s? We learn when we study medicine that women who are “fat, fertile, forty and flatulent” are often the gallbladder girls. They are much more prone to having gallstones or a sluggish liver and gallbladder. The following list provided here may be related to gallbladder but please bear in mind that it could also be something else. The first four symptoms mentioned are the most indicative of gallbladder issues. It is not necessary to have all or many symptoms to have gallbladder problems but the more you have from this list, the more confirmation you have that your gallbladder is involved. Please note that it is still advisable to consult your GP for an accurate diagnosis.

Signs and symptoms of impending gallbladder problems (If you answered yes to the first four (with an asterisk) go to your health-care professional for a more accurate diagnosis.)

• Pain or tenderness under the rib cage on the right side, could be central too*
• Pain between shoulder blades, central but could be under the shoulder blades*
• Stools light or chalky colored*
• Indigestion after eating, especially fatty or greasy foods*
• History of gallstones or gallbladder removal in your family
• Weight gain after recent digestive troubles or after gallbladder removal
• Frequent use of antacids
• Nausea
• Dizziness
• Bloating
• Farting
• Burping or belching up gas easily after meals
• Feeling of fullness or food not digesting
• Diarrhea (or alternating from soft to firm)
• Constipation (or simply skipping a day here or there)
• Headache over eyes, especially right
• Bitter fluid comes up after eating, could be a slight reflux and very subtle
• Frequent use of laxatives

Being big is actually in itself a big risk factor in gallbladder problems, and women with a BMI (body mass index) of 30 or greater are more than double at risk than women who have a BMI of 25 or less. Although a decrease in weight reduces the risk of gallstone formation, there is a 15 to 25 percent increase in gallstone formation during or immediately following weight loss! I have seen this with several patients over the years; they have lost weight and are proud of if only to experience digestive problems and then a bad bout of pain within twelve to eighteen months after the weight loss. A major heart study in America discovered that women with Type 2 Diabetes were almost twice as likely (41.8 percent versus 23.1 percent) that non diabetics to have gallstones, and the risk was highest amongst the 30 to 59yr old group.

I always ask a person these standard questions when they come in with a (suspected) gallbladder dysfunction – “Did you loose weight recently, say in the past two years?” “Have you been on a fat free diet lately?” “What kind of foods/drinks do you like to habitually have?” By asking the right questions, you would be surprised how many will actually tell you what is wrong with them, and their answers can point right to the heart of the problem. In my observation, the main factors leading to gallbladder attacks and dysfunction are obesity (and rapid weight loss (for example1 pound a week); “fat-free” diets are especially bad.

Poor dietary habits – especially too many fatty and fried foods, alcohol, too much dairy food like cheeses and full cream milk, refined sugars and starches, high protein foods (in excess), food allergies, parasites, long-term use of birth control pills, and a sedentary (couch potato) lifestyle. The Atkins diet craze caused a lot of gallbladder problems, for example. Once these factors are operating, bile produced in the liver and flowing through the biliary ducts into the gallbladder becomes too thick, the bile ducts may then become obstructed, gravel and stones may form (90% of all gallstones are cholesterol), and the whole biliary system may become clogged. Other causative factors include insufficient water consumption, a weak immune system (increases likelihood of infection in the gallbladder), as well as diabetes and various liver diseases.

Prevention of gallbladder problems lies in controlling obesity, diet and adequate intake of consuming water, and the use of appropriate physical exercise. Louise Hay, an interesting lady who wrote the famous book “Heal Your Life” way back in 1976 with regard to how emotions can trigger physical problems, mentions that anger, aggressiveness, and bitterness can result in gallbladder problems. Keeping the immune system strong and the liver and small intestine healthy is very important too. Let’s look now at some non-medical alternatives once gallbladder problems are evident, and also how to prevent this problem in the first instance.

Food allergies

Often finding and eliminating food allergies can stop frequent attacks of gallbladder pain and prevent unnecessary surgical removal. In one study, avoidance of allergens relieved symptoms in 100% of 69 patients with symptomatic gallstones or post-cholecystectomy (after the operation) syndrome (uncontrolled trial commented on by Dr. Alan Gaby, USA). I’m not convinced just testing for antibodies in terms of food allergies is the way to go, try also: muscle testing, you may know somebody who does do electro-dermal testing. Either way, try going on an elimination or allergy diet, it may be the answer to your problems.

For recurring gallbladder pain – suspect food allergies in just about 100% of patients. On average I find that they are reactive to 4 or 5 foods, and according to Dr. Jonathon Wright, one of America’s most experienced natural medicine doctors, egg is generally always one of the prime food allergens involved. There are over 800,000 cholecystectomies (gallbladder operations) performed in USA per annum, they cost $5,000 US to perform. If you do the math here, effective preventative natural medicine treatment could spare 4 billion US dollars with gallbladder conditions alone. I can imagine how many of the operations are performed needlessly in NZ each year, and it is truely amazing how many people I have seen who have their gallbladder out only to find that it did not fix up the problem they originally went to the doctor for in the first place.

Other medical methods of handling gallstones in the gallbladder include attempts to fragment them with sonic shock waves (lithotripsy). Of course there are other times when surgery may become necessary, such as in perforation of the gallbladder (often from gangrene) or where for example non-benign tumours and cancers are present. All this is what I call “crisis medicine,” so common in the orthodox medical procedures used in the hospital system. Does it not make sense to prevent a gallbladder condition in the first place rather than waiting for disaster to strike and then to take action?

How is your back?

See your Chiropractor; you may have mid-thoracic vertebral subluxations. If you have back issues, your fourth thoracic vertebrae may a bit “dodgey”, you could be looking at a subluxations which means a slight dislocation (misalignment) or biomechanical malfunctioning of the vertebrae (the bones of the spine). These disturbances may irritate nerve roots and the blood vessels which branch off from the spinal cord between each of the vertebrae, and if this is what is happening around the middle of your back it could be affecting your gallbladder.

Gallbladder removed? – take bile salts

I always recommend that a patient who has had their gallbladder removed take bile salts (digestive enzymes) because fats & oils are not properly digested and absorbed by these folk. I always give bile salts when I give them fish-oil, or Vitamin A. Digestive enzymes are essential for those who have had their gallbladder removed, they will feel a lot better for taking them regularly. Their digestion will improve, their bowels will work better and they will feel less full and bloated. For patients who do not improve their diet following surgical removal of the gallbladder the removal leaves the person with an increased risk of colon cancer. Although fast relief of some symptoms can follow this surgery, the relief is often short-lived and the basic causes are still present. If you have lost your gallbladder, the regular use of bile salts at the start of meals can help substantially, including better processing of the fat-soluble essential nutrients such as essential fatty acids and vitamins A, D, E, and K. Probably the best way to tell if you are using enough bile salts is to monitor the colour of the stool. If the colour is lighter than the normal brown colour, or is even a light beige or yellow, this implies insufficient bile flow; with it’s under absorption of essential nutrients, and a need for more bile salts. Such a need for more bile salts will be greater after a meal with greater amounts of fats and oils. Talk to your Naturopath more here, he or she can recommend a product which should work well. I generally find that the digestive enzymes prescribed by your Naturopath to be stronger and much more effective than the retail (health-food shop) products. That is why they are classified as “practitioner-only” products. My website (see resource box) explains more about “practitioner-only” products.

Useful herbal supplements with liver & gallbladder complaints: Swedish bitters, milk thistle, chamomile, peppermint, greater celandine, gymnema, gravel root, dandelion leaf & root, chicory, rhubarb, burdock, cramp bark, ginger root, fennel, and turmeric.

Homeopathic medicine: one of the most specific homeopathic medicines is Chelidonium 30C, and I recommend this remedy for patients who complain of right-sided pains radiating through the back, pains radiating to the right shoulder blade region. It is mainly thought of as a liver remedy, but I find it fantastic for gallbladder disorders as well.

Diet

Eliminate refined sugar and other refined carbohydrates, because it is these foods which in particular increases the cholesterol saturation of bile. Gallbladder problems don’t generally happen in under developed countries, they are a phenomenon of the Western developed world. We call these sorts of health problems the “diseases of modern civilisation”. You will find that our Western diet is the highly refined one, most people eat foods from the supermarket and our diets are the ones high in the refined sugars, starches and flours. Foods and drinks to strictly avoid One of the worst beverages to drink with gallbladder issues is coffee whether decaffeinated or not, it aggravates symptoms by causing the gallbladder to contract along with sugar. So, sugar and coffee is not a good idea! I also tell patients to avoid chocolate, deep fried foods and saturated animal fats in general. Most tell me that they cannot tolerate these foods anyway, so listen to your body and avoid what makes you feel unwell or sick.

Gallbladder foods which have a particular favourable effect include beetroot, Brussels sprouts, fennel, sauerkraut, parsley, artichokes, pears, granny smith apples and the bitter foods such as rocket, endive, chicory, and capers.

Consume a little olive oil daily One way to prevent build-up of gallstones is to eat some oil, particularly extra virgin olive oil, daily; this encourages the gallbladder to contract and to daily “sand dump” its contents into the small intestine, preventing sludge from accumulating and forming gallstones.

Treatments

Warm castor oil packs. All you need is 200ml castor oil (try the chemist or supermarket), and old saucepan, an old cloth, and an old towel. Just warm the old cloth in the pot of oil until it is quite warm, squeeze it out and apply it over the region of the gallbladder – central a little to the right just near where your ribcage finishes. Cover with the old towel, place a hot water bottle on top for added warmth and lie down for fifteen to twenty minutes, then rub the area for 2 minutes with an ice cube in a cloth-repeat 3 times once daily for a week can sometimes dislodge gallstones, and is especially a powerful treatment if used in conjunction with the flush and dietary approach. Careful with castor oil, it can stain.

Liver and gallbladder flush

there are many different gallbladder and liver flushes that will work if you have had recurrent gallbladder problems and your diet has been typically Kiwi. You really need to work in with your health-care professional like your naturopath here. I have guided many patients through this procedure the past twenty years and have never experienced a problem, and to be honest have very rarely found somebody with a “gallstone too big to pass” as some may fear.

For a gallbladder “attack” try these recipes Here are a couple of tips to try with acute pain, if the pain doesn’t subside, seek medical opinion.

o Drink 1 tbsp of apple cider in a glass of apple juice (warmed). This should relieve the pain quickly.

o In a small glass add ¼ tsp turmeric, ¼ tsp cumin, and ½ tsp Manuka honey – top with boiling water, stir to dissolve and mix together, drink when warm. Take: 3 times a day.

o Citrus tea: have 3 glasses daily of tea made by boiling for 20 minutes in water the rind of a grapefruit.

Recommendations stopping future gallbladder attacks

1. Each morning, drink a “gallbladder attack flush”; 300mls Apple juice (or dilute with water), 3 cloves of raw finely chopped garlic, 1-2 inches of raw finely chopped ginger root, mix well in blender. This drink helps soften sludge and helps prepare your gallbladder to dump rubbish.

2. Liver & gallbladder flush. One simple flush is to drink 3 Tbs of extra-virgin olive oil with the juice of a lemon before retiring and on awakening for at least 3 days, or until no more stones pass. I have other flushes but tend to use them in a consultation with the patient only. This is one procedure in my opinion you are best not to do yourself at home without any guidance, but get the advice from a qualified Naturopath, preferably one with experience in this area.

3. Eat a well balanced diet of 50% raw or partially steamed foods and fresh juices, fruits, vegetables, whole grains, legumes, and nuts/seeds. This low saturated fat, high fiber diet is a must for healing gallbladder disorders. Flaxseed and olive oil are great additions to your diet for repair and prevention of gallstones. Bitter foods (see below) are a great addition, and will help prevent a build up in future. The two top foods to consume? – Lemon juice and olive oil.

4. Increased your intake of Vitamin C can help with gallbladder ailments. Replenish your vitamin C stores by eating plenty of vitamin C-rich fruits and vegetables on a daily basis. Good sources include capsicums (red/green/yellow), berries, lemons, and broccoli/green leafy veg. I recommend a high grade Vitamin C powder daily for the prevention and maintenance of many conditions in the body.

5. Herbal detoxification products may be helpful in stopping and reversing a gallbladder attack. I suggest using formulas that use organic, whole herbs. There are some excellent products available, just ask your herbalist or naturopath.

3 tips for after the gallstones have passed

o Dr. Dick Versendaal, a Chiropractor from America recommends his “carotid-umbilicus technique”. For the best results, it is to used every 15 minutes for 1-3 hours as follows (it’s easier if someone else does it on you than you try to do it yourself ): using the index finger, apply a steady pressure into the belly button for 5 minutes, such as to depress the belly button 1-1 ½ inches (but avoiding pain). Do this once a day for up to 12 weeks after the stones are passed, it will help your gallbladder a lot.

o Firm rubbing for at least 30 seconds1-2 times a day of the neuro-lymphatic reflexes (these points may feel quite tender if you have gallbladder issues) between ribs 3 and 4, and ribs 4 and 5, just to each side of the breastbone, and between ribs 5 and 6 just under the nipple of the right breast can be quite helpful.

o Also softly holding (not pressing or rubbing) for at least one minute the neurovascular reflexes at the anterior fontanel (front of head the baby’s soft spot near crown of head- locate at tip of middle finger when the wrist crease of either hand is placed on the eye brows and the middle finger extended onto the midline of the skull) and at the hairline on the forehead directly above the outer corner of each eye. Look for the “tender spots”, you will find them.