Is it your gallbladder? The most common symptoms of gallbladder problems are:
Abdominal pain, which may range from dull to sharp, and which may worsen after eating a fatty meal.
Heartburn, indigestion, and excessive gas
Stools that are pale, clay, or putty-colored
Frequent bowel movements, light-colored stools, and dark-colored urine
Gripping or gnawing pain in the upper right abdomen near the rib cage, which can be severe and can radiate to the upper back. Some patients with biliary colic experience the pain behind the breastbone. Nausea or vomiting may occur.
Sensation of fullness in the abdomen
You should especially stay vigilant of signs of gallbladder issues or gallbladder-related diarrhea if you:
Have a high cholesterol diet
Are overweight or obese
Are over the age of 60
Are assigned female sex
Have a family history of gallbladder disease
Are of Native American or Mexican heritage
Are pregnant or just had a baby
Take cholesterol-lowering drugs
Have lost a significant amount of weight
Have had your gallbladder removed
Be aware that you are at a higher risk of gallbladder disease if you have the following:
Diabetes
Crohn’s disease
Cirrhosis of the liver
Sickle cell disease
One of the most common surgeries in the United States is removal of the gallbladder. The conventional medicine approach to gallstones/gallbladder pain is surgery: "Take it out; it doesn't really matter anyway" is what most patients hear when they seek help. However tiny it is, the gallbladder is mighty, and it plays a vital role. Removing it often leads to chronic digestive health issues down the road. So before you opt for the knife, here are some tried and true options to treat the root cause of gallbladder problems, get relief, and heal from the inside out.
First, you should know what the gallbladder is and why it is important (because most people don't!) I PROMISE all the juicy pearls are towards the bottom of this post, but having an understanding of what is happening to your body empowers you to heal your body.
Gallbladder: small, pouch-like organ in the upper right part of your stomach, next to liver. It stores bile.
Bile: a yellow-green digestive fluid produced in your liver, stored in gallbladder. When you eat, your gallbladder empties bile into your small intestine. Bile is critical for normal digestion by breaking down fats.
Bile salts: Bile salts are one of the primary components of bile. Bile salts help with the digestion of fats. They also help the body absorb fat-soluble vitamins, like vitamins A, D, E, and K. Bile and bile salts are made in the liver and stored in the gallbladder between meals. In addition to bile salts, bile contains cholesterol, water, bile acids, and the pigment bilirubin.
Gallstone: An abnormal, small, hard mass made of bile, cholesterol and calcium salts, which is formed in the gallbladder or bile ducts. Gallstones can cause a blockage of the bile duct (resulting in severe pain). This is the main reason folks seek help and have their gallbladder removed.
Causes of Gallstones: Most are actually cholesterol stones: Excess cholesterol and a reduced secretion of bile acids and phosphatidylcholine cause the bile to contain more cholesterol than bile salts can dissolve. The bile then builds up in vesicles and begins to form gallstones.
Types of Gallstones
Cholesterol stones: accounts for 80% of gallstones. Thus, folks with high levels of cholesterol are at higher risk of having gallstone.
Cholestasis is the slowing or stalling of bile flow through your biliary system. It can be a problem in your liver or in your bile ducts. Bile that can’t flow (perhaps from gallstones) leaks into your bloodstream and backs up into your organs, causing inflammation. Bile that can’t reach your intestines can also cause problems in your digestive system.
Bile acid deficiency in your small intestine leads to malabsorption of fats and fat-soluble vitamins (A, D, E and K). This can lead to malnutrition and specific problems related to fat-soluble vitamin deficiencies. For example, vitamin D deficiency affects your bones, mental health, and immunity, and vitamin A deficiency affects your vision and immune system among other things.
Backed-up bile can cause inflammation in your liver, gallbladder, pancreas or bile ducts. This may cause pain, nausea and other symptoms. It also makes infections more likely. Cholestasis affects your small intestine by depriving it of the bile it needs to break down fats in your food. This may cause symptoms of indigestion and diarrhea.
Bilirubin: Bilirubin is a yellowish substance made during your body's normal process of breaking down old red blood cells. Bilirubin is found in bile, a fluid your liver makes that helps you digest food. Once bilirubin has left the liver, its levels may be high because it is unable to leave the body due to a gallstone. When we are looking for signs of possible gallbladder issues, we measure bilirubin levels.
Other causes of high bilirubin may include inflammation or cancer of the gallbladder, which produces bile, or pancreatitis.
If your liver is healthy, it will remove most of the bilirubin from your body. If your liver is damaged, bilirubin can leak out of your liver and into your blood. When too much bilirubin gets into the bloodstream, it can cause jaundice, a condition that causes your skin and eyes to turn yellow
High levels of bilirubin may indicate different types of liver, gallbladder, or bile duct problems. Sometimes, higher bilirubin levels may be caused by an increased rate of destruction of red blood cells.
High levels of bilirubin in the blood can cause jaundice, which may cause symptoms, such as:
yellowing of the skin
yellowing of the whites of the eyes
dark-colored urine
itchy skin
pale stool
Because an underlying condition, such as liver disease or hemolytic anemia, may cause high bilirubin levels, a person may also experience other symptoms, including
nausea
vomiting
stomach pain
bloating
unintentional weight loss
headaches
confusion
fatigue
drowsiness
Gallbladder disease and gallstones commonly cause cholecystitis, inflammation of the gallbladder which may be acute or chronic.
Cholecystitis is associated with gallstones in 90% of cases.
Cholecystitis may be classified as acute or chronic:
Acute cholecystitis is caused when bile becomes trapped in the gallbladder (usually by a gallstone), causing irritation and pressure. If left untreated, may lead to infection (gangrene) and perforation.
Chronic cholecystitis also involves gallstones and mild inflammation.
Risk factors of Gallstones and Gallbladder disease:
Intestinal Permeability (leaky gut) Microbes leaking into the blood can impair the release of bile and contribute to gallbladder disease
Western diet: high in refined carbohydrates, white bread, high meat/dairy intake, vegetable oils and low in fiber
Gluten and other gliadins can impair the gut wall and in turn compromise the blood-biliary barrier.
Increasing age: causes increased biliary cholesterol secretion due to a decrease in decreased biliary salt excretion
Obesity and high serum triglycerides (cholesterol): causes increased liver secretion of bile with high amounts of cholesterol; High triglycerides are often associated with/exacerbated by high blood sugar levels.
Diabetes / metabolic syndrome
Crohn’s disease / cystic fibrosis
Cirrhosis-liver disease
Rapid weight loss, weight cycling and prolonged fat-restricted diets: exacerbate gallbladder problems
A gallbladder-provoking meal:
Signs & symptoms of Gallstones
*60-80% gallstones are asymptomatic but the most common symptom of chronic cholecystitis/ gallstones is intermittent biliary colic: abdominal pain upper mid- or right side of abdomen. Pain is usually gripping or gnawing, and may radiate to back or right shoulder blade. This happens especially when someone is eating something fatty/greasy.
The gallbladder may hurt after eating because the body secretes more bile after large or high fat meals. Bile works to break down fats we eat so the body can absorb them. When fats are ingested, the gallbladder contracts significantly in response, and combined with blocked ducts, this pressure can cause pain.
An Acute Gallbladder attack is more serious and should also be seen urgently:
Severe constant biliary colic which may last for days
Fever and chills in 30%
Nausea and vomiting
Clay-coloured stools
Jaundice
Signs & symptoms – Chronic Gallbladder disease
Gas, nausea and abdominal discomfort after meals
Intermittent pain in right upper stomach or around belly button lasting 30 minutes to several hours. Episodes may occur daily or every few months
Chronic diarrhea--It is thought that diarrhea is caused by an increase in bile, especially bile acids, entering the large intestine — which may act as a laxative. **Note! Chronic diarrhea is also common after gallbladder removal surgery (cholecystectomy) due to the unobstructed flow of bile into the small intestine.
Gallbladder disease results in reduced bile flow into the gut lumen causing an increase in small intestinal bacterial overgrowth (SIBO) and a much higher risk of bacterial, fungal and parasitic infections of the gut in general
Testing of Gallbladder disease & Gallstones Some of the tests we may run to investigate further includes:
Labs (CBC and a comprehensive blood chemistry panel, LDH, Haptoglobin, Retic Count, hepatic liver function, SPEP, Smear, AFP, hepatic function panel)
Abdominal ultrasound/CT scan/x-ray/MRCP
Advanced Stool Analysis
SIBO breath test
Functional Medicine TREATMENT STRATEGY OF GALLBLADDER DISEASE & GALLSTONES
First, Resolve underlying cause of stones such as gut bacterial overgrowth (dysbiosis) and/or SIBO
1. Treat root cause (often high cholesterol and dysbiosis)--eat a low saturated fat diet (avoid processed snack foods, inflammatory oils such as seed oils, avoid/limit animal and dairy products), increase HDLs (good cholesterol) such as avocado, chia, flax, fish, fish oil supplement, increase fiber. If SIBO is one of the root causes, we will want to test for this and treat it.
A gallbladder-healing meal:
Increase fiber: very important in the prevention and reversal of gallstones – helps to increase solubility of bile salts and facilitates excretion of cholesterol/bile
For example: Fruit & vegetables, pectin, oat bran, psyllium, chia, linseeds – (contraindicated with SIBO during L0w-fodmap phase of treatment)
2. An anti-inflammatory diet and supplements that can improve bile flow and break up gallstones like bitters, dandelion, lemon oil, and phosphatidylcholine can help reduce inflammation and prevent gallstone formation. I like the book "The Peagan Diet" by Dr Mark Hyman to use as guide.
3.Increase bitter foods: e.g. rocket, dark leafy greens, lemon, beetroot--consider using "bitters" which can be purchased at our apothecary, via our fullscripts, or at most natural grocers.
4. Research has linked gluten intolerance and celiac disease to increased prevalence of gallstones and biliary cirrhosis--reduce gluten or avoid strictly
5.Increase omega-3 and mono-unsaturated fatty acid intake: oily fish, linseeds, olive oil, avocado, nuts and seeds, etc.
6.Reduce sugars and refined carbohydrates, saturated fats, fried foods, trans fats, food allergens
7. Increase water intake to 2 L/day
Supplements that support Gallbladder disease & Gallstones:
Lecithin- increases solubility, emulsification and excretion of cholesterol;
Phosphatidylcholine , may help dissolve gallstones
Choline, methionine, glycine – increases solubility, emulsification and excretion of cholesterol
Soluble fibre supplements e.g. psyllium, pectin: increase solubility of bile salts and facilitates excretion of cholesterol/bile
Vitamin C – stimulates bile production
Vitamin E – stimulates bile production
Omega-3 essential fatty acids – controls blood lipids
Red yeast rice + Co-q10, garlic extract, berberine and curcumin to control and lower cholesterol and prevent cholesterol gallstones from forming
TUDCA – TUDCA (Tauroursodeoxycholic Acid) is still being investigated as a potent bile acid; TUDCA supports healthy bile flow, which aids in detoxification and digestion, reducing the risk of gallstones and liver diseases.
A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
***Vitamin D , for immune support. Preliminary studies suggest a link between vitamin D deficiency and gallstones
Herbal medicine treatment that supports Gallbladder Disease & Gallstones:
Cholagogues / choleretics (stimulate gallbladder): globe artichoke, St Mary’s thistle, dandelion root, greater celandine, barberry, yellow dock, turmeric
Anti-lithics (dissolve gallstones): gravel root, hydrangea, crataeva, peppermint oil (enteric-coated)
Relaxation of bile duct: vervain (especially in obstructive gallbladder disease)
Anti-inflammatory: turmeric, bupleurum
Bitters: gentian, goldenseal, agrimony
Heal the gut: While it’s a bit of a chicken-or-the-egg situation as to which came first, leaky gut and biliary disease certainly go hand in hand. It’s important to address both simultaneously in order to break the cycle of gut inflammation → biliary stasis → lack of bile → more gut inflammation.
Stimulate bile flow: Bitters like curcumin, dandelion, milk thistle, and ginger are well known for their ability to stimulate bile flow. These can be taken as supplements, included in meals, or consumed as tea.
Dissolve gallstones: Beet root, taurine, phosphatidylcholine, lemon, peppermint, and vitamin C have all been shown to reduce the impact of or even dissolve gallstones.
Consider supplementing with bile: If having trouble with fat digestion, you can also consider a supplement with bile itself from a bovine or ox source until flow is restored, such as Digestion GB from Pure Encapsulations. Take these with each meal/snack.
For rapid Gallbladder pain relief:
For gallbladder pain relief, you can try applying a warm compress to the affected area. You may be able to drink peppermint tea to soothe the pain or take a magnesium supplement to help empty your gallbladder. Though there is little evidence for it, some folks swear that sipping on diluted apple cider vinegar during a gallbladder attack is a useful first aid remedy. I strongly suggest taking Biogest by Thorne pre-emptively or when the first signs of an attack come on.
Conventional medicine treatment options:
Endoscopic transpapillary gallbladder drainage is an alternative non-surgical treatment for patients with severe symptoms of gallbladder disease. This type of procedure uses a stent to enlarge the gallbladder opening to allow drainage and the removal of gallstones.
This method has many advantages, like being cost-efficient and eliminating the risk of pancreatitis associated with ERCP (endoscopic retrograde cholangiopancreatography). It also has a success rate of up to 95%.
Lithotripsy
ERCP
Removal of gallbladder (can and will cause downstream health problems, chronic digestion issues and possible chronic change in bowel movements such as diarrhea)--should be last resort
RX options: Actigall (ursodiol) and Chenix (chenodial) are two bile acid drugs that may break up gallstones.--May take years of using these to break up all stones, especially if more keep forming because root causes are not being addressed
Cholestyramine is a bile acid sequestrant mainly used to treat high cholesterol but it can also be used off-label to treat bile acid diarrhea. The drug is taken by mouth and works by clearing excess bile acid from the body. Many cases of chronic diarrhea are caused by bile acid malabsorption. Bile acid malabsorption is found in a number of conditions. For example, it can be caused by diseases of the small intestine, such as Crohn's disease, and it is seen in people who have had an operation to remove or bypass their small intestine.
Our functional medicine gut-health specialist, Havilah Brodhead, FNP, provides a thorough assessment for our patients, offering them an individualized treatment plan, sometimes using conventional medicine and imaging if needed. Here is a sample of an integrative medicine prescription sent for a patient having gallstone pain who also had fat-soluble vitamin deficiencies:
Cholacol® (90 tablets) (Standard Process): Please take 2 tablets, three times / day (Bile salts and Collinsonia (root)).
Digestion GB (180 capsules) (Pure Encapsulations): Please take 1 capsule, three times / day .
Gallbladder Nutrients (120 capsules) (Seeking Health): null .
Chanca Piedra (90 capsules) (AOR US):
Stress B-Complex (60 capsules) (Thorne): Please take 1 capsule, once / day .
Vitamin D-A-K (60 capsules) (Natura Health Products): Please take 1 capsule, once / day .
Omega-3 (100 Softgels) (NOW Foods): Please take 2 gels, three times / day .
Cholesterol Care (120 capsules) (Restorative Formulations): Please take 1 capsule, twice / day
For discounts on any of the above-mentioned nutrients/supplements, create an account in our Fullscripts Online Apothecary, search for the items, and have it mailed quickly to your home.
Havilah Brodhead is currently accepting new patients from the states of Oregon and Washington via telehealth (virtual) or in-person appointments in our Bend, Oregon clinic.
Call to schedule: 541-516-5693 or schedule on our website (www.hearthsidemedicine.com)
