Gall Bladder Disease

by Dr. Sandra Cabot

What is the gall bladder?

The gallbladder is a small pear-shaped organ situated directly under the liver in the right upper quadrant of the abdomen.

What is the function of the gall bladder?

Its main function is to collect and concentrate the bile that the body uses to digest fats.

Problems with the gall bladder and biliary system are very common and consist of -
• Inflammation of the gall bladder and bile ducts
• Muscular spasms and/or poor contraction of the gall bladder wall
• Stones forming in the gall bladder and/or bile ducts
• Obstruction to the free flow of bile

Surgeons are often very keen to remove the gall bladder as it is believed that it 'serves no purpose' This is very untrue.

The process of bile production is an 'expensive' biochemical process. The body has developed the gall bladder to store bile that has been recovered from the bowel to be recycled - thus saving the liver from having to produce new batches. Therefore, the gall bladder is vitally important as it takes a lot of workload off the liver. If the gall bladder is diseased and dysfunctional, it is often due to the fact that the liver is under stress and is also dysfunctional. A dysfunctional liver will tend to produce toxic unhealthy bile.

What is bile

Bile is a substance made in the liver cells (hepatocytes) consisting of water, electrolytes, bile acids, cholesterol, phospholipids and bilirubin. It is a fat emulsifying agent helping to keep cholesterol levels in check. it also assists with absorption of certain nutrients, namely the fat soluble vitamins A, D E and K.

What causes gall bladder problems?

• Production of toxic bile by the liver
• Inadequate production of bile by the liver
• Sluggish flow of bile
• Excess amounts of cholesterol in the bile resulting in stone formation
• Infection of the gall bladder
• Poor dietary choices with excess consumption of fatty foods, dairy products and fried foods.
• The hormonal changes of pregnancy
• The oral contraceptive pill and some types of hormone replacement therapy
• Some types of blood disorders

You may be suffering with chronic infections because your immune system is weakened and over loaded. To reduce the workload of the immune system it is vital to improve the liver function.

What are the symptoms of gall bladder disease?

• Indigestion and nausea after eating (especially fatty foods)
• Vomiting attacks
• Pain in the right upper abdomen, which often radiates to the right shoulder and back.

What can I do to help prevent/treat gall bladder problems?

To improve gall bladder problems, we must improve the quality of the bile, by improving the liver function. See suggestions below.

What causes gall stones?

Sometimes crystals precipitate out of the bile to form gallstones. Generally speaking the gall bladder becomes diseased or dysfunctional because the liver is producing unhealthy bile. The bile is either toxic or contains excess amounts of fat and bacteria.

What are the symptoms of gall stones?

The majority of gallstones stay in the gallbladder and cause no symptoms. However, if a stone moves it may obstruct the neck of the gall bladder or common bile duct giving rise to severe pain in the upper right side of the abdomen.

A stone in the common bile duct will frequently cause jaundice. Jaundice is a condition in which the skin and the eyes become yellow due to accumulated bile pigment.

Some people with large stones in the gall bladder will never have any problems, and should not rush into surgery. In such cases you may want to try and dissolve the stones gradually over several years by following the recommendations given below. Of course you will also be doing your liver a good service, as you will be removing the unhealthy fats from the liver.

Acute cholecystitis is when the gallbladder becomes distended and inflamed often with resulting localized peritonitis. It usually follows obstruction to the neck of the gallbladder or cystic duct by an impacted stone. Acute cholecystitis classically affects females in the 20 to 40 year age group but may occur at any age. The pain in the central and right upper abdomen is continuous and severe and increases in intensity over 24 hours. It frequently radiates around to the back and may be associated with nausea and vomiting. Fever is usual. The presence of gallstones and acute cholecystitis can usually be confirmed by an ultrasound scan. Repeated attacks of cholecystitis may occur if the condition remains untreated.

Treatment

Generally speaking the gall bladder becomes diseased or dysfunctional because the liver is producing unhealthy bile. The bile is either toxic or contains excess amounts of fat and bacteria. To improve gall bladder problems, we must improve the quality of the bile, by improving the liver function. Even after the gall bladder is removed there may still be problems in the bile ducts inside & outside the liver. This is because the underlying problem of toxic bile has not been corrected.

Indeed after gall bladder removal the following things may still happen –
• Stones & gravel may form in the bile ducts inside & outside the liver
• The liver may develop fatty changes

Thus it is important to take extra care of your liver if you have gall bladder problems, or if you have had your gall bladder removed.

Common questions about the gall bladder

Q: Can I still do the Liver Cleansing Diet or follow Liver Cleansing principles even though my gall bladder has been removed?
A: Yes – infact it is highly recommended as even after the gall bladder is removed there may still be problems in the bile ducts inside & outside the liver. This is because the underlying problem of toxic bile has not been corrected.

Q: What can I do if I have Gallbladder Disease or Gallstones?
A:Diseases of the gall bladder and biliary system are surprisingly common, and many cases could be avoided simply by following the principles of the Liver Cleansing Diet.

Q: I have been diagnosed or believe I have gall stones – should I do a gall bladder/liver flush?
A: No – this is not recommended as a first step. These flushes using olive oil, lemon juice or apple juice etc work by shrinking the stones and causing the gallbladder to contract forcefully to hopefully expel the stones to be passed in the faeces. Alternatively, a teaspoon of good quality apple cider vinegar mixed with a teaspoon of honey in a small glass of warm water and sipped slowly during every meal can be taken to help dissolve the stones.
These flushes are best done after at least 6 months of following the "Liver Cleansing Diet" principles and taking the recommended supplements to shrink and soften the stones before flushing. Once this has been done – the shrunken softened stones and remaining sludge may then be safely flushed out.

It is recommended to have an ultrasound of the gall bladder before undertaking the flush to make sure. The reason being that if the gall bladder is full of silent gall stones and a flush is undertaken – these stones may become impacted in the narrow bile ducts as they are flushed out. This may cause a tear in the duct.

A standard and alternative method of gall bladder flushing is outlined in Dr Cabot's “Healthy Liver and Bowel Book”

Orthodox Medical Treatment

Gallstones which are not causing any symptoms require no treatment. Acute cholecystitis is commonly managed conservatively with bed rest, nil by mouth and intravenous fluids, plus an antibiotic. Strong analgesia (pain relief) is also usually needed. As repeat attacks are likely, surgical removal of the gallbladder (cholecystectomy) is recommended at some future date. This is also the preferred option for any gallstones which are causing symptoms. These days, the operation is frequently done via a laparoscope (operating telescope) requiring only a very small incision ("keyhole surgery"). This means a much shorter hospital stay and much faster recovery. Other possible treatments for gallstones include the administration of bile acid preparations which can be used to dissolve certain types of stones. This takes anything from six months to two years and after the treatment is stopped 50 percent of the gallstones recur, especially if you don't follow our dietary recommendations. For these reasons it is rarely advocated. Shock-wave treatment (lithotripsy) can be used in some cases to break up the stones, followed up by bile acid therapy. The role of this approach is still being evaluated. In our experience, by using these dietary and natural therapy measures, surgery can often be avoided.

References

Bergman F et al. Gallstone formation in guinea pigs under different dietary conditions. Effect of vitamin C on bile acid pattern. Med Biol 599(2):92-8,1981; Ginter E, MIlus L. Reduction of gallstone formation by ascorbic acid in hamsters. Experientia 33(6):716-7,1977; Saito T. The preventive effect of vitamin E on gallstone formation. Arch Jpn Chir 56(3):247-88,1987; Tuzhilin SA et al. The treatment of patients with gallstones by lecithin. Am J Gastrenterol 65(3):231-5,1976; Tompkins RK et al. Relationship of biliary phospholipid and cholesterol concentrations to the occurrence and dissolution of human gallstones. Ann Surg 172(6):936-45,1970; Faber K. The dandelion - taraxum officinale. Pharmazie 13:423-35,1958.) November 7, 2002

Articles

Dealing with Gallbladder Disorders

If you suffer from high cholesterol and regular bouts of indigestion, your gallbladder may be trying to tell you something.

The message that your gallbladder is sending could very well be this: Beware the effects of bad nutrition. In recent years surgeons have been increasingly removing gallbladders, presumably in an attempt to treat gallstones and related disorders. But the gallbladder is fundamental to your well-being. Among other functions, it stores bile, a powerful fat-emulsifying substance that the liver makes from cholesterol. A healthy gallbladder works with flawless precision, releasing bile just when it’s needed to help digest food. It also absorbs nutrients and keeps your cholesterol levels in check.

Even as many doctors subscribe to the myth that eating fat and cholesterol leads to gallstones, research indicates that eating too little fat and too many carbohydrates in the form of grains, sugars and starches actually leads to gallbladder ailments.1 The organ has one fundamental purpose: to help you digest food, specifically fats. Meddle with the performance of its job—as you do when you don’t eat enough fat to keep it in working order—and you endanger its health. Instead, the bile just sits in the organ, losing water and thickening.

Upsetting the Bile Balance

When you eat a meal that contains fat, the gallbladder releases bile into the small intestine. The bile breaks down the fat so the body’s tissues can absorb it, also enabling absorption of fat-soluble nutrients such as vitamins A, D, E and K. But the wrong food choices can toss a variety of diet-related wrenches into this machinery.

For example:
• Without adequate protein, the liver won’t produce enough bile for the body to digest fats and allow nutrient absorption. After a while, stores of fat-soluble vitamins, especially vitamin K, decline. With time, outright deficiencies can occur—along with the illnesses they trigger.

• A diet high in sugary foods or refined carbohydrates has the same consequences.
• Frequent fasting—even just skipping breakfast—also sets the stage for a drop in bile production and usage.

• A low-cholesterol diet disrupts the system in two ways: First, the liver makes bile acids from cholesterol, so a scarcity of the raw ingredients causes a drop in production. Second, the main way the body gets rid of cholesterol is through bile metabolism, which transforms a third to a half of our total cholesterol into bile acids.

The Growth of Stones

Besides nutrient deficiencies and impaired digestion, the biggest repercussion of gallbladder dysfunction is the formation of gallstones, which can block bile ducts and cause nausea, abdominal pain, indigestion and inflammation. If gallstones are not treated, they can become steadily worse and ultimately prove fatal.

Approximately 80 percent of gallstones are composed mostly of cholesterol. As bile stagnates or thickens, cholesterol concentration increases. Cholesterol crystals eventually form, becoming like grains of sand in a gallstone “pearl.” So, if excess cholesterol is the basis of gallstones, why doesn’t a low-cholesterol diet solve the problem? It doesn’t work that way. People with high cholesterol levels in their blood are not any more likely to develop gallstones or gallbladder problems. In other words, dietary cholesterol (as opposed to cholesterol made by your liver) is not an important risk factor for gallstones.

What, then, are the risk factors for gallstones? Depending upon which study you read, women are anywhere from four to eight times more likely to get gallstones than men.2 Pregnancy and estrogen therapy raise the odds a woman faces, as do obesity, diabetes and aging. We can’t do much about gender and age, but diet is a common denominator in obesity and diabetes. In too many instances they are provoked by an insulin disorder that’s caused by eating high-sugar, high-carbohydrate foods. Eating a lot of refined carbohydrates has also been identified as a risk factor for gallstones.3

Rapid weight loss also has been implicated. In the last few years researchers have debated whether it’s the speed with which pounds are dropped or the composition of the diet plan, but upon closer inspection, the culprit repeatedly proves to be a low-calorie, low-fat diet.4,6 Dietary fat and cholesterol promote normal gallbladder function.5 If you take cholesterol-lowering drugs, be aware that they can raise the risk of gallstone formation.6
Consuming sufficient healthy fat while shunning sugar and other carbohydrates empty of nutrients promotes gallbladder contractions and prevents gallstones better than anything else. So, long before surgery becomes a necessity, look at changing your diet. It’s a lot safer. For a list of nutrients that assist in gallbladder health, see Supporting Your Gallbladder with Supplements.

Selected References
1. Tseng, M., Everhart, J.E., Sandler, R.S., "Dietary Intake and Gallbladder Disease: A Review," Public Health Nutrition, 2(2), 1999, pages 161-172.
2. Everhart, J.E., Khare, M., Hill, M., et al., "Prevalence and Ethnic Differences in Gallbladder Disease in the United States," Gastroenterology, 117(3), 1999, pages 632-639.
3. Boland, L.L., Folsom, A.R., Rosamond, W.D., "Hyperinsulinemia, Dyslipidemia, and Obesity as Risk Factors for Hospitalized Gallbladder Disease. A Prospective Study," Annals of Epidemiology, 12(2), 2002, pages 131-140.
4. Festi, D., Colecchia, A., Orsini, M., et al., "Gallbladder Motility and Gallstone Formation in Obese Patients Following Very Low Calorie Diets. Use It (Fat) to Lose It (Well)," International Journal of Obesity and Related Metabolic Disorders, 22(6), 1998, pages 592-600.
5. Gebhard, R.L., Prigge, W.F., Ansel, H.J., et al., "The Role of Gallbladder Emptying in Gallstone Formation During Diet-Induced Rapid Weight Loss," Hepatology, 24(3), 1996, pages 544-548.
6. Michielsen P.P., Fierens, H., Van Maercke, Y.M., "Drug-Induced Gallbladder Disease. Incidence, Aetiology and Management," Drug Safety, 7(1), 1992, pages 32-45.

Other Treatments

Other treatments available for gall stones consist of drugs used to dissolve the stones. This is not hugely successful because it takes 6 months - 2 years for the stones to dissolve and the recurrence rate is high. Only stones made from cholesterol can be dissolved with drugs such as the bile acids chenodeoxycholic acid and ursodeoxycholic acid. These drugs will not dissolve calcified stones, which makes only around 10% of patients with gallstones suitable candidates for these drugs. Therefore these drugs are not recommended for the majority of patients with gallstones.

Gall bladder disease is very common, with around one million new cases of gallstones occurring every year in the U.S.A. This equates to 1 in every 250 persons who develop gallbladder problems annually, and the incidence is only slightly less in Australia. So do not feel alone if you have this problem! The good news is that most cases of gall bladder disease could be prevented if we consumed a diet that was good for the liver.