To Remove or Not to Remove the Gallbladder? That is the Question.

To Remove or Not to Remove the Gallbladder? That is the Question.
Posted on Dec 17, 2014 by ntischool

That’s the question that I’m asking myself, right now. I was in a head-on car accident several weeks ago in which my chest area slammed against the steering wheel. Two hours later, I was having intensive pain in the gallbladder. I went to the doctor and found out that I have a 16 mm gallstone that is now giving me problems. The doctor recommended that I have my gallbladder removed.

In this day and age, gallbladder removal has become more of a routine operation than one that is done out of necessity. Gallstones affect 1 out of 10 Americans. Over 800,000 people are hospitalized each year for gallbladder pain, and, of these, 500,000 will have their gallbladder removed. Interestingly, women are two times more likely to develop gallstones than men, and it usually effects women who are in their forties. After gallstones form, it generally takes an average of 8 years for symptoms to develop.

So, should I have my gall bladder removed at my doctor’s suggestion? While this is certainly an individual choice, I opted to first research my holistic alternatives before undergoing the knife. Gallstones can be dangerous. If they block the cystic duct or the common bile duct, infection may ensue. In this instance, gall stone surgery may be appropriate.

What is the gallbladder and why is it important?

The gallbladder is a hollow pear-shaped organ located under the right rib. Its well known function is that it acts as a storage area for concentrated bile. Bile is an important substance that helps to emulsify fats into smaller droplets, so that the enzyme lipase can further breakdown those fats. Bile is produced in the liver. It’s made of water, bile salts, bilirubin (a waste product from the normal breakdown of red blood cells), fats (cholesterol, fatty acids and lecithin) and electrolytes.

When fat enters the first 10 inches of the small intestine (the duodenum), the hormone cholecystokinin is released and causes the gallbladder to contract and squirt bile into the small intestine.

Bile is necessary to break down most fats, including the essential fatty acids (Omega-3 and Omega-6). The emulsification of the fats makes it possible for fat soluble vitamins (A, D, E and K) to pass through the intestinal lining and enter the bloodstream.

Bile not only breaks down fats, but it is an important method of flushing toxins from the body. It is an alkaline substance that helps to bring down the acidity of the chyme in the duodenum, so that the other pancreatic enzymes can do their jobs. It’s also a natural laxative for the colon.

What are gallstones and how are they formed?

Gallstones are pebble-like substances that are either cholesterol stones, or pigment stones. Most gallstones in the Western world are cholesterol stones, which are formed when there is not enough bile salt. (Note: dietary cholesterol is different from the cholesterol made by your liver and deposited in the gallbladder. Dietary cholesterol is not an important risk factor for gallstones. In fact, you need dietary cholesterol to make bile.)

Several studies have shown that a low-fat or fat-free diet causes gallstones. See here and here, while a higher fat diet prevents gallstone formation. See here .

When there is not enough fat in the diet, the gallbladder does not contract, and therefore does not empty. The bile becomes stagnant and concentrated. The cholesterol becomes supersaturated and causes gallstones.

Another strong risk factor is elevated estrogen. Estrogen is known to affect cholesterol metabolism, gallbladder and sphincter of Oddi motility, which leads to a higher incidence of gallstones. (See here.)

You can see this with pregnant women, as they have a higher risk of developing gallstones during pregnancy when their estrogen levels go up.

Women who are in their forties are also more prone to gallbladder disease. This is because progesterone levels drop during perimenopause, which prompts the body to increase estrogen.

Contraceptives and hormone replacement therapy will cause an increase in estrogen, as does alcohol, pesticides, herbicides, plastics, solvents, and hormones that are used to fatten livestock and promote milk production.

Did you know that fat cells produce estrogen?

Certain genetics will also impact estrogen levels. The COMT gene for instance, is responsible for breaking down estrogen. If you have a COMT gene mutation, estrogen breakdown is slowed, as it is broken down via another pathway in the body.

Constipation causes elevated estrogen, as bile, cholesterol and toxins are sent back to the liver.

Other causes for gallstone include rapid weight loss and diabetes.

What can you do to save your gallbladder?

If you search the internet on ways to get rid of gallstones, you will no doubt read about a “gallbladder flush”, which involves a lemon and olive oil tonic. When people do this flush, they have small stones appear in their stool.  There is controversy about whether or not these stones are actually gallstones. The Lancet did a laboratory analysis of these stones, which can be found here.

You basically want to get bile to flow freely through the gallbladder again. Dandelion root will stimulate the flow of bile and milk thistle will encourage bile circulation and lower cholesterol. (I drink these as teas.)

Supplementing with betaine (found in beets) along with bile salts will help break down fats and help to decongest the gallbladder.

The amino acids taurine, glycine and methionine are important for proper gallbladder function.

You may need to supplement with taurine. Taurine is essential for bile production and the excretion of cholesterol in the bile. Because of its importance, make sure that you are not ingesting MSG, as MSG will reduce taurine levels.

The body can make taurine if there is enough cysteine and methionine in the body. Most people with high estrogen don’t make enough taurine. This is because there may not be enough methyl donors to make methionine. High estrogen uses up a lot of methyl donors. The more estrogen you have, the more methyl groups you need. Basically, inadequate methyl donors will cause gallstones, as bile is methylation dependent.

Choline, with its metabolite of betaine, is a very important methyl donor. If the body cannot get enough choline from dietary sources, it will take choline out of the cell wall, as 90% of the choline in the body is found in the cell membrane. Unfortunately, this process will break down the cells of your body, which of course you want to avoid. It’s best to get your choline from dietary sources, such as egg yolks, shrimp, collard greens and Brussels sprouts.

Folate, B12 and B6 are also important components for the methylation cycle.  If you have the MTHFR gene mutation, (which about 40% of the population has) you may be better off taking the methyl versions of these supplements. Talk to your nutritionist.

The body also needs an enzyme to make taurine (cysteinsulfinic decarboxylase). This enzyme is found in meat, fish, eggs or brewer’s yeast. Vegans may have an enzyme deficiency.

Probiotics and prebiotics help reduce estrogen levels, as there are pathogenic bacteria in the large intestine that allow estrogen to re-enter circulation. Supplementing with Lactobacillus acidophilus and Bifiobacterium infantis with a diet high in fiber will help to reduce the population of pathogenic bacteria.

SAM-e supplementation may reverse a sluggish gallbladder and the effects of estrogen on gallbladder function.

Constipation will cause bile, cholesterol and toxins to be absorbed and sent to the liver. Probiotics, fiber, digestive enzymes, magnesium and more water should help with constipation.

Other strategies to lower estrogen include:

  • Eating organic foods so that you don’t ingest pesticides and chemicals
  • Not drinking water from plastic bottles or microwaving foods in plastic containers
  • Eating more cruciferous vegetables, such as broccoli. Sulfur foods help to detox the liver
  • Reducing alcohol consumption
  • Exercising
  • Limiting dairy intake, especially if dairy is not organic

I’m personally adding whole oats into my diet again to trap and get rid of estrogen, bile and cholesterol.

I’m increasing my magnesium intake, as a magnesium deficiency is extremely common among gallstone sufferers. I’m also increasing my vitamin C and antioxidant intake, as low levels are contributors to the development of gallstones.

I’m adding the herb Vitex (chaste tree), to normalize estrogen and progesterone balance.

And finally, I’m working on reducing stress, as high stress leads to high estrogen levels.

What should you do if you don’t have a gallbladder?

The liver will still make bile, but the bile will continuously drip into the small intestine. The bile that enters the small intestine is no longer regulated by the gallbladder. This is why about 20% of people who have their gallbladder removed, experience chronic diarrhea. If you have diarrhea, you might eat more fiber to help bulk up your stools.

Many health professionals will recommend a very low fat diet. Unfortunately a high carb diet isn’t the answer either, as that impacts blood sugar and insulin. Excess insulin in the bloodstream causes the ovaries to secrete excess testosterone, which in turn also increases estrogen. Keep in mind that if you had elevated estrogen before gallbladder surgery, you probably still have elevated estrogen. I would suggest incorporating some of the strategies mentioned above to help bring estrogen levels down.

You still have to include fat in your diet. Omega-3 and Omega-6 are essential, and you still have to absorb your fat-soluble vitamins. If not, you will have nutrient-deficient related issues.

The trick is to find the right macronutrient ratios (fat, carb and protein) for your body, and to see how much fat you can handle at once. For many people it’s best to eat small amounts of fat throughout the day, as consuming too much fat at once can overwhelm the liver.

When you do eat fat, keep in mind that the bile that enters the small intestine is not as potent as the bile that would normally come from the gallbladder, so it will be more difficult to break down fats, and absorb fat-soluble vitamins.

Not all fats are the same. Certain fats are easier to break down than other fats. Medium chain triglycerides (MCTs) such as coconut oil for example, are much easier to break down than long chain fatty acids, as it requires less bile for absorption.

Long chain triglycerides (LCT) however, require bile to break down. If they are not broken down, fat will overwhelm the liver and clog up artery walls. Your all-important Omegas fall into this category.

And, or course you want to make sure that you avoid trans-fats and hydrogenated oils.

Supplementing with bile salts (particularly when you have a fatty meal or a meal with LCTs  will help break down fats so the body can absorb vitamins.

Taking bitters 15 minutes before a fatty meal will also help to stimulate bile production from the liver.

It would be a good idea to supplement with vitamin D3, which is the active form of vitamin D. Vitamin D needs cholesterol to become activated. Because of that, it’s very easy for someone who has had their gallbladder removed to be deficient. Vitamin D plays many important roles in human health, so it’s not something you want to be deficient in.

Hopefully this article has given you something to think about. I’m choosing to take the holistic route to save my gallbladder. I realize that there may be a time where I have no choice but to remove it. But for now, I’ll take care of my gallbladder and liver the best I can.

And you know what? So far it feels like what I’m doing is working!

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The supplements mentioned and suggestions given are not intended to diagnose, treat, cure or prevent any disease.

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