By Naturopathic Doctor Amy Neuzil.
Your gallbladder is a small sac-shaped organ that sits in the right side of your abdomen directly underneath your liver and close to both the stomach and small intestines. Your liver makes something called bile, which is an integral part of our digestive process that allows us to dissolve the fats that we eat in water and so process them more easily. Your gallbladder catches the bile made by the liver and stores it until your body is ready to use it. Your gallbladder also takes some of the water out of the bile it stores, making the bile more concentrated and more effective. When food, especially fatty food, enters your small intestines it signals your gallbladder to contract and squeeze all of that bile out through the bile duct into the small intestines.
There are two common presentations with gallbladder conditions. One is acute, meaning sudden or short-term, and the other is chronic, or long-term. Acute gallbladder disease is usually inflammation, infection or obstruction. Chronic gallbladder disease is usually caused by a build-up of sludge or stones in the gallbladder itself. There are also rare instances of polyps or tumors in the gallbladder so it is important to have a full diagnostic work-up. For the purposes of this article we will focus on the most common conditions affecting the gallbladder.
Symptoms and Signs:
Acute gallbladder disease, which is usually inflammation, infection or obstruction typically has these symptoms:
As you can see, acute gallbladder disease often looks like a heart attack and is actually the most common non-heart related condition that produces heart type ER visits.
Chronic gallbladder disease looks very different and is usually caused by a build-up of sludge or stones in the gallbladder itself. These are the typical symptoms:
Causes and Associated Factors:
The biggest associated risk factors with gallbladder disease are the 'Five Fs':
Other contributing factors with gallbladder diseases include rapid weight loss, diabetes, pregnancy, liver disease and anemias that cause high levels of bilirubin. Also excessive alcohol intake, diet high in fats and especially fried foods or trans fats, sedentary lifestyle and family history.
Your doctor may order the following blood tests:
Imaging tests that may be used to detect gallstones or inflammation are:
Additional testing that may be helpful includes:
Conventional Treatment and Side Effects:
Acute gallbladder attacks are highly painful and generally people will go to the ER with their symptoms. If there is evidence of infection then an antibiotic is given, along with medications for the pain. Although inflammation of the gallbladder will often resolve spontaneously there is a high rate of relapse and so many doctors recommend removal of the gallbladder. If there is an acute obstruction, meaning that evidence shows that a gallstone may be lodged in the ducts of the gallbladder, or if the gallbladder has abscessed, ruptured or threatens to rupture then emergency surgery to remove the gallbladder is performed. In emergency situations there is no natural treatment that will work quickly enough and the risk of complications is too great to wait for slower treatments.
Chronic gallbladder conditions, either in repeated inflammation or gallstones are generally treated with surgery, either traditional or laproscopic, to remove the gallbladder. In some cases where the patient isn't a good candidate for surgery, lithotripsy can be used. Lithotripsy involves using electrohydraulic shock waves to break up stones in the gallbladder so that they are small enough for the body to pass naturally. This is not often done because stones frequently recur. There are medications called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) which can be given orally to help dissolve cholesterol gall stones, but this process can take up to two years and the stones often reappear after the treatment is discontinued.
The most common treatment for gallbladder disorders is removal, which is generally successful. As with any surgery there is a small risk of damage or injury to the surrounding tissues, but the risk is minimal. Because the gallbladder is involved in the digestion and subsequent absorption of fats, there is a risk of fat malabsorption as well as long-term risk for deficiencies in fat soluble vitamins. In a small number of cases the abdominal pain and discomfort are not relieved by the gallbladder removal.
Your gallbladder is integral in the processing and absorption of dietary fats gallbladder disease can mean that your absorption of fats has been impaired for some time. In these cases it is important to measure your blood lipids like cholesterol and triglycerides to see how those have been affected. Also it is important to consider that you may not have been absorbing your fat soluble vitamins, and so may need to supplement. Vitamins A, D, E ad K are fat soluble. Spectracell testing can give you a good idea of your nutritional status and can be very useful in these cases. These are also important considerations if you have previously had your gallbladder removed, simply because your body still makes and uses bile, but the gallbladder is no longer there to concentrate it.
In general if you are prone to gallbladder problems or have already had your gallbladder removed it is a good idea to eat a low fat, low sugar, high fiber diet. Decreasing your dietary fat intake reduces the amount of work your gallbladder has to do every day. Increasing your dietary fiber helps your liver to eliminate toxins more quickly and anything that supports liver function indirectly helps the liver to produce more bile. Your diet plays a tremendous role in the health and functioning of your gallbladder and so it must be a part of any good protocol. If you do have your gallbladder removed surgically then it is important to maintain this type of diet after the surgery because your body will be physically less able to process large amounts of dietary fats.
In an emergency situation, the best course of action is always the ER. In chronic problems, however, there are many alternative treatments that can be extremely helpful to enhance the functioning of your gallbladder and gradually dissolve existing stones. Typically alternative treatment has three short-term goals.
Supporting liver function and increasing bile production generally involves reducing the total toxic burden of your body through a gentle detox with liver support. Eating foods that are beneficial to your liver and to the production of bile helps tremendously. These include beets, artichokes, greens and cruciferous vegetables. Drinking lots of water, especially water with lemon juice, lime juice or a small amount of apple cider vinegar also helps stimulate liver function. There are many products as well for liver support, and most include vitamins and minerals that are directly involved in the detoxification systems of the liver including B vitamins and magnesium. Also choline, inositol, methionine and often ox bile, which specifically supports and supplements the bile production and functioning. These steps also help to liquefy the bile.
Many herbs support bile production and functioning. These are called cholagogues and they stimulate and increase the flow of bile in the body. They are not safe in cases of severe liver disease or in gallstones causing pain. The most commonly used cholagogues are artichoke, burdock, dandelion, gentian, celandine, and yellow dock. Digestive bitters are products that generally combine several of these herbs into a bitter formula used to stimulate and strengthen digestion. These formulas can be used before meals to aid in bile flow and the absorption of fats.
The dissolution of cholesterol stones can be achieved by using the methods above combined with a dilute phosphoric acid solution taken internally, but must be done with the supervision of a physician. It is important to have an accurate diagnosis as well, because not all stones will respond to this treatment. This must be done carefully and in a controlled environment. The phosphoric acid solution pulls calcium out of the stones and softens them, ultimately allowing them to pass naturally. It is important to use correctly since it will also leech calcium out of both teeth and bones.
Another alternative treatment is the “gallbladder flush” which involves drinking large quantities of apple cider to stimulate bile production and then olive oil to force the gallbladder to contract. Often people will see bright green 'gallstones' in their feces and take that as evidence that they have passed stones out of their gallbladder. Unfortunately the more likely explanation is that these bright green stones formed in response to the trauma of the flush, rather than being actual preexisting stones from within the gallbladder. The flush can be dangerous for people with gallstones already simply because it forces the gallbladder to contract so strongly that it can create an acute gallbladder attack. I have seen more than one patient who had to go to the emergency room and have emergency surgery because of a self-directed gallbladder flush that they found on the internet. I strongly recommend avoiding these types of processes and helping your gallbladder in a more gentle, educated way. This is too abrupt and often too traumatic for the body.
In general our gallbladders are a little bit like the canary in the coal mine and gallbladder trouble is the first indicator of a larger imbalance, so I strongly suggest working with a professional who can help you to uncover the problems underneath the gallbladder symptoms. These symptoms are often the first red flag for estrogen imbalance, nutritional deficiencies, food sensitivities, high toxic buildup or reduced liver processing. Taking the first steps at home is always a great idea, but if you find that the problem isn't responding well or if you find that you have trouble with the basics then see a Naturopath who can help streamline your treatment plan and tailor it to your particular needs.
What You Can Do:
There are lots of simple ways to address gallbladder disease without having to resort to surgery or removal. The easiest things you can do at home are to:
If those steps aren't working, or if your doctor is pushing you to have surgery than come see us at the clinic and we can start you on a more aggressive protocol to help clear out and heal that gallbladder quickly. Remember that in a truly acute gallbladder situation sometimes surgery really is the best option.
Disclaimer: Excelon Health Articles (Excelon Health LLC) do not
replace the advice, treatment or diagnosis of your doctor. Information is provided as a
resource for general understanding and never as a substitute for treatment by a qualified physician.
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