natural medicine

Gallbladder Disease

By Naturopathic Doctor Amy Neuzil.




Background:

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:

  • Moderate to severe pain in the chest, shoulder blades or on the right side of your abdomen
  • Sweating, nausea and vomiting
  • Fever, chills or shaking
  • Extreme exhaustion
  • Worse after eating or taking a deep breath
  • Yellowing of the skin and the whites of the eyes (jaundice)
  • Clay colored stools
  • Moderate to severe pain when your doctor presses on your abdomen

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:

  • Abdominal fullness or gas or a sense of discomfort in your right upper abdomen
  • Pain or discomfort under the shoulder blades or in the chest usually with indigestion
  • Low-grade heartburn or nausea or a sense of indigestion after meals
  • Worse after eating, especially after eating fatty, creamy or heavy foods
  • Mild yellowing of the skin or whites of the eyes (jaundice)
  • Clay colored stools
  • Pain or discomfort when your doctor presses on your abdomen
  • Symptoms carry on for weeks or months with gradual worsening or just no progress


  • Causes and Associated Factors:

    The biggest associated risk factors with gallbladder disease are the 'Five Fs':

    • Female
    • Fair (skin and hair color)
    • Forty-ish
    • Fertile (gallbladder trouble is associated with high estrogens)
    • Fat (obesity increases the risk of gallbladder disease)

    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.




    Lab Testing (Conventional and Alternative):


    Your doctor may order the following blood tests:

    • Amylase and lipase – these will be elevated in acute gallbladder attacks, or in diseases of the pancreas
    • Bilirubin – elevated levels may indicate blocked bile ducts
    • CBC (complete blood count) – this may show high white blood cell counts if there is an infection
    • Liver function tests – this will help to determine if your bile ducts are blocked or if your liver is having trouble making bile
    • Imaging tests that may be used to detect gallstones or inflammation are:

      • Ultrasound (abdominal)
      • Abdominal X-ray
      • Oral cholecystogram (X-ray using a contrast medium that you take in pill form)
      • Gallbladder radionucleotide scan
      • Abdominal CT scan

      Additional testing that may be helpful includes:

      • Vitamin D blood test
      • Blood lipid panel
      • Hormone testing (blood or saliva)
      • Spectracell nutritional blood test


      • 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.



        Nutritional Associations:

        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.



        Alternative Treatments:

        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.

        1. Increase bile production in the liver and support liver function in general.
        2. Liquefy the bile to help flush any built-up sludge from the gallbladder.
        3. Dissolve stones slowly so that they can be reduced to a size that is able to pass naturally

        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:

        1. Make sure your gallbaldder disease isn't something more serious like a tumor, polyp, sclerosing cholangitis, gangrene, abcess or disorders that prevent the gallbladder from emptying. Your doctor should be able to tell you what is wrong. If you have one of these more serious conditions then talk with your doctor or see a Naturopathic doctor before starting any new protocol.
        2. Decrease the fats in your diet and switch to high quality cooking oils like olive or coconut oil
        3. Start a regular exercise routine that includes both weights and cardio
        4. Lose weight- if this is difficult for you then talk to your doctor about it
        5. Take a good digestive enzyme which has HCL and Ox Bile, especially with heavier meals
        6. Support your liver with lots of veggies like beets, greens, artichoke and liver support supplements or digestive bitters before meals
        7. Increase your dietary fiber either with whole foods or a supplement
        8. If you're female then hormones are usually involved. If you know your cycle or hormones are out of balance then talk with your doctor about balancing them gently.

        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.