Why You Need Your Gallbladder, And What To Do If It's Been Removed

Photo Credit: WebMD, LLC

Photo Credit: WebMD, LLC

Bile and your gallbladder

Bile helps your body digest and absorb fat. You need fat in your diet for a wide range of reasons. Without dietary fat, you cannot absorb important fat-soluble nutrients including vitamins A, D, E, and K. Dietary fat also provides energy, is required for hormone production, and your cell membranes are made up of fats.

Bile is made in your liver and then it is stored in your gallbladder. Bile is released from your gallbladder during digestion.

Gallstones

When the concentration of a normal component of bile gets too high, gallstones can result. Bile is mainly made up of cholesterol, bile salts and phospholipids. Most gallstones (80% in the U.S.) are made of mixed components (usually cholesterol, bile salts, bile pigments, and inorganic salts of calcium).

Cholesterol stones are most common in women and in those living in larger bodies, and result from bile that is supersaturated with cholesterol.

Pigment stones can be black or brown, and they form when there is a lack of motility, or when there is excess unconjugated bilirubin.

Whatever the type, gallstones form when bile hardens into pieces. This requires three factors:

  1. Bile must be supersaturated with cholesterol

    • Excess cholesterol with normal quantities of bile salts

    • Normal levels of cholesterol with decreased quantities of bile salts

  2. Accelerated cholesterol crystal formation, or quick transition from liquid to crystal

    • High levels of factors (such as excess mucin) that form crystals

    • Lack of factors that inhibit crystal formation (dietary fish oils may inhibit crystal formation)

  3. Low gallbladder motility

    • Crystals remain in the gallbladder too long and stones form

      • Some drugs can cause low motility

      • Low intestinal motility

 Causes and risk factors for gallstones

  • Functional (examples)

    • Impaired liver transport of bile acids

    • Impaired secretion of bile acids

    • Low gallbladder and/or intestinal motility

  • Diet

    • Low fiber intake

    • High sugar intake

    • Coffee intake

    • High calorie intake

    • Rapid weight loss, and fasting

    • Food allergies/sensitivities can cause and contribute to gallbladder attacks. Common food triggers include:

      • Eggs

      • Pork

      • Onion

      • Turkey and chicken

      • Citrus (oranges, grapefruit)

      • Corn

      • Beans

      • Nuts and peanuts

      • Tomatoes

      • Soy

      • Gluten (wheat, barley, rye, other grains)

      • Dairy

      • Shellfish and fish

  • Metabolic imbalances

    • Obesity

    • Type 2 diabetes

    • Insulin resistance

    • Elevated blood triglycerides

  • Gender and hormones

    • Women are 2-4 times more likely to develop gallstones, and this may be due to increased cholesterol synthesis or suppression of bile acids by estrogens

    • Elevated estrogen levels (in men and women)

    • Hormone imbalances

  • Race

    • Gallbladder problems are more common in Native American women, likely due to diet and lifestyle factors

  • GI diseases

    • Crohn’s 

    • Cystic fibrosis

    • Malabsorption of bile acids

  • Age

    • Average onset is 40-50 years old

    • With increased age, there is a natural decline in the activity of enzymes that make bile acids and this leads to increased cholesterol availability for the formation of gallstones (not necessarily due to high cholesterol levels)

  • Medications

    • Tamoxifen (breast cancer)

    • Oral contraceptives (birth control pills)

    • Ceftriaxone (antibiotic)

    • Octreotide (cancer treatment)

    • Statins and other lipid lowering drugs (cholesterol is needed to make bile acids)

Gallstones can be prevented with diet and lifestyle interventions

  • Maintain a healthy body weight

  • Avoid rapid weight loss and fad diets

  • An anti-inflammatory diet is recommended (Mediterranean style diet for example)

    • Lower intake of estrogenic foods (like soy)

    • Eliminate processed foods and sugar

    • Reduce intake of trans fats and fried foods

    • Increase fiber intake (especially soluble from flaxseed, oat bran, pectin, buckwheat)

    • Eat beets, artichoke and dandelion greens (they support digestive health because they improve bile flow to help break down fat)

    • Drink lots of water, at least 8 glasses per day

  • Easily digestible fats, consume in small amounts throughout the day (1-2 Tbsp at a time)

    • Fish oil

    • Coconut oil

    • Olive oil

  • Nutrients important for gallbladder health and support

    • Vitamin C: Bell peppers, papaya, citrus fruits, Brussels sprouts, strawberries, kiwi 

    • Vitamin E: Sunflower seeds, spinach, Swiss chard, avocados, turnip greens, asparagus, mustard greens 

    • Vitamin D: Salmon, herring and sardines, cod liver oil, canned light tuna (lower in mercury), oysters, egg yolk, mushrooms

    • Omega 3s/essential fatty acids: Flaxseed, eggs, fatty fish like salmon and fish oils (EPA and DHA), sea vegetables/seaweeds, avocado, coconut oil

    • Grape seed extract: Supplements

    • SAMe: Supplements

    • Phosphatidylcholine (made from choline): Eggs, liver, meat, poultry, fish and shellfish, dairy foods, rice, spinach, beets, supplements

Gallbladder removal (cholecystectomy)

A cholecystectomy is most often performed to treat gallstones and the complications they cause. Your doctor may recommend this procedure if you have:

  • Gallstones

  • Gallbladder inflammation

  • Pancreas inflammation due to gallstones

It is important to remember that you need your gallbladder (no matter what your doctor says to the contrary) in order digest and absorb fats. It is essential for proper digestion!

If your gallbladder is removed you absolutely need to supplement with bile to make sure your body functions appropriately.

Diet changes can help, but will not replace or do away with the need to supplement bile. There are different bile supplements, and combination bile, stomach acid and enzyme products available. Your supplement needs to be customized for your body’s needs. To learn more about what is right for you, contact me.

References

Murray MT, Pizzorno J. Gallstones. The Encyclopedia of Natural Medicine, Third Edition. New York, NY: Atria; 2012. 605:614.

http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/pancreas_biliary_tract/gallstone_disease.pdf

https://www.ncbi.nlm.nih.gov/pubmed/7652688

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899548/

https://www.ncbi.nlm.nih.gov/pubmed/7719416

https://www.mayoclinic.org/tests-procedures/cholecystectomy/about/pac-20384818