Why Do We Have Gallbladder Attacks?

By Carol Chuang, MS, CNS, CMTA, FDN

Gallbladder disease is a modern degenerative disease. An estimated 10-15 percent of Americans have the illness. Every year, about a million new cases are diagnosed and some 800,000 surgical operations are performed to remove the gallbladder (a procedure known as cholecystectomy).

Most people never give a thought to the gallbladder. The only time you consider your gallbladder is when it is hurting bad, a situation called a gallbladder attack. If your attacks hurt too much or are too often, the nearly universal prescription from doctors is to get it out. They tell you that the gallbladder is not an important organ and it is perfectly fine to remove it, especially since the procedure is now done laparoscopically. Instead of a 5-7 inch incision, the operation requires only four small openings in the abdomen. The recovery is relatively fast and there is minimal post-operative pain, plus it is usually covered by insurance.

But is it really true that the gallbladder serves no purpose at all?

If you still have your gallbladder, please note that it performs some rather important functions in your body. The most essential is to regulate bile flow to optimize fat, oil, and fat-soluble nutrient absorption. Without the gallbladder, it is almost impossible for this function to carry out properly. Unfortunately, most doctors do not advise their patients to do anything to compensate for the removal of this important organ.

This article covers the role of the gallbladder, factors that contribute to the development of gallbladder disease, how to avoid gallbladder attacks, and what you should do if you no longer have your gallbladder.

What Does The Gallbladder Do?

The gallbladder is a small pear-shaped organ that rests beneath the right side of the liver. It stores bile produced by the liver. Before a meal, the gallbladder is often full of bile and is about the size of a small pear.

When you eat any food that contains fat, it triggers the release of the hormone cholecystokinin (CCK). CCK travels to the gallbladder, which responses by squeezing the stored bile through a series of tubes called ducts into the small intestine. By the end of the meal, the gallbladder is usually empty and flat, like a deflated balloon.

Bile helps digest fats and oils, as well as the absorption of fat-soluble vitamins such as A, D, E, and K. Without the gallbladder, even though there will still be a small, steady trickle of bile from the liver, it is no longer matched to the amount of fats or oils you eat in either quantity or timing. The resulting mismatch inevitably compromises your digestion and absorption and puts your fat-soluble nutrient status at risk. In the long-run, if the deficiency is severe, it may affect every aspect of your health.

In gallbladder disease, bile in the gallbladder becomes concentrated and thickens. Gallstones are formed out of this sludge from cholesterol and bile salts. The end result of the disease process is inflammation (cholecystitis) or stones (cholelithiasis). While most gallstones produce no symptoms, some may result in a gallbladder attack. A gallbladder attack occurs when the gallstone blocks the flow of bile from the gallbladder and is manifested as a pain in the upper right side, which can be as severe as the excruciating pain of a heart attack.

When your gallstones produce no symptoms, most doctors would advise you to do nothing. However, for symptomatic gallstones, the most widely used conventional treatment is surgical removal of the gallbladder.

Risk Factors For Gallbladder Disease

The Five Fs

In medical school, the five Fs help doctors to remember the typical gallbladder disease patient: fair, fat, forty, fertile, and female. It may sound sexist but this is the group that is most frequently affected by gallbladder disease: overweight, middle-aged white women who have had several pregnancies. It has been implicated that excess estrogen may be the culprit, hence, women who are pregnant, are taking high-dose birth control pills or estrogen after menopause may be at increased risk.

Obesity and Rapid Weight Loss

In comparison with people of normal weight, the bile of obese people is supersaturated with cholesterol, predisposing them to the development of gallbladder disease. Weight loss may reduce the risk of gallstone formation, but excessively rapid weight loss (more than three pounds per week) causes the liver to secrete extra cholesterol, which may promote the development of gallstones or increase the risk that silent gallstones become symptomatic.

Diabetes

People with diabetes tend to have higher levels of triglycerides (a type of blood fat) which is a risk factor for gallstones.

Sedentary Lifestyle

People who get very little or no exercise are at higher risk. Therefore, regular exercise is a great proactive prevention step.

Food Allergies and Sensitivities

Do not eat anything you are allergic or sensitive to. This is probably the simplest and the single most important step you should take if you have gallbladder attacks.

Food allergies and sensitivities, apart from invoking an inflammation response in the body, may result in delayed gallbladder emptying, an abnormality associated with the formation of gallstones. 

Studies have found that people who have Celiac disease (an autoimmune disease caused by reaction to eating gluten, a protein from wheat, rye, and barley) take a much longer time to empty the gallbladder. However, once they go on a gluten-free diet, the gallbladder emptying defect is reversed. Other studies have shown a high correlation between gallbladder disease and those with Celiac disease and non-Celiac gluten sensitivity.

Besides gluten, there are other common offending foods too. When a patient identifies and eliminates the allergenic foods, gallbladder symptoms tend to go away. If you currently have symptoms, you can do an elimination diet or get a food sensitivity test (such as IgG and IgA) to determine your offending foods.

Highly Processed Diet

Studies have found that a diet low in fiber, high in sugar and refined carbohydrates is associated with an increased risk of gallbladder disease. On the other hand, people who consume foods with more omega-3 fats (found in fish and fish oil), monounsaturated fats (found in olive oil and avocados), vegetables, and fruits appear to have a lower risk.

What To Do If Your Gallbladder Is Already Gone?

High quality fats, especially omega-3 fats, as well as fat-soluble vitamins (A, D, E, and K) are essential for good health. If you do not have a gallbladder, you will have an impaired ability to absorb them. Trying to digest fat without bile is like trying to wash greasy dishes without soap or detergent, it just does not work well. In the long-run, your missing gallbladder may send your health on a downward spiral. 

To compensate for the missing gallbladder, you will need some supplements: 

Bile Salts. Improper digestion and absorption of fats can lead to symptoms such as belching, bloating, gas, and abdominal pain, especially after a large meal. The solution is to get a bottle of bile salts (conjugated bile acids), either in tablet or capsule form. After any meal or snack containing fat or oil, take 1-3 tablets or capsules. Continue for the rest of your life to ensure the fats you eat are properly absorbed.

There are a number of brands that offer bile salts. They include: 

• Standard Process (Cholacol), 
• Dews (Bile Salts), 
• Swanson (Liquid Liver Extract with Bile Salts), 
• NutriCology (Ox Bile), and 
• Jarrow Formulas (Bile Acid Factors). 

(Author is not associated with any of these companies.)

Many people will find relief from taking bile salts although there is one main side effect that some will experience: diarrhea. This can be attributed to the fact that unabsorbed bile salts go directly into the colon and acts as a laxative. In this case, lower the dosage to find your own comfort level. Everyone is different, so you need to find the right balance for your body.

Digestive enzymes with betaine HCL. They aid in the breakdown of fats, just as bile salts do. These can be taken in conjunction with the bile salts. Or, if you are experiencing constant diarrhea, swap the bile salts for these instead.

Probiotics. These are good bacteria commonly found in the gastrointestinal tract. The body normally maintains about 400 strains of probiotics in the gut. These good bacteria can be killed off when you take antibiotics for an infection. Probiotics have been found helpful in dealing with gas and other digestive disorders.

Conclusion

The risk of developing gallbladder disease can be reduced by maintaining an ideal body weight, exercising regularly, and eating an unprocessed, whole foods diet emphasizing omega-3 and monounsaturated fats, as well as vegetables and fruits.

If you have been suffering from gallbladder symptoms, make sure you identify your food triggers and eliminate them from your diet.

If you no longer have a gallbladder, supplement each meal with bile salts and/or digestive enzymes for the rest of your life. Probiotics are beneficial for digestive health too.

© Carol Chuang 2015