Download The Impudence of the Lowly Gall Bladder

IT TAKES A LOT OF GALL:
The Impudence of the Lowly Gall Bladder
The word “gall” may be derived
from “ghel” meaning golden
yellow which interestingly, is
the color of bile held in the gall
bladder. “Gall” is synonymous
with emotional words such as:
bitter, angry, choleric, impudent,
bold, annoying or cruel. Some
believe that bile is one of the
four humors first described by
Hippocrates and it was thought
an excess of golden bile would
create a choleric temperament.
The gall bladder, which holds
this golden bile, is a small pear
shaped sac located just below the
liver. Its purpose is to hold the
bile fluid produced by the liver
and release the accumulated
bile in response to signals produced by certain foods. After a
meal, the gall bladder becomes
flattened as it empties its fluids
into the small intestine. WebMD
declares the gall bladder to
be a non-essential organ and
states there is little difference
to your health if you still have
a gall bladder or if it has been
removed.
However, when a gall bladder
“attack” occurs, many experience considerable pain and suddenly we are forced to consider
this otherwise quiescent organ.
Given the large number, about
half a million, of cholecystectomies (gall bladder removals) performed annually; shouldn’t we
be absolutely sure that this organ
is truly non-essential?
Traditional Chinese
Medicine
Traditional Chinese Medicine
assigns prime importance to the
gall bladder. The gall bladder
meridian exists with or without
the presence of the organ.
According to acupuncturist
Neil Gumenick, the gall bladder is “The Official of Decision
Making and Judgment. In any
given day, this Official makes
countless decisions - conscious
and unconscious which influence
every aspect of our being…”
“In health, this Official brings
a sense of purpose, order, selfassertion, confidence, hope and
optimism to our lives.”
The Golden Liquid
Bile is composed primarily of
bile salts. Lesser components
include: cholesterol, phospholipids-particularly phosphatidyl
choline, minerals, bilirubin from
the breakdown of hemoglobin in
the blood, and even some estrogens and assorted debris from
the liver. Bile salts are produced
by the liver when cholesterol is
broken down and are similar in
Liver
Stomach
Gall
Bladder
Small
Intestine
Bile
Duct
Continued on Page 2
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structure to the sex and adrenal
steroid hormones. Bile salts are
so important that 90-95% are
reabsorbed from the large intestine and returned to the liver
to be used again for as many
as 20 cycles. Studies have demonstrated that bile has a role in
liver regeneration. Some drugs
which have been developed
to reduce cholesterol levels in
the body by binding bile salts
can create bile salt deficiencies
leading to an inability to repair
liver damage. Excess fiber in
the diet can also bind bile salts.
What Does Bile
Do?
Bile is released slowly from the
liver into the small intestine
and into the gall bladder for
storage. Bile fluid may be quite
thin or may thicken upon storage in the gall bladder. The
main function of bile is thought
to be two fold. First, bile mixes
with fats creating an emulsion
of very small droplets which
enhances the absorption of
fat into the body. Secondly,
bile assists in the breakdown
of bilirubin (formed from the
breakdown of red blood cells)
and cholesterol. Interestingly,
bile salts, which are formed
from cholesterol and bilirubin,
also help with the excretion of
cholesterol and bilirubin. Fats
are important in our diet and
fat soluble vitamins such as A,
D, E, and K are essential. If the
amount of bile in the body is
inadequate, undigested fats are
excreted in the stool. When this
happens, fat soluble vitamins
are also lost. Undigested fats in
the stool can be identified when
the stool becomes sticky and
adheres to the toilet bowl.
Lopping off the gall bladder does
not necessarily mean the end of
gall bladder woes.
Gall Bladder
Emptying
When food containing fat enters the digestive tract, it stimulates the release of a substance
that causes the gallbladder to
contract and release its contents. A study using various
foods such as coffee, tea, milk
and yogurt, curcumin, and fat
demonstrated that eating fats
stimulated the highest volume
of bile release. The mineral
magnesium, acting under similar hormone control as fatty
food intake, also stimulates gall
bladder emptying. Magnesium
can also assist by relaxing the
gall bladder sphincter.
The Gall Bladder
“Attack”
A gall bladder attack is extremely painful with abdominal pain usually on the right
side and referred pain to the
right shoulder. Gall bladder attacks usually occur after eating.
Dr. James Breneman published
the elements of a “gall bladder
diet” in 1968. He maintained
that gall bladder attacks were
actually the result of food sensitivities. He found in his study
that the top food offenders
were eggs, pork, onions, chicken and turkey, milk, coffee, and
oranges. Using an elimination
diet, the unique sensitivities of
each person could be identified
and then eliminated. About
20% of the participants were
actually sensitive to prescription drugs they were using. All
in the study successfully ended
their recurrent gall bladder attacks. Unfortunately, as gall
bladder surgeries have become
more commonplace, modern
medicine tends to offer removal of the gall bladder as an expedient solution to gall bladder
attacks rather than focusing on
sensitivities and diet.
Gall Stones
Gall stones can form when the
bile fluid becomes thickened
and sludgy. Cholesterol or
bilirubin can remain in the gall
bladder and form hard particles called stones. Often these
stones are silent and don’t
seem to cause a problem unless
a bile duct or the gall bladder
sphincter becomes blocked.
Surgery is often performed if a
blockage occurs. Using supplemental bile salts may resolve
gall stones if used for a longer
period of time.
Continued on Page 3
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How Are Hormones
Involved?
Estrogen
Gall bladder woes are associated with estrogen dominance.
A large prospective French
study revealed that the use of
unopposed oral estrogens, both
conjugated equine estrogens
(Premarin) and estradiol, were
associated with an increased
number of cholecystectomies
(gall bladder removals). This
association was not seen when
estradiol was applied to the skin.
Excess estrogen activity tends
to increase cholesterol levels in
bile and thicken the bile liquid,
a condition thought to lead to
the formation of gall stones. Gall
bladder disease is listed as a side
effect of estrogen therapies including birth control pills which
also create an environment of
estrogen dominance. Copper
excess often occurs with estrogen
excess and copper IUDs may be
an additional source of gall bladder problems.
Progesterone
Progesterone may actually relax
the smooth muscle in the gall
bladder. According to Dr. John
Lee, progesterone helps to relax
the gall bladder sphincter to enable emptying in response to a
meal. Conversely, gall bladder
issues may appear in pregnancy
when very abundant amounts of
progesterone are produced and
normal contraction of the gall
bladder is diminished or relaxed.
Thyroid
Bile salts have been shown to
improve the conversion of inactive thyroid to active thyroid in
brown fat cells improving the
metabolic rate. There is a strong
association between gall stone
formation and hypothyroidism. Low thyroid activity leads
to a reduction in bile flow, an
increased concentration of cholesterol in the bile fluid and less
bile secretion. Thickened bile can
also cause insufficient absorption of nutrients needed for the
conversion of inactive thyroid to
active thyroid. Individuals with
sluggish gall bladders may not
see improvement with natural
thyroid supplements due to the
inhibited absorption of these
needed nutrients.
Non-surgical
Options
In addition to maintaining optimal hormone balance, there are
other non-surgical options to
consider. According to Dr. David
Williams, beets have abundant
amounts of betaine which stimulates gall bladder function and
has a protective effect on both
the liver and bile ducts. Gall
bladder pain can sometimes
be relieved with a glass of beet
juice. Lemon and ginger have
also been used to treat gall bladder pain and nausea. Steer clear
of food items which will aggravate the gall bladder. These
include trans-fats, refined carbohydrates, excessive caffeine and
alcohol, and aspartame (artificial
sweetener).
symptoms may persist and new
ones may appear. Complaints of
abdominal pain, diarrhea, gastritis, IBS, pancreatitis, and liver
disease occur in 10-20% of those
who have had their gall bladder
removed. Fasting levels of bile
acids may increase with the loss
of bile storage in the gall bladder
which may cause gastritis in 3050% of people after surgery.
After Surgery
What if you are reading this
and have already had your gall
bladder removed? Your liver
is still producing bile and dribbling it into the small intestine.
However, the wonderful reserve
of bile that had been stored in
the gall bladder is no longer
available to respond to the intake of fatty foods. Fats may be
difficult to digest or may not
be digested at all. Fat soluble
nutrients may not be absorbed
as well. The gall bladder is all
about digestion. Although it has
been deemed non-essential since
life doesn’t end with its removal,
consequences may emerge as
years go by with less than optimal nutrition. Some practitioners
recommend that bile salts be
used as a supplement with each
meal containing fatty foods to try
to recapture some of the benefits
a bolus of bile from the gall bladder may have provided.
What About
Surgery?
Lopping off the gall bladder does
not necessarily mean the end of
gall bladder woes. Gall bladder
surgeries have produced another
condition called “postcholecystectomy syndrome”. Old
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Continued on Page 4
To Wrap Up
We don’t have gall bladder
appreciation days or months
or walkathons to curb the
number of gall bladders lost
every year. However, we can
stop for a moment to reflect
on the wondrous gall bladder
quietly completing its work;
to consider the exquisite coordination that takes place
with signals from fatty foods
directing the gall bladder to
release just the right amount
of bile; to marvel at the balance achieved between fat
absorption and cholesterol
elimination. Who can maintain that the gall bladder is a
non-essential organ?
References
nA Manual of Physiology,
Yeo Gerald Francis 1845
“Composition of Bile”
nAlan F. Hofmann,
MD “The Continuing
Importance of Bile Acids
in Liver and Intestinal
Disease” Arch Intern Med.
1999;159(22):2647-2658.
nAntoine Racine et. al.
“Menopausal hormone
therapy and risk of cholecystectomy: a prospective
study based on the French
E3N cohort” CMAJ. 2013
Apr 16;185(7):555-61
nBreneman, JC “Allergy
elimination diet as the
most effective gallbladder
diet” Ann Allergy 1968
Feb: 26(2): 83-87
nBrooke Keefer “The Gall
Bladder: An Essential
Organ Influenced
by Hormones”
HormonesMatter.com
April 2015
nJohanna Laukkarinen
et al “The Underlying
Mechanisms: How
Hypothyroidism Affects
the Formation of Common
Bile Duct Stones—A
Review” HPB Surgery
Volume 2012
11 issue 9 October 2004
nMarciani, L. et al “Effects
of various food ingredients on gall bladder emptying” European Journal
of Clinical Nutrition
(2013) 67 1182-1187
nNeil Gumenick “The
Spirits of the Points, The
Gall Bladder Official”
Acupuncture Today
June, 2013, Vol. 14, Issue
06
nWu, Z. et al,
”Progesterone inhibits
L-type calcium currents in gall bladder
smooth muscle cells” J
Gastroenterol Hepatol
2010 Dec; (25) 12)
1838-1843
ndrgangemi.com
nmerckmanuals.com
ndrdavidwilliams.com
nJonathan Wright,
Nutrition and Healing Vol
Connections is a publication of Women’s International Pharmacy, which is dedicated to the
education and management of PMS, menopause, infertility, postpartum depression, and other
hormone-related conditions and therapies.
This publication is distributed with the understanding that it does not constitute medical
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advice should be sought from a competent healthcare professional.
Publisher: Constance Kindschi Hegerfeld, Executive VP, Women’s International Pharmacy
Editor: Michelle Violi, Pharm.D. & Sheena Hirschfield; Women’s International Pharmacy
Writer: Carol Petersen, RPh, CNP; Women’s International Pharmacy
Illustrator: Amelia Janes, Midwest Educational Graphics
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