Article: A Nutritional Perspective on Gallbladder Dysfunction
By Laurel Blair, NTP
WaccoBB.net
Since publishing my recent article about the current epidemic of low stomach acid, I’ve received questions from several readers wondering what can be done for digestive health if the gallbladder has been removed. I’d like to address the subject of gallbladder dysfunction publicly, because it affects so many people.
The tremendous importance of the gallbladder has often been overlooked by the medical establishment. Gallbladder removal (also called cholecystectomy) is one of the most common surgeries performed in the United States. Many people have come to view the gallbladder as something unnecessary, something that can be removed without causing serious problems. My view is that the gallbladder is there for a reason, and removing it can have serious detrimental effects on health if certain precautions are not taken. In order to see how we can regain digestive health after a cholecystectomy, we first need to understand what the gallbladder does.
Why We Have a Gallbladder
The gallbladder is a small storage organ that sits just below the liver. The liver has a wide variety of known functions, and one of them is to produce bile, which is then stored in the gallbladder for later use. Bile released from the gallbladder is an emulsifier that enables us to absorb dietary fats, as well as fat soluble vitamins A, D, E, and K, and essential fatty acids like omega-3's. Without bile, these nutrients pass through our bodies without being absorbed.
Deficiencies in these nutrients have widespread consequences for our health. We need a constant supply of healthy fats to build new cell membranes, to make hormones, and to maintain the health of the brain and skin. Without vitamin A, the body cannot use protein, minerals, or water-soluble vitamins properly. Vitamin A is an antioxidant, and it plays major roles in maintaining vision and protecting against infection. The importance of vitamin D is becoming widely known, as vitamin D deficiency is a factor in numerous chronic conditions, including cancer, autoimmune disease, and depression. Vitamin E is another antioxidant that is important for healing and repair, as well as for normal circulation. The various forms of vitamin K play vital roles in blood clotting, bone mineralization, and prevention of heart disease. The anti-inflammatory benefits of omega-3 fatty acids are also well-known, and deficiencies can lead to depression, heart disease, and joint pain. The nutrients that bile helps us absorb are so important, so essential to our health and well-being that our bodies provide us with a gallbladder to store that bile, ensuring that we have some on hand no matter what time of day or night we happen to eat a meal.
In light of the tremendous importance of these nutrients, it’s clear that simply removing the gallbladder when it's "diseased” and calling it a day is irresponsible. This approach does not address the cause of the gallbladder disease, and even worse, very few people are warned of the long-term consequences of not being able to assimilate these nutrients, or given any instruction on how to have normal digestion without a gallbladder.
Of course, there are some situations in which the best option is to remove the gallbladder. If gallstones are large and the patient is in pain, a cholecystectomy is probably inevitable. My concern is that there is a lack of emphasis on preventing gallbladder problems, as well as a lack of education about why the gallbladder is important and what to do if it has been removed.
Causes of Dysfunction
So the first thing to consider is.....what causes gallbladder dysfunction in the first place? There are a number of factors that can play a role, including food allergies and obesity, but the two that seem to be the most important are low-fat diets1 and excessive consumption of refined carbohydrates2, 3.
The gallbladder is designed to empty several times per day in response to dietary fat and acidity, but it can continue to concentrate and store bile temporarily when food is scarce. When you eat a meal that contains little or no fat, the gallbladder will not get the message to empty itself. The liver, however, will continue to make more bile whether the gallbladder empties or not. The gallbladder has the ability to concentrate the bile and save it for the next meal. But if the next meal (and the next, and the next…) is low in fat as well, the bile begins to become thick, sludgy, and congealed, a condition called biliary stasis. Over long periods of time the thickened bile can crystalize into actual gallstones. This is particularly true if the bile is super-saturated with cholesterol. Refined carbohydrates have been shown to increase the cholesterol saturation of bile3. Refined carbs also deplete magnesium rapidly from the body, and magnesium deficiency is another factor that has been linked to gallstone formation4.
Most people with gallstones have what are known as silent stones, or gallstones that produce no overt symptoms. But in some people, gallstones can become lodged in the cystic duct or common bile duct, causing painful gallbladder attacks characterized by cramping or pain in the upper right abdominal area or right shoulder blade, sometimes accompanied by fever, nausea, or vomiting. These attacks are generally triggered by eating a meal that is moderate to high in fat. Those with silent stones may be spared from these painful attacks, but unfortunately they will not be spared from the multitude of problems that result from impaired flow of bile.
Politically correct meals of baked boneless skinless chicken breasts, rice, and steamed broccoli with no added fat are not just unappetizing; they are a recipe for future gallbladder dysfunction. Even worse are the plethora of processed food-like products that advertise themselves as low-fat. They inevitably contain plenty of refined carbs, along with plenty of chemical additives and MSG. Since fat is what makes our food taste good, food manufacturers have to add flavor enhancers to make their low-fat products palatable.
Unfortunately, people who develop gallbladder attacks are often advised by the medical establishment to continue eating a very low-fat diet. This will minimize symptoms but will also contribute to making the problem worse over time. Often people with gallbladder problems are firmly convinced that dietary fat is the cause of their digestive woes, while in reality the problem is impaired fat digestion. A healthy person can digest a meal that is high in healthy fats with no problems.
An Ounce of Prevention is Worth a Pound of Cure
For those who still have their precious gallbladders, prevention is the name of the game. Here’s how to avoid sludgy bile and gallstones:
1) Avoid refined carbohydrates (white flour and sugar) as much as possible! The conventional view of refined carbs is that they are "empty calories"; in other words, they are only bad for us because they are stripped of nutrients, and they displace other more nutrient-dense foods in the diet. But this only represents a partial truth, and it makes it seem like refined carbs are okay in moderation. In actuality, it takes a lot of nutrients to process refined carbs, and those nutrients (like chromium, magnesium, and certain B-vitamins) have to be pulled from your body's own stores.
Nature has wisely packaged sweet foods with the nutrients that we need to process the sugars they contain. Take sugar cane, for example. Whole sugar cane is rich in minerals and some vitamins (chromium, magnesium, B6, etc.), but we remove all of the good stuff and are left with a product that actually depletes us of nutrients every time we eat it!
Refined carbs are also extremely addictive (more so than cocaine, believe it or not!5), even in small amounts, so the best policy is to completely avoid them. Because of their addictive nature it can be difficult to cut them out of your diet, but that’s really the only way to get rid of the cravings they cause. Switching over to whole grains and unrefined sweeteners is well worth the effort.
2) Eat plenty of healthy fats. And no, that doesn’t mean canola oil! Healthy fats include saturated fats from pasture-fed animals (butter, ghee, cream, tallow, lard, fatty meats, egg yolks, organ meats, etc.) and tropical oils (palm and coconut), as well as monounsaturated fats from extra virgin olive oil and avocados, and small amounts of polyunsaturated fat from nuts, seeds, and fish.
Fats to avoid include seed oils (corn, soy, canola, sunflower, safflower, cottonseed) and hydrogenated oils. Seed oils are completely inappropriate for use as cooking oils, because the polyunsaturated oils they contain are very delicate and are damaged by heat and light. These oils have been shown to increase the body’s need for vitamin E, probably due to the free radicals formed when they’re exposed to heat or light. They also have high levels of omega-6 fatty acids, which most Americans have too much of already. And hydrogenated oils, or man-made trans fats, are completely unnatural to our physiology and increase the risk for heart disease. Be careful to read ingredient lists, and reject anything containing partially or fully hydrogenated oils of any kind. Products labeled “trans fat free” may still contain trans fats. Always check the ingredients to be sure!
If you’ve been following a low-fat diet for some time, the best approach is to gradually increase the amount of fat in your diet. Don’t be tempted to jump up from reading this article and go eat a bunch of bacon; it’ll probably make you feel sick to your stomach! Patience is definitely necessary here. Coconut oil is the best kind of fat to start with, because it is high in medium-chain fatty acids that don't need to be emulsified by bile to be absorbed.
Symptoms of trouble digesting fat include nausea, abdominal pain, vomiting, constipation, diarrhea, and dry skin. The stools may be pale or clay-colored, shiny, greasy, or may float (which indicates the presence of fat in the stool). Those who have these symptoms may need additional support to thin the bile or support bile production in the liver. Work with a knowledgeable health professional to address these problems.
3) Make sure your diet contains plenty of minerals, especially magnesium, which has been shown to prevent gallstones.4 My all-time favorite source of magnesium and other minerals is homemade bone broth, which is also a general digestive tonic. Dairy products, organ meats, seafoods, and organic vegetables (especially dark leafy greens) are other good sources of minerals.
4) Include taurine-rich foods in your diet. Taurine is an amino acid found in animal proteins, including meats, seafood, eggs, dairy products, and brewer’s yeast. It is a major constituent of bile, and it increases the conversion of cholesterol into bile acids6. Bile that is saturated with cholesterol puts you at increased risk for cholesterol stones, which make up 80-90% of all gallstones.
5) Eat beets. Beet root and stem are natural bile thinners and can be eaten daily by people who are prone to gallstones7. Beet greens are also high in magnesium. Try grating some organic beets on a salad or make a slaw with grated carrot and beet, lemon juice, and olive oil. Pickled beets are another good way to get this vegetable into your diet.
6) If you need to lose weight, do so, but avoid rapid weight loss and very low calorie diets. Obesity is associated with gallstone formation, but starvation diets and losing weight too quickly will only increase you risk of stones1. A better option would be to follow the above suggestions, with an emphasis on coconut oil, cutting processed foods out of the diet, and moderate exercise. Don’t attempt to lose more than about 2 pounds per week. At that rate you can expect to lose about 50 pounds in 6 months.
Life Without a Gallbladder
So, what do you do if your gallbladder has already been removed? My number one piece of advice is to supplement with bile salts. While the liver will still continue to make bile, without a gallbladder the bile cannot be saved for later use. In order to have proper digestion and absorption of fats, bile salts must be taken with every meal. I find it absolutely astounding that doctors so often fail to mention this essential fact to their patients!
The next thing to consider is the risk of nutrient deficiencies, particularly if your gallbladder was removed a long time ago. Especially important are the fat-soluble vitamins, and vitamin A in particular. Vitamin A is so important that the body has stores to last at least a year or more. Without bile you cannot absorb preformed vitamin A, and your body can only convert beta-carotene into preformed vitamin A in the presence of bile salts, so a person without a gallbladder can become deficient quite rapidly, especially if there is any kind of infection or emotional or physical stress.
Vitamin D deficiency is also very common in the general population, and those without gallbladders are even more likely to be deficient8. Those without a gallbladder are at increased risk for colon cancer9,10, but adequate stores of vitamin D are protective against this condition. Anyone whose gallbladder has been out for more than 1 year should be assessed for vitamin A and D deficiencies, as well as mineral and essential fatty acid deficiencies.
Once deficiencies are taken care of and bile salts are taken regularly, the rest of the suggestions for prevention can be followed safely. Life without a gallbladder certainly isn’t as convenient, because you have to do the work (taking bile salts) that your body would normally do for you, but it is definitely possible to have fully-functioning digestion after a cholecystectomy.
About Laurel: I'm very passionate about food and nutrition, as changing my own diet has has a profound effect on my health and well-being. At the age of 22, I began to experience disturbing health problems along with a worsening of health issues I'd had since childhood. Concern over my rapidly declining health launched me into an amazing journey of discovery and multiple paradigm shifts, and I'm grateful for the entire experience. With my new-found understanding I was able to improve my health (both physical and mental) dramatically, using nutrient-dense foods and targeted supplementation. I love to cook from scratch with traditional techniques and provide nourishing and satisfying meals for myself and my family. I'm here to spread awareness of the amazing healing powers of whole foods and traditional diets, and to dispel common myths about food and nutrition that prevent so many from achieving optimal health . My insatiable appetite for learning about nutrition led to my certification as a Nutritional Therapist Practitioner in 2010, and my intention is to share my knowledge with the community and support others in improving their health with real food. I offer nutritional consultations personalized to my clients' specific health concerns. Visit my website (www.dynamicbalancenutrition.com) or follow me on Twitter at twitter.com/@Dynamic_Balance for more information. Blessings to all!
References
1. https://onlinelibrary.wiley.com/doi/...14s2051.x/full
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1441393/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1419917/
4. https://www.ncbi.nlm.nih.gov/pubmed/18289201
5. https://www.plosone.org/article/fetc...l.pone.0000698
6. https://www.ncbi.nlm.nih.gov/pubmed/4032076
7. https://altmedicine.about.com/od/det..._Nutrients.htm
8. https://www.ncbi.nlm.nih.gov/pubmed/7676706
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1345271/
10. https://www.nature.com/bjc/journal/v.../6600661a.html
Disclaimer: All information provided in this article is for educational purposes only and is not meant to be a substitute for medical evaluation and treatment. No comment should be construed as medical advice. If you have a medical condition, please consult a physician. Always inform your doctor of changes in your supplementation.
Re: Article: A Nutritional Perspective on Gallbladder Dysfunction
Not all fats are created equal. Animal fats from healthy animals along with unrefined plant oils are what we evolved to eat, and a person with a healthy digestive system will not have trouble digesting these natural fats. There are well-studied examples of indigenous peoples that maintained excellent health on high-fat diets made up of natural animal and plant foods. Of course, these people did not eat refined sugar or flour, seed oils or hydrogenated oils, canned foods, or any kind of chemical food additives. Their animals were raised on natural diets or were wild-caught. These are important distinctions to make, because simply adding more fat to your diet will not necessarily be beneficial. Everything depends on the type and the quality of the fat, along with the individual’s ability to digest that fat.
People with gallbladder dysfunction invariably cannot digest even the healthiest fats. Eating the foods Will mentioned can definitely provoke an attack for those with gallstones. That is why I suggest slowly increasing the amount of fat in the diet (beginning with unrefined coconut oil, NOT bacon!), while simultaneously following other recommendations for supporting gallbladder health, and working with a healthcare professional if necessary to thin the bile and provide additional support. The idea that fatty foods are inherently unhealthy to eat is contradicted by the fact that there is a threshold level of fat that must be present in a meal (10 grams) to trigger the gallbladder to empty. A Lean Cuisine frozen meal, in comparison, contains only 2 grams of fat. Eating this kind of diet will inevitably lead to thickened bile and trouble digesting fats.
Looking at the kinds of foods Will mentioned as being unhealthy, we can see that there are plenty of other factors besides the fat content that make them bad for us. Muffins and other baked goods are nearly always made with refined flour and sugar, which as I've mentioned are strongly linked with gallbladder dysfunction. A lot of baked goods also contain trans fats which are bad for your entire body, along with numerous chemical additives. Similarly, I'm not aware of any commercial truffles that are made without refined sugar. Most commercial refried beans are actually non-fat, and those that contain fat usually have sunflower, safflower, or soy oil, which are fats that my article recommends avoiding for gallbladder health. Excess omega-6 fatty acids from these oils can lead to increased inflammation in the body, including in the gallbladder, and the sharp increase in omega-6 levels in our diets coincides with the increase in obesity. Canned foods like refried beans also contain BPA, an endocrine-disrupting chemical that can lead to weight gain.
Commercial sausages, pepperonis, and other meats are practically without exception from animals eating a diet of GM corn and soy, which is not a natural diet for these animals. The health of the animal is directly reflected in the healthfulness of the foods from that animal. It has been shown in studies that the diet of a cow dramatically changes the fatty acid content of that cow's meat, with grass-feeding producing an ideal ratio of omega-3 to omega-6 fatty acids and much higher levels of CLA. Bacon and sausages from pigs that have access to sunlight are an excellent source of vitamin D, a nutrient that is deficient for many Americans. Commercial bacon from confined pigs, on the other hand, has no vitamin D and has been treated with chemicals, and there are probably other deleterious effects on the fatty acid profile. Commercial sausages often have MSG added which contributes to obesity, and obesity is a risk factor for gallstones. And even commercial butter is not something I recommend because the cows have often been treated with GM growth hormones, and they haven't eaten a natural diet. Grass-fed butter is a good source of vitamins A, D, E, and K2, as well as selenium and iodine, and it also supplies CLA which has been shown helpful for weight loss and in protecting against cancer.
I personally used to get painful gallbladder attacks often (nausea, vomiting, splitting headaches, and severe abdominal pain). At the time I ate a diet that was very low in fat for most meals. I ate no meat, fish, eggs, or butter, and cooked only with canola and olive oil (used very sparingly). My diet was mostly "healthy" - lots of brown rice, lentils and beans, whole grain pasta, raw salads with nuts and seeds, and lots of veggies. The only animal fat in my diet was from occasional cheese, and from the ice cream that I often craved at night after avoiding fat all day (my body, in its wisdom, knew I needed those saturated fats). Before I had been very skinny, but on this diet I gradually gained weight until I was overweight, despite regular exercise. The gallbladder attacks would usually happen after I would eat a meal that was somewhat higher in fat, like pizza with lots of cheese, or restaurant food. It’s interesting to note that I never got an attack from ice cream.
Fortunately for me, I found out about holistic nutrition before things progressed to the point where I needed a cholecystectomy. I started eating wild-caught seafood and meat, eggs, and dairy from pasture-fed animals, and slowly increased the healthy fats in my diet. I made a lot of other changes to my diet, supplementing with cod liver oil, bone broth and fermented foods often, along with occasional liver and bone marrow. I began avoiding refined sugar, flour, and chemical additives. I also recognized the signs of low stomach acid, which is a major contributing factor to gallbladder dysfunction, and began supplementing with hydrochloric acid.
With these changes, I no longer get gallbladder attacks from eating fatty foods. I regularly eat bacon, sausage, butter, and homemade eggnog, and they never give me any problems whatsoever. On this diet my hormones are more balanced, I have more energy and clearer thinking, my skin and hair have improved, my digestion is normal for the first time in my entire life, and many other symptoms that I’d had for years simply vanished. I also returned to a healthy weight without even trying to lose weight, and I don’t crave ice cream anymore because I get plenty of healthy fat during the day. I include these details to demonstrate that fatty foods will not necessarily, as Will claims, “do ya in”, or even cause gallbladder pain. Everything depends on the quality of the fats in question and the support you provide to help your body digest those fats.
As far as Weight Watchers goes, a significant deficit in calories will often produce weight loss, but that does not mean that the diet is healthy or providing for your nutritional needs. A person on Weight Watchers can eat a diet of entirely processed foods as long as they do not exceed their allotted calorie points. Interestingly enough, multiple studies have actually shown that a high-fat diet is superior to a low-fat diet for weight loss, even when the low-fat diet is calorie-restricted and the high-fat diet is not. Studies that have examined the effects of these diets on cardiovascular risk factors have shown that high-fat diet participants have either improvement in risk factors (usually greater improvement than the low-fat diets) or no change. These results demonstrate that many of our societal beliefs about dietary fat leading to weight gain and heart disease are mistaken.
Thanks for reading,
Laurel Blair, NTP
www.dynamicbalancenutrition.com
