Gallbladder Disease and Gallstones

Gallbladder disease and gallstones commonly cause cholecystitis, inflammation of the gallbladder which may be acute or chronic.

Cholecystitis is associated with gallstones in 90% of cases.

Gallstones are formed from normally soluble components of bile which become supersaturated and precipitate. An estimated 14-20% of Australians will develop gallstones in their lifetime.

Cholecystitis may be classified as acute or chronic:

• Acute cholecystitis is caused when bile becomes trapped in the gallbladder (usually by a gallstone), causing irritation and pressure. If left untreated, may lead to infection (gangrene) and perforation.
• Chronic cholecystitis also involves gallstones and mild inflammation.

Types of Gallstones

• Cholesterol stones: accounts for 80% of gallstones. Contain cholesterol (70%), bile salts, bile pigments and inorganic calcium salts
• Black pigment stones: made up of calcium bilirubinate present in haemolytic disorders
• Brown pigment stones: linked to bacterial or helminthic infection in the biliary tree

Causes of Gallstones – Cholesterol stones

Excess secretion of cholesterol and a reduced secretion of bile acids and phosphatidylcholine cause the bile to contain more cholesterol than bile salts can dissolve.

The bile then builds up in vesicles and begin to grow into gallstones.

Causes of Cholecystitis

• Gallstones: 90%
• Severe illness
• Gallbladder carcinoma (rare)

Risk factors of Gallstones and Gallbladder disease

• Intestinal Permeability (leaky gut) – key transport systems of bile are impaired through the inflammation cascade that’s results with intestinal permeability.  Microbes leaking into the blood can impair the release of bile and contribute to gallbladder disease
• Western diet: high in refined carbohydrates, vegetable oils and low in fibre
• Insufficient methylation – require to methylate and clear estrogens and is upstream of detoxification, poor methylation has a negative impact on the gallbladder and causes bile, a soap like substance to thicken and reduce its effectiveness
• Gluten and other gliadins can impair the gut wall and in turn compromise the blood-biliary barrier.
• Increasing age: causes increased biliary cholesterol secretion due to a decrease in cholesterol 7-a-hydroxylase activity and decreased biliary salt excretion
• Female – endogenous estrogens are linked to increased liver cholesterol uptake and synthesis, gallbladder sludge and decreased cholesterol 7-a-hydroxylase activity
• Obesity and high serum triglycerides: causes increased liver secretion of bile with high amounts of cholesterol
• Pregnancy
• Hormone Replacement Therapy (HRT)
• Diabetes / metabolic syndrome
• Crohn’s disease / cystic fibrosis
• Cirrhosis
• Rapid weight loss, weight cycling and prolonged fat-restricted diets: exacerbate gallbladder stasis

Signs & symptoms – Gallstones

• 60-80% gallstones are asymptomatic
• The most common symptom of gallstones is intermittent biliary colic: abdominal pain upper mid- or right side of abdomen. Pain is usually gripping or gnawing, and may radiate to back or right shoulder blade.

Signs & symptoms – Acute Gallbladder attack

• Severe constant biliary colic which may last for days
• Fever and chills in 30%
• Nausea and vomiting
• Clay-coloured stools
• Jaundice

Signs & symptoms – Chronic Gallbladder disease

• Gas, nausea and abdominal discomfort after meals
• Episodic biliary pain in the right upper quadrant or epigastric area lasting 30 minutes to several hours. Episodes may occur daily or every few months
• Chronic diarrhea
• Gallbladder disease results in reduced bile flow into the gut lumen causing an increase in small intestinal bacterial overgrowth (SIBO) and a much higher risk of bacterial, fungal and parasitic infections of the gut in general

Differential diagnosis

• Angina pectoris or myocardial infarct
• Appendicitis
• Bowel obstruction
• Gastro-oesophageal reflux or oesophagitis
• Irritable bowel
• Peptic ulcer
• Pneumonia
• Hepatitis or liver disease
• Pancreatitis
• Gallbladder cancer

Investigations of Gallbladder disease & Gallstones

• FBC (bilirubin, WBC, LFT) and a comprehensive blood chemistry panel
• Abdominal ultrasound/CT scan/x-ray
• Advanced Stool Analysis
• SIBO breath test
• Methylation pathway analysis

TREATMENT STRATEGY OF GALLBLADDER DISEASE & GALLSTONES

NB. If acute cholecystitis is suspected, patient may require acute medical care.

• Resolve underlying cause of stones such as gut bacterial overgrowth and/or SIBO
• Assess and regulate adequate methylation function
• Increase solubility of cholesterol in bile
• Support bile and cholesterol excretion
• Reduce bile and cholesterol reabsorption in the small intestine
• Support optimal digestive function
• Weight loss if necessary

Diet plan guidelines for Gallbladder disease & Gallstones

• Increase fibre: very important in the prevention and reversal of gallstones – helps to increase solubility of bile salts and facilitates excretion of cholesterol/bile
• Fruit & vegetables, pectin, oat bran, psyllium, chia, linseeds – contraindicated with SIBO
• Increase bitter foods: e.g. rocket, dark leafy greens, lemon, beetroot
• Increase water intake to 2 L/day
• Increase omega-3 and mono-unsaturated fatty acid intake: oily fish, linseeds, olive oil, avocado, nuts and seeds, etc.
• Reduce sugars and refined carbohydrates, saturated fats, fried foods, trans fats, food allergens

Supplements that support Gallbladder disease & Gallstones

• Lecithin / phosphatidylcholine- increases solubility, emulsification and excretion of cholesterol
• Choline, methionine, glycine – increases solubility, emulsification and excretion of cholesterol
• Soluble fibre supplements e.g. psyllium, pectin: increase solubility of bile salts and facilitates excretion of cholesterol/bile
• Vitamin C – stimulates bile production
• Vitamin E  – stimulates bile production
• Omega-3 essential fatty acids  – controls blood lipids
• TUDCA – 
• Gallbladder Nutrients – All round support  

Herbal medicine treatment that supports Gallbladder Disease & Gallstones

• Cholagogues / choleretics (stimulate gallbladder): globe artichoke, St Mary’s thistle, dandelion root, greater celandine, barberry, yellow dock, turmeric
• Anti-lithics (dissolve gallstones): gravel root, hydrangea, crataeva, peppermint oil (enteric-coated)
• Relaxation of bile duct: vervain (especially in obstructive gallbladder disease)
• Anti-inflammatory: turmeric, bupleurum
• Bitters: gentian, goldenseal, agrimony

Gallbladder Flush

There is little evidence to suggest that the gallbladder flush is effective for gallstones; in fact, it is thought that the ‘stones’ that are passed are, in fact, simply emulsified olive oil. The gallbladder flush can result in stones becoming trapped in the biliary duct, causing further complications. 

FUNCTIONAL MEDICINE TREATMENT OF GALLBLADDER DISEASE & GALLSTONES

The above basic nutritional, herbal and dietary considerations will help support someone with Gallbladder disease and / or Gallstones. 

A functional medicine approach will address the underlying causative pathways that are contributing to a biliary system issue.  As mentioned above, bacterial overgrowth of the colon, SIBO, intestinal permeability, fat metabolism, methylation problems and diet all play major roles in gallbladder disease.

At our Perth clinic of Advanced Functional Medicine we regularly treat patients with gallbladder insufficiency and gallstones.  We also work with many patients that have had their gallbladders previously removed. 

If you or a family member are suffering from Gallstones or gallbladder disease we would love to hear from you, please write a comment below.

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