What does this tiny organ do?

Your gall bladder is a small pouch-like organ that is nestled below your liver in the right upper quadrant of your abdomen. It stores bile, a fluid that is produced by the liver, to help break down fatty food. The gallbladder releases bile in response to acid in the stomach when food is eaten. When you consume food, the stomach releases a hormone that causes the muscles around the gallbladder to contract and release bile. Bile, a yellow-green fluid, is made up of several substances including cholesterol, bile salts, and water.

The bile produced by the liver flows directly into the small intestine during a meal. Between meals, when there's no fat that needs to be digested, most of the bile flows into the gallbladder instead, where it is concentrated and stored. The gallbladder usually holds about 30 to 80 milliliters of fluid. When we eat fatty foods, the gallbladder contracts and squeezes bile through the bile duct. The bile is mixed into the semi-digested food in the small intestine.

Bile is mainly made of water but also has bile salts, cholesterol, certain fats (lecithin) and bile pigments in it. The most important bile pigment, bilirubin, is made when red blood cells are broken down in the liver. Bilirubin is what makes urine yellow and stool brown. However, sometimes stool can be green. This is because food may be moving through the large intestine too quickly. As a result, bile doesn't have time to break down completely.

One of the main functions of bile is to break down larger fat globules in food into small droplets of fat. Smaller fat droplets are easier for the digestive enzymes from the pancreas to process and break down. The bile salts also help the cells in the bowel absorb these fat droplets.

Bile serves many additional functions that are not as well known:

• increase the digestion and absorption of fat-soluble vitamins (A,D,E,K)

• acts as an antibacterial agent keeping microbial balance in the intestines

• breaks down lipopolysaccharides (LPS) to reduce the immune system’s reaction to excess levels of the endotoxin

• regulates pH in the intestines to optimize the action of digestive enzymes and prevent microbial overgrowth

• carry waste product bilirubin and other toxins from the liver to the GI tract for disposal via stool

• helps to regulate blood cholesterol levels

• regulates insulin production and release via secondary bile acids

Gallbladder disease may be caught early if you recognize certain lab patterns. Often gallbladder trouble begins as just sluggish bile. This is bile that doesn’t move freely and gets thick. This can be a much easier fix. Treatment consists of thinning the bile and ensuring it is properly moving through.

Common risk factors for gallbladder disease (referred to as the 5 F’s)

• Female- higher risk

• Fat- overweight

• Fair-skinned- more common in Caucasians

• Forty- over the age of forty

• Fertile- women with multiple children
  

  If caught early, surgery might be avoided. However, many people believe that you don’t really need a gallbladder, and surgery to remove it solves the problem.

  When early gallbladder symptoms are left untreated, it can eventually lead to severe symptoms such as :

• pain in the upper right quadrant of the abdomen,

• pain that radiates between the shoulder blades

• nausea and vomiting

• diarrhea

• fever

• chills

• jaundice

Surgery gets rid of the victim (the gallbladder) but doesn’t address the root cause. It may get rid of the pain, but the underlying problem still exists. Functional Medicine aims to identify the cause of biliary congestion so surgery may be avoided.

Many patients present with gallbladder symptoms but no stones are seen on imaging tests. Though gallbladder symptoms related to gallstones are far more common, the gallbladder can also malfunction without stones. Gallbladder dysfunction that leads to gallbladder symptoms without the presence of gallstones is called biliary dyskinesia. Sometimes the gallbladder doesn’t respond correctly to the signal to squeeze. It can respond by ineffectively squeezing or by squeezing too aggressively. If the gallbladder doesn't empty completely, particles in the bile, like cholesterol or calcium salts, can thicken from staying in the gallbladder for too long. They eventually become biliary sludge or gallbladder sludge.

Biliary dyskinesia can cause the same pain as is experienced by people who have gallstones and result in improper digestion of fats which can lead to bloating, belching, fullness, nausea, vomiting, foul-smelling gas, and irregular bowel movements.  These can often be early signs of future gallbladder trouble.

What happens to the bile if your gallbladder has been removed? Without the gallbladder, the liver still produces the bile necessary to digest fat in food. But instead of entering the intestine all at once with a meal, the bile continuously drains from the liver into the intestine. This means it may be harder and take longer for your body to digest fat.

If your body isn’t digesting fat properly, then it may result in vitamin deficiencies, especially fat-soluble vitamins. With lower concentrations of bile, you may develop a disruption in the gut microbiome and a leaky gut. One important job of bile is to remove lipopolysaccharides (LPS). These are bacteria parts from gram-negative bacteria. A leaky gut allows LPS to escape through the gut into circulation. These LPS are associated with autoimmune disorders such as rheumatoid arthritis.

Bile acids stimulate glucagon-like peptide 1 (GLP1) production, which stimulates insulin secretion. Bile acids through their insulin-sensitizing effect play a part in insulin resistance and type 2 diabetes.

Lower levels of bile can result in higher levels of circulating LPS. These LPS have been associated with risk factors for metabolic syndrome, including insulin resistance, autoimmune disease, and chronic inflammation.

So what may cause gallbladder disease? There are many many causes, but one main root cause of gallbladder disease is estrogen dominance. Excess estrogen activity tends to increase cholesterol levels in bile and thicken the bile liquid, a condition thought to lead to the formation of gallstones. Gallbladder disease is listed as a side effect of estrogen therapies, including birth control pills, which create an environment for estrogen dominance.

So removing the gallbladder may soothe the pain, but the original cause still remains. If estrogen dominance continues, other problems may arise. The same for elevated cholesterol and other causes of biliary sludge. Even if the gallbladder was removed, the root cause needs to be addressed.

If you have had your gallbladder removed, you may consider digestive enzymes and Ox Bile.

Contact me to see how we can work together to “Take Back Your Health”!!

Melissa Bass, PharmD

Sources:
https://www.sciencedirect.com/science/article/pii/S1665268119310397

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215539/

https://www.jrheum.org/content/44/11/1569