March 28th, 2013 by Digestive Detective
Each year, over 700,000 gallbladder removal surgeries (medically referred to as cholecystectomy) are performed, making this procedure one of the most commonly conducted surgeries. The rationale behind gallbladder removal may include the presence of gallstones or a "sluggish" gallbladder that doesn't flow and adequately transport bile. The introduction of laparoscopic gallbladder surgery in 1987 simplified the procedure for physicians and eased the recovery time for patients, and as such, the incidence of cholecystectomies has risen significantly. This increase in gallbladder removal has raised concerns over whether the relative ease of laparoscopic gallbladder surgery may be causing physicians to unnecessarily recommend gallbladder removal before seeking other methods to improve gallbladder function and bile flow. In this article, we'll examine potential underlying causes behind gallbladder issues and detail strategies for optimizing bile flow and digestion even if your gallbladder has already been removed.
Your gallbladder is a pouch-like organ whose purpose is to store bile - a greenish-yellow, detergent-like substance made in the liver. Our livers make bile constantly, producing between 600-1200 mL per day. Bile is composed of cholesterol, bile salts (the end-products of bile acids), bilirubin (a breakdown product of hemoglobin from the blood), electrolytes, and water. Water is essential in bile synthesis, as a good deal is used to produce bile from the conversion of cholesterol happening in the liver. Bile serves to emulsify or break down dietary fat and clear cholesterol out of the body. Bile acids, a component of bile, serve other functions, including driving the flow of bile to eliminate catabolites from the liver, emulsifying fat soluble vitamins in the intestine, and aiding in the reduction of the bacteria flora found in the small intestine and biliary tract. ¹
When food digestion is not taking place, bile backs up the cystic duct and enters the gallbladder to be stored. While in the gallbladder, bile is concentrated by the removal of water. The removal of water and electrolytes allows the gallbladder to concentrate bile and store more of it. When we eat and fats enter the first section of the small intestine, a hormone stimulates the gallbladder to contract and spurt out stored bile. The higher fat content of a meal, the more hormone is activated to signal the gallbladder to release bile for digestion. When bile enters the small intestine, its typically accompanied by digestive enzymes from the pancreas such as lipase - a class of enzymes that assist in fat digestion.
Problems with the Gallbladder
If bile is stored in the gallbladder for too long or too much water is removed, the cholesterol it contains may crystallize forming gallstones. While gallstones are relatively benign when small in size and quantity, when they grow larger or move from the gallbladder and get trapped in the cystic duct (the tube that delivers bile to and from the gallbladder), then can cause pain, swelling, and inflammation. Cholecystitis (inflamed gallbladder) and gallstones are among the primary issues seen with gallbladder dysfunction and may be the reason a physician recommends gallbladder removal.
Gallstones are more common in people over the age of 60, in those who are obese or have lost a lot of weight in a short amount of time, in those who have diabetes, and in women who have had multiple pregnancies and who take birth control pills. ² Research has also shown that diets that are low in fat can contribute to gallstone formation; less fat consumption results in less activity and contraction of the gallbladder, allowing for stones to develop and solidify. ³
Slow emptying or "sluggishness" of the gallbladder may also occur. The presence of gallstones and abnormalities in the structural tissue of the gallbladder are potential factors. In addition, inefficient signaling from digestive hormones may also result in poor gallbladder motility.
Improving Gallbladder Function (even in the absence of a gallbladder)
While the gallbladder is sometimes viewed as a "throw away" organ, not needed for proper function, its role in storage and secretion of bile is an integral part of digestion. When the gallbladder is removed, the liver will deliver bile directly to the small intestine, but due to capacity and overall signaling for bile excretion, dietary fat intake becomes more challenging and individuals without a gallbladder will no longer be able to digest and handle fat consumption as effectively. This leaves patients with 2 options: restrict dietary fat intake (not a great option as dietary fat serves a variety of functions elsewhere in the body) or implementation of strategies to support fat digestion and bile secretion/flow (better option).
Let's begin with some basic measures to ensure proper gallbladder function and motility for those who still have their gallbladders intact:
- Moderate to high-fat diet. Dietary intake signals contraction of the gallbladder resulting in optimal bile flow and secretion thus the prevention of gallstones. Choose a variety of healthy fats such as omega-3 fatty acids from cold-water fish (salmon, herring, sardines), monounsaturated fats from olive oil, avocado, and nuts as well as saturated fats from sources such as coconut oil, grass-fed beef, and butter.
- Adequate hydration. With water being critical in bile synthesis, dehydration can limit bile formation and result in gallstones when too little water and too much solid matter in bile builds up. Drink for thirst but be sure to account for drinks that dehydrate such as coffee or tea, and add back water for every glass of those fluids consumed.
- Maintain a healthy weight level and when losing weight - go gradually. Rapid weight loss is associated with gallstone formation so if you are working to lose weight, don't diet dramatically - reduce carbohydrate intake, monitor fat intake, incorporate exercise, stress management, sleep and overall healthy habits.
If you have already had your gallbladder removed and are looking to optimize digestion as well as avoid the pain and discomfort often associated with difficulty in fat digestion, consider implementing the following strategy and developing a supplement regimen that supports all aspects of dietary fat digestion:
- Pancreatic lipase. As mentioned previously, the pancreas adds in fat digestion by secreting enzymes that assist in fat break-down. Pancreatic lipase will help in the digestion of fats when the gallbladder is no longer present.
- Cholegogues. Compounds that help stimulate the flow of bile and are found in a variety of herbs and other constituents.
- Cholarectics. Compounds that stimulate the production of bile for increased fat digestion capacity.
- Ox bile. Chemically similar to human bile, ox bile is used in traditional medicine, particularly Chinese herbal medicine, and assists in fat digestion.
*An important note: One of the unfortunate side effects of gallbladder removal is the ineffective digestion, absorption, and assimilation of fatty acids such as the important anti-inflammatory omega-3's EPA and DHA. In addition, without optimal fat digestion, individual’s void of a gallbladder will also have difficulty and decreased absorption of fat soluble vitamins. These nutrients are essential for optimal health and disease prevention so taking steps to enhance fat digestion and bile support is crucial for this population.
Two highly reputable supplements that contain the above mentioned fat digestion/bile support compounds are Digest GB by Pure Encapsulations and Bio-Gest from Thorne Research. I would highly recommend supplementing with these as directed (typically 1-2 capsules per meal) to ensure proper digestion and nutrition.
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