No Gallbladder – Now What?
By Dr. B.J. Hardick
People frequently enquire about a natural, healthy approach to resolving gallbladder issues. Poor digestion, gallstones, the absence of the gallbladder after surgery – these are frequent concerns for people consuming the average North American diet. Gallbladder problems are not confined to people who are overweight – many skinny people have the same issues. And it’s not necessarily tied to genes.
The gallbladder is a misunderstood organ. Because it is medically considered to be a non-vital organ, people often misunderstand the ramifications of living with gallbladder troubles, or without one at all. At least 10 percent of adults, twice as many women as men, form stones in their gallbladders. The incidence rises with age; after the age of 60, 10 to 15 percent of men and 20 to 40 percent of women have gallstones. i The gallbladder is frequently removed at the first sign of gallstones, which affect more than 25,000,000 Americans; there are 500,000 to 700,000 gallbladder removals every year in the U.S., and this is one of the most frequently performed elective surgeries here in Canada, as well. Truthfully, however, every part of the body was made for a purpose and the gallbladder is no exception.ii
About the Gallbladder
Your gallbladder is part of the digestive system. It is closely connected to your liver, and is designed to store the bile produced by the liver. It’s the only organ that stores fluid in your body to aid with digestion. Every time you eat, your gallbladder squeezes and releases a surge of bile into your small intestine to assist in digesting and absorbing fats. It also helps to digest other nutrients, and to remove toxins and cholesterol by the nature of its manufacturing process in the liver. The gallbladder breaks down fats by emulsification so they’re more easily digestible.
Why would the body have a gallbladder, instead of just create bile whenever needed? First, during storage in the gallbladder, bile becomes more concentrated which increases its potency and intensifies its effect on fats. Then, when you eat, your body needs an instantaneous release of bile, and the liver doesn’t produce it in large quantities over a short period of time – it’s waiting for the time when it’s needed to digest. It would be very taxing on the body to produce bile with every meal.
Without bile to break down the fats, the body would naturally experience higher levels of toxicity as most toxins are fat soluble. When your body doesn’t know what to do with external toxins, nor with damaged fats that we put into our digestive system, it sends them back to the liver, thus creating inflammation. Such toxins may end up in the gallbladder and accumulate in the form of gallstones (consisting of cholesterol and calcium). If the stones accumulate, there is less room for bile. The liver tries to fill the gallbladder, but it’s blocked because of the stones. The gallbladder becomes sluggish and can become inflamed or infected. The conventional medical solution is surgery – a cholecystectomy – to remove the gallbladder.iii
Symptoms of poor gallbladder function include bloating, gas, heartburn, constipation or diarrhea. Some people experience no symptoms, even though their body has created gallstones. The symptoms occur when the gallstone blocks the bile duct. The stone either passes into the duct itself, causing pain, or it blocks the duct, causing a buildup of bile. The most common symptoms are pain in the upper right abdominal area, with referred pain in the midback or shoulder blade. The pain often increases after eating, and is worse at night.
Gallbladder symptoms often appear as other problems – ulcers, heart attack or other gastrointestinal issues. People experiencing gallbladder problems may complain of neck pain, or even knee pain (Applied Kinesiology has established a relationship between the gallbladder and the popliteus, a knee stabilization muscle). Undigested fats show up in light coloured stools, or stools that float.
Causes of Gallbladder Disease
The cause of gallbladder disease can arise from a variety of factors. It may arise from sensitivities or allergies to less-favorable foods such as pork, wheat, conventional dairy, chocolate and coffee, and even some healthier foods like eggs. Consuming refined foods such as sugar and white flour, damaged fats, particularly trans-fats such as margarine and Crisco, can contribute to the disease. It is important to note that stone accumulation may occur over years! Therefore, symptoms may still easily present in a person who has changed his or her diet and lifestyle for the good – the damage was done years earlier.
Additional risk factors for gallbladder troubles are insufficient exercise, obesity, and using hormone replacement therapy or birth control pills. From a neurological perspective, the presence of gallbladder disease would be evaluated for any association with thoracic spinal dysfunction in the regions of nervous system control of the gallbladder.
Although conventional medicine considers a cholecystectomy to be a routine procedure, prior to the 1960’s, removal of the gallbladder was not a common at all. Treatment consisted of two operations to open and clean out the gallbladder. It was laborious, time consuming and doubled the risk that any surgery presents – but you got to keep your gallbladder. In 1965, President Lyndon B. Johnson elected to have his gallbladder removed through surgery and made national news when he showed his scar to reporters in a news conference. At that time, elective gallbladder removal had become a common practice. Currently, the common treatment is to remove the gallbladder through laproscopic surgery, a procedure that has increased the frequency of surgical removal.ivOther techniques for removing gallstones include extracorporeal shockwave lithotripsy (ESWL) to break up the stones into small pieces that can then pass through the bile duct and be excreted through the urinary tract, and using drugs to dissolve the stones. Surgery may prevent the reformation of stones in the gallbladder, unlike treatment by ESWL or drugs, but it leaves the patient with a host of other potential complications.
Removal of the gallbladder does not always eliminate the symptoms, and it can create new issues. The liver continues to make bile, but the reservoir has been removed. The amount of bile is insufficient to handle the fat and toxin load ingested through diet and lifestyle. Though most medical experts protest that we can manage without a functioning gallbladder, one must be concerned about where toxic sludge would accumulate without one. People having had their gallbladder removed are seldom given good medical advice on how to manage the impact of living without it. Removal of the gallbladder treats the symptom, but not the disease. Having no gallbladder, and without a change to diet or lifestyle, a person can expect to have further health issues as the body tries to find ways to eliminate toxins and fat.
Prevention, of course, would be our first line of defence. Adopting the five essentials ofMaximized Living – eliminating stress, maximizing the nerve supply to the digestive system, eating properly with healthy fats, exercising effectively, and minimizing the number or toxins we absorb – will naturally enhance one’s health outcomes and reduce the chance of developing this disease. It’s particularly vital to engage our children in this process of healthy living to prevent the potential of becoming ill.
Natural methods of treating gallbladder disease would include these five essentials along with adherence to a nutritional system consistent with the Maximized Living Advanced Nutrition Plan. The traditional advice of greatly reducing fats from the diet (often in exchange for various sources of fiber) is not a comprehensive approach that, on its own, would necessarily improve a person’s overall health, never mind the health of his or her digestion.
Instead, it remains vital to consume healthy fats such as coconut oil, hemp oil and extra virgin olive oil. Eliminate refined carbohydrates such as sugar, white flour, and anything that turns into sugar once in your body, such as potatoes, rice or pasta. Increase your consumption of vegetables, especially raw vegetables. Reduce your weight if you are overweight. Exercise to increase your oxygen uptake and decrease stress. Consider specific supplementation and cleansing of the liver, which we’ll describe later. These measures will help you to reduce the toxic overload that is the cause of gallbladder disease, and will assist in managing any symptoms you are experiencing.v
What if my gallbladder is already gone?
Obviously, people without a gallbladder may have a difficult time breaking down and digesting fats. Remember, in order to do this, your body must produce bile, which is done in the liver, and eject it from the gallbladder, the sac responsible for holding some of the bile that the liver produces. Despite your gallbladder being removed, your liver is still producing bile in order to digest fats. Without the gallbladder, however, the bile is not as readily secreted in the body, and the liver can become overwhelmed when faced with large amounts of any fats, particularly damaged fats, and some healthy, longer-chain fats described below.
Quite often people whose gallbladders have been removed either become overweight due to their weakened ability to metabolize fats, or underweight, which is not good either, due to a modified but unhealthy diet after surgery.
Fat is essential for hormone function, brain function, cellular regeneration and detoxification. Although we need lots of healthy fat, people without a gallbladder must be cautious about consuming too much of it at once. Moderation of the good fats and complete elimination of the bad fats are essential. However, the complete elimination or radical reduction of all fats is an amplification of this often-misunderstood phenomenon. Don’t do this.
The Maximized Living Advanced Nutrition Plan recommends having three meals a day, high in healthy fats which are your primary source of energy. People without a gallbladder may have to moderate this, perhaps having four to five smaller meals per day, and/or adding a snack. This would be one of few exceptions to the Advanced Plan rule of three meals per day. You need to consistently be getting healthy fats in smaller doses, as the level of bile available to emulsify the fats is lower. The body can’t squish a large quantity of bile into the digestive system, so handling a larger amount of food will be strenuous on the liver. Moderate the amount of eggs, higher fat dairy products, beans and legumes, nuts and red meats you consume. These are long chain triglycerides that require a significant amount of bile to break down and digest. Truthfully, every individual will have to tweak his or her own consumption, and monitor closely. Although the Advanced Plan recommends no snacking, someone without a gallbladder may benefit from snacking in moderation, but this could also vary with the person’s body mass, levels of activity, and meal sizes.
Words about healthy fats
Current opinion in the media would suggest that all saturated fats are unhealthy. This is misleading.
While the saturation content is one method of differentiating fatty acids, what is most important to the health of your gallbladder in this context is the length of the fat triglycerides, whether they are long chain, medium chain, or short chain triglycerides. The long chain triglycerides (LCT) require bile to break down and are circulated through the intestinal walls and back into the bloodstream, releasing particles of fat that collect in and clog up artery walls.
Medium chain triglycerides (MCT) are water soluble and do not require bile to break them down. They are broken down almost immediately by enzymes in the saliva and gastric juices, so they may be sent directly to the liver and are preferentially used as a source of fuel to produce energy. Not only is there less of a bile surge required to break down MCTs, pancreatic fat-digesting enzymes are not even essential.vi
Coconut oil has been targeted by both conventional medicine and dieticians as evil. The natural health care community does not agree. Coconut oil is a medium chain triglyceride and is an excellent energy source that doesn’t create a lot of stress on the gallbladder, if it is still present. It certainly puts less stress on the liver than do the other 95% of fats typically consumed, which are long chain triglycerides. That’s a good thing with or without a gallbladder. Consuming coconut oil is absolutely the best way to get the essential fats needed for fuel without requiring large amounts of bile, so it’s perfect for those who have had their gallbladder removed.vii
The fact that a body would be missing the gallbladder – or severely taxed by gall stones blocking bile –creates the need for some supplementation.
Healthy fats essential fatty acids, Omega 6 and Omega 3, should be combined and then metabolized in the body in the optimal ratio of between 1:1 and 4:1, respectively. The current North American diet and person ranges from 10:1 to 25:1 – or worse. The imbalance creates and/or exacerbates health issues. Supplementing with healthy fats in the optimal ratio, two to three times over the day in smaller doses, would allow the body to process the healthy fats at a slower rates. Monitor this to determine the best frequency, for you. One to two teaspoons per day of hemp seed oil in a smoothie, a shake or in salad dressing is a good way to get in this cold-pressed oil which contains the optimal ratio of healthy fats. Maximized Living’s Perfect Ratio Omega comes from healthy, clean sources and gives the right balance of healthy fats and is my supplement of choice.
There is nothing that takes the place of bile in emulsifying and breaking down fats, therefore actual Ox Bile is a preferred supplement in natural health care to aid digestion. Additional natural digestive support comes in the form of digestive enzymes, specifically pancrealipase and lipase, and glutamine for for integrity of the intestinal walls.viii Betaine Hydrochloride can help to prevent fat accumulation in the liver.ixHerbal supplements such as golden seal, rose hips, and red beet may also support digestion. Often, these digestive enzymes and co-factors can be found in one supplement, but be careful not to become dependent on these supplements, no matter how natural they are, for digestion. What supplements you use and what quantity is very much dependent upon the individual. Monitor your response as you try the supplements to see which may aid in supporting digestion.
The liver and gallbladder: keeping them clean
With or without a gallbladder, it should be clear that keeping the liver as purified as possible should be a goal for anyone striving to maintain optimal health. (The same goes for keeping the gallbladder purified, assuming it hasn’t been removed.)
Liver detoxification, in addition to daily cellular detoxification, will not only support a healthy digestive system, but one’s overall health, energy, and wellbeing. Cellular and liver detoxification supplementation are in most cases more essential than are digestive enzymes and herbal support. (A healthy body will produce its own hydrochloric acid and digestive enzymes.)
Activated charcoal is a toxin binder and helps to rid the intestines of toxins. It also binds toxic bile and removes it from the body, allowing for new, healthy bile to be produced without re-toxifying the liver. Ideally, a daily detoxification protocol would incorporate activated charcoal along with natural liver detoxifiers such as fenugreek, ginger and milk thistle, and the body’s strongest antioxidant responsible for cellular detoxification, glutathione, and its precursors. All of these ingredients can be found in Maximized Living’s Daily Detox system, as can be magnesium, to enhance gentle flushing of the bowels while detoxifying.
If the gallbladder is full of stones, a person may want to attempt one or more cleanses, which most natural health practitioners agree have been practiced for hundreds of years. The gallbladder “flush” typically involves a number of days of supplementation or consumption of apple juice to soften bile ducts, then a non-fat period of rest on the gallbladder, leading up to a night-time ingestion of olive oil and lemon juice to cause incredible pumping of the gallbladder and ejection of stones by the next day. Although the flush is lauded by many in the natural health field, it is contested by others, and can be swapped for natural, homeopathic, or herbal remedies when treated by a naturopathic doctor, homeopathic physician, or integrative medical practitioner. Regardless of one’s approach, the intentional flushing of the gallbladder is a process which should be supervised by a natural health care practitioner to avoid complications, and pre- and post- objective assessments of gallbladder health (i.e. gallstone sizes and density within the gallbladder) should be done to ensure progress is being made, if a person follows this path.
With or without a gallbladder, and with or without a “flush,” it’s generally a good idea to enhance detoxification and cleansing of the liver on a cyclical basis – it’s also much safer and predictable than the gallbladder cleanse. The following sample practice can be performed once every 4-8 weeks with ease. Though this is a conservative practice, because it is an advanced approach to improve one’s health naturally, this and other cleanses should in all cases be done with appropriate consultation and/or supervision with a trusted physician.
Step one would be to double up on ML Daily Detox and ensure “no cheating” on the ML Advanced Plan on a regular, rhythmic basis. Step two would be to periodically use ML Body Detox (part of ML Daily Detox), as follows:
- On a Friday night, two hours after dinner, consume a large dose of ML Body Detox (for its activated charcoal), i.e. 4-6 tablets, therefore 400 mg to 600 mg.
- One hour later, consume a double dose of liver digestive support supplements (i.e. ML Perfect Ratio Omega, 6-9 capsules, plus Ox Bile, digestive enzymes, etc.) and do not eat again before bed. Phosphatidylcholine is an additional supplement which can be ingested due to its cell membrane functions and benefits for liver repair. 5-10 total grams of phosphatidylcholine, taken with this flush, would be a good number of capsules, but in a 4:1 ratio would be appropriate for an adult liver.
- The next morning, consumer 4-6 tablets of ML Body Detox.
- Repeat on Saturday night into Sunday morning.
Ultimately, there are many ways to provide liver support. Some people may need liver enzymatic support and herbs that contribute to liver health, and we all need some level of daily detoxification to fight the toxins in the foods we eat and the environment in which we live.
The importance of nerve supply
Fundamentally, all disease processes will first manifest in the nervous system, and/or will communicate through the afferent nervous system via viscero-somatic reflexes in the body. Present-day opinions on the benefits of corrective chiropractic care not only validate the removal of physical stressors from nerves in the body, but improvement in the afferent-efferent communications within the central nervous system. Whereas the nerves supplying the gallbladder and liver derive from hepatic plexus exiting the mid-thoracic spine at T4-T9, and the from the tenth cranial (Vagus) nerve in the upper cervical spine, either of these nerve supplies when impinged with improper spinal alignment should be assessed in the management of a person with gallbladder or liver concerns.xii, xiii Healthy care of the spinal column and maintenance of proper spinal alignment before the onset of illness is a vital factor in maintaining good health. Maximized Living doctors not only practice spinal corrective care to enhance the health of the nervous system, but address advanced nutrition and detoxification protocols to ensure all vital factors in the restoration of one’s health, naturally.
Regardless of the condition, current trends continue to show that consideration of dietary and toxic stresses on the body, improved oxygenation of tissue cells, release of stress, and vital control of the nerve system are critical factors in the maintenance of good health. With or without the gallbladder, attention to the five essentials, albeit with some modification and refinement will allow the patient to develop a wholly functioning digestive system and to live a healthy lifestyle.