Most people have heard of gallstones, but other problems of the gallbladder invariably precede and accompany gallstones. In order to understand the various problems, it is necessary first to understand the nature of the gallbladder, and how it works.

What is the gallbladder?

The gallbladder is a small organ situated between the liver and the upper end of the small intestine. Its function is to hold bile produced by the liver, to be released into the small intestine as needed. Bile is needed for the emulsification of fats and the absorption of fat-soluble nutrients, including some of the vitamins. About two litres of bile are manufactured per day. Most of it is re-absorbed through the intestinal walls, taking with it the fat-soluble nutrients, but some of it is excreted via the colon, taking with it toxic substances, including excess hormones.

Bile consists of water, bile salts (which help to emulsify fats), lecithin, inorganic salts and bilirubin, which is the pigment from broken- down red blood cells. The emulsifying effects of bile salts and lecithin help the action of lipase, a fat-breaking enzyme released by the pancreas. Bile also stimulates peristalsis (the movement of faecal matter through the intestines) and is mildly laxative.

The gallbladder is therefore an important organ and we are better off with it than without it.

The signal for the gallbladder to release bile is the release of the hormone cholecystokinin, which is released from the intestinal walls when fatty food enters the small intestine. This hormone causes the gallbladder to contract, expelling the bile forcibly.

With every hormone in the body, if the demand is too great, then eventually the secreting organ becomes exhausted, and unable to produce enough. This applies to cholecystokinin as much as to every other hormone. The average modern diet of pies, burgers, chips, fried foods, sugar, white bread and hydrogenated fats is a perfect example of a diet designed to maximise gallbladder problems by over-stretching the system.

When following this diet, production of bile by the liver becomes impaired, and the expelling action of the gallbladder becomes sluggish. The bile becomes thickened, and materials which are usually held in solution begin to precipitate out. This provides the nucleus of gallstones.

Gallstones vary in composition from entirely cholesterol to entirely mineral (calcium etc.), or mixtures of these with bile salts or bilirubin pigments.

Causes of Gallbladder Problems

This is another case, as with cardiovascular problems, where cholesterol is given much blame for problems arising, when the problem really lies elsewhere. Most gallstones consist quite largely of cholesterol, with other materials mixed in. In healthy bile, with correct proportions of bile salts, lecithin and water, then cholesterol remains in solution. If proportions alter, by reduction of lecithin, salts or water or by increase of bilirubin, then cholesterol is precipitated out, and can form the nucleus of gallstones.

Note: Excess breakdown of red blood cells can be caused by lack of vitamin E.

Lack of Dietary Fibre

Gallbladder problems, as with many other diseases, have been shown to be a product of the modern high refined food, low fibre diet. It has been shown that a diet high in sugars and fats and low in fibre results in a reduced production of bile salts in the liver, and also a reduced amount in the gallbladder. The reduction in bile salts then leads to formation of cholesterol-rich gallstones.

There is a substance called deoxycholic acid, which is produced from bile acids by certain bacteria in the intestine. This compound greatly reduces the solubility of cholesterol in bile, and therefore leads to cholesterol precipitation. Dietary fibre binds onto this compound and prevents its activity on cholesterol. The best type of fibre for this is soluble fibre, as found in fruit, vegetables, oats and psyllium.

Food Allergy and Intolerance

Food allergies and intolerances have been shown to increase the incidence of gallstones. It is thought that they have this effect purely because they cause inflammation of the bile duct, thus reducing bile flow.

The main foods causing these problems are egg, pork, poultry, milk, coffee and citrus fruits. In addition, all chemical additives such as preservatives, artificial colours, sweeteners and flavourings increase the problem.

Treatment

A) Prevention

On the principle that prevention is better than cure, we would advise that a diet low in sugars, chemicals and saturated fats, and high in fibre from fruit, vegetables, oats, psyllium and linseed would be wise, together with plenty of water.

B) Treatment

However, if gallstones have already formed, stronger measures may help, as follows:

1) Diet

Reduce consumption of animal fats and cholesterol, including from eggs. No sugar, no fried foods, no food additives. Avoid the foods mentioned above under food allergy and intolerance.

2) Water

At least three or four pints of water should be consumed per day, to prevent the bile becoming too concentrated.

3) Nutritional supplements

¨      Deficiency of vitamins C and E has been shown to cause gallstones, because of an increased rate of red blood cell breakdown, causing an increased rate of formation of bilirubin. They should be taken at the rate of at least 2 grams per day of vitamin C and 200-400iu of vitamin E.

¨      Lecithin; 2 dessertspoons of granules per day to supply phosphatidylcholine.

¨      Methionine; 1000mg per day, away from food. This helps to prevent fatty build-up in the liver.

¨      Fibre supplement; psyllium, oatbran or pectin.

4) Herbal supplements – to stimulate bile flow

¨      Dandelion

¨      Milk thistle

¨      Artichoke leaves

¨      Circumin (from turmeric)

The last two mainly help to detoxify the liver.

All the above measures may help to dissolve or pass the gallstones, but care should be taken if X- rays show the stones to be large; any action could cause them to become lodged in the bile duct, necessitating surgery.

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