If you’re like most people, your gallbladder is unlikely to cross your mind much until it’s causing problems, so let's discuss the importance of supporting the liver and the gallbladder as important detoxification pathways.
A functioning gallbladder secreting adequate bile is vital not only to effective fat digestion but also to the ability to fight bacterial overgrowth, make hormones, navigate perimenopause, control blood sugar levels, relieve constipation, lower cholesterol levels and fight coronary artery disease!
Gallbladder problems can cause severe pain as well as vague symptoms that you’re less likely to realise are connected. Let's look at why the gallbladder is so important to our health, the benefits of bile, how to support the gallbladder with food and herbs and when to seek professional help.
What is the gallbladder?
Your gallbladder is your liver’s closest ally and vital to its operations. The liver (amongst many things) makes and secretes about 800 ml of bile daily, storing and concentrating it in your gallbladder, a small pear shaped organ below the liver.
What is bile made of?
Bile acids, also known as bile salts, which blend together during digestion
Cholesterol, the precursor to bile acids and all steroid hormones
Bilirubin, which is a waste product of haemoglobin that carries oxygen in the blood. Bilirubin is secreted into bile to be excreted in faeces.
Phospholipids, complex fats that contain phosphorus
Fat Digestion + Absorption
Bile is produced by the liver and stored in the gallbladder, becoming more concentrated the longer it is stored. When we eat foods that contain fat, the gallbladder releases bile into the duodenum, (part of the small intestine), via the common bile duct. It emulsifies, or breaks apart the fat so it can be absorbed by our small intestine and fat soluble vitamins can be transported into our bloodstream to be used by the body
Adequate, healthy bile is essential for your body to absorb fat-soluble vitamins, such as vitamin A (an antioxidant and important for vision), vitamin E (another powerful antioxidant, known as the fertility vitamin), vitamin K (vital for bone health and blood coagulation), and vitamin D (a hormone with vital immune functions). Indications of low levels of Vitamin A, D, E or K could be a sign of something amiss with your gallbladder!
Every hormone is made from fats so not being able to absorb them has major consequences. If undigested fat globules are not being used in cell membranes they are being stored as subcutaneous and visceral fat!
Bile is a natural laxative
Bile is necessary for removing whatever the liver is getting rid of including heavy metals, chemicals, toxins and metabolic waste, including bilirubin and cholesterol. This is why it's so important to have a bowel motion every day, because if you're constipated, or if bile is congested and not flowing well, those toxins keep circulating instead of being removed. As we said earlier, they have to go somewhere, so they are stored in the fat cells! Fortunately bile in itself, when being released, has important laxative properties, encouraging movement in the digestive tract known as peristalsis. (1)
Bile helps control cholesterol levels and protects the heart
Our liver makes 80% of cholesterol produced, and the body packages it up in lipoproteins so it can travel in the bloodstream as it is vital for every cell in the body. Cholesterol is crucial for cell membranes, fat soluble vitamins such as Vitamin D, steroid hormones such as oestrogen and testosterone. Of course, we also want to ensure cholesterol does not clog up the arteries and cause heart disease, so it needs to be disposed of efficiently!
Bile salts are amphipathic, that is they have a fat and water soluble section meaning cholesterol can attach to it and become soluble. Every day (where the gallbladder is healthy) about 500 mls of cholesterol is converted into bile salts and eliminated from the body through digestion. The excretion of of large amounts of bile protects against atherosclerosis, while diminished excretion may lead to coronary artery disease (CAD) which is caused by the buildup of cholesterol deposits forming plaque in the arteries that supply blood to the heart. (2)
Melatonin, the hormone known for its sleep promoting properties in the brain is also found in the gallbladder! It turns out melatonin is also a potent antioxidant that prevents oxidative stress, supports optimal gallbladder motility and helps convert cholesterol to bile! (3).
Bile is a natural antimicrobial
When our digestive system is working well, the small intestine should have a relatively small number of bacteria, whereas our large intestine, or colon, is teeming with them! As a result, the nutrients absorbed in the small intestine feed the host (us humans) and the large intestine feeds our gut microbiome. Bile salts are antimicrobial and healthy bile flow ensures pathogens are regularly swept up and removed from the small intestine (4). Bile can be reabsorbed in the digestive tract and can recirculate 15 times after each meal, constantly breaking down nutrients and killing pathogens! When bile acids are not flowing well such as with liver or gallbladder disease, bacterial overgrowths such as SIBO occur with its symptoms such as abdominal pain and bloating (5).
Hormonal regulation
Oestrogen dominance is a hormonal imbalance where oestrogen is out of balance with other hormones such as progesterone, and can occur even in perimenopause when oestrogen fluctuates up and down, from Bisphenol A (BPA) in plastic water bottles, food storage containers etc increase oestrogen levels that the liver must deal with. The liver packages up these hormones and relies on bile to carry excess oestrogen out of the body via the digestive system. If however, there is bile congestion, liver stagnation or constipation, this process is slowed, allowing hormones to re-circulate causing a range of oestrogen imbalances such as heavy periods, breast tenderness and lumps, headaches and weight gain.
Oestrogen, whether it is produced as a hormone by the body or as a result of the oral contraceptive pill or hormone replacement therapy , increases the amount of cholesterol relative to bile salts in bile, increasing the saturation of bile with cholesterol, which leads to cholesterol crystal formation. Oestrogen also alters bile acid composition, increasing the chance of gallstone formation (6).
Blood sugar balance
Recent studies have shown that a receptor activated by bile acids can reduce fat-tissue inflammation and insulin resistance in Type 2 diabetes. Diabetes develops when the body has problems with insulin, a hormone that regulates sugar levels in the blood. Scientists working with researchers from Italy and the Netherlands have shown that bile acids activate a receptor to overcome the loss of insulin sensitivity, forming the basis for a new class of drug against type-2 diabetes according to the Journal of Clinical Investigation.
Bile acids have traditionally thought to be confined to the small intestine for fat digestion but the research showed bile acids enter the bloodstream and behave like hormones, acting on the receptors of cells triggering a cascade in the cells that reduced the accumulation of immune cells called macrophages that are associated with the inflammation of type-2 diabetes (7).
Bile acids and thyroid activity are interconnected.
Studies show a direct link between bile acids and thyroid function, if you have been diagnosed with gallstones, it is important to have your thyroid tested.
Fats from food are needed to produce active thyroid hormones so poor fat digestion lowers thyroid activity
Bile release triggers an enzyme that converts T4 (the body’s less active thyroid hormone) into T3 (the more active form), boosting metabolism, so sluggish bile release will interfere with thyroid function.
Hypothyroidism slows all digestion including bile secretion, increasing the risk of gallstones
Bile is released from the gallbladder through the sphincter of Oddi, a small muscle in the bile duct. T4 (thyroxine) is responsible for relaxing the sphincter allowing bile to flow. With low T4 the sphincter will not relax, bile will accumulate and form sludge and gallstones.
With hypothyroidism, the lack of T4 (thyroxine) decreases liver cholesterol metabolism resulting in bile being supersaturated in cholesterol, which in turn impairs the motility, contractility and filling of the gallbladder, contributing to the more cholesterol crystals and gallstones.
Gallbladder disease increases the risk of psoriasis and skin problems
Psoriasis (and psoriatic arthritis ) is a chronic inflammatory disease that can affect the skin, joints, nails and scalp. Psoriasis has a multifactorial aetiology involving genetic, environmental and autoimmune factors, and studies have shown that a history of gallbladder disease is associated with an increased risk of psoriasis, independent of body weight! (8)
If bile flow slows or stops (known as cholestasis) due to disease or inflammation of the liver, gallbladder or pancreas, the buildup of bile salts can cause severe itching similar to eczema. Bilirubin can build up in the bloodstream and lead to jaundice. Signs include dark yellow urine and yellowing of the skin and eyes.
Other signs and symptoms of cholestasis include:
Light-coloured stools that float (known as steatorrhea and due to a blockage of bilirubin)
Itchiness (possibly from bilirubin accumulating in the skin)
Bile acid malabsorption (BAM) is a condition in which bile acids are not reabsorbed by the liver for reuse and end up in large amounts in the large intestine. This causes chronic, watery diarrhoea which is often misdiagnosed as diarrhoea-predominant IBS (D-IBS). Anyone who has diarrhoea which lasts for more than 4 weeks should be evaluated for BAM.
Could your gallbladder be struggling?
To some extent, the symptoms of gallbladder disease will depend on the cause. If your gallbladder is inflamed and bile is thick and sludgy (sorry!) or blocked due to gallstones, you will likely have a crushing pain in the middle to upper-right part of your chest after a fatty meal. It can radiate up the right arm and into the neck and jaw because when the gallbladder is inflamed, it irritates the right phrenic nerve that runs from the jaw down through the neck to the diaphragm and alongside the gallbladder. It can also radiate between the shoulder blades. Of course, NEVER assume chest pain is due to the gallbladder, it could be a cardiac issue, so if you have any chest pain, seek immediate medical advice!!
Other prominent symptoms that you may not think to connect with your gallbladder include:
Nausea
Vomiting
Acid reflux: heartburn is often due to low stomach acid and a weak lower esophageal sphincter allowing acid to back up into the oesophagus. Taking proton pump inhibitors (PPI’s) reduces stomach acid further. Bile production needs stomach acid so if you are taking antacids or PPI’s longer than 3 months, you may be reducing your gallbladder function.
Burping, gas, bloating, constant feeling of fullness
Abdominal pain
Constipation and haemorrhoids
Dry skin and hair from a lack of fatty acid nutrient absorption
Varicose veins from a sluggish liver and gallbladder, particularly when combined with oestrogen dominance
Genetics may play a role in gallbladder disease
The PEMT (phosphatidylethanolamine N-methyltransferase) gene expresses an enzyme that generates phosphatidylcholine (PC) which is crucial for maintaining a healthy cell membrane as well as bile flow, liver health, muscle health and brain development. Phosphatidylcholine made by the PEMT gene must be in balance with cholesterol for good bile flow.
Oestrogen promotes expression of this gene too, so post-menopausal women are at higher risk of gallstones due in part to potentially lower oestrogen levels. Type 1 diabetes also tends to decrease phosphatidylcholine production.
What if you have had your gallbladder removed? Is there anything you can do? Even without a gallbladder, bile still needs to get into and around the digestive tract and the following points will be relevant for you!
Want to support bile flow ? Here's where to start:
As with everything gut related, the foundations of good eating will support good bile! Eat mindfully and slowly and chew your food well. When the nervous system is in ‘rest and digest’ it can prioritise the production of stomach acid, digestive enzymes and bile. If we are stressed and in a state of ‘fight or flight’ it will not!
For clients with sludgy bile, gallbladder disease or who have had their gallbladder removed, I recommend eating at least 3-4 small meals a day with some fat, protein and carbohydrate in each meal. Bile should be released from the gallbladder regularly throughout the day or it becomes too concentrated and stagnant, leading to gallbladder disease. Eating one or two bigger meals a day can cause pain as the gallbladder or liver contracts in response to the larger amount of fat in the meal. Managing the amount of fat in meals can help, although fat itself is not the problem (unless it is from highly processed foods), rather the body's inability to release bile to emulsify it.
A diet high in sugar and highly processed carbohydrates such as bread, pasta and soft drinks is associated with a higher risk of gallbladder disease, whereas a high fibre diet reduces the risk. Salads are full of good fibre, but soups are easier to digest.
Bitter foods such as rocket, watercress, broccoli, dandelion as well as herbs are amazing for not only the gallbladder but our whole digestive tract! They stimulate the release of enzymes for digestion, act as prebiotics for the microbiome and release hormones that control appetite and assist with weight loss. I like my clients to take a gently bitter tonic such as Iberogast to tone the gallbladder and pancreas. (Just a reminder that coffee is bitter and ‘could be’ good for the gallbladder!!).
Speaking of bitters, be mindful that excess oestrogen in the body requires adequate amounts of bile to bind to the circulating oestrogen for it to be removed from the body via the bowels. Bitters stimulate bile flow and assist with digestion, reduce constipation, and the symptoms of oestrogen dominance common in PCOS and perimenopause. Magnesium is a wonderful supplement not only for the nervous system and sleep but also to keep bowels regular.
Exercise is great for the lymph, blood bile and bowels! Regular exercise consisting of a brisk 45 minute walk at least five times a week can reduce the risk of gallbladder disease by one third. Not only does exercise stimulate bile flow, it also reduces the risk of metabolic syndrome ( abdominal obesity, high blood pressure, impaired fasting glucose, high triglyceride levels, and low HDL cholesterol levels) that affect the gallbladder.
Beetroot contains betaine, a phytonutrient that thins bile and supports liver and gallbladder health. A little fresh beetroot grated in a salad or soup, or in a juice with green apple and ginger can be a wonderful way to support detoxification. It is also a good source of iron, manganese, zinc and folate.
Working with a clinical nutritionist for personalised nutrition and advice on supplements to support bile flow such as digestive enzymes, taurine, choline and ox bile as well as minerals and vitamins that can be of direct benefit whether you wish to support the gallbladder or have had your gallbladder removed and need advice on the best foods for you.
Supporting the gallbladder and liver as detoxification pathways is important for not only our digestive health and nutrient absorption, it's also antimicrobial and plays a vital role in nurturing happy hormones and cardiovascular health. If you would like to learn more, have a look at my insta page maryanne@bespokenutrition.com.au or my website www.bespokenutrition.com.au, I'd love to chat with you about your health goals!
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