Ode to the Gallbladder
“You who do so much
to help me digest fats and such,
occasionally seem to be quite unhappy,
causing me to feel more than a little crappy.
In the middle of the night,
you wake me to pick a fight
bringing on symptoms that are rather gross
and putting me in a mood that could be called morose.
Just when I least expect it,
my day – you’ve gone and wrecked it!”
Okay, I admit my poetry writing skills have slipped a bit since my creative writing days. But anyone who has had their gallbladder wake them in the night, with the tell-tale signs of pain in the right rib area and a host of other symptoms, might actually appreciate this poem.
In this post, I’m going to share a few tips that could help someone in the midst of a gallbladder attack. In my clinic, I treat many types of gallbladder problems, and have helped people eliminate the need for gallbladder removal, greatly improving the function of the gallbladder, while reducing the frequency and severity of attacks to the point that they rarely experience any symptoms.
What is the gallbladder?
First, a quick tutorial on the gallbladder: this is a small pouch-like organ that is tucked up under the liver. It stores a light green, alkaline fluid called bile, which is made by the liver and consists of bile salts, cholesterol and lecithin.
The main function of bile is for adequate digestion of fats. When you eat food that contains fats, it first passes through the stomach. Once in the small intestine, the gallbladder is triggered to squeeze out some bile into the small intestine via a small network of ducts. When working correctly, it releases just the right amount needed to emulsify and break down the fats in the food.
Unfortunately, several things can go wrong with the gallbladder:
Gallstones are the most widely known gallbladder malady. The cholesterol in the bile can be too concentrated or build up, creating thick,“sludgy bile” and eventually gallstones. This is especially true if the body is exposed to a high fat, low fiber diet. Other risk factors are obesity, rapid weight loss, pregnancy, and being an overweight female over 40 years old.
These stones can clog up the gallbladder, creating irritation and inflammation, and disrupting the gallbladder’s ability to secrete the correct amount of bile at the appropriate times, compromising the process of digesting dietary fats.
Gallstones can also get lodged in one of the ducts when bile is released for digestion. This causes a painful cramping, twisting or sharp sensation in the upper right abdomen or rib area, radiating to the upper back. This is the classic gallbladder attack. These attacks often strike in the middle of the night, or following a meal that contained high fat foods. Stress can also be a contributor. The pain can be accompanied by burning in the stomach, sweating and nausea with vomiting. The attack can last several hours. This condition has the potential to be an emergency surgery situation, if the stone is too large to pass through the duct.
Another possible complication of gallstones is pancreatitis, since the bile and the pancreas share a common duct into the intestine. If it is obsructed by a stone, then pancreatic enzymes cannot pass through, and back up into the pancreas causing inflammation and pain.
For these reasons, it is important to get a gallbladder ultrasound if you suspect gallbladder symptoms, to determine if you have stones, and how large they may be.
Gallbladder spasms, or biliary dyskinesia, is a lesser-known gallbladder condition that I see in my clinic with some frequency. It is often diagnosed as irritable bowel syndrome, or patients are simply told there is no reason for them to be experiencing pain in the gallbladder region.
This is because in this condition, the ultrasound shows no gallstones, and all lab tests could be normal. But the person still experiences gallbladder attack-like episodes, often in the middle of the night, or after a meal containing typical gallbladder trigger foods. They will have the classic pain in the upper right abdomen or rib area, radiating to the upper back, burning pain in the stomach, as well as nausea with vomiting, and/or severe intestinal cramping with diarrhea.
If there are no stones, what could cause this condition? There may be bile sludge, or very tiny stones or crystals that are not visible in ultrasound, yet are still irritating to the gallbladder. It could also be a result of toxins that are dumped into the bile by the liver for disposal. Certain toxins or waste products have the potential to irritate the gallbladder. This irritation, like stones, can trigger spasm or over-reaction when bile release is stimulated.
As a result, too much bile may be expelled into the intestines, causing intestinal irritation and leading to intestinal cramping and diarrhea.
Because there are no observable gallstones, many patients who come to me with these symptoms have a diagnosis of “irritable bowel syndrome” from their M.D. This is especially true if the patient has frequent constipation with occasional bouts of painful diarrhea. (Indicating that the gallbladder could be underfunctioning much of the time, causing constipation, and then over-reacting in acute episodes, causing painful diarrhea).
If there is burning in the stomach (which could be from reflux of bile into the stomach), many doctors consider this to be acid-peptic disease or GERD and treat with antacids. Click For more info on bile reflux.
What is the treatment?
Western medicine has no treatment for gallstones, except to remove the gallbladder entirely. In situations where the stones are very large, or there is danger of a rupture or emergency, then removal is completely necessary. In other, less severe cases, most people don’t realize that they have other options.
Removal of the gallbladder does not ensure that the pain will be completely gone, or that the patient will not experience bile reflux. And after gallbladder removal, fat digestion is never really optimal, as bile is no longer stored for when it is needed. Rather, it slowly drips into the small intestine as the liver produces it. While some people don’t have many symptoms associated with this, others do. I have had patients with chronic intestinal irritation as a result.
As mentioned above, Western clinicians usually diagnose gallbladder spasms as irritable bowel syndrome or acid-peptic disease.
Eastern medicine, on the other hand, can address all types of gallbladder issues, including stones and spasms. I have helped many people avoid gallbladder surgery, and others to recover from lingering symptoms after surgery. Treatment to resolve stones is a rather intensive 6 to 12 week period of acupuncture, herbal medicine, and dietary therapy as we soften, dissolve, and safely expel the stones, cleaning up the gallbladder.
For those without stones, we use a combination of acupuncture, herbal medicine and nutrition to regulate the function of the gallbladder, to address the patterns of underfunctioning and over-reacting, by smoothing out the energy (Qi) of the Liver and Gallbladder, while harmonizing the relationship between the Liver/Gallbladder and the rest of the digestive system.
Of course, in all cases, dietary indiscretion can still trigger attacks, but with treatment, the body does become more tolerant.
What to do during an attack:
When you are in the midst of an attack, there are several things you can do to help minimize the pain and duration of the attack: (Note: If you have stones, and your pain is very severe, this could mean you are in an emergency situation, so it would behoove you to seek an emergency room.)
First, I recommend sipping peppermint herbal tea. Peppermint is anti-nausea as well as anti-spasmodic. It will reduce nausea as well as the spasms in the gallbladder and/or bile duct that are causing the cramping/twisting pain. Deep, slow breathing techniques can also help ease the spasms.
Once the nausea has subsided, I recommend taking 300-400 mg of magnesium citrate or magnesium glycinate. Magnesium is a natural muscle relaxer. Here we are targeting the smooth muscles of the gallbladder and bile ducts so that they stop spasming (further reducing pain) and perhaps even dilate (allowing small lodged stones to pass.)
If you are having intestinal cramping and/or diarrhea, I also recommend making a bowl of plain, old-fashioned, gluten-free oatmeal, cooked with water. Why oatmeal? Because your intestinal linings are irritated from the large amount of bile that was released into them. Real, old-fashioned oatmeal is very soothing to the intestinal lining, much in the same way that is it soothing to skin irritations. (You’ve heard of oatmeal baths for skin rashes, right?) And the soluble fiber in the oatmeal can “sop up” any extra bile that might be lingering in the intestines, causing irritation. Do not add anything to your oatmeal: no spices, sweeteners, fruit, nuts or milk.
Once your symptoms have passed, eat very plainly for the next several days. Eat oatmeal, sweet potatoes, winter squashes, brown rice, cooked vegetables, beets, cucumbers, apples, grapes, clear-broth soups, avocados, and flax seed meal. Avoid the most common gallbladder triggers: eggs, meats, all dairy including cheese, yogurt and ice cream, oils, nuts, nut butters, and for some people, beans. Continue to drink peppermint or chamomile tea. Continue to take supplemental magnesium (200-400 mg once or twice daily, to bowel tolerance) until you can get to the health care provider of your choice.
One Last Note:
I do not recommend the olive oil with lemon juice “gallbladder flush’ that is common in many natural medicine circles. It is too extreme, and can cause an emergency surgery situation if you manage to get a large stone lodged in a duct. Also, for many people, it produces poor results, and makes people feel very sick. There are better ways to clear the gallbladder.