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By Dr. Justin Marchegiani
A common theme that we see in any patient that is chronically ill is gallbladder issues and problems digesting fats. There’s always a hormonal fatigue, maybe a thyroid or female hormone component, and there’s also a digestive component, whether it’s maldigestion, inflammation, leaky gut, or an autoimmune condition that’s emanating partly from the underlying gut issue. So let’s journey through the digestive system, starting with the moment you take a bite of food, and explore why your gallbladder may be preventing you from digesting fat.
Step One: Chewing Your Food
When you take a bite of food, chewing is really important because it increases the surface area of the food and breaks it down. The more you chew, the better exposure you have to bile salts, enzymes, and hydrochloric acid, and these begin that break-down process. It’s best to take smaller bite-sized pieces of food and chew once for each tooth you have, that’s 32 chews at a minimum—work at getting that food to a steel-cut oatmeal-like consistency. That’s step one.
Step Two: Breaking Down Food in Your Stomach
When you swallow, the food goes down the esophagus and empties into the stomach. The stomach needs a nice, low pH for proper digestion. Our bodies are slightly alkaline on average, about 7.35 or so, and hydrochloric acid (HCl) is the guy to help get the job done. HCl is very acidic, and it drops the pH in our stomach and gets it into that nice acidic range we need for proper digestion.
When the pH is nice and low, it starts to increase enzyme activity. One of the main ones it increases is pepsin, which is a proteolytic enzyme. Proteo- means protein, and -lytic means to break or cut. So the food breaks down further in the stomach, becoming chyme, which is a mixture of the food, enzymes, and acid.
The Role of The Nervous System in the Stomach
Acetylcholine is a really important compound because it’s part of the vagus-nerve stimulation. So the vagus nerve is actually cranial nerve number 10, right in the back of the skull, and it goes throughout the entire body and has an effect on the parasympathetic nervous system. The parasympathetic nervous system tells the body to hit the brakes and rest and digest as opposed to the sympathetic nervous system, the fight or flight system, which tells the body to go, go, go.
Our parasympathetic nerve fibers from the brain actually start innervating the stomach, and we have acetylcholine being produced in the stomach because of this vagus-nerve stimulation from the brain. So chewing your food and not eating on the go is very helpful because it creates a relaxed, stress-free environment for food digestion. That stress-free environment turns on the parasympathetic nervous system and in turn stimulates the activity of the vagus nerve and production of acetycholine in the stomach. helps get the whole ball rolling from a nervous system standpoint. This is called our cephalic phase of digestion.
Step Three: Breaking Down Fats and Proteins in the Intestines
The chyme enters the small intestine and starts to trigger some enzymes, such as cholecystokinin and secretin, which break down our fats and proteins.
Cholecystokinin (CCK) is stimulated by increased fat, and it causes the gallbladder to contract and produce and release bile salts. The gallbladder is a small organ that sits just below our liver, and it takes bile from the liver, concentrates it (making it more potent), and releases it into the small intestine. Bile’s primary purpose is to break down fat; it emulsifies it, like soap on a greasy pan. It’s also a detox mechanism for cholesterol and hemoglobin or bilirubin, which is like the broken-down skeleton remains of red blood cells.
Our bile will deplete itself every six hours or so. So one of the big things we can do is eat good fat. It’s like changing the oil in our car. If we don’t change our oil for a long period of time, things start to get very gelatinous and sticky and sludgy. If we eat enough fat, it’s like giving ourselves an oil change every day because it stimulates our CCK, which allows our gallbladder to contract and then release bile, and it keeps us from getting gallstones (watch the video above for more detail about gallstones and how these form).
Secretin is a compound made from about 22 amino acids. The lower our pH is, the more secretin we get, and secretin stimulates our pancreas to make and release more enzymes and bicarbonate to break down our proteins. Bicarbonate is important because our super acidic food coming down from our stomach has to be made more alkaline to complete digestion. Bicarbonate acts like baking soda, regulating the pH, bringing it back up to neutral or slightly alkaline.
Symptoms of Gallbladder Trouble
When something isn’t quite right in the steps of digestion, your gallbladder may experience trouble. There are some common symptoms you can watch for, including the following:
- Right-sided abdominal pain with possibly some right shoulder pain as well
- Bloating and gas
- Blonde-colored stools
- Floating stools (extra fat in the stool is like oil and water, and the fat will float to the top instead of sinking, so floating stools aren’t good)
Causes of Gallbladder Trouble
Allergens are a big common cause of gallbladder trouble. Let’s say you’re already Paleo, you’re already gluten-free—all of these things are already addressed. There are still some other allergens that can cause gallbladder trouble. In order of the most likely offender to the least, these include the following: eggs, pork, onions, chicken, turkey, milk, coffee, oranges, corn, beans, nuts, apples, tomatoes, peas, cabbage, spices, peanuts, fish, and rye. This may seem like a lot, but start with the most likely offenders and work your way down when trying to pinpoint the food allergen affecting you.
Additionally, some medications, whether its birth control pills, antibiotics, and even some other statin and lipid medications, are known to cause gallbladder issues. Almost 20% of all gallbladder issues are induced by medications.
There are also infections that can drive gallbladder issues. A big one is Giardia, a parasitic infection. Giardia can nest itself up in the gallbladder and create inflammation.
How to Treat Gallbladder Pain
Now in conventional medicine, doctors see the increased bilirubin levels, they see the inflamed gallbladder, and they just want to go in and cut that gallbladder out—that’s it. In functional medicine, we want to address the issue causing the gallbladder pain and trouble.
The easiest things, right off the bat, are to make the diet changes, add in some stomach acid, add in some bile salts and some bile-supporting agents, whether it’s fringe tree, dandelion root, taurine—these can all be helpful for enhancing gallbladder bile flow, increasing the HCl, and cutting out the bad foods.
Get yourself tested to determine the root cause. Do you have an underlying infection? If so, it needs to be treated. Are you taking medications that may be irritating the gallbladder? If so, we need to find a good alternative. Do you have more symptoms outside of the digestive problems? If you have those gallbladder symptoms—the right-sided pain, indigestion, floating stools, nauseous after meals—there’s a really good chance that you have a gallbladder problem and you need to dig in and get to its source.
If your gallbladder is painful and inflamed, it is likely preventing you from properly digesting fat. While conventional medicine is quick to go in and just cut it out, there are other ways to treat gallbladder trouble and get to the true source of the issue, including changes in diet, eliminating offending medications, and killing off irritating infections. Taking care of the source of the problem may regulate your gallbladder and get it back under control.