Gallbladder Attacks| Podcast #228
Gallbladder seems like a small pouch that is located just under our liver and is responsible for storing the extra bile the liver makes. Pretty easy, right? No. The gallbladder plays a very important role especially in digesting fatty foods.
In today’s podcast, Dr. Justin Marchegiani and Evan Brand talk about the importance, and how to take care and address problems when it comes to our gallbladder. Stay tuned!
Dr. Justin Marchegiani
In this episode, we cover:
02:52 Gallbladder’s Function
07:43 Risks of Taking Out a Gallbladder
12:45 Mechanisms Behind The Damage
19:26 Gallbladder Damaging Foods
23:53 Hormones and Birth Control Pills
25:50 Keeping It Safe
31:25 Fiber and Sugar
Dr. Justin Marchegiani: Hey guys it’s Dr. Justin Marchegiani here, I was out of the office last week. I’m so excited to be back in action. We get Evan brand here in the house and we’re gonna be doing a talk on gallbladder attacks what you can do to treat, prevent and what the physiological cause of this is. Again do we have to rely on conventional medicine to get your gallbladder out. Can we do more natural means to get to the root cause. So, Evan how we doing man?
Evan Brand: Hey man pretty good, yeah. This is timely because as I told you before my mother-in-law she ended up having a bunch of pain last night and goes into the ER and they say after doing an ultrasound, which is one of the diagnostic tools that conventional medicine is really useful for, they said, yep you’ve got gall stones, you got to get your gallbladder taken out and they’re gonna say, hey you got to go right into surgery and get it out and I’m trying not to let that happen but I may lose this battle, it’s hard to say right now.
Dr. Justin Marchegiani: Oh, before we dive in man you had a baby in the last week. Congratulations!
Evan Brand: Good, thank you. I can’t show her off, she’s gone. Mom took her out somewhere, but yeah she’s, she’s healthy. She was 8 pounds 1 ounce. No complications during birth at all. Everything went absolutely amazing and, right yeah, yeah my wife had her in a big old bathtub that we bought and got set up just for that so.
Dr. Justin Marchegiani: Her name is Jenna Rose B.rand
Evan Brand: Yep, that’s it.
Dr. Justin Marchegiani: That’s awesome JRB, I love it man.
Evan Brand: Yeah, yeah.
Dr. Justin Marchegiani: So she’s drunk right there, right.
Evan Brand: There man, mom’s good, mom’s recovering and we’re figuring out our sleep schedule. Still the baby’s sleeping pretty good, she’s breastfeeding pretty good. So far so we can’t complain, I’m still in kind of that like oxytocin overload so I don’t have much to complain about right now.
Dr. Justin Marchegiani: Yeah, a little hazy. It’s always a little tougher when you have another kid because you got to still manage the other kid while this new babies into the world and then maybe it is a jealousy thing going on so you got to manage that so it’s definitely tightrope walking. I’ll be there in like 3 months so it’s like crazy that I’m just, you know, you’re like a sneak preview of what’s to come 3 months ahead of time here.
Evan Brand: I know all I can say is enjoy it with one kid because you don’t realize how easy it is to have one until you have two, and then it’s like wow this is more than twice as complicated as one it doesn’t just double it’s an exponential work scale.
Dr. Justin Marchegiani: I know that’s first six months of the hardest wood getting the sleep on track everything is possible with good sleep. When sleep is not there, everything becomes so much harder across. You got a good sleeper.
Evan Brand: Yep.
Dr. Justin Marchegiani: And of course you’ll do all the right stuff so much of baby sleep has to do with you know early on it’s tough because the baby just doesn’t have the blood sugar stability aspect but having good quality breast milk and good proteins and fats in Hannah’s diet will be huge with providing sustenance for the baby, so, fingers crossed that you guys are on the right track there.
Evan Brand: Yeah, thank you man I appreciate it.
Dr. Justin Marchegiani: Well let’s dive in the gallbladder issue, so physiology 101. What is your gallbladder? So, it sits right below your liver so your livers on your right side, here so in this quadrant here and the gallbladder kind of tucks up underneath and it’s there to primarily concentrate bile salts and bile is designed to help emulsify fat. So think of emulsification is when like greasy pan soap it’s the pan it starts to kind of like suds and break down that’s emulsification in the ability the reason why we want to emulsify it so we can absorb if not if you just try to wash a let’s say a greasy baking dish with just like water use a big sheen right and that essentially what happens in your stool you’ll see that kind of a sheen in your stool and you may even see your stool float if we can’t break down fat adequately, so we need that emulsification so we can break down that fat. And it’s important because there’s actually nutrients in fat like vitamin A, D, E and K these are fat soluble nutrients vitamin A is great for your skin for your thyroid for your immune system D is obviously great for your immune system you make it from the sun as well vitamin E is a powerful antioxidant and great for cardiovascular health and stress and then vitamin K is amazing for your bones it’s also a very important nutrient for your immune ___[04:04], your immune function and healthy vascular system so vitamin A, D, and K really important and you will not be able to optimally break those down within adequate bile salt production so if your gall bladder is not working and that can be a problem. Now, your gallbladder provides a benefit because it concentrates violet and the 15 acts some people report you and higher compared to what your liver could do so your gallbladder sits there. It’s just little pouch and then it concentrates that bile. And then when you eat food by protein and fat primarily it’s gonna be fat but typically protein is batter together that’ll go into your stomach you’re gonna make a whole bunch of stomach acid that lowers the pH. That nice low pH causes activation of proteolytic enzymes. That nice low pH then goes into your small intestine. That nice low pH then triggers bicarbonate from your pancreas which helps bring that acidity back to neutral about, but that nice low acidity triggers a hormone a hormone peptide called CCK, or cholecystokinin for short, and cholecystokinin causes that gallbladder to contract and release that bile salts and that good acidity also causes the pancreas to produce light pace in proteolytic enzymes lipase means fat digestive enzymes proteolytic, means protein digesting enzymes so we need that nice low pH, and that triggers our gallbladder to work and if we don’t have a good gallbladder, that bile from the most part your liver becomes your gallbladder. So you’ve become and hepatic bile duct expands and that gallbladder just kind of drips and it doesn’t really get to that nice concentrated fashion and work as well, so you’re not gonna have good fat digestive capacities.
Evan Brand: Man, I didn’t even know this there’s so cholecystokinin can also be its officially called pancreozymin, did you know that?
Dr. Justin Marchegiani: No, I didn’t know that was, uh, another name for it.
Evan Brand: I guess that’s another name for it. But yeah, so it’s made right there in the first sect ion of your small intestine. That’s pretty cool. I never knew that name before. Yeah, this is interesting because you, you gave a really good visual about the whole bacon grease on a pan thing because it’s fat soluble when I picture that and, and I, and I use your visualization. I’m seeing all these nutrients that are almost hidden or protected by the layer of fat and if you can’t bust apart that fat and emulsify it, it’s like those nutrients just go to waste you could be eating those nutrients but if you’re not emulsifying the facts those nutrients are not really getting absorbed and I think this is why so many people you even who take vitamin D supplements, maybe they’re deficient because they’re not maybe one they don’t have a gallbladder or two they’re just not eating it with fat or three they just don’t have the emulsification process working.
Dr. Justin Marchegiani: 100%, and again like if you’re eating really good foods fats and proteins and that’s not digesting properly a lot of times, you’re gonna feel nausea. You’re gonna have indigestion because a lot of these proteins and fats they’re gonna go rancid. They’re gonna rancidification and then they’re gonna get putrified right so rotting proteins Beautification rotting fats rancidification fermentations the carbs and that can create a lot of bloating and gas and digest the de-stress, so and that can even create more nausea. Yhen what tends to happen is a lot of these kind of people are, are ones that tend to go more vegan, vegetarian plant-based because they’re really just having a hard time with these harder. Let’s say energy intensive foods to break down and then their diet starts to shift so we got to get to the root cause and say what’s going on with our digestive system and figure it out.
Evan Brand: Well, you know, what I just found out too is kind of a risk of getting out the gallbladder is the increase of colorectal cancer goes up quite significantly. When you get the gallbladder removed, if you just Google gallbladder or they call it a cola how do you even pronounce this, is a sola, coalescedectomy-
Dr. Justin Marchegiani: (Cross-talking.) Yep.
Evan Brand: Coalescedectomy, anyway, remove the gallbladder alright it’s quite significant, I’m trying to find the exact percentage here but I would just say that there is a big increase in different types of cancers after you get the gallbladder removed and I would say probably just because the gallbladder does have some function to help with detoxification, because you’ve got this connection between your liver and your gallbladder and your bile so that whole system gets disrupted if gallbladder is removed.
Dr. Justin Marchegiani: Yeah 100 % yep, so in general we have like two major ducts right we have like this common, this common bile duct right, and then we have this pancreatic duct because you have bile coming out so you have liver, gall bladder, common bile duct ,or the common duct and then you have the pancreas hanging over here, and you have a successive pancreatic duct. So what happens is these kind of conjoined and then they eventually go to this hepato pancreatic ampule er there’s a couple names for it, it’s the same thing it’s basically just where the liver and the gallbladder duct meet the pancreas dock and then they go into the small intestine. You can have stones that go right after, they, here they go a little bit lower. You can have some stones join now when those stones are there it can create a blockage and it can create a backup of enzymes in the pancreas, and they can create a backup of gall bladder or the bile or essentially you can create more pressure where those stones are up in the gall bladders and then you can create pancreatitis issues on the pancreas side right because it tees to the right and then we’re at each to the left. You can create inflammation in the gall bladder right and these are both issues so typically they lean more on pulling out the gall bladder than they would the pancreas just because the pancreas has a lot of other exocrine functions like insulin and glucagon and other types of hormones so they typically go right to the gallbladder and remove it. Now we can talk a little bit about should you remove itn should you not. It just depends on how acute it is and how long it’s been going on. But I’ve had great experience saving people’s gall bladders by doing some of the things that we’re going to talk about in a bit so you really have to sit down and talk with your doctor see how your immune system is doing. See how inflamed jar but you really if you’re gonna let’s say try some of the more natural things to save your gall bladder, you really want to be monitoring it especially if you’re on the pancreatitis side because that can definitely be dangerous. Any thoughts on that Evan?
Evan Brand: Yeah, I wonder if looking at the pancreas, if that would be something they would look at via blood or if that would just be the ultrasound maybe they would look to see if the pancreas is inflamed, I mean how would you judge the pancreatitis so you would know?
Dr. Justin Marchegiani: That’s a great question. I’m not sure the exact what they — I imagine the ultrasounds and to be a big component in it they’re probably gonna also look at your immune markers as well to see how jacked up your immune system is from what’s going on and like you probably also look at some various pancreatic enzymes as well.
Evan Brand: Okay here’s the National pancreas Foundation testing would be yes ultrasound so this would look for acute pancreatitis there’s an endoscopy basically endoscopy type of ultrasound that they can do them RCP which is basically like a special type of MRI and then a CT scan.
Dr. Justin Marchegiani: Yeah and they’re gonna look at also the pancreatic enzymes like we talked about the amylase and the light base.
Evan Brand: Okay.
Dr. Justin Marchegiani: Exactly, so yeah when you understand physiology, it’s not that complicated because you only can test them look at, so many things so you have your physical exam where they’re just gonna touch and and poke in that area and see where that pain is and just assess how it feels on the outside. They’re gonna look a little deeper with an ultrasound. They’re gonna look a little deeper with immune testing to see how much your immune system is stimulated and also look at the enzyme see how bad the enzymes are and that’s normal.
Evan Brand: I mean if you had a gallbladder attack, it’s normal to have some back up and for that pancreas to be dysfunctioning a bit. It doesn’t mean, you know, just if you do have maybe some pancreatitis, I don’t think that necessarily makes a situation any more detrimental like if you avoid surgery. I don’t think that means you can’t avoid surgery if your pancreas is inflamed bit.
Dr. Justin Marchegiani: Yeah. My biggest thing, because this is a podcast and we’re not seeing people individually. So make sure you check with your doctor just know that every conventional doctor or surgeon is going to be prone to pulling your gallbladder out because that’s what they do. They don’t understand nutrition or the root cause of what’s happening so you have to understand that to begin with ,but my goal is at least to get your doctor’s blessing you at least try some of these things and then you can come back and monitor and see how you do, but we’ve had great success. So let’s talk about some mechanisms that drive these problems, so the first thing I would say is just poor digestion to begin with, right. We don’t have enough stomach acid, we don’t have enough stomach gas so we missed the stimulation for the pancreas pancreatic output. If we miss the stimulation for the pancreatic out, but we probably have missed stimulation for the gallbladder to contract and the more we have bile that sits in our gob line or longer we can get crystals to form and when these crystals form at some point your gallbladder will start to contract, and that’s like going and petting a porcupine. Like giving a porcupine a big hug right because these crystals are forming and then they’re inside this gallbladder now the gallbladder contracts over time and it’s like given that pork you find a big hug and then you get a lot of inflammation then they go and they’re gonna test your gallbladder via ultrasound then it’s, yeah, it’s inflamed we got to pull it out but it’s not getting to the root cause of why it needs to be pulled out or why it’s inflamed to begin with so we want to. Just keep that in mind.
Evan Brand: Yeah well said well also we’ve had some people that they’ll go from like a really low fat or a nonfat diet – paleo and then they have pain in that area. Kind of that low right side under the ribcage there, and I think your analogy works perfect for that which is that their gallbladder really probably hasn’t been being worked it hasn’t been being squeezed and pumped like it would if they were eating good fat so that’s why some people will go on paleo or keto or something similar and they’ll complain of issues.
Dr. Justin Marchegiani: Yeah, I think a lot of women have been brainwashed. You know, from the 80s or 90s where you’re kind of going lower fat and then when you’ve gone lower fat for a while and that gallbladder is not having to contract. It’s like the equivalent I’m not changing the oil in your car for a while that oil in your oil tank gets sludgy it gets really sludgy it’s not moving well and then it’s possible that you could have a blockage or a stone could form and then you start eating paleo and you’re eating all these really good healthy fats your gallbladder is contracting you’re hugging that porcupine or that that backup occurs maybe to your pancreas, and back to your gallbladder and then you get a whole bunch of inflammation but and then you’re told hey we got to get your gallbladder removed, so we got to understand the mechanisms here another major mechanism is estrogen dominance so if you’re a woman or even guys – because guys are getting exposed to lots of estrogens in the food the water and through plastics and pesticides and glyphosate, that this can cause the bile to get more sludgy. It can turn it into molasses, so you have kind of let’s just say more weakened or decrease bile flow and this can create issues as well so sludgy bile can be a big concern in the hormones have a major impact on that.
Evan Brand: Well now that you say that, the natural question becomes what about all the women that are on bio identical hormones and they’re getting put on progesterone and estrogen creams and all that I mean that’s got to be playing a factor in this.
Dr. Justin Marchegiani: Yeah, I mean if you’re on hormonal support make sure it’s bio-data and make sure you’re being monitored. Make sure it’s really being monitored so you know that you’re not in an estrogen dominant state. You want to make sure you have a good ratio of estrogen to progesterone, so typically on average is about 22 to 23, to one progesterone over estrogen right because progesterone should be more dominance but a lot of women just natural they’re more estrogen dominant and a lot of people if they’re supplementing hormones a lot of times they may not provide that good progesterone with it or if they’re cycling females, they do it at the wrong time may just do progesterone throughout the month which is not what you do for a cycling woman because they have a follicular phase which is the first half and they have a luteal phase which is the last half first l, and luteal for last and that last half is where progesterone really predominates and I’ve seen a lot of doctors recently where women they’re cycling they’re still in their cycling age their follicles are still active and they just kid progesterone flat line throughout the whole month that’s not how you treat a cycling female.
Evan Brand: (Cross-talking.) Yeah, well-said.
Dr. Justin Marchegiani: So getting back to that we talked about the hormonal imbalance and then of course if we start having sludgy or dodgy bile flow that’s going to start to impair really good fats, and fats are great because they make up our cell membranes they all. We also tend to have fat and cholesterol together a lot of times and cholesterol is a really important hormonal building block so when you start to have poor bile flow and poor fat digestion then you start to have more bloating and gas issues because things are rancid if I and putrifying in our guts right and then we need these important nutrients to make our hormone so then we start to have digestive issues and now we start to have more hormone issues because these building blocks aren’t being absorbed and we know vitamin K vitamin A is really important for the thyroid and then we start having thyroid issues. And we also know vitamin A is really important for skin too and then you start to have skin issues so you can see with some of these cascades you can start off with poor digestion got symptoms hormonal imbalances skin issues and then when you start affecting more hormones, you can affect mood cognitive so you can see how that gallbladder domino can fall and then so many other cascades of symptoms can occur after the fact.
Evan Brand: Yeah, well thyroid too I mean we could go on and on we if we unpack this thing fully this could take us all day, but we know that low thyroid, so hypothyroidism and especially Hashimoto’s. you know that’s gonna be a link to with gallbladder function if your thyroids under functioning that’s gonna affect things to the stomach acid you already hit on that so i always think of H pylori soon as you stay low stomach acid, i think of all these women with H pylori infections or women that are on the anti-acids or PPIs that’s a contributor to.
Dr. Justin Marchegiani: Big-time, so being on PPI is also antibiotics because antibiotics really mess up our gut bacterial balance and then that can really have some negative effects of – some studies showing that antibiotic exposure can significantly increase cholestasis so stasis this means like the flow is impeded so the flow starts to get more dodgy and kind of more like molasses versus water so to speak so that can start to create issues with bile flow and then of course we talked about the stomach acid and enzymes the next big when I say it would be food allergens
Evan Brand: Yeah this is huge. You gave me a good article on this it was about Dr. Jonathan Right, who you and I both love and look up to his book Why Stomach Acid is good for you. Its amazing, if you don’t own that book it’s like bucks on Amazon totally favorite books of all time and he talked a lot, yeah, I mean we’re talking I was telling you I think he’s in his mid to late 80s now I mean he was talking in the 1960s about food allergies in this article food allergies and what and in the contributing factor to took all bladder issues and he was saying that eggs was number one the number one offender for these people 90 almost 93 percent of people that they were studying had an issue with eggs that’s gigantic and then.
Dr. Justin Marchegiani: Also number two is pork aka bacon. So this is big because if you’re in the paleo community and you’re on a paleo template you’re probably eating a lot of eggs and bacon so one of the first things that we see with patients is if we have any gallbladder issues we pull out eggs and bacon and I’ve seen it work phenomenal now after that there’s I’ve done a video on this a few years back so we’ll try to put that the gallbladder video in the references, if you just put my name and gallbladder you’ll probably find the article in the video but we have eggs and bacon number 1 and 2, onions number 3, chicken and turkey 4 and 5 and then milk coffee and then we have some citrus oranges and then corns beans nuts apples tomatoes peas cabbages spices peanuts fish and rye to follow so I gave you a long list and you may be overwhelmed the, the biggest thing I’d focus on is the first yeah focus on eggs. I focus on the baking component. I focus on the coffee and I’d focus on maybe chicken or turkey but at least do those first out of the eggs and bacon maybe some coffee because those are pretty common and see how we do from there now of course the gluten and the refined sugar in the trans fats the junkie or standard American foods are like first so if you got someone that’s on a standard American template well first thing is just try to get them to go paleo first that may be a good first step but go paleo but cut out eggs and bacon as a starting point and maybe coffee just to see how we do to start.
Evan Brand: Yeah I don’t do eggs that often. I mean I had a lot of digestive problems with them in the past when I had parasite infections. I couldn’t tolerate eggs they send me straight to the bathroom so I don’t know if that was related to gall bladder if that was just due to my infections but now I’m ok with eggs I just don’t really care for them I only eat them maybe, maybe once a week I’ll do a few eggs.
Dr. Justin Marchegiani: I mean eggs are a super food there. They got a whole bunch of really good fat soluble nutrients in the yolk really good protein source. I think eggs are phenomenal but not everyone can do it and if you can’t do it just make sure you, if you love it, rotate it, if you love it, rotate it. So, we have those common foods of course we’re going to add in extra enzymes and hydrochloric acid so we can break the foods down right those would be the next steps and I would say a couple of other things here for poor digestion is you kind of already alluded to it with H pylori but other types of infections whether it’s SIBO bacterial overgrowth whether it’s other types of parasites blastocyst is hominis Giardia Giardia is also known to hang out in bile ducts in the out ladder so Giardia can definitely be a gallbladder a stressor for sure I don’t remember if.
Evan Brand: I told you that I mean this was coming up on four or five years ago, now I’m pretty confident I had a gallbladder attack due to Giardia, I mean I was doubled over in pain and it was in that low right quadrant of my abdomen and that was when I got my stool test back that said Giardia is, so if you just type in Giardia bile duct you can read about it they’ve known about this since like the s that Giardia can hang out around that area and cause sort of a phantom gallbladder attack I mean it’s real the pain is real but it’s not actually a gallstone or anything it was the Giardia doing it which is hard to believe because it’s such a tiny organism it make you think how could it do that.
Dr. Justin Marchegiani: Yeah exactly, and also healthy bile flow is really important because bile acids which is what they are vile acids help provide a really good environment for good gut bacteria and keep the bad stuff down in the gut, so when you start having poor bile flow and you’re not producing good bile guess what happens you have less bile acids in the intestines so then you start to have more gut bacterial imbalances so we just have imbalances and the bad bacteria higher amounts of bad verses lower amounts of good and then this starts to wear away or create leaky gut because now we have this dysbiosis. Bad bacteria tends to produce something called lipopolysaccharides or endotoxins that’s the outer coating of the bad bacteria and it can be stressful on the gut lining and actually can create leaky gut so another mechanism is this poor bile flow can, can create imbalances and bad bacteria and that bad bacteria can also start to affect leaky gut now also one other thing we talked about hormones right but also birth control pills are in a similar category especially most of them are going to be estrogen base and they’re gonna be very high levels faster than to times typically more estrogen than normal and that can start to sludge up gallbladder and bile flow so you can start to see right birth control pills prescribed decrease bile flow decrease bile acids and the intestines more despotic bacteria less good bacteria leaky gut more food allergens food allergens then cause markov ladder is so you can see how that vicious loop kind of plays out ,and then also you can add in while your immune system gets compromised more infections come in that feeds back to more gallbladder stress that you can see the vicious cycles here and you can see how okay just cutting out my gallbladder doesn’t really fix that that mechanism is still in effect.
Evan Brand: Yeah. Well that’s why people report having a lot of pain and post gallbladder issues and they say well I’ve got my gallbladder remove and I’m still having all these symptoms. So some of the sites that we had referenced about symptoms after gallbladder removal could be guess what gallbladder attacks, nausea, vomiting, discomfort, gas and bloating, burping, and belching, heartburn new or worse Barrett’s esophagus, constipation, diarrhea, weight gain that’s all after the gallbladder is gone so it’s really not a miracle cure as it’s promoted unfortunately.
Dr. Justin Marchegiani: Exactly so if we can avoid gall bladder removal, that’s ideal. If it’s incredibly late stage it may be tough but if we can get to it early enough we can definitely keep your gob wider now. So we have the foods, we have the gluten we have the refined sugar, right we have the big things on the Paleo side which are eggs and bacon now when your gallbladder is kind of inflamed we may have to go a little bit lower on the fat in the meantime just because we don’t want to be hugging that porcupine so to speak meaning gallbladder stones contracting on those stones could create more inflammation. we may have to go lower fat or at least rely more on coconut oil for our fat because that does not require as much bile basically bile flow to be able to emulsify coconut oil and then we want to cut out some of those bigger foods we talked about the bacon and the eggs and we’d probably do some leaner proteins good healthy vegetables and lower sugar fruits maybe a little bit of safer starches and keep it all cooked really easy to digest use enzymes use acids and we also want to use supplemental bile salts to break down the small amount of fats that we are eating but we would want to keep the fats down just because you wouldn’t want to be causing that gallbladder to contract around those stones and pet that porcupine so to speak, yeah.
Evan Brand: And if the if the media were trying to sabotage you, they would take that clip that you just said, you may need to go lower – fat and use it against you just to be clear, that is the only time you’re ever going to hear him say go lower fat that’s in this context don’t know the context of-
Dr. Justin Marchegiani: It’s a transitionary period to allow the inflammation to drop to bring and support some extra digestive nutrients so your body can actually handle the fat that you’re taking in and then as the inflammation and the gallbladder symptoms in the pain improves then we can start to taper it up but this advice that I’m giving you really want to be working with a functional medicine doctor you do not want to be doing this on your own absolutely not.
Evan Brand: And I just wanted to point out that because some people may be driving or listening or something and they hear oh I need to be lower fat that’s in the context of this.
Dr. Justin Marchegiani: It’s a season for a reason and it’s designed to help take stress off those systems so they can heal better. Now there’s certain things that will add in as well like we have certain supplements in our line that are have ox bile in it or we’ll use phospholipids like phosphatidylcholine or phosphoric acid which can help dissolve the stones and help decrease the nausea. We may do things like dandelion or fringe tree or artichoke which help thin out bile flow and help support and nourish the gall bladder we may do extra things like beetroot which thin out the bile salt as well we may do things like taurine that help with bile flow, as well so we may do these different things to support and nourish the gall bladder. In the meantime we may do extra stomach acid and enzymes and of course we’re gonna look deeper at the gut and then got bacteria we’re gonna look at some of the lifestyle causes whether it’s medication or hormones that may have driven the issue to begin with and we’re also gonna dive in and look deeper at what the if there’s leaky gut what the potential causes of leaky gut are do you have also some infections that are happening so we got to hit this thing you know 360 degrees it’s really important.
Evan Brand: Yeah, well said. I’m glad you gave all the notes about. Okay, here’s what you do in the situation but then you always have to work backwards because if you just take a digestive enzyme that hasn’t addressed the root cause, yeah, I’m gonna call it and you guys credit the root cause because maybe your age above and you have low stomach acid because you’re aging but you still go to work backwards and fix the other stuff too.
Dr. Justin Marchegiani: Exactly. Now couple of tests that we’re gonna see here or you know first thing is pain that’s gonna be there. Second will be ultrasound to look and see the inflammation in this area and then third, are gonna be the blood markers for the gall bladder you’re gonna see alt or ast for the liver which can be affected by the gallbladder Gigi T’s more specific to the gallbladder and then of course you have, um, you have a LP alkaline phosphatase. They’ll be another one and then you have LDH which are various enzymes in that area of pancreatic enzymes that you can see increase as well and then also the amylase and the lipase are gonna be other ones that may go up if the pancreas is affected. As well so those are the big tests there and then on the functional medicine side we want to dive in deeper to some of the root cause tests which will be gut function just good clinical work up because a lot of people can see low stomach acid can be a really important root cause and then also to make sure we’re infection free cuz infections can be a big part of what’s going on and of course if, like for instance your mother-in-law, I mean if she’s had impairments with, you know, good fat soluble vitamins for the last ten years there’s probably other hormonal systems that have been impaired because of it.
Evan Brand: Oh I guarantee it I’ve got her on enzymes. Luckily she’s been on enzymes and acids for a while but yet you know she’s still sedentary you know.
Dr. Justin Marchegiani: I had a study pulled up right here over sixty thousand women regular exercise reduced gallbladder surgery risk by % she said in Terry she did have a family history of gall stones her mother had her gallbladder removed so there, there is a somewhat of a you know family history which plays a part of part of the battle and then fiber too, you know, she does quite a bit of dairy so I know that’s one of the big no nos to is staying away from, like, your creams and cheeses and ice creams and yogurts and all that and then fiber. I definitely know she’s not getting enough fiber so I didn’t know this until just now so I’m just reading this that I knew fibers’ good, you always hear well fiber is good. Well, why? Well here’s the mechanism. So fiber reduces the absorption of the deoxycholic acid so this greatly lessens the cholesterol solubility in the bowel and promotes its excretion so that’s the mechanism fiber reduces absorption of deoxycholic acid which lessens cholesterol solubility in the bile promotes its excretion rather than the cholesterol forming a stone it.
Evan Brand: Sounds like, yeah, so it basically helps that cholesterol kind of move its way out of the body that way it’s not hanging around too long and forming crystals and stones that makes sense yes. Okay.
Dr. Justin Marchegiani: That’s cool, so, so fiber is key blood sugar keeping your, keeping your out your, blood sugar stable which she doesn’t eat a bunch of good fat so I’m sure her blood sugar’s all over the place.
Evan Brand: That’s probably where exercise has a play into. It’s like what’s the mechanism why would exercise help your gall bladder. I think it has to do with the insulin resistance and the better you know the more insulin sensitive you are the more you can handle extra carbohydrates and of course extra carbohydrates if your insulin resistant that can start screwing up your hormone so as a woman you know you can create more estrogen dominance and higher levels of testosterone when your insulin resistant. And as a guy, you up regulate an enzyme called the aromatase which can increase estrogen formation and that can also dug up and slow up your bile flow which can promote more crystallization and thus blockages and inflammation so all this makes sense so we’re trying to lay out these various mechanisms so people listening can wrap their heads around it from a root-cause perspective, yeah, I always love to read like well.
Dr. Justin Marchegiani: This study says this, but if you don’t have the mechanism behind it, to me it’s kind of useless so here’s, here’s one more and then we’ll wrap up maintain a normal weight so obesity which she’s definitely overweight I don’t know if I’d obese but definitely overweight obesity increases cholesterol synthesis which leads to more cholesterol secreted in the bile and when you lose weight that will that will reduce your risk as well so I mean really it’s the perfect storm we talked about it it’s the dairy it’s the gluten over age not enough fiber sedentary eating conventional fats not probably doing enough enzymes and acids until I came into the picture and through supplements at her and she took some of it history of birth control I mean it makes sense why this is such a common issue and why there’s billions of dollars being spent year to remove these i found one estimate here that’s around the guy was Doctor. right it’s article you gave me here where’d it go yeah here we go every year in the U.S. four hundred thirty thousand gallbladders, four hundred thirty thousand gall bladders are removed. Average cost is thirty thousand dollars this gets up to an annual grand total of twelve point nine billion, is in with a be twelve point nine billion dollars. Wow unbelievable, that’s a lot of money is that, I mean there’s got to be a money component is that why is it the combination of the money and that the doctors are not trained on this stuff.
Evan Brand: Yeah, I mean if you don’t understand root cause and all you understand is you know as typically its general surgeons doing these surgeries. If all you understand is how to cut then that’s gonna be your solution and again he may not go away cuz you know you have other areas that can be inflamed besides just the gallbladder.
Dr. Justin Marchegiani: That’s right.
Right, and you mentioned that earlier yeah what a trip.
Evan Brand: Well, I’m ready to wrap it up, if you are you talked about the testing so you know from a functional perspective getting the stool looked at we can measure your fecal fat for one that can be a good indicator just to see hey look we have high static rib not digesting facts you mentioned the infection piece looking at H pylori and parasites and bacterial overgrowth and Candida organic acids testing. We’ll look at other types of bacterial overgrowth that can be throwing things off nutritional markers we’ve got a whole ton of nutritional status markers we can look at via blood and urine and then getting your foundational supplements in order on top of your diet, I mean, that’s really the secret sauce right there yeah I think so.
Dr. Justin Marchegiani: I think we hit it all. So if anyone has any gallbladder issues or digestive issues please feel free and reach out to Evan at evanbrand.com or me at justinhealth.com and we can get you in and schedule for a consult to look deeper at what is going on because we really want to get to the root cause of what’s happening, I mean, the root cause really is. Where you want to be and you want to have someone that can connect all the dots because it’s not just a hormone issue or a gut issue or a leaky gut issue or an infection issue or a medication issue, it’s a combination of a lot of things. Some people that maybe more than others so you really want to look at everything d and connect the dots. Yep, if we’re doing, you know, put your comments below we really appreciate your comments. Make sure you’re sharing it to friends and family that could benefit we’re trying to just put so much information for people because a lot of let’s just say other people that are out they maybe aren’t as transparent or reachable right they’re hard to get ahold of or they’re just more blogging and you can’t really connect with them via video like this so this is a great medium take advantage put your comments below and give us a thumbs up as well and a share we really appreciate it and then you can head over to iTunes as well Evan brand.com / iTunes Justin health.com / iTunes write us or review we really appreciate it.
Evan Brand: Yep good, good, good, good, for all the plugs. The only other thing I would say is take the two minutes to write us a review because when you do that what it does is I’ll actually pull us up in the iTunes charts so when your average Joe Schmo with gallbladder pain goes in the health and nutrition category on podcast will be at the top of the charts and then they click there and they get to hear this verses who knows what else.
Dr. Justin Marchegiani: Exactly. Well, everyone thank you so much. Hope you guys have a phenomenal week I’ll be back for some live Q&A; so stay tuned subscribe to my channel hit the subscribe they subscribe button hit the bell as well to get notifications. Evan, congrats on the new baby, will talk soon man
Evan Brand: Thanks, take care.
Dr. Justin Marchegiani: Take care, bye.
Is Your Gallbladder Preventing You from Digesting Fat?
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. This tells the body to go, go, go.
Our parasympathetic nerve fibers from the brain actually start innervating the stomach. 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. This in turn stimulates the activity of the vagus nerve and production of acetycholine in the stomach. It helps get the whole ball rolling from a nervous system standpoint. This is called our cephalic phase of digestion.
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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. It concentrates bile (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 this 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
These 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.
For professional advice on gallbladder issues from a functional medicine doctor, click here!
How to Treat Gallbladder Pain
Now in conventional medicine, doctors see the increased bilirubin levels, they see the inflamed gallbladder then 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. We 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.