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
14:58 Hormones
19:26 Gallbladder Damaging Foods
22:32 Parasites
23:53 Hormones and Birth Control Pills
25:50 Keeping It Safe
31:25 Fiber and Sugar
34:15 Tests
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.
References:
https://www.youtube.com/user/JustInHealth
Improving Gallbladder Function with Functional Medicine | Podcast #216
Digesting fat is so important for one’s hormone growth and for healthy cell membranes as every single cell has a lipid bilayer. If one wants to be a good fat burner on a ketogenic template, it is really important to have great gallbladder function.
In today’s podcast, Evan Brand and Dr. Justin Marchegiani talk about utilizing functional medicine principles and assessment to figure out how one’s gallbladder is doing. Listen as they talk about what can one do about it, the common gallbladder symptoms, root cause solutions, and how can one get better from these symptoms. Stay tuned for more!
Evan Brand
In this episode, we cover:
00:35 What is Gallbladder?
04:47 Consistency of Chewing Foods
08:16 Bile Surgeries
14:18 Autoimmune Issues that Affect Gallbladder
17:28 The 3 F’s of Gallbladder Issues
20:26 Some Advises if Your Gallbladder was Removed
26:32 Comprehensive Stool Test
Dr. Justin Marchegiani: Hey there, it’s Dr. Justin Marchegiani, welcome to today’s podcast. We’re gonna be talking about utilizing functional medicine principles and assessment to figure out how your gallbladder is doing. Also talking about what we can do about it, what are the gut- what are the common gallbladder symptoms, what are root cause solutions, and how we can get you better. We know, digesting fat is so important for your hormone growth, for healthy cell membranes. Every single cell has a lipid bilayer. And also, if you wanna be a good fat burner on a ketogenic template, it’s a really important we have great gallbladder function. So Evan, welcome to today’s podcast, man!
Evan Brand: Hey man, thanks for having me.
Dr. Justin Marchegiani: Awesome. Well, let’s dive in brother. I’m excited to- to dive in. So, first off, let’s just first dive in just to kinda physiology 101: what is the gallbladder? Why is it even so important? So, off the bat, gallbladder is kinda in this upper right quadrant here just beneath the rib cage, ‘kay? If it’s tender in that area like they’ll do a- a palpation that’s called Murphy sign, uhm, in that area where they’ll look for tender type of gallbladder issue where the gallbladder’s inflamed. But the gallbladder, it- it basically concentrates bile at about a 15 times above than the common hepatic bile duct in the liver wood. So when you’re having your gallbladder removed, that common hepatic bile duct up in the liver just drips bile all the time, it’s not specific, it’s not during a fatty meal, just kinda hits, and you can definitely have some bile acid diarrhea issues. When you have a gallbladder it concentrates that bile 15 times and then allows it to come out and time it, it- it squeezes, it contracts, and s- puts up that bile especially during a fatty meal ’cause you have these hormones in your stomach when that food- when that uhm, kind, that mixed up food in your stomach gets released into the small intestine. Uh, the nice acidity of that stimulates this uhm- neuropeptide called cholecystokinin or CCK for short. And that cause the- the gallbladder to contract and stimulate all these bile release which helps with fat digestion. If we don’t have a gallbladder, we’re not gonna be able to breakdown fat optimally through biliary concentration.
Evan Brand: Yup. So, you’re in to that fast, I’m just gonna repeat it so it gets into some people’s heads.
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: So, you say, when your- you put food down the hatch, especially fat, it enters the digestive tract, the body says “Okay, boom. There’s fat in here now, I’m gonna start making CCK”, and that comes from your duodenal, and I believe the jejunal as well, and then- it- to respond to the CCK, then the gallbladder goes “Oop, CCK is in the neighborhood, now I’m gonna release my stored bile because we’ve got fats to take care of”. So then the bile, or they call gall, will start working on these fats and then turning those fats into usable fuel.
Dr. Justin Marchegiani: Yeah, think of emulsification is like you have a greasy pan, and you put a drop of like soap, right, like some- some dish soap like dawn dish soap, and it kinda breaks it up, it emulsifies it. Think of that’s what’s happening if you got this greasy pan in your stomach, which is all the fat in your stomach going into your small intestine, that emulsifies it and allows your body to break it down and absorb it. It goes in these little things that form uhm- a- uh- a- a- a micelle, and that allow it to get into your body and be able to utilize it. Now, going up one kind of marker is hydrochloric acid levels. This is even important, this is more important because hydrochloric acid stimulates, it lowers the pH, and a nice low pH triggers cholecystokinin. So, we also need good pH function, good hydrochloric acid function and then that then, in the small intestine really gets the bile going, and then we also have some enzymes in the pancreas called lipolytic enzymes, lipase enzymes that also help with the pacre- with the- with the gallbladder in the- in the bile digestive process.
Evan Brand: Well, you make a good point, ’cause when we jump into this conversation, if we’ll look at the whole digestive cascade, as a big row of dominos, when you get to CCK and you get to the gallbladder, you’re really talking 3 or 4 dominos down the list but it’s good that you went upstream first to the mouth, where that’s where you’re chewing your food – hopefully you’re chewing your food, you’re not rushing through your meal. That’s why I don’t like things like chipotle, I enjoy the food itself, but it’s all soft, it’s mushy, meat and rice and guacamole, and you can just shove it down the hatch and you really have to chew the stuff. So, if I eat a soft meal, I still try to be very condescend about chewing, chewing, chewing, chewing, tellin’ the digestive system, “Hey, something’s coming down the hit- down the hatch”, but, you make the point about HCL. It’s why it’s so important when we- uh, talking about gallbladder symptoms which we’re getting to in a minute, to look for, and to treat if you have them, H-Pylori, and other infections ’cause, if H-Pylori is reducing your HCL levels, well, you can’t go straight to the gallbladder. I mean, you- you can, you can take bile salts to help it, but you didn’t fix the root cause, it was H-Pylori.
Dr. Justin Marchegiani: Exactly. So, kinda highlighting, we went from the gallbladder. What’s happening at the gallbladder, upstream to HCL, and that- that also activates other enzymes in the stomach called pepsin, and also gets the pancreas producing lipolytic fat breaking down enzymes, and then proteolytic protein breaking down fat enzyme, it’s- it’s very rare that you just have fat by itself, typically fat, protein and cholesterol tend to come together. And then, up one stream above is the chewing part. We wanna make sure we’re chewing our food at least 32 times, that’s about one chew per tooth, right, you have 32 teeth, so think of 32 chews, 32 teeth. And in general, getting your food’s to like an oatmeal like consistency, like- if you’re having a food that’s kind of more predigested like a chipotle meal, you gotta just make sure you at least chew to that good oatmeal-like consistency, and try to be in a relatively stress-free environment because the parasympathetic nervous system is really important for HCL secretion, thus enzyme secretion, and thus, uhm- bile secretion because we need that nice acidity, we need the enzymes, we need the digestive secretion. And for a sympathetic state, all that blood flow is going out extremities, our arms and our feet to run, fight and flee. So, it’s very important that we have good parasympathetic, so good breathing, gratitude, being in a quiet kind of relaxed setting to start our digestive processes.
Evan Brand: You know, I was trying to find some research on this, I am just gonna guess based on the mechanisms we discussed, that people on acid blocking medications probably have more issues with gallbladder. Would that make sense, ’cause let’s say you don’t have H-Pylori infection but you’re on an acid-blocking drug, isn’t that gonna just down-regulate this whole process we’re talking about?
Dr. Justin Marchegiani: Yeah, we need good acidity to trigger that CCK. So, that totally makes sense, right? And then we need- to be able to break down god fats. What are good fats? Well, we have our mono unsaturated fats are gonna be things like olive oil, avocado oil, and then maybe even some nuts and seeds. We have more saturated fats which are gonna be animal products, right? Grass-fed beef, uhm- any of our like, you know, fish, chicken, beef stuff, you’re gonna have omega-3 fats which are on the polyunsaturated category. Omega-3 is more polyunsaturated, and then you also have your saturated coconut oil which I think is your only plant fat that’s saturated, maybe that and palm I think are the only 2 big saturated ones that are plant-based. So, we have our saturated fats, right? Coconut, plant-based fat- coconut, and animal-based fats. We have our mono-unsaturated which typically are gonna be uh- a lot of the olive oil, potentially avocado oil, we have our polyunsaturated, a lot of times which are fish, and then maybe some of the nuts and seeds kind of fit into that monounsaturated category omega-6 kind of category as well. And then we have our uhm- Vitamins-A, D, E and K, “ADEK”, these our fat-soluble vitamins. So if we don’t have good bile-support, we’re not gonna be able to break fat down by the minute which is really good for our uhm thyroid function, it’s good for our skin, right? Higher dose Vitamin-A is great for skin that’s why they use uhm- Accutane which is- is a Vitamin-A analog to shrink the oil cells on the skin, also great for our eyes. Vitamin-D obviously great for our immune system, we make it too from the sun. Vitamin-E is great for our heart, it’s a natural antioxidizing, great for inflammation. Vitamin-K is really good is found in butter fat. It helps get calcium into our bone, right? Vitamin-K2, consider activated- a- activated X by western price, really important nutrients. So, these fat-soluble vitamins, we really need good gallbladder function to absorb them.
Evan Brand: Yeah, and if you don’t have a gallbladder, we’ll get into that in a minute, you know, I was just looking up, uh- reading the bile, the surgeries that people get. When you get into the gallbladder world, gallbladder surgery is just such a huge, huge money maker and it’s done often times in cases where it didn’t have to be done. And I told you we need to get a lady on whose uh, got a specific website about protocols for people with gallstones to try to help give them relief and to save their gallbladder. But another surgery which is crazy to me is called fundo- fundoplication, and it’s what they do to relieve chronic acid reflux. The surgeon tries to recreate your lower esophageal sphincter, by taking the upper portion of your stomach and wrapping it around the lower part of your esophagus and sewing it into place.
Dr. Justin Marchegiani: Wow.
Evan Brand: That just seems insane to me, they call it anti reflux surgery. How many of those people, just have H-Pylori infections that were put on acid blockers, therefore that LAS, that lower esophageal sphincter wasn’t working properly, or maybe they had a mineral deficient or maybe it was a ___[09:18] issue and structurally, that could get adjusted, but instead, they go get their stomach wrapped around their esophagus and sewing together. That’s insane!
Dr. Justin Marchegiani: It really is, and that’s kinda what conventional medicine does. They can go to some extremes to fix things that in my opinion are much more foundational and much more simple. And most of the time I would say 99% of the time, the surgeries aren’t root cause, right?
Evan Brand: Yeah.
Dr. Justin Marchegiani: So if we look at the conventional side, we have things like a HIDA scan which is like a nuclear image, they swallow s- solution that’s nuclear, and uhm- they kind see kind of biliary function, right? You want typically a 33 to 40 percent kind of dejection fraction that’s normal, on the gallbladder. So, you can look at that with the HIDA scan, you can even look at, an ultrasound, uhm, to give you a window of the inflammation in the gallbladder. It’s not gonna give you how much uh, bile is flowing to the duct but at least give you- okay it- it- is there- is it stagnant, or just stuffed in there, is it inflamed. You can kind of get that sense as well. A lot of times they’ll do some conventional testing, ’cause if your gallbladder is inflamed, and there’s an immune response, you may see white blood cells uh- on the higher side, right? Uhm, you may also see certain liver enzymes, ALT is a common liver enzyme, AST is another enzyme that can be effective in the skeletal muscle, you can see GGT, think of the “G” in gallbladder, GGT is a big gallbladder enzyme. Bilirubin is a byproduct of red blood cell metabolism that comes out in the gallbladder. With high bilirubin, we may have some- some backed up gallbladder bile issues. And then a- also, I think alkaline phosphatase is another big one that we may see on the higher side. So, we’re gonna see bilirubin on the higher side, alkaline phosphatase on the higher side, and then we’re also gonna see potential HIDA scan issues, that can- those are- HIDA scans more like pathological.
Evan Brand: Yep.
Dr. Justin Marchegiani: There are a lot of people that are in between that may be okay on the ultrasound or maybe okay on the HIDA scan and we can use some of this functional test as well. Uhm, but really important we gotta dig to the root, underlying issue on what’s going on there. And again, AST is more skeletal muscle but there’s some crossover with the liver, ALT is more liver. Think of the “L” in ALT as liver and then the alkaline phosphatate is a big gallbladder one, also a big one for zinc. Alanine transferase or ALT, asphotate transferase, and then alkaline phosphatase for ALP.
Evan Brand: Well, the good thing is, a lot of the blood markers you just mentioned are pretty standard. So, even if you’re not working with the functional medicine practitioner like one of us, you may be able to get your doctor to just run these labs, refer back to this podcast and look and see if you have an elevation. Now, the only problem is, the conventional reference range for blood testing is very bad. So, you may be quote, “normal” by your doctored standards but our reference ranges maybe tighter. So if we start to seal your ALT or your AST enzymes go up, it may not be up enough to flagged. So, that’s why it takes a trained eye to look at these numbers and see, and we’ve seen it time and time again, we get somebody on gallbladder supplements their AST and ALT go down. So, it’s amazing to see, we gave this nutrient, “boom” look at the blood changing just based on this nutrients, it’s really cool. Let’s talk about symptoms now, I think we’ve given a good-
Dr. Justin Marchegiani: Yeah, just to highlight one thing, you just wanna get that CBC done at- which is a complete blood count, and then also a CMP – Comprehensive Metabloc Panel profile, and it’s important, you need to work with a good functional doc because you may be okay in a lot of these areas and you still may have issues, so now what, right? So you don’t wanna just rule it out ’cause some of these testing are good, you wanna look at subjective symptoms, connected to the anatomy, connected to how your stools look, right? If we have fatty stools, blond stools, excessive amount of wipes to clean out your- you know, to clean yourself after going number 2 or just, you get skin marks on the toilet seat, we’re probably not breaking down fat. And again, if you have too much MCT oil in the morning, that can also do a tube instead as a laxative effect. So, you gotta look at it the trend in general, clinical symptoms, subjective symptoms, and then lab symptoms to really make a complete picture of what’s going on.
Evan Brand: That’s a good point ’cause my AST and my ALT on my blood looked perfectly fine. But when I had parasite infections, I had that low right side pain under my rib cage where my gallbladder and liver are. Your gallbladder is kinda tucked in with your liver under there, so if you look down at yourself on your right side up where that rib cage, if you’re having pain there, when I had parasites, I had ton of pain there, my blood looked perfectly fine. So I don’t want, like you said, you don’t wanna give a- a false sense of hope just ’cause your blood looks okay. There may be other functional problems that you’ll find by looking at stool testing for example. But let’s hit- let’s hit-
Dr. Justin Marchegiani: Yes.
Evan Brand: -on these symptoms, because you mentioned some but we needed just go through symptoms here and tell people, “okay, what would you be experiencing?”.
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: So, you mentioned, fatty, greasy stools-
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: You mentioned it takes a lot of wipes to clean your butt, you mentioned the skid marks in the toilet which if everybody is going on a high-fed diet these days, sure, that may be okay but if you’ve got gallbladder problems to start and then you try to go on to ketogenic diet and you don’t feel well or you don’t lose weight and you’re complaining to your doctor, that may be the part of the problem is gallbladder.
Dr. Justin Marchegiani: 100%. Also, autoimmune issues can affect the gallbladder as well. Gluten’s a big one, it creates those condition called primary biliary- what’s that last?
Evan Brand: I think you call it cholangitis.
Dr. Justin Marchegiani: Yeah, primary biliary cholangitis. I mean, typically just “PBC” for short. But basically you can have some scla- scarring of this uhm- on the- the kind of biliary tubes that go out of the gallbladder, and as well as the- you know, the gut- the liver goes to the gallbladder, the gallbladder kind of comes out together with the pancreas and comes out the sphincter of oddi, or the hepato biliary kind of ampulla, and that- that can kind of scar and it can sclerose, it can kind of have uhm narrowing of the- of that vasculature. Of course, it can back up, and if that backs up, and those enzymes can’t get out you can have pancreatitis as well. But that’s an autoimmune condition where your body is attacking a lot of that tubing that goes up to the gallbladder and maybe even can help with the pancreas, and that can narrow and prevent a lot of that stuff from coming out. So of course, gluten is a big component because that can really activate a lot of au- autoimmunity and you can also have a leaky gut, you can also have a leaky gallbladder which does aggravates more autoimmune attack because things that shouldn’t be out in the bloodstream are out and that exacerbates the immune system going after it.
Evan Brand: Yeah, so let me just read a few sentences on these whole PBC thing ’cause I think this is critical. We know, even just this is just standard you know, medical textbook stuff that says “it’s the most common among women”. And we know that Hashimoto’s is more common in women and men. So it says here, “the cause is not clear but we know it’s more common in people with…” guess what, “…hashimoto’s thyroiditis”.
Dr. Justin Marchegiani: Yes.
Evan Brand: So, it says here, “An autoimmune cause is- is thought possible because more than 95% of people with PBC have certain abnormal antibodies in their blood. These antibodies attack mitochondria. What triggers these attack is unknown…”, of course they say that but it may be exposure to a virus or toxic substance A.K.A. ‘gluten’, maybe dairy, I mean, you and I talk so much auto about- about autoimmunity so I’m glad that your brought this up because, you know, these people may have these symptoms, and they’re not gonna know what’s autoimmune in nature, they may just get the- the knife and say, “Hey, we’ve gotta pull this gallbladder out”. Not necessarily, what if we can shut down this autoimmune attack?
Dr. Justin Marchegiani: 100%. Also, here’s the bigger issue too. Okay, great, the gallbladder is removed, your digestion is now forever altered. I’ve yet to meet a conventional patient of a gallbladder procedure, whether surgeons that “oh, by the way, you’re gonna have to add in HCl, pro- or- lipolytic enzymes and bile salts for the rest of your life”. I’ve never really heard that, at least bile salts seem to be added in. I would say HCl and enzymes too, but I’ve never heard someone do that. Now, your digestion is forever altered, do you think there’s a connection with now you’re not being to breakdown cholesterol optimally ’cause that’s gonna be in the bile, right? The bile is 97% water, then you have some cholesterol, and cholesterol salts as well, and you also have some toxins coming out, that’s why if you have uhm- poor, you know, gallbladder-emptying, then you’re not getting rid of potential toxins that are in there too. So, we gotta be emptying that gallbladder. If we’re not breaking down Vitamin A, D, E, and K, if we’re not breaking down our fat-soluble vitamins, which I just mentioned, if we’re not breaking down cholesterol which is the building block for all of our hormones, do you think we’re gonna have problems ladies, uh- as you get into your 40’s and 50’s, with menopausal issues, perimenopausal issues, PMS, and we know the main connection, it’s kind of a slang but, I’ve heard many uhm- let’s just say general surgeons say it, it’s the 3 ‘F’s’ of gallbladder issues: fat, female and forty. And that’s the time to- late 40’s, early 50’s where hormonal transitions happen, and if you can’t breakdown those nutrients, you are setup for a menopause uh- of “hell”, so to speak.
Evan Brand: Yeah, in terms of side-effects, possible side effects of gallbladder remover- removal, it could be anything from pancreatitis, to increased risk of choline cancer to increased digestive sy- symptoms like heartburn, could be constipation. So, we’ve seen people that- they don’t feel well, after they get the gallbladder removed. And uh, like you said, there’s no surgeon out there saying, “Hey, I’m gonna put you on this comprehensive digestive support protocol, after we remove it”, no, they’re gonna you out with anesthesia, cut that bad boy out, and send you home in a day or 2. Uh, there’s a- a whole lists symptoms here I’m looking at now, symptoms of- uh- symptoms after gallbladder removal. I’ve had women have gallbladder attacks, but they don’t have a gallbladder. You know, it’s like, “well, how the heck does that happen?”. So, you know, the- the- the removal is not the “cure all”. Anything from nausea to gas and bloating, distension, burping, belching, feelings of fullness, heartburn, barrett esophagus, diarrhea, dumping syndrome, weight gain. There’s a whole article here all about post gallbladder removal weight gain happening.
Dr. Justin Marchegiani: And part of the reason why women get targeted so much – I hate to say it – is the estrogen. The estrogen kind of makes things sluggish and slow, it kinda takes- it kinda makes it turn into molasses. So, things really are very sluggish, very viscous, and of course, that can affect gallbladder and bile flow. Women that are on, you know, uh, birth control pills, that’s gonna- in- obviously increase estrogen levels, obviously just being stressed, right? You’re gonna take your progesterone, you’re gonna shoot it downstream to cortisol, and that’s gonna basically cause estrogen dominance there because you’re already starting to lower progesterone in relationship to estrogen. You’re getting estrogen in the environment from the conventional meat products, uh, water, plastics, chemicals, hormones in the meats as well, and then you’re also gonna be just getting it, just from uhm- being a woman, having 10 times more estrogen than a man. So, you’re- you’re already predisposed, and then when you add stress to it, it’s going to exacerbate it uh, big times. So, you really wanna make sure that you’re fixing the- like if you’re having- if you know you have a gallbladder issue, you also need to be going after the- the hormonal issues as well. And then we can dive deeper into the food allergies stuff too, so you gotta go after the hormones, gotta make sure you fixed the estrogen dominance, you gotta make sure you fix the digestive aspects, and then we can go into foods later.
Evan Brand: Well, I’m sure there’s gonna be a ton of people that are just yelling at us right now through they’re podcast app or YouTube or wherever they’re listening to us, and they’re saying, “Well, this is not fair, I already have my gallbladder removed, so what the heck do I do now?”. So, do you wanna address that now or should we talk about that later?
Dr. Justin Marchegiani: Yeah, so, off the bat, the underlying mechanism that was driving that inflammation in the body’s still there. Just the end target, the end uh manifestation of it is removed, but now other tissues may start to, uh, have issues, then also if you don’t fix the underlying uhm, digestive im- impediment which is, your fat-soluble vitamins, your cholesterol, your hormone building blocks are now gonna be thwarted in their digestive processes. So, you have to fix that to prevent compounding hormonal issues, 10, 20, 30 years later, number 1. Uhm, and then so obviously this- so- err- if you’re- if you still have your gallbladder, we wanna keep it by doing a lot of the preventative things. But on the food side, I outlined this in a couple of my gallbladder videos are down in the past. But there’s some common foods that are even uhm- let’s just say paleo-approved, but should probably be looked at- look at removing. So, of course we have the refined sugar in the guts. That’s kind of a no-brainer right here. But, uhm, in order of kind of like uhm, the most likely offender are gonna be eggs.
Evan Brand: Yes.
Dr. Justin Marchegiani: So definitely autoimmune template, cut out the eggs, pork, onions, chicken turkey, milk, coffee, corns, beans, nuts, apples, tomatoes, peas, cabbage, spices, peanuts, fish, rye. I’m gonna link my article that goes into this. So, everyone’s probably like, “Say it again!”, no, I’ll put the link below, don’t worry, take a look at the article, alright? But, I have them in most likely to offend to least. So, if you’re overwhelmed after hearing that like, “What the hell am I gonna eat?”. Just start with the biggest 3 or 5, or look at that list and say, “What are the biggest 3 or 5 that I eat on a daily or weekly basis” and just pull that out. Once we get the inflammation under control, we support HCl, we support enzymes, we support bile salt production, we look at the gut ’cause sometimes there can be infections like H-Pylori and giardia, and of course SIBO in and around that ___[22:31] that can exacerbate everything too. So, we get the infections clear, if we get the acidity and the enzymes dialed in, if we cut out some of the common offending foods, we may be able to start adding some of these foods in overtime. But I find pork’s a big one, eggs are a big one, those are like my- my 2 biggest right there off the bat, and they’re kind of paleo-friendly too.
Evan Brand: Yeah, eggs are huge and people over-eat them and, if you have gallbladder issues, uh- when I interviewed Ann Louise Gittleman, she said the same thing, she said eggs are the biggest offender. I’m like, “Wow, I thought that was just me”, no, it’s- it’s a real thing, and then also onion. I think she said onion are ready-
Dr. Justin Marchegiani: Yes.
Evan Brand: But that was- that was a problem for me when I had parasites and I would try to do like stir or fry and throw some onion in there, I’d end up with that lower right side stomach pain, I’m like, “What the heck is it”, or if it was I had parasite infections but, the other- the other part of it was the onion. So, yeah, I at least temporarily, like you said going on an autoimmune protocol while you’re working with your practitioner to fix the other underlying causes, you’re gonna be in good shape if you do that.
Dr. Justin Marchegiani: Onions are also a ___[23:28] too. So there could be some underlying SIBO or small intestinal bacterial overgrowth going on as well. So, you gotta look deeper at everything. So, kinda like piggy-backing everything, alright? Women are gonna be the- more bigger offenders ’cause of the hormones, because of the- you know, the pregnancy prevention with the birth-control pill, so you have that, right? So we gotta fix the hormones, fix the hormones, number 2, cut out the foods, at least paleo to autoimmune paleo with those additional 3 to 5 to 8 foods I just mentioned. Get enzymes dialed in, get acids dialed in, and definitely bile salts added in, and if you already had your gallbladder removed, definitely do all 3, and those that up and watch your stools and make sure your stools go floating to sinking, right? Oil and water mix, so if you had the stool, with the whole bunch of undigested fat, and oil and water mix, the stools stay on top of the water, they don’t sink. So, you wanna see the stools sink, and ideally you wanna be able to clean yourself, you know, 3 to 5 wipes on average, and you wanna make sure when you flush, you’re not seeing big skid marks all the time. If you’re doing some MCT oil in your coffee there may be some issues there, too much of that can cause some undigested MCT, so be mindful of that. So, foods, acid, enzyme, bile salts, get the infections cleared, and if you’re a woman, get the estrogen dominance fixed, get the hormones balanced.
Evan Brand: Yup, and, how can you do that from a testing perspective, we mentioned the blood, but I’ll just throw a few other components of this in. Number 1 is the stool test, so we’re always gonna be running a PCR stool panel, or gonna be looking for all this. As you mentioned, we’re gonna look at H-Pylori, we’re gonna look for giardia, we’re gonna look for cryptosporidium, blastocystis hominis, there’s a ton of different bugs, there’s worms, there’s parasites, there’s bacterial overgrowth we look at, there’s candida that we look at, that’s all done with the combination of stool and urine testing. And on the stool, there’s a couple markers that we can track, obviously, you looking in the toilet is gonna be the best way to track. Well, we like numbers, you know, Justin and I like data. So, when we look at steatocrit, which is a fecal fat marker that usually is expressed as a percentage. I like to see it, you know, 10% or below, we’ll see some clients, they’re 30, 35, 40 percent steatocrit, that means they’re not digesting their fats at all, and they while I’m doing a ketogenic diet and I feel like crap, it’s ’cause they’re not digesting anything.
Dr. Justin Marchegiani: That’s it.
Evan Brand: So, we gotta get that steatocrit down, and how you do that, well, one, clear the bugs too, supplement, and then, what was the other part of my brain? The blood, we talked about the blood, we talked about the stool, oh, the beta glucuronidase. So, beta glucuronidase at enzyme on the stool test we look at, that enzyme gets messed up due to bacterial overgrowth. When we see the enzyme is high, that’s when the estrogen dominance probably becomes more problem- problematic because now, they’re re-circulating the hormones. So, we do some like a calcium d-glucarate or a DIM, or something else, maybe a broccoli seed extract to try to get, or could be probiotics, could just be clearing bugs, taking care of the SIBO, the glucuronidase goes back down, and now all these quote, “estrogen-dominance symptoms” just disappear, and it’s really fun to see that.
Dr. Justin Marchegiani: 100%. So, kinda highlighting the test again, look at your symptoms, if you have pain in the upper right quadrant, under the rib cage, if you have problems breaking down fat, if you’re seeing a lot of your fat, your stool sinking or floating on top, not sinking. If we run a ho- comprehensive stool test and we see a lot of uhm, steatocrit, undigested stool, we see that greater than 10 or 15, whatever that lab marker is right in that area, we got problems, and then we gotta dig in deeper, and this could be the reason why you have hormonal issues too so we have to highlight that. Is there anything else in this topic Evan that you wanna go into that we haven’t gone in deep enough?
Evan Brand: I don’t think so, I would just tell people that if you feel discouraged, or, you know, you’re facing surgical removal of your gallbladder, I’m not saying the gallbladder can always be saved. I have a friend of mine, she’s in her late 50’s, maybe early 60’s at this point, and she was having major, major gallbladder pain, and I told her about taking digestive enzymes, but the pain just continue to grow. So, you know, I said hey, you might have to, you know, go to a doctor and get this checked out. This is very recent, so she did. And her gallbladder function was basically nothing, and she went in and she had to get surgical removal and because of with so much inflamed tissue around her gallbladder they couldn’t do the- the- the uh, laparoscopy, where they just give you a small- a small uh surgical side, they had to really cut her open like 6 to 8 inches, they hadn’t take out the gallbladder, and the surgeon told her, that her gallbladder was so heavy, full of stones that it felt like a concrete block. He said there was no way you were gonna save this gallbladder. So, I think there is a point of no return, where surgical removal does happen, we’re not shaming anybody or making fun of anybody if you got your gallbladder removed, that sucks, like she had to get it out, there was no turning back. And now, you know, she’s got tubes coming out of her stomach to drain her bile until she recovers from the surgery. So, obviously, that’s an extreme case but man, uh, you know, it can- it can get to a point where surgery is the only option but we’re just trying to help you before you get to that point.
Dr. Justin Marchegiani: Yeah, so if we don’t have enough, if you don’t eat good fats, then we don’t have good gallbladder flow, then, what happens is, it’s like not changing the oil. A lot of that bile uhm, and that cholesterol can crystalize. And then overtime those crystals can- can produce more and more crystals. And then imagine these little crystals that are like- a little mini or- miniature-like porcupines. And imagine that gallbladder contracting, it’s like giving a- a big porcupine a nice hug, right? Probably not the best thing. So, that can create a lot of inflammation, and the more little porcupine you’re having your gallbladder, the bigger issue every time you have fat that contracts. And then also, we can have potential pancreatitis because of it ’cause those gallstones can eventually produce, can block the bile flow, and that can stop pancreatic enzymes from flowing into the small intestines. So, that can create more inflammation. So, the more this thing, err- there’s more of this issue, the underlying cause goes unaddressed, the more the inflammation accumulates, accumulates, accumulates, accumulates, there may be a drastic solution of cutting out the gallbladder. Now, I would say, the vast majority of the time, it can be saved. We have to make the food changes, uhm, we also do a lot of gallbladder bile support, we’ll also use things like phosphatidylcholine, we’ll do beet root powder, we’ll do taurine, we’ll do dandelion, we’ll do artichoke, French trees, or herbs that’re designed to help to help one thin out bile flow, they can smooth out the little crystals, so imagine like kinda coming in there and smoothing out all the little porcupine barbs. Uh, that way they aren’t as sharp, and then we can be very careful with our fat consumption, maybe we do the tiniest amount possible. A lot of the coconut fats are easier to process and digest. So, maybe we’ll do more coconut fat, we’ll just do- just the- the largest amount of fat we can handle without issues, we up the enzymes, we up the bile salts, and then we give a lot of those herbs to smooth out the bile flow, thin out the bile, and smooth down the crystals. We’ll even do some- some like extra phosphorus drops to even thin out the bile uhm stones as well.
Evan Brand: Yeah, I do beet powder every day. You know, part of that for my circulation issues dues to all the mold in my body, so- so the beet powder’s been really helping. But, you know, back to my friend, you know, she was, she’s a woman, she’s over age 40, she does have excess weight, you know, she is overweight, she is very sedentary, uh, she did have some familiar health issues as well, you know, any- any family history of uhm- diabetes, other type issues like that can- can increase the risk of gallstones which then increase the risk of these problems, so, if you were to take all of the things you don’t wanna be sedentary, you know, overweight, uh, etc., poor diet, she had all those things against her. So, I’m not gonna- I’m not saying that everyone’s gonna end up like that with her case which is extreme but, you know, I just wanted to point out, hey, sometimes there may need to be a surgical removal. But, we just- we wanna try to prevent that. Statistics I found say there is about uh- 3 quarters of a million surgeries every year for gallbladders.
Dr. Justin Marchegiani: Exactly. Then we kinda talked about, our women- right- our- our fat, 40 and female. The big issue is, estrogen is a big uhm cause of kind of making the- the gall uhm, making the bile more sludgy, so is insulin. So, insulin is also another stimulating factor, this is part about I think where the fat comes in there, because the more weight you have typically is more insulin-resistance, insulin’s that hormone that sticks sugar into the cell, converts it to fat, so if you have more insulin, that’s a greater likelihood of making the bile flow more sludgy. So, if you have high levels of insulin, that’s gonna slow up the bile flow, and then if we have uhm, high levels of estrogen or just estrogen dominance, that’s gonna sludge up the bile flow as well.
Evan Brand: Yup. I’m sure we could keep going on this topic all day but, we should probably wrap it up. Reach out if you do need help, you can go to justinhealth.com, and Justin’s summit is coming up very-very darn soon. So, I don’t know when you’re listening to this, if you listen to it in the future, and you already missed out, well, you can purchase his summit, but if you’re listening to it ahead of time, his summit is going live very soon, in two weeks at the first week of March. So, go to thyroidresetsummit.com. Go register for Justin’s event, it’s gonna be awesome, I interviewed him, which I thought was probably one of the best interviews possible, and interviewed me, and I talked about some other stuff that he hadn’t talked about. So make sure-
Dr. Justin Marchegiani: [Crosstalk] …interviews too.
Evan Brand: Thank you, thank you [crosstalk].
Dr. Justin Marchegiani: …for sure.
Evan Brand: So, so go register, uh, it’s- it’s gonna be probably one of the biggest events of the year called Thyroid Reset Summit. So, thyroidresetsummit.com, go check it out and to run through health talks which is like the apple of summits, they do a great job of putting things on, and there’s, I don’t know what, 30 other experts on there. So-
Dr. Justin Marchegiani: 30 great experts. And also, I’m giving way the first uh- 3 to 4 chapters of my new book coming out, the thyroid reset. That book will be coming out in the next uh, few months here, so, get your free intro copy and then I really appreciate you guys picking up the book as well. Get me up there on the Amazon ranking so we can help more people, I appreciate it. And also, just to finish with this uh, article, here, the uhm conclusion, very important here for gallbladder issues, just to tight home, repeat yourselves a lot because repetitions some other skill, here’s the conclusion, insulin resistance is a risk factor for the incidence of gallbladder sludge and stones during pregnancy and after. And then it says insulin resistance may represent a causal link between obesity, overweight and gallstones. So our big mechanisms here, just kind of- f- coming in full summaries, if you missed the whole entire podcast, if you get this one thing, you got it. High levels of insulin, increased gallbladder sludge. High levels of estrogen, or estrogen-dominance, increased gallbladder sludge. Inflammatory foods, right, that drive insulin and inflammatory foods that are paleo friendly like, pork, like onions, like eggs, like coffee, maybe an issue, and then of course the low HCl levels, uhm, the low-fat diet, uh, all of those things and eating in the stressed out environment, those are gonna be your big 3 or 4, then also infections, giardia, gluten-sensitivity, SIBO, all of those things are gonna drive, probably the big 5 factors. Infections, insulin, estrogen dominance, low HCl enzymes, and then hidden food allergens. Those are your big 5 factors of this gallbladder issue here.
Evan Brand: Yeah, well said. And I love my friend to death but my wife and I were driving in the parking lot the other day, and she’s- and- and then we see our friend who just got her gallbladder taken out, and she’s sitting in the Taco Bell Drive Thru, and I’m just like, “No, that’s exactly what got you in this problem in the first place”. So, the diet is so critical, you can’t skip it.
Dr. Justin Marchegiani: Hundred percent, excellent. And for anyone enjoying this, I’m gonna do another live Q&A here tonight, this at- you know, the very end of the day, probably around 5, 6 o’clock here central time. Make sure you subscribe to the YouTube channel, we do a lot of live Q&A. So, go to justinhealth.com/YouTube. If you’re listening to the channel now, make sure you hit that bell, that gives you the notification. So, if you’re on your phone, it’ll pop-up as it ___[35:35] doing a live chat. Even if you’re not around for it, just your little- little question in. So, we do a live Q&A, it’s op-in question, if there’s a topic, keep your question to that topic, if it’s a podcast, we may or may not get to questions ’cause we kinda get in our flow state and uhm, we may just be really focused on our conversation.
Evan Brand: Take care.
Dr. Justin Marchegiani: Hey Evan, you have a good one, take care.
Evan Brand: You too, bye.
Dr. Justin Marchegiani: Bye everyone.
References:
https://www.thyroidresetsummit.com/