Gallstones and Gallbladder Disease

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Thursday, November 15, 2007

Gallstones and Gallbladder Disease

Gallstones and Gallbladder DiseaseYou Really Can Keep your Gallbladder!BackgroundThe Gallbladder is a small pouch-like organ located below the liver in the upper right abdomen which temporarily stores bile, produced in the liver, until it is needed to help digest fats. After eating a meal, when food leaves the stomach and enters the upper end of the small intestine, hormonal signals are sent to cause the gallbladder to contract, squeezing its contents of bile into the small intestine. There, bile then breaks down the fat you have eaten into small enough particles that your other digestive enzymes can digest and absorb it. Gallstones form when bile in the gallbladder condenses into solid, crystal structures. Gallstones can be made of bilirubin, a bile pigment, cholesterol, or both. In the U.S., 90% of gallstones are cholesterol stones. These stones can cause the walls of the gallbladder to become inflamed or can get stuck in the bile ducts, either of which can produce excruciating pain. In severe cases this can be life threatening, though such occurrences are rare.Epidemiology: How Serious is the Problem?Risk factors for gallstone formation are being female, age over forty, and obese, though this stereotype is not entirely accurate. About 40% of gallstone patients are men. Caucasians are roughly three times more likely to be afflicted than Blacks. Certain Native American tribes have the highest incidence in the world, with up to 90% of women of the Pima tribe in Arizona affected by age 65. More than one million new cases of gallstones are diagnosed in the U.S. every year. Roughly 700,000 will undergo the conventional treatment of choice – Cholecystectomy – or surgical removal of the gallbladder. While this is generally recognized as a "safe" procedure at 99.0 to 99.5 percent effective, between 0.5 and 1.0 % of these surgeries result in death, about 3500 in 2003. These statistics on the safety of gallbladder surgery have changed little in the last 20 years. While the risks of surgery are believed to be declining slightly, which reduces the risks of fatality for any one individual undergoing surgery, the incidence of gallstone disease is rising, and total morbidity and mortality in the US population may be increasing.Symptoms of Gallstone DiseaseFor some people, gallstones produce no symptoms at all. They only find out they have them when they undergo an ultrasound or other imaging study for another condition. Many people, though, experience pain in the upper-right abdomen just below the ribcage. This pain is usually worse after eating, and high-fat meals, which cause the strongest contractions of the gallbladder, produce the most pain. This pain may not start until 1-2 hours after a meal, and is often referred to as a "gallbladder attack".Other symptoms may include fever, sweating, nausea, vomiting, constipation or diarrhea, and sometimes pain radiating to the right shoulder. Definitive diagnosis of gallstones is made with ultrasound imaging, as shown at the right.Ironically, after surgery up to 20% of patients still experience the pain of "Gallbladder Attacks", even though their gallbladders are gone. This may be due to spasms in the bile duct, the liver or general inflammation in the digestive system, which is especially possible if part of the root cause includes food allergies, which can inflame all the body's mucous membranes.The figure at the lower right shows a gallbladder containing stones after it was removed. Stones can range in size from a few millimeters to several inches across.Gallstone FormationBecause most gallstones in the US are cholesterol stones, this discussion will focus on their formation. If you have been told you have pigment stones, call the office to discuss their treatment with Dr. Cage.Abnormal bile composition. Gallstones form as the result of abnormal bile composition, specifically, more cholesterol than bile acids. Bile is produced in the liver. Normal bile contains roughly equal amounts of cholesterol and bile acids. If the bile composition is wrong, it is a sign of abnormal carbohydrate and lipid processing in the liver, which, in turn, means that carbohydrate and fat metabolism in the entire body has been altered in an abnormal way!! The factors that cause this are either excess cholesterol, or an inability of the liver to convert cholesterol into bile acids. Vitamin C, Vitamin B3 (niacin) and the amino acids Taurine and Glycine are all needed to form bile acids. The standard American diet is often deficient in vitamins which can contribute to the formation of gallstonesThicker and Stagnant Bile. One of the gallbladder's normal functions is to slightly concentrate the bile, which it does by re-absorbing water. When first produced by the liver, normal bile is about 97% water; after a number of hours in the gallbladder, the percentage of water is down to 85%. When too much cholesterol is present, the bile gets thicker and harder to move. As the gallbladder tries to contract and force the bile into the duodenum, less bile leaves and more remains behind in the gallbladder. The longer bile remains in the gallbladder, the more concentrated it becomes as the gallbladder continues its job of reabsorbing water, making the bile left behind even thicker. Eventually a pool of thick, stagnant bile builds up in the gallbladder. When concentrated chemicals are allowed to sit a long period of time, chemical reactions can take place that normally wouldn't occur. The bile becomes super saturated and the excess cholesterol begins to crystallize. In other words, gallstones are born.Risk Factors for Abnormal Bile1. Refined sugars and starches2. Poor quality fats3. Lack of essential fatty acids (EFAs)4. Lack of Dietary Fiber5. Food Allergies6. Hormonal Factors7. Dehydration8. Specific Nutritional Deficiencies9. Lack of ExerciseLong Term Naturopathic Treatment for GallstonesGallstone treatment requires altering carbohydrate and lipid metabolism of the entire body, especially of the liver. This will mostly involve changing the foods you eat, as well as adding specific supplements to encourage particular biochemical paths in the body. The details of this process consist of three major categories of actions.1) Normalize bile composition leaving the liver2) Dissolve existing gallstones in the gallbladder3) Prevent the reabsorption of bile and cholesterol in the small intestineNaturopathic treatment will start with a core, high-quality nutrition program designed to reduce your body's tendency to produce excess cholesterol. It will also use a variety of nutritional supplements called lipotropic factors to break up fat deposits in the liver and thin the bile. Still other agents, both herbs and supplements, can dissolve existing gallstones. The exact details will vary from one individual to another depending on your medical history. As always in Naturopathic Medicine, the treatment program is customized to you and your individual situation. Dr. Cage will review your health history and any medications you are currently taking so he can ensure the natural treatment program he prescribes will be safe and effective. Possible Contra-Indications for Natural Gallstone TreatmentNatural gallstone treatment addresses the true root cause of gallstones, altered lipid and carbohydrate metabolism, and as a result it is highly effective. Because everyone's health situation is different, however, there may be reasons that some individuals should not attempt it. Factors your Naturopathic Doctor will consider which might prevent proceeding with the treatment plan include:• Stones that are calcified, very large, or bilirubin stones• Pregnancy• Advanced Liver disease, such as hepatitis or cirrhosis• Possibly in extremely obese patients• If the gallbladder is non-functional• In advanced gallbladder disease(e.g.: chronic infection, cancer, calcification or rupture of the gallbladder wall)• Presence of some other serious metabolic disease which might take precedence in treatment(e.g.: cardiac disease or other systemic cancer)• Patients unwilling or unable to make the necessary dietary and lifestyle changesThe Take Home Message:The Naturopathic philosophy towards gallstones and gallbladder removal can be summarized as follows:• Gallstones are NOT the result of problems in the Gallbladder!!• Instead, gallstones are the result of abnormal bile entering the gallbladder from the liver• Abnormal bile production in the liver results from improper diet and lifestyle, primarily overconsumption of simple carbohydrates and low-quality fats leading toimbalanced carbohydrate and lipid metabolism and excess cholesterol production. • Gallstones are thus a systemic disease, not solely a condition of the gallbladder• Removing the gallbladder DOES NOT correct the underlying, systemic causes of gallstones, which are also risk factors for hypertension, obesity, diabetes, atherosclerosis,heart disease, heart attacks and strokes.• Gallstones are preventable, and in most cases reversible, without surgery!If you have been diagnosed with gallstones and want to explore options other than surgery, especially if you already have one or more of the other conditions listed just above, call the office to speak with Dr. Cage to find out if you are a candidate for Natural Gallstone Treatment.