Q: I was diagnosed with gallstones and my primary doctor suggested I have my gallbladder removed. He also said the gallbladder "has no purpose." Is there a nutritional approach to solving my upper abdominal pain?
-Patricia U., Phoenix
A: Nature is very efficient. Good designs, no waste. The purpose of the gallbladder is to store a small repository of bile, which serves many important functions. Its main purpose is to break down fat into absorbable components. For anything you eat to become useful nutrition, it needs to be broken down (catabolized) into tiny sub-units to fit through the microcapillaries in the villi of the small intestine. This is where all nutrient absorption occurs: starches and carbs break down to glucose; proteins break down to amino acids; and fats break down to essential fatty acids before absorption. Bile is produced in the liver from recycled red blood cells, cholesterol, and bile salts (which are a variety of minerals), and production cannot be dialed up on demand.
When you eat a meal containing a larger amount of fat, more bile is needed. Therefore, the gallbladder, while not as essential as the liver itself, is very handy for storing extra bile for when that big fat meal comes along. From a standpoint of human evolution, feast or famine was a fairly common dilemma in the days before grocery stores. The gallbladder was probably more necessary in primitive humans, and that's why the huge numbers of gallbladders that are extracted (at an average cost of about $12,500 per removal) and dumped into medical waste annually aren't usually killing people. Nevertheless, it's always a great idea to try a nutritional approach to your health care problem before committing to a definitive surgery-unless of course there is an urgent or life-threatening need to have a tumor removed or a wound repaired.
If your upper abdominal pain is significantly correlated to eating fatty foods-usually within the hour-and occurs in the upper right quadrant, up under the right rib cage, sometimes with a sharp pain that radiates through to the right shoulder blade, then some degree of gallbladder congestion is likely. Gallstones are easier to prevent than to reverse. It's important to try to eat approximately the same amount of healthful fats on a daily basis. It's generally not a good idea to commit to a completely low-fat diet because that is not compatible with good health. Your brain, nervous system, and all your hormones are made primarily of fat molecules. You need fat, especially cholesterol and the omega-3 oils, to stay healthy. However, if you go for many days without eating much fat, the bile in the gallbladder may stagnate. Eating fat daily promotes flow of bile through the liver and out of the gallbladder into the upper small intestine. When bile stagnates, it tends to form a thick sludge first, then "sand," then "gravel," and finally may coalesce into one solid stone. This stone may be as big as a robin's egg. The duct through which the bile flows into the intestine is not designed to accommodate anything as large as this. So you'd better believe this hurts like heck.
Once you are in the throes of a gallbladder attack, you can try heat over the upper-right abdomen, as well as ingesting several thousand milligrams of magnesium; both serve as muscle relaxants. Dioscorea (wild yam) can also be an effective antispasmodic if you take several teaspoons of a standardized tincture every hour for up to six hours.
If you get upper-right abdominal twinges after eating fatty foods (such as ice cream or a cheeseburger), consider regularly using bile stimulants and digestive enzymes. The enzyme that helps digest fat, produced primarily in the pancreas, is called lipase, and this can be found at most health food stores.
The solubility of your bile is a major component of your tendency to form sludge or stones. This is the "flow" part of the equation. A diet high in processed foods, particularly refined carbohydrates, is well established to reduce the solubility of bile. A diet high in soluble fiber (apples, steel-cut oats, celery, and dark leafy greens are examples of good day-to-day choices) is very important in the prevention and reversal of gallstones. Some of my favorite cholagogues (agents that promote bile production and flow) are artichokes and beets. Other cholagogues include dandelion root (Taraxacum officinale), turmeric (Curcuma longa) and boldo (Peumus boldo). Never eat fried food. Drink plenty of fresh water. Take 1-3 grams of vitamin C daily.
Another nutrient, related to B-vitamins, that promotes bile solubility is lecithin. Lecithin granules are available at most health food stores. Take 1 rounded tablespoon (500 mg) daily in applesauce, yogurt, or oatmeal.