The Health and Healing of Your Humble but Mighty Gallbladder

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Your gallbladder—or bile bladder—is a small organ tucked beneath the liver behind your ribs on the right side of your abdomen. This humble but vital little organ, also known as the cholecyst—from the Greek khole or chole- for “gall” or “bile” and kystis (or the Modern Latin cystis) for “bladder,” “sac” or “pouch”—is a holding tank for bile.

In this article, I will provide a general overview of the gallbladder, the bile and the biliary ductal system (or biliary tree), including the primary roles they play in the digestion of fats. I will also discuss some potential health issues that may arise regarding the gallbladder, bile and biliary tree, as well as offering some suggestions for natural, holistic approaches for supporting their healthy functioning.

GALLBLADDER OVERVIEW

The gallbladder serves four primary purposes. First, it is the storage vessel for bile, and second, it concentrates bile during storage. Third, it releases bile on demand into the small intestine to assist with the break­down of dietary fats for digestion. Finally, it keeps bile and the metabolic wastes and toxins contained within bile sequestered, thereby preventing it from entering into circulation in the bloodstream or body systemically.

The gallbladder’s relationship with the liver is in some ways analo­gous to the relationship between the urinary bladder and the kidneys. Both the gallbladder and the urinary bladder serve primarily as dedicated storage receptacles for fluids that have been filtered or generated by the liver and kidneys, respectively. The gallbladder and urinary bladder are specifically designed to contain these fluids, thus ensuring they remain out of general circulation.

The main difference between these two organ pairs, at least as is relevant to this discussion, is that the constituents within the urine held by the bladder are for direct evacuation. Therefore, once the bladder is full, this fluid is excreted directly out of the body via the urethra for im­mediate elimination.

Bile, however, contains components that are necessary for the diges­tion of dietary fats we consume. Therefore, bile is held continuously by the gallbladder and is excreted by the gallbladder into the duodenum as and when required for fat assimilation. The second primary function of bile is to carry away wastes and toxins that the liver has filtered from the blood and deposited in the bile; earmarked for disposal, these eventually bind with feces further along the digestive tract and are eliminated from the body via the stool.

WHAT IS BILE?

Bile (or “gall”) is a sticky, greenish, brownish or yellowish fluid that is produced continuously by hepatocyte cells within the liver. The liver of an average adult produces approximately eight hundred to one thousand milliliters of bile per day—about one quart.

About 95 to 97 percent of bile is water, with the remaining 3 to 5 percent composed mainly of bile salts (aka bile acids), cholesterol, phospholipids, lecithin, electrolytes and pig­ments. The latter include bilirubin (yellow) and biliverdin (green), which is the oxidized form of bilirubin; combined, these give bile its distinct greenish-yellow color. Bilirubin and biliver­din—produced through the catabolic processes involved in the breakdown of hemoglobin in old or damaged red blood cells—are some of the metabolic wastes that the bile sequesters for subsequent elimination.

The bile salts are primarily what make bile a vital digestive fluid, used by the body to break down dietary triglycerides into individual fatty acids, assisting in their assimilation, absorption and digestion. Besides helping to break down consumed fats for digestion, bile salts are also natural laxatives that help soften stools and promote regular bowel movements.

The body considers bile salts so valuable— perhaps even somewhat “expensive” for the liver to produce—that they are recycled back to the liver via absorption through the small intestine. Once absorbed there by enterocytes, they pass through the intestinal wall and are then returned through the hepatic portal vein back to the liver for reuse in bile.¹ This natural recycling process of bile salts is called “enterohepatic circulation.”

Enterohepatic circulation is an especially important concept in the field of toxicology, as lipophilic (fat-soluble) xenobiotics sometimes also undergo this process of being reabsorbed along with bile salts and recycled back to the liver.² Examples of lipophilic xenobiotics include some pharmaceutical drugs and pes­ticides, polychlorinated biphenyls (PCBs) and contaminants generated by the incineration of industrial wastes.³ Due to the toxic nature of these chemical substances, their reabsorption back into the system may be a contributing factor to the development of diseases or other disorders of the liver, gallbladder, biliary tree and perhaps beyond.

CHOLECYSTOKININ AND THE BILIARY TREE

After we eat a meal, the food we’ve con­sumed eventually passes from the stomach, in the form of chyme, into the uppermost part of the small intestine, the duodenum. If the meal we’ve eaten contained fat, the presence of fat when it enters the duodenum stimulates the mucosal epithelial duodenal cells to secrete a signaling peptide hormone called cholecysto­kinin (CCK). Cholecystokinin is the primary stimulus for the delivery of bile into the small intestine. Once CCK has been secreted, it in turn signals the gallbladder to contract, releasing a portion of its stored bile.

The biliary tree consists of a system of ducts or vessels through which secretions from the liver, pancreas and gallbladder—including bile—flow into the duodenum. The main ana­tomical parts of the biliary tree include intra­hepatic bile ducts; right and left hepatic ducts; the common hepatic duct; cystic duct; common bile duct; ampule of Vater; sphincter of Oddi; and major duodenal papilla.⁴

Once created in the liver, bile collects into the intrahepatic bile ducts. These ducts direct the flow of bile into the right and left hepatic ducts, which then converge to form the com­mon hepatic duct. The common hepatic duct connects to the cystic duct, which transfers bile to the gallbladder for storage.

Bile stored in the gallbladder remains con­fined there until it is delivered on demand into the small intestine to assist in the digestion of fat. This happens when the presence of fat is detected in the duodenum. As mentioned, the re­lease of fat from the stomach into the duodenum triggers the gallbladder to contract and release some of its stored bile, which flows via the ducts in the lower portions of the biliary tree (the ampule of Vater, sphincter of Oddi and major duodenal papilla ) directly into the duodenum.

UNDERSTANDING FAT EMULSIFICATION AND DIGESTION

Luscious, rich and satisfying, deeply flavor­some and an essential source of vital nutrients (including the key fat-soluble vitamins A, D, E and K), traditional dietary fats and oils are arguably the cornerstone of a nourishing Wise Traditions diet.

All fats and oils have a unique and very distinctive viscous consistency that we associ­ate with being “oily” or “greasy.” Due to this particular texture, and because the fat molecules (called triglycerides) in the foods we eat are relatively large, fats need to be broken down into smaller particulates, whether to wash them away from our dirty dishes or to digest them inside our bodies.

Those of us who consume liberal amounts of foods rich in fats and oils, particularly fats that are saturated and therefore solid at room tem­perature, know from experience that after eating a meal that features generous amounts of fats, the fats tend to cling to our plates, utensils, cookware and surfaces. We also know that when we clean up after eat­ing such a meal, we need to use lots of warm, soapy water if we’re to be successful in our cleaning process. As the saying goes, “oil and water do not mix.” Fats are simply not soluble in water; therefore, using nothing but water to clean fats from our dishes and surfaces is generally not very effective. Adding soap or detergent to our wash water solubilizes the fats, working to dissolve their macromolecules into much smaller molecular particles. This process, whereby soap emulsifies fat and turns it into tiny particulates, allows the particulates to become much more easily dispersed and dissolved into the wash water, leaving our dishware clean.

In this context, bile is one of the most important substances our body produces. Upon reaching the duodenum, bile works together with diges­tive enzymes secreted by the pancreas to assist in the further breakdown of dietary fats, employing a similar detergent action as occurs in the cleaning of fats in the kitchen, via the process of emulsification. This allows us to digest and assimilate fats and the fat-soluble nutrients carried within them properly. In other words, just as the fats on our plates, cookware, stovetops and countertops need to be broken down via the process of emulsification to be washed away effectively, so, too, must our bodies break down and emulsify the relatively large molecules that comprise the dietary fats we consume into smaller particles, so as to render them into a form that may be absorbed through our intestinal lining into the watery matrix of our lymphatic system and bloodstream. Only when broken down into their simpler fatty acid components can the fats we eat—and the all-important fat-soluble vitamins—be effectively absorbed by the tiny villi in the brush border that forms the intestinal lining of our digestive tract.

LOW-FAT DIETS AND GALLBLADDER PROBLEMS

The free flow and systematic movement of bile from the liver into and through the gallblad­der and biliary tree and into the small intestine are vitally important and intrinsic to the good health and proper functioning of these organ systems. Conversely, when there is stagnation, reduction or stoppage of bile flow, this may contribute to several potential health issues. The medical term for this condition—where bile flow is slowed or impaired—is cholestasis.⁵

The underlying reasons why cholestasis and other afflictions involving the gallbladder and biliary tree arise are not well understood. However, because fat consumed in the diet is the only way the discharge of bile by the gall­bladder into the digestive tract is triggered, it stands to reason that one’s fat consumption—or rather a lack thereof—may well be a significant contributing factor to the onset of cholestasis. If, over the course of time, people purposely limit their intake of fat, they may quite possibly be stagnating the flow of bile from the gallbladder into the small intestine.

Cholestasis is often a precursor to more serious conditions involving the gallbladder and biliary ducts. Such conditions include chole­cystitis (redness, swelling and/or inflammation of the gallbladder); cholangitis (inflammation of the biliary tree resulting from infection); cholelithiasis (gallstones); and choledocholi­thiasis (one or more gallstones in the common bile duct). These conditions can involve severe discomfort and pain, which is generally felt on the right side of the trunk or in the back, near or under the right shoulder blade.

THE DOWNSIDE OF GALLBLADDER SURGERY

When allopathic doctors diagnose someone with a gallbladder condition, they often recom­mend a cholecystectomy—the surgical removal of the gallbladder—a procedure first performed in the 1870s.⁶ Although most surgeons who rou­tinely perform cholecystectomies will tell their patients that the gallbladder is a non-essential organ without which they can live perfectly well, the truth is that we were all born with a gallblad­der for a reason. It is, in fact, a vital organ that serves important purposes.

What happens when someone’s gallbladder is surgically removed? After a cholecystectomy, there is no storage, sequestration or concentra­tion of the bile as occurs when the gallbladder is intact, and because the gallbladder has been removed, there is no discharge on demand of bile as and when it’s needed when a meal contain­ing fat passes from the stomach into the small intestine. Instead, the biliary tree is rerouted so that the bile, which is constantly produced by the liver twenty-four hours a day, flows directly into the duodenum, perpetually and steadily dripping into the small intestine, essentially at the rate it is produced.

Evidently, the majority of people who have had a cholecystectomy are fortunate enough to experience no noticeable symptoms after having their gallbladders removed, seemingly living up to physicians’ assurances that they can get along quite well without this organ. However, as was already noted in the 1940s,⁶ a subset of people either experience no improvement post-surgery or develop new symptoms.⁷ Most often digestive in nature, these symptoms have been given the label of “post-cholecystectomy syndrome” (PCS).

Current estimates suggest that four in ten post-cholecystectomy patients experience symptoms of PCS,8 which can include pain or discomfort similar to that experienced prior to surgery. Other PCS symptoms include intoler­ance of or inability to digest fatty foods, nausea, vomiting, jaundice, diarrhea, indigestion and the passage of oily stools.

HOLISTIC APPROACHES TO GALLBLADDER HEALTH AND HEALING

Healing the gallbladder holistically

The presence of overly thick, sludgy bile or of gallstones is indicative of aggregation or cal­cification of constituents within the bile, likely resulting from stagnation. The inflammation caused by stagnated or blocked bile flow can result in discomfort and pain in the areas of the gallbladder and biliary tree.

Fortunately, there are several options that may help naturally maintain healthy gallbladder and biliary tree function, or promote healing in individuals experiencing health issues as­sociated with these organs. Some of these may also be helpful for those who are experiencing health challenges after having gone through a cholecystectomy.

First, as much as possible, consume plant foods that are organically grown and choose animal foods from humanely raised, pasture-fed livestock not given feed sprayed with pesticides or other poisonous agricultural chemicals. Remember that the liver is likely to sequester some of these toxic compounds into the bile for elimination with the stool; eating as cleanly as possible can go a long way toward helping the entire biliary system work properly, especially with regard to the clear and free flow of bile as nature intends.

Second, avoid eating a low-fat diet. In­stead, include in your diet generous amounts of nutrient-dense traditional fats and oils such as pastured butter, ghee, tallow, lard and poultry fats (goose, chicken and duck). In particular, avoid the consumption of genetically modified, chemically sprayed seed oils and margarine, in­cluding those derived from soy, corn, canola and cottonseed, which are unnatural, toxic and may impose a potentially damaging, noxious burden on the liver, bile, gallbladder and biliary tree.

Third, consider taking about one-quarter teaspoon of an herbal digestive bitters extract before meals,^9,10 holding the extract under the tongue or against the gums for a minute or so to allow the active constituents of the herbs to penetrate into the oral tissues sublingually. The absorption of bitters in this way creates a cascading signaling effect through the body systemically, encouraging the flow of stomach acid and other beneficial digestive supporting fluids through the wider digestive system in anticipation of the incoming meal.

Fourth, some may wish to take digestive enzymes with meals. The older we become, the fewer digestive enzymes our bodies are capable of making naturally. Taking supplemental di­gestive enzymes is a very safe and easy way to help improve digestive function in both young and old. It may be especially helpful for some individuals to supplement with the digestive enzyme lipase. Lipase is naturally produced by the mouth, stomach and pancreas, and works together with the bile specifically in the emul­sification and digestion of dietary fats.

Fifth, taking supplemental ox bile is another potentially helpful option for those suffering with digestive challenges, particularly post-cholecystectomy. Ox bile contains the very bile salts that are required for the proper breakdown of dietary fats prior to their digestion. Ox bile may also be helpful for those who still have their gallbladder intact but are dealing with symptoms of cholestasis, gallstones or other gallbladder/biliary tree issues.

Sixth, consider certain herbs (see sidebar below). Choleretic herbs specifically promote increased bile secretion by the liver and flow of bile from the liver, while cholagogue herbs specifically promote increased gallbladder contraction (ergo, increased secretion of bile), promoting the free flow of bile through the bili­ary tree into the small intestine. Some herbs are crossovers—considered to be both choleretics and cholagogues. Many of these herbs also support the liver. Our livers—never designed to cope with the levels and types of poisons commonly found today in our air, water and soils—deserve proactive support. The more liver support we provide, the better our liver will be able to deal with the unprecedented levels of toxic environmental burdens imposed by our modern world.

Seventh, the topical application of warm castor oil packs is another holistic approach that can support the health and healing of the gallbladder and liver. A castor oil pack applied externally, placed over the liver and gallbladder area on the upper right side of the abdomen, encourages improved lymphatic movement and drainage and promotes increased blood circula­tion to the area, while soothing discomfort and easing pain. Naturopath Louisa Williams does not advise the use of hot water bottles or heat­ing pads and recommends using the packs no longer than twenty to forty minutes, as well as being sure to use fresh castor oil that has not developed rancidity.¹¹

Eighth, coffee retention enemas are another very effective practice supportive of the liver, bile and gallbladder. The late Nicholas Gonza­lez, MD, past presenter at Weston A. Price Foun­dation conferences, heavily promoted coffee enemas, often prescribing them as an integral component of his holistic treatment plans for his patients—many of whom had been diagnosed with cancer.¹² According to Dr. Gonzalez and other proponents of coffee enemas,¹³ the palmi­tates or palmitic acids in the coffee used in the enema travel via the portal vein from the lower portion of the bowel to the liver, where their presence stimulates the release of bile into the biliary tree.

Finally, the bile, the liver and the gallblad­der are all classically associated energetical­ly—particularly by practitioners of traditional Chinese medicine—with emotions such as anger, bitterness and resentment. In light of this, it may be helpful for people who are deal­ing with health issues related to those aspects of physical anatomy and physiology to focus on finding healing and promoting the resolution of such energetic underpinnings, which may be influencing their ability to maintain optimal physical health.

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SIDEBARS

HERBS SUPPORTING THE GALLBLADDER AND THE LIVER
The following is a partial list of herbs—including choleretics (which promote increased bile secretion by the liver and flow from the liver), cholagogues (promoting increased bile secretion by the gallbladder) and others—that may support the healthy functioning of the liver, bile, gallbladder and biliary tree.

• Chanca piedra (Phyllanthus niruri), aka “stone breaker”: Leaf, stem, and root
• Milk thistle (Silybum marianum): Seed
• Burdock (Arctium lappa): Root
• Yellow dock (Rumex crispus): Root
• Dandelion (Taraxacum officinale): Root
• Gentian (Gentiana lutea): Root
• Stone root (Collinsonia canadensis): Root
• Turmeric (Curcuma longa): Rhizome

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REFERENCES

1. Mertens KL, Kalsbeek A, Soeters MR, Eggink HM. Bile acid signaling pathways from the enterohepatic circu­lation to the central nervous system. Front Neurosci. 2017;11:617.
2. Levine WG. Biliary excretion of drugs and other xeno­biotics. Annu Rev Pharmacol Toxicol. 1978;18:81-96.
3. Jandacek RJ, Tso P. Factors affecting the storage and excretion of toxic lipophilic xenobiotics. Lipids. 2001;36(12):1289-1305.
4. Strazzabosco M, Fabris L. Functional anatomy of normal bile ducts. Anat Rec (Hoboken). 2008;291(6):653-660.
5. Christiansen S. An overview of cholestasis. Verywell Health, May 26, 2020.
6. Womack NA, Crider RL. The persistence of symptoms following cholecystectomy. Ann Surg. 1947;126(1):31-55.
7. Farsakh NAA, Stietieh M, Farsakh FAA. The postchole­cystectomy syndrome. A role for duodenogastric reflux. J Clin Gastroenterol. 1996;22(3):197-201.
8. Saleem S, Weissman S, Gonzalez H, et al. Post-chole­cystectomy syndrome: a retrospective study analysing the associated demographics, aetiology, and healthcare utilization. Transl Gastroenterol Hepatol. 2021;6:58.
9. Charles-Davies D. Bitters: the revival of a forgotten fla­vor. Weston A. Price Foundation, Feb. 26, 2018. https://www.westonaprice.org/health-topics/abcs-of-nutrition/bitters-revival-forgotten-flavor/
10. Mase G. Herbal bitters: as crucial as salt in the modern kitchen. Wise Traditions. Summer 2018;19(2):32-35.
11. https://www.louisawilliamsnd.com/post/the-castor-oil-pack
12. Why detox with coffee enemas. The Nicholas Gonzalez Foundation. https://thegonzalezprotocol.com/videos/why-detox-with-coffee-enemas/
13. Schuette K. Reviving health through gentle detoxifica­tion. Wise Traditions. Spring 2015;16(1):35-44.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Fall 2022

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