GALLBLADDER DISEASE AND BILE FLOW
What Your Doctor May Not Tell You…
by John R. Lee, M.D.
Most people don’t even know where their gallbladder is located, never mind what it does, yet gallbladder disease is the most common digestive disease in the U.S. It affects over 20 million Americans, with a million new cases diagnosed each year. Half of those to on to have surgery to remove gallstones or the gallbladder.
So-called “gallbladder attacks” are extremely painful. These pains are often felt in the upper right quadrant of the abdomen, the right collar bone area, or under the right scapula of the back (the wing-shaped bone below the shoulder and overlying the upper ribs in back). Not being at the location of the gallbladder itself, these pains are called “referred” pain. Other symptoms include bloating, gas, nausea and stomach pain, especially after meals.
If the bile duct is blocked, you may become jaundiced (yellowing of the skin) and the sclera (the whites of the eyes). The good news is that most of you can avoid gallstones and gallbladder disease altogether by knowing a few simple guidelines for preventing them.
Women are twice as likely as men to develop gallstones, probably largely due to un-identified estrogen dominance and the excessive estrogen used in hormone replacement therapy (HRT).
Other risk factors include diet in general, especially diets involving rapid weight loss, and obesity. By common wisdom, fried foods are thought to bring on gallbladder attacks but, when studied objectively, this connection is inconsistent. Similarly, attempts to identify “trigger” foods that prompt gallbladder attacks are inconsistent. Most patients find it difficult to associate any specific food with their gallbladder attacks.
The Inner Workings of Your Gallbladder
Bile production by the liver is controlled by a several factors including the food you eat and a variety of gastrointestinal polypeptide hormones. One of these hormones, somastatin, is a major regulator within the central nervous system (produced by the pituitary), but is also made by the adrenal medulla, the pancreas and the gastrointestinal tract, a fact that confirms the essential unity of the brain and body. These hormones are autonomic and cannot be altered by voluntary control. However, sex hormones and fiber also play a role in bile flow and bile constituents, and these are under your control. To understand their roles, one must understand how bile is carried to the intestines and the factors that influence the fluidity of bile.
The Common Bile Duct
The liver is a large organ functionally divided into two lobes. Within an inch or so of exiting the liver, the two hepatic (liver) ducts merge to form the common hepatic duct. In another inch or so, a small convoluted duct branches off to the gallbladder, a pear-shaped hollow bag about the size of a man’s thumb. As a result some bile is drained into the gallbladder to form a reservoir for extra bile, should circumstances require it. The main bile duct beyond the branch leading to the gall bladder is called the common bile duct.
The common bile duct passes under the pylorus (the sphincter through which food exits from the stomach) to the duodenum (the first 10 inches or so of the small intestine) to reach the Sphincter of Oddi which, by constricting or dilating, controls the flow of bile into the duodenum. The duodenum follows a C-shaped path, and is plastered, so to speak, against the back of the abdomen, holding it securely in place, unlike the rest of the 20’ of intestine that freely moves around in the abdomen. Thus, the duodenum is a fixed site for the entrance of the common bile duct.
Interestingly, the pancreas is also secured against the back of the abdomen, sitting like a beached flounder with its head in the concavity of the C-shaped path of the duodenum. The pancreas secretes insulin into the bloodstream but also secretes digestive enzymes through a duct from its “head” into the same Sphincter of Oddi. The passage of secretions from two different organs through a single sphincter is truly quite remarkable.
Keep the Bile Flowing
The flow of bile is very important to health. Its two major functions are excretory and digestive. In its excretory function, bile acts as a carrier for toxins and waste products being excreted from the body. For example, red blood cells become “senescent” (old, unable to function) in 120 to 140 days. The spleen and liver select out these older cells, save the iron, and excrete the rest as bilirubin via the liver. It is the bilirubin that gives bile its characteristic color. Undesirable solids such as sand, soot, and metal particles are also captured in the liver and disposed of through bile.
The digestive action of bile is two-fold: its high bicarbonate content creates a pH of about 8, which is very alkaline. This is necessary to counteract the high acidity of gastric juice arriving from the stomach, and allows intestinal and pancreatic enzymes to work effectively to digest your food. Secondly, bile is a wonderful emulsifier, which means that it breaks up the fats that you’ve eaten into tiny droplets so that they are readily digested by the pancreatic enzyme lipase.
Pancreatic enzymes are very potent – amylase digests starches; protease digests proteins; and lipase digests fats. It is a wonder to me how the pancreatic duct can carry these potent enzymes and not be digested itself.
The flow of bile and pancreatic secretions through the Sphincter of Oddi is primarily a matter of 1) the size of the sphincter opening, and 2) the fluidity of the secretions. If the sphincter is constricted, flow is decreased. Progesterone (and not estrogen, testosterone, thyroid, or insulin) causes a relaxation of the sphincter, thus increasing bile flow. Thus, people with estrogen dominance (relative progesterone deficiency) are more likely to have a constricted Sphincter of Oddi. Perhaps that’s why so many women tell me their digestion is so much better after they correct their estrogen dominance with progesterone supplementation.
Another Reason to Get Plenty of Fiber
Fiber helps prevent viscous (thick) bile by reducing cholesterol absorption in the intestines, and also reducing cholesterol synthesis. A primary ingredient of bile is cholesterol, much of it in the form of cholesterol monohydrate crystals. This, along with calcium bilirubinate granules, creates biliary sludge. Biliary sludge can obstruct the Sphincter of Oddi. In addition, these crystals and granules can coalesce to make gallstones which totally obstruct the Sphincter of Oddi, or they can accumulate in the gallbladder, leading eventually to surgical removal of the gallbladder.
When the sphincter is obstructed, bile backs up into the pancreatic duct. This is particularly disastrous since the addition of the emulsifying effect of bile combined with the potent digestive pancreatic enzymes causes damage to pancreatic tissue and leads to pancreatitis. Biliary sludge is the probable cause of 30 to 50 percent of the incidence of recurrent pancreatitis, which is not only extremely painful and difficult to treat, but is also quite often fatal.
Other factors contributing to sluggish bile flow are sugar and highly refined starches, over-eating, and a couch-potato life style. Once a person has pancreatitis, all alcohol must be discontinued.
Guidelines For Preventing Gallbladder Disease
- Avoid fried food, especially if you’ve had attacks after eating fried food.
- Avoid sugar and highly refined starches.
- Drink plenty of good water.
- Recognize estrogen dominance and correct it.
- Make sure you have adequate progesterone (saliva test is best for this).
- Aim for 20-24 grams of fiber a day. Fiber supplements can help.
- Do not be afraid to consume olive oil and good omega-3 fatty acids such as fish.
- Keep your liver healthy.
- If you’ve had any attack of pancreatitis, you must avoid all alcohol.
- Do not over-eat.
- Avoid rapid weight-loss diets.
- Chew your food well. Take time to eat in a leisurely fashion, setting aside anger and stress.
Some High Fiber Foods
wheat and oat bran
whole grain breads
whole grain cereals
For more detailed information about how to balance hormones and avoid estrogen dominance, please read Dr. John Lee's bestselling book, What Your Doctor May Not Tell You about Menopause.
This article was originally published in the John R. Lee, M.D. Medical Letter. Although the Medical Letter is no longer published, you'll find many articles from it on this website.
Note to Reader from Virginia Hopkins
Dr. John Lee was my great friend, mentor, co-author and business partner. This website is dedicated to continuing the work that Dr. Lee and I did together to educate and inform women and men about natural hormones, hormone balance and achieving optimal health. Dr. John Lee was a courageous pioneer who changed the face of medicine by introducing the concepts of natural progesterone, estrogen dominance and hormone balance to a large audience of women and men seeking answers to their hormone questions. Dr. Lee has left us a wonderful collection of writings from his newsletters that are, in large part, freely shared on this website. Enjoy!