According to a study in the Journal of American Medicine (JAMA), out of the 700,000 gallbladder-removal surgeries each year, more than 10% are still left with pain in the area that once was the gallbladder. (1)
The current treatment involves inspecting the common bile and pancreatic ducts for a small stone, or a surgical procedure that cuts the sphincter muscle in order to relax the sphincter enough to allow the bile to flow. The risks of pancreatitis from this procedure are high and, according to the new JAMA study, the surgery is not a viable option. (1)
Logically, removing a bile or pancreatic duct stone or relaxing the sphincter muscle makes sense, but these procedures have not proven to be very effective, and many folks end up with chronic post-surgical gallbladder pain – even when there isn’t a gallbladder.
In this article, I want to explore some other possibilities that could cause lingering digestive problems after a gallbladder removal. Those of which are very often the same reasons behind indigestion in folks that do have a gallbladder.
The number of gallbladder surgeries is rising each year, leading some to suggest that perhaps we don’t need a gallbladder. I probably get more questions about how to navigate around a cholecystectomy (gallbladder removal) than any other condition, and the good news is that we can safely navigate around this. I do not think it means that we have somehow evolved away from needing a gallbladder.
No Gallbladder Does Not Mean No Bile
The gallbladder does not produce bile, it just stores it in a super 15-20x concentrated form. (2) Without a gallbladder, the liver simply makes bile on demand when you ingest a fatty meal. So as long as you are not eating the brains and fatty intestines of a Woolly Mammoth, you will likely be OK without a gallbladder.
The concentrated nature of the bile stored in the gallbladder sheds light on how the gallbladder evolved. While anthropologists agree our ancestors did not have meat for breakfast, lunch and dinner, when they did catch a rabbit, they ate all of it. The fatty parts, like the brains, eye balls and intestines spoil quickly, so that was eaten first and all at once. So, in times of feasting on the innards of a freshly killed animal, we needed a source of unmitigated bile. Such a bile surge would require some time for the bile to be replenished, suggesting that these fatty feasts were not a daily occurrence.
Few people in this day and age ingest enough fat in one sitting to demand a Paleo dose of bile. Today, meals tend to be more balanced with proteins, fats and starches that allow the liver to make the needed on-demand bile to emulsify dietary fats – after gallbladder surgery.
What is the Real Cause of Gallbladder Pain?
The gallbladder and the liver get the signal to secrete bile into the small intestine from the stomach and the lining, or what I like to call the skin of the intestinal tract. If either of these feedback loops are disturbed, the bile flow from either the gallbladder or liver can be disturbed.
For folks without a gallbladder, this kind of disturbance can cause either too much or too little bile in the small intestine at any given time. The gallbladder is not only a storage site of bile, but a regulator of its flow. When the gallbladder is removed, the liver makes the bile as needed. If the signals from the stomach or small intestine are out of balance, a host of digestive symptoms can ensue.
The same exact symptoms can arise if you have a gallbladder that is getting disturbed signals from the stomach or small intestine. So, in most cases, the therapies are the same for both, with the caveat that provoking bile flow with large amounts fats in folks without a gallbladder is not advised. A more kind and gentle approach is used.
I have numerous free articles and videos that discuss the importance of the integrity of the intestinal skin, and the critical nature of the digestive coordination between the acid production in the stomach, the production of the pancreatic and duodenal digestive enzymes, the bile flow from the liver and gallbladder and the microbes that weave it all together. This, in great detail, is the topic of my book, Eat Wheat, A Scientific and Clinically Proven Approach To Safely Re-introducing Wheat and Dairy Back Into Your Diet.
Low Cholesterol Diets Linked to Indigestion and a Blood Sugar Epidemic
The other primary reason for gallbladder concerns and lingering indigestion after a gallbladder removal is the American diet. In 1961, the FDA put cholesterol on the nutrient concern list and, in short order, fats became highly processed and indigestible. Fat was a major source of energy for the body and without good fats, the demand and cravings for sugar soared.
The result of more than 60 years of a low cholesterol, highly processed fatty and sugary diet is the blood sugar epidemic we face today. The first response in the regulation of healthy blood sugar is more related to liver function than pancreatic function. Metformin, the pre-diabetic drug, blocks the production of sugar in the liver and has no effect on the pancreas.
A low quality, highly processed fatty diet will gunk up the bile ducts, causing thick and viscous bile that cannot flow easily through the very small bile ducts. When these ducts become congested, bile will build up in both the liver and gallbladder. The result is a host of digestive symptoms related to a congested gallbladder or the inability for the liver to produce an adequate amount of bile. The latter is a critical cause of indigestion and pain after gallbladder removal.
Simply taking the gallbladder out does not fix the underlying problem of thick, viscous bile, congested liver function and bile ducts. For most folks, getting the gallbladder removed takes away the log jam of bile flow, but if the digestive problems persist after surgery, the problem is likely in the liver.
Common Symptoms Related to Gallbladder Concerns:
- Gas and Bloating
- Occasional Heartburn
- Occasional Constipation
- Looser stools
- Gray Stools
- Yellow Stools
- Blood sugar concerns
- Stomach discomfort
- Abdominal discomfort
- Chest discomfort
- Breathing concerns
Top 10 Ways to Improve Bile Flow and Bile Production
Perhaps the most well-studied herb for the increased production and delivery of bile is turmeric. In one study, just 40mg of the extract of turmeric increased the contraction of the gallbladder by 50%. (3)
Note: Turmeric is high in oxalic acid which, in excess, can precipitate as gallstones. If you are sensitive to oxalate, you may want to avoid turmeric, although the science is not totally clear here. In one study, curcumin was found to significantly reduce oxalic acid levels when study participants were fed a high oxalate, gallstone-promoting diet. (4)
2. Fish Oils
Fish oils were evaluated in a controlled study on their ability to reduce oxalic acid levels in the urine. Supplementation with (EPA) eicosapentaenoic acid and (DHA) docosahexaenoic acid was compared with a standardized control diet. The fish oils significantly lowered oxalic acid levels in the blood. (5,6)
Eat one red beet per day. Beets have natural nitrates that open up bile ducts and increase bile flow. Studies suggest that beets can increase the liver production of detox enzymes like glutathione and decongest an ischemic liver. (7)
- Hot Sips: Sip 2-3 sips of plain tea hot water every 15-20 minutes throughout the day for two weeks.
- Drink half your ideal body weight in ounces of purified room temperature water each day.
Eat 1-2 apples a day. Apples are high in malic acid, which naturally opens bile ducts and allows bile to flow. Apples are also shown to increase the elimination of bile acids into the toilet, more effectively detoxifying the body and forcing the liver to manufacture new bile. (8)
Soluble fiber attaches to toxic bile and takes it to the toilet, forcing the liver to manufacture fresh bile. Eat more:
- Slippery elm, marshmallow root and licorice
- Roughage like leafy greens
- Root veggies
- Apple pectin and celery contain insoluble fiber, which sweeps the intestines of toxins. (8)
Lemons reduce uric acid levels and increase bile flow. Try to consume the juice of 1 lemon per day. (9)
8. Lemon Juice + Olive Oil
Take 1-2 tsp of lemon juice and 1-2 tbsp of extra-virgin organic small farm olive oil together before bed for a month.
Adding 1-2 tsp of ghee in the diet per day is a great way encourage bile flow, better intestinal health and gallbladder contraction. When doing one of our LifeSpa kitchari cleanses, start with just 2 tsp of ghee each day and only increase the dose if the previous dose was comfortable. This is for those without a gallbladder or those who are having gallbladder issues. Ghee has been shown in numerous studies to support an effective detox of the liver. (10)
10. Protect the Intestinal Skin
Colonizing probiotics are also an important component of protecting the intestinal skin and sending balancing signals to the liver and gallbladder to produce and deliver bile.