Most everyone looks forward to a bit of indulgence when holiday meals roll around. Yet for a percentage of the population, discomfort hits about 20 minutes into dinner, and they end up seeing a gastroenterologist within days.
It’s a trend Dr. Daniel Davila, gastrointestinal surgeon at Northwestern University Feinberg School of Medicine, sees every year starting after Thanksgiving.
“Usually this is related to gallstone disease which is not uncommon, particularly in the American population. Gallstone disease is often precipitated by fatty meal exposure,” he told The Epoch Times. “Especially after Thanksgiving, it’s not uncommon for us to see patients coming in to see us because the Thanksgiving meal, which often is fatty, has precipitated either new or worsening symptoms related to gallstones.”
Gallstones— made of cholesterol or bilirubin—can be as small as a grain of sand or as large as a golf ball. The gallbladder may make one or hundreds of them in various sizes and types; they are more common in developed countries. Those more at risk of gallstones include women who have extra estrogen, older adults, and those with a family history. Its symptoms are similar to ulcers, appendicitis, pancreatitis, and gastroesophageal reflux disease.
A small sac-like organ in the upper right quadrant of the abdomen, the gallbladder stores bile. Bile is essential for breaking down fats into fatty acids in the digestion process.
Bile—composed mostly of cholesterol, bile salts, and bilirubin—is actually made by the liver. It’s held in the gallbladder until the body signals to empty into bile ducts leading to the duodenum, the entry to the small intestine.
“Certain cells in the small bowel detect a fatty meal, send a hormone to the gallbladder to secrete more bile,” Dr. Davila explained. “Sometimes the stones are there, and it causes them to become symptomatic and painful for patients.”
That could include getting lodged in bile ducts causing a gallbladder attack that can result in an inflamed gallbladder, as well as damage to the organ, bile ducts or liver. Stones can also cause bile to back up ducts and spill into the adjacent organs such as the pancreas, causing swelling and redness.
Oftentimes gallbladder attacks will last about three to seven hours once the pain first begins, Dr. Davila explained. When pain recedes, that usually means the stones dislodged themselves.
“For people whose pain persists and lasts for seven hours…those stones may not be clearing and they may need to go to the emergency room to be evaluated,” he said. “It really can happen to anyone. Oftentimes they don’t even know they have gallstones.”
About 25 million people in the U.S. have gallstones, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It affects up to 15% of the population. About 1 million people are diagnosed with gallstones annually, with about 25% being treated, typically with surgery.
“The urgent fix to get out of pain is to remove the gallbladder,” said Loredana Shapson, pharmacist, health coach, and functional nutritional therapy practitioner. “There’s a lot of pain. If you think about how small those ducts are that are passing bile, if it’s really sludgy and thick and full of stones. When you’re talking about stones, you’re talking about sharp crystal-like objects. They’ll end up tearing at the tissue.”
Living Without A Gallbladder
Because you can live without a gallbladder, cholecystectomy—surgery common for problematic gallstones—is not considered a risk to overall health and quality of life. Your liver still produces the necessary bile. But it may not make enough to aid in digestion of large or fat-heavy meals.
Cholecystectomy is generally safe, though all surgeries carry risks from anaesthesia and injury to nearby organs. Other risks include leaking bile, bleeding, infection, blood clots, and pneumonia, according to Mayo Clinic. Without a gallbladder, bowel movements can either become loose or inconsistent.
“You don’t get that burst [of bile] at meal time and can’t make enough to store. You can’t eat certain foods because it upsets the stomach,” Ms. Shapson said. “Then it becomes a food restriction thing. When you don’t have a gallbladder, you’ll most likely suffer from constipation.”
Also, surgery does not solve the problem of gallbladder attacks, called choledocholithiasis. Stones can still get stuck in the ducts and cause symptoms, according to the Icahn School of Medicine at Mt. Sinai.
Severe cases can involve nausea and vomiting, fever, chills, jaundice, tea-coloured urine, and pale stools. The precise process of bile transforming into stones is not fully understood.
Newer research is challenging the knee-jerk reaction of removing gallbladders due to pain and stones. A study published in The Lancet in 2019 concluded that certain patient groups do not benefit from gallbladder removal.
Over three years, 1,067 patients were analysed: 537 were given “usual care” and 530 were assigned to a “restrictive strategy” that reserved surgery. Patients were followed for a year, and 56% were pain-free in the restrictive group, compared to 60% in usual care. Additionally, the restrictive group had 358 cholecystectomies, compared to 404 in the usual care group.
“We have to conclude that the restrictive approach does not solve the problem. Nor does the gall bladder removal, because a year after the procedure about forty percent still have symptoms. There was a need for new research asking which patient, with which type of symptoms, benefits most from gallbladder surgery,” said Dr. Philip de Reuver, a surgeon at the Radboudumc University Medical Centre and a lead author on the study, in a statement.
The researchers believed those patients who wouldn’t benefit from surgery could be identified in advance. They completed a follow-up study and developed an app to help patients and surgeons make better assessments.
Surgery isn’t the only treatment for stones, but ursodiol, the medicine used to break them up, can take months or years of treatment. Lithotripsy, using shock waves to break gallstones into smaller pieces, is rarely used—usually in conjunction with ursodiol.
Ms. Shapson also helps patients who want to avoid having their gallbladder removed with various supplements and lifestyle changes.
“You can save every gallbladder, even if it’s sludgy and full of stones and really backed up,” Ms. Shapson said. “People can get ahead of it when they start to feel discomfort in that lower right rib cage area. If you start soon enough, you can catch it before you’re in that place of excruciating pain.”
The key, she said, is thinning out bile by:
- Drinking warm water with lemon in the morning to stimulate the digestive system.
- Taking digestive enzymes.
- Consuming bitters, such as arugula, before each meal.
- Eating beets, which are associated with better bile flow.
- Drinking adequate water.
- Eating quality fat.
“Avoid seed oils and use avocado, coconut, olive, sesame and macadamia nut oils, and grass-fed organic animal fats,” Ms. Shapson said. “Even if your gallbladder is struggling, you want to eat fat. That’s what’s going to trigger that [bile] release so if there is sludge and that sort of thing going on, it’s going to push it through.”
Weight Is A Factor, Too
The National Institute of Health also recommends eating fewer refined carbohydrates and less sugar and eating more foods high in fibre. It’s also important to lose weight in a way that’s healthy. Obesity is associated with gallbladder disease.
“Whether it’s related to diet or not, it’s hard to say. What’s interesting especially in the world of these new diet medications, is we found that even weight loss is also associated with an increased likelihood of gallstones,” Dr. Davila said. “We’ve definitely seen that in that population in the past who either lost weight intentionally quickly or had surgery and lost weight.”
That connection could be hormonal or related to changes in metabolism, he said. Being healthy in general is protective, as well as lowering stress—which can turn off mechanisms associated with digestive problems. Unfortunately, once gallstone pain begins, there’s nothing that can alleviate it except time.
“Try to stay healthy with all meals, not just thanksgiving. Whether you have gallstones or not, especially during Thanksgiving when the meals tend to be a little fattier, take your time,” said Dr. Davila.
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