No Gallbladder, But You Still Have Gall!

Cholecystitis is inflammation of the gallbladder and may present with symptoms such as right upper abdominal pain with or without pain that can radiate or move to the right shoulder blade and cause nausea, vomiting and fever. This inflammation of the gallbladder is often caused by gallstones and may lead to gallbladder removal, a surgery called cholecystectomy. This condition affects more females than males due to higher levels of circulating estrogen.

How do you get diagnosed?

It’s likely if you’re experiencing acute cholecystitis, you’re headed to the emergency department to be evaluated. There are a couple lab tests that are helpful – CRP, or C-Reactive Protein, an inflammatory marker, and a CBC, or complete blood count, to check on white blood cells. An ultrasound of the upper right abdomen will also be performed to look for a blockage of the biliary ducts, the ducts that connect the gallbladder to the rest of the digestive tract.

Allopathic Treatment

The treatment for acute gallbladder issues is a cholecystectomy to remove the gallbladder. But then what? Most patients are only to be told to avoid high fat meals as the best guidance moving forward. I frequently see patients that feel much worse after this procedure.

Root Causes

While gallstones can block the bile duct, the question becomes HOW did the body get to the point of stone formation? The most common type of gallstones are cholesterol stones. Cholesterol is the backbone structure of hormones, including estrogen, and women have higher levels of circulating estrogen, which is a risk factor for developing gallbladder issues. Oral contraceptives and hormone replacement with oral estrogen also contribute to increased incidence of acute cholecystitis.

Blood sugar issues or insulin resistance also plays a role. Insulin resistance is when the body is producing plenty of insulin, but the body is not responding properly. A person may or may not have diagnosable type two diabetes mellitus by conventional measures such as hemoglobin A1c (HbA1c) and fasting glucose.

In naturopathic medicine, we look at the body as making the best choice it can by creating those stones. Before stone formation, there was biliary sludge, or thickened bile. Both blood sugar issues and estrogen play a role in development of thickened bile (gall).

Other contributing factors including a diet high in trans-fats and sphincter of Oddi dysfunction. While trans-fats have been removed as additives in most ultra-processed foods, trans-fats via deep frying foods still occurs. The sphincter of Oddi is the doorway that dumps bile and pancreatic enzymes into the first part of the small intestine, the duodenum. Dysfunction here also leads to thickened bile because bile can’t be released appropriately into the duodenum.

Naturopathic Treatments

In naturopathic medicine, we treat the whole person; treatment plans may vary depending on the patient’s presentation. Dr. Powell approaches patients that no longer have a gallbladder by improving bile flow to ensure proper fat digestion, stabilizing blood sugar, improving estrogen detoxification and nutritional guidance.

By supporting the liver, which is where bile is produced, to improve bile flow allows for better fat digestion. Often folks without a gallbladder are told to eat a low-fat diet, this is rarely enough to improve bile flow. Botanical medicine is powerful here, and may include herbs such as fringe tree, milk thistle, artichoke or burdock root. Supplementation with stomach acid may be necessary too.

Blood sugar dysfunction will be treated by supporting the liver, changing the order of how a person eats, and stress management. Estrogen detoxification occurs in the liver and by default of supporting proper bile flow, excess estrogen, also known as unopposed estrogen, will leave the body without impacting medications.

Our digestive process is a series of elegant steps that rely on the process before to ensure the appropriate secretion of digestive juices. If you want to learn more about this process, consider checking out Dr. Powell’s YouTube channel @ShaynaLKellerND, specifically watching the episode is called “What Makes a Gut Healthy?”

If you have been dealing with gallbladder issues, whether you have had surgery or not, consider reaching out to Dr. Powell (formerly Dr. Keller) for a free 15-minute consultation to determine if we are a good fit.

References

Almajid, A.N. (2022) Physiology, bile, StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK542254/ (Accessed: 01 January 2025).

Hundt, M., Basit, H., & John, S. (2022, September 29). Physiology, Bile Secretion. Europe PMC. https://europepmc.org/article/NBK/nbk470209#__NBK470209_dtls__

Lewis, T. (n.d.). Gallbladder disease increasing and trending younger. Brattleboro Memorial Hospital iCal. https://www.bmhvt.org/gallbladder-disease-increasing-and-trending-younger-2/