5 min|Integrative

The Gallbladder: An Unsung Hero of Detox & Metabolism

Wellness, Health

The gallbladder is often disregarded, and rarely discussed. In one of the most common surgeries, it is even removed. However, the gallbladder performs many functions essential for great health.

Many of the benefits of gallbladder activity is due to a single digestive fluid: bile.

Bile is made in the liver, and stored in the gallbladder. The gallbladder is a small, pear-shaped organ, located on the right upper side of the abdomen under the ribcage, alongside the liver. Bile consists of bile salts, cholesterol, bilirubin, and water. With healthy bile, and a healthy gallbladder, bile flows easily into the gut, whenever we need it.

Why is Bile Important?

1. Bile breaks down the fats you eat, including fatty acids essential for the health of our cell membranes, brain and nervous system, hair and skin, hormonal system, and clotting cascades, just to name a few!

2. Bile aids in the digestion of fat soluble vitamins such as A, D, E, K

3. Bile flow supports detoxification - toxins processed by the liver are moved into the intestines within bile, where they can then be removed from the body via a bowel movement

4. Microbial management: bile with high levels of bile salts released into the gut can impact bacterial colonization, supporting the growth of Gram-positive bacteria, and reduction of pathogens (1)

5. Bile salts regulate appetite and metabolism-regulating hormones (2)

6. Hormones, such as estrogens, prolactin, and insulin, and hormone metabolites can be cleared from the body via bile

It’s no wonder - with all of these essential functions - that gallbladder dysfunction, and the dysfunctional bile flow that results, can create so many, widespread issues.

When Biles Goes Bad

Unfortunately, bile can become thick, sludgy, and congested. In this state, it doesn’t flow freely into the intestines; instead, it stays in the gallbladder, or, when it does move, it is sluggish, and possibly painful. Bile can also thicken to the point of developing stones, known as gallstones; (3) when the gallbladder tries to move bile out, a stone can become lodged, creating severe pain.

Without adequate healthy bile flow, you cannot digest fats and fat soluble nutrients, and are at risk for significant nutritional deficiencies. These deficiencies can manifest as many health concerns, such as dry skin and hair, low mood, weakened immune system, vision problems, easy bruising, and blood clotting issues.

Biliary sludge can also create many digestive symptoms, such as abdominal pain, nausea, vomiting, floating stools, constipation, and gastroesophageal reflux. Gallbladder inflammation, due to sludge or stones, can manifest as right-upper abdominal pain, and may lead to back pain. This inflammation can also irritate the phrenic nerve, a nerve closely associated with the gallbladder that stretches through the chest, shoulder, and neck; irritation within this nerve can lead to chest or rib pain, right shoulder pain, right sided neck pain, and headaches. (4)

Lack of healthy bile flow can predispose to gut infections, due to the microbiome modulating effects of bile. It is possible that gallbladder dysfunction, and inadequate bile flow, is at the root of multiple infections, including small intestinal bacterial overgrowth (SIBO).

Another sign of deficient bile is hypothyroidism; normally, bile triggers the release of an enzyme that converts T4 (the less active thyroid hormone) to T3 (the more active thyroid hormone), helping to fuel the metabolism. (5) Without adequate bile flow, this conversion is impaired.

Complete blockage of the duct that releases bile can cause severe upper abdominal pain, particularly after meals, and is considered a medical emergency. Once biliary sludge or stones creates a blockage, removal of the gallbladder may be the only treatment option. Once the gallbladder is removed, the liver can continue to synthesize bile, but flow of bile can become erratic and irregular without the important carrying capacity of the gallbladder.

Causes of Dysfunctional Bile

Bile flow can be negatively impacted due to many factors, including:

Rapid weight loss, as it can predispose to gallstones
Eating less often can reduce the frequency of bile flow, and may predispose to biliary sludge and gallstones
Dehydration - bile is 95% water; even mild dehydration can lead to thicker bile, or biliary sludge
Alcohol abuse
Excess estrogen (from pregnancy, birth control, or hormone replacement therapy) can increase cholesterol in bile and decrease gallbladder contraction, predisposing to sludge and stones
Low intake of nutrients required for bile synthesis, such as lecithin, taurine, choline, and glycine
Unhealthy dietary choices, such as a high intake of refined grains, sugar, soft drinks, processed meats, and high glycemic foods (6, 7)
Certain medications, such as somatostatin analogues, certain hypolipidemic medication, ceftriaxone, erythromycin, and ampicillin (8, 9)
Aflatoxin, a mold toxin, may damage the gallbladder and may lead to an increased risk of gallbladder cancer (10)
Stress suppresses bile release, as energy and blood flow is diverted away from the digestive system