Keep Your Gallbladder Healthy

The gallbladder is a small pear-shaped organ that sits just below the liver. It is attached to the liver and the duodenum (the first part of the small intestine) through tubes, called ducts.

The gallbladder functions as a reservoir for bile, a thick yellow-green fluid made by the liver. The liver makes about 3 to 5 cups of bile everyday, to help digest fat. The bile is stored in the gallbladder between meals, and released into the small intestine when you eat a meal that contains fat.

Gallbladder removal

Surgical removal of the gallbladder is one of the most common surgical procedures performed throughout the world. In 2014–15, there were about 50,000 people who had their gallbladder removed in Australia (220 per 100,000 population).

The medical term for this surgery is cholecystectomy, and it is commonly performed laparoscopically (keyhole surgery).

Why might I need a cholecystectomy?

You may need to have your gallbladder removed if you have painful Gallstones. These are small stones that can form in the gallbladder. They are made mostly of cholesterol (80%) with calcium salts and bilirubin compounds (bile pigment) making up the other 20%.

Gallstones are very common, but in most people they do not cause symptoms and thus no treatment is required. They are more common in people over the age of 50, and in people who are overweight or have diabetes or Crohn’s disease. Women are twice as likely to develop gallstones than men, especially if they are overweight, pregnant or on hormone replacement therapy or birth control pills, due to excess oestrogen.

Occasionally, gallstones grow bigger. Once they reach a certain size, they become lodged in the bile ducts and block the flow of bile. This can lead to complications such as inflammation of the gallbladder or the pancreas, jaundice and infection, and cause sudden and intense pain in the upper right portion or the centre of the abdomen, pain between the shoulder blades, nausea, and vomiting.

Removal of the gallbladder is highly effective in resolving all the symptoms in the majority of patients. However, 10-15% of patients continue to have symptoms after the removal of their gallbladder. These can range from mild gastrointestinal symptoms such as diarrhoea, nausea, bloating and gas to other symptoms including pain and jaundice. 

Cholecystectomy is considered a very safe procedure, but like any type of surgery, it is not without a risk. According to the American College of Surgeons, possible risks include bile leak, bile duct injury, bleeding, infection, fever, liver injury, hernia at the incision site, anaesthesia complications, puncture of the intestines and death.

Life without a gallbladder

Once removed, the bile is not regulated anymore by the gallbladder and flows directly and continuously from the liver to the small intestine. You can live perfectly well without your gallbladder as your liver continues to produce bile.

Nevertheless, the gallbladder plays an important part in fat digestion. Its removal, and the subsequent increased rate of bile acid, can lead to inadequate digestion of fats, resulting in diarrhoea, reflux, Non Alcoholic Fatty Liver Disease, and metabolic syndrome, which is the name given to a cluster of conditions - increased blood pressure, high blood sugar, excess abdominal fat, and high cholesterol or triglyceride levels - that increase your risk of heart disease, stroke and diabetes. Additionally, as a result of the changes in digestion, the composition of your gut bacteria can change. Finally, even without a gallbladder, gallstones may recur in the bile duct.

Maintaining a healthy lifestyle can prevent gallstone formation, reduce complications following cholecystectomy and minimise symptoms. The following tips should be adopted even if you had your gallbladder removed.

What can I do to keep my gallbladder healthy?

Maintain an ideal body weight. People who carry excess weight, especially around the abdomen, have a higher incidence of gallstones and gallbladder cancer compared with individuals with normal weight.  

Lose weight slowly. Rapid weight loss causes the liver to secrete extra cholesterol into bile, which increases the risk of stone formation.

Eat more fibre. A diet high in fibre has been shown to reduce the risk of gallstones. Fibre is only found in foods that come from plants. Eat more plant-base foods such as fruit and vegetables, legumes (beans, lentils and chickpeas), nuts, and whole grains (brown rice, oats, barley, millet, quinoa, buckwheat, etc.). Increase the amount of fibre you eat gradually to avoid gastrointestinal symptoms.

Choose the right fats. High-fat foods, especially saturated fats, have been shown to contribute to the formation of gallstones. Reduce your saturated fats intake (lamb, pork, fatty beef, processed meats, chicken with skin, dairy products, many baked goods and fried foods) and replace with healthy fats from fish, nuts, seeds, avocadoes, and olive oil.

Lower your sugar intake. Similar to high-fat diets, foods high in sugars and carbohydrates (such as cake, sweets, biscuits, white bread, ice-cream, and sugar-sweetened drinks) increase your chances of developing gallstones.

Spice it up. Studies in animals found that including turmeric, chilli, fenugreek, garlic and onions in the diet can prevent formation of gallstones and may also shrink existing gallstones. These spices contain active compounds that are known for their ability to lower cholesterol and triglycerides and have been shown to prevent cholesterol gallstones.

Avoid prolonged fasting. Fasting causes the bile to become over concentrated with cholesterol, leading to gallstones. Eat smaller, more-frequent meals.

Exercise. Exercising 2 to 3 hours a week reduces the risk of gallstones.

Vitamin C. If you are at risk of developing gallstones, 500-2,000 mg per day of vitamin C supplement has been shown to reduce formation of gallstones.

References

1. Altomare, D.F., Rotelli, M.T. & Palasciano, N., Diet After Cholecystectomy. Available at: http://lifewithnogallbladder.com/wp-content/uploads/2017/11/Diet-after-cholecistectomy.pdf
2. American College of Surgeons 2015, Cholecystectomy - Surgical removal of the Gallbladder, Available at: https://www.facs.org/~/media/files/education/patient ed/cholesys.ashx
3. Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare. The Second Australian Atlas of Healthcare Variation: Laparoscopic cholecystectomy hospitalisations. Sydney: ACSQHC; 2017. Available at: https://safetyandquality.gov.au/wp-content/uploads/2017/06/4.4-Laparoscopic-cholecystectomy.pdf
4. Camilleri, M., Malhi, H. & Acosta, A., 2017. Gastrointestinal Complications of Obesity. Gastroenterology, 152(7), pp.1656–1670. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28192107
5. Gaby, A.R., 2009. Nutritional Approaches to Prevention and Treatment of Gallstones. Alternative Medicine Review, 14(3). Available at: http://www.altmedrev.com/publications/14/3/258.pdf
6. Li, L. et al., 2016. Overweight, obesity and the risk of gallbladder and extrahepatic bile duct cancers: A meta-analysis of observational studies. Obesity, 24(8), pp.1786–1802. Available at: http://doi.wiley.com/10.1002/oby.21505
7. Jensen, S. W, 2017. Postcholecystectomy Syndrome. Available at: https://emedicine.medscape.com/article/192761-overview
8. Mayo Clinic, 2017. Gallstones - Symptoms and causes -. Available at: https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214
9. Digestive Health Foundation, 2010. information about Gallstones, Available at:http://cart.gesa.org.au/membes/files/Consumer%20Information/Gallstones.pdf