Gallbladder disease

The gallbladder is a sac located under the liver. It stores and concentrates bile produced in the liver. Bile aids in the digestion of fats, and is released from the gallbladder into the upper small intestine (duodenum) in response to food, especially fats.

Types of gallbladder disease include:

• Cholecystitis (inflammation of the gallbladder)
• Cholelithiasis (gallstones)

You can have gallstones without any symptoms. However, if the stones are large, they can block the duct that leads from the gallbladder. This can cause pain and require treatment. At first they may block the duct and move away, causing only occasional pain. Continuous blockage of the duct, however, can be life threatening and requires surgical removal of the gallbladder.

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Signs and Symptoms

• Pain, mostly on the upper right side of the abdomen
• Pain following meals, intolerance of fatty foods
• Nausea and vomiting
• Loss of appetite

What Causes It?

A gallbladder attack usually happens because a stone is blocking a passageway in the gallbladder. Gallstones develop in the gallbladder when substances in bile form hard particles. They can be as small as a grain of sand or as large as a golf ball. Women are at higher risk of developing gallstones than men, and the risk increases the more children a woman has had.

Pregnancy is also a risk for gallstone formation. The increased risk associated with having children can be offset by breastfeeding. Women who use hormone replacement therapy are also at higher risk of developing gallstones. Being overweight and rapid weight loss followed by weight gain are other risk factors for gallstones. Having coronary artery disease is also associated with gallbladder disease.

What to Expect at Your Doctor's Office

If you are having a gallbladder attack, you will feel tenderness when the upper right side of your abdomen is touched. Jaundice (yellowing of the skin) occurs when the bile duct (a tube between the liver and gallbladder) is also blocked. If your doctor thinks you have a gallstone, you will probably need an ultrasound. During an ultrasound, sound waves take pictures of your gallbladder. This test is fast and painless.

Treatment Options

Doctors typically remove gallbladders that cause pain. There are no known problems caused by living without a gallbladder. Today, most gallbladder surgeries are performed with a laparoscope. This instrument shows the surgeon pictures of your gallbladder as it is being removed. The minimally invasive procedure allows for a smaller incision and a shorter hospital stay than traditional surgery.

Some drugs can dissolve stones, eliminating the need for surgery. They include:

• An oral bile acid, ursodeoxycholic acid (Ursodiol), can dissolve cholesterol stones that are quite small (less than 15 mm in diameter). The drug is successful in about 40% of patients.
• Methyl tert-butyl ether and monooctanoin (Moctanin) are solvents that are infused directly into the bile duct or the gallbladder to dissolve stones.
• Doctors may use shock wave therapy (lithotripsy) to break up stones.

However, it can take 2 years for a stone to dissolve, and gallstones often return.

Complementary and Alternative Therapies

Gallstones should always be treated by a doctor. If you would like to add complementary remedies to your treatment, see your doctor for tests before you start any therapies. This will help determine the remedies that are right for the size of your stone and your condition. DO NOT attempt complementary and alternative therapies (CAM) on your own. Work with an experienced provider. Keep all of your physicians informed regarding CAM, as some therapies may interfere with conventional medical treatments. Work with a provider who is knowledgeable in complementary medicine to find the right mix of treatments for you. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives and chemical food additives. Eggs, especially, may irritate the gallbladder. Your doctor may test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Eat more fiber. Consider fiber supplements, such as flaxmeal. Combine 1 heaping tsp. of flaxmeal in 8 oz. of apple juice for a drink high in fiber and pectin.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol, and tobacco. Some evidence suggests that people who drink caffeinated coffee have a lower risk of gallstones, though study results are mixed. Talk to your doctor before increasing your caffeine intake, as caffeine can affect several conditions and interact with medications.
• If possible, exercise lightly 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Vitamin C, as an antioxidant and for immune support.
• Phosphatidylcholine, may help dissolve gallstones. May interfere with some medications, including anticholinergic medications used in the treatment of Alzheimer disease and glaucoma, among others. Talk to your doctor.
• Alpha-lipoic acid, for antioxidant support. It is possible that alpha-lipoic acid could interact with some chemotherapy agents.
• Magnesium, for nutrient support. Magnesium can potentially react with a variety of medications, including some antibiotics, blood pressure medicines, diuretics, muscle relaxers, and others. Large doses of magnesium may result in dangerously low blood pressure and slow breathing. People with kidney disease may have problems clearing magnesium from their body.
• Taurine, for nutrient support. Taurine can potentially interact with lithium. People with a history of bipolar disorder should take taurine with extreme care.
• Vitamin D, for immune support. Preliminary studies suggest a link between vitamin D deficiency and gallstones.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting any treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted. If you are pregnant or nursing, speak to your doctor before using any herbal products.

A gallbladder attack can be a medical emergency. DO NOT use herbs to treat gallbladder disease on your own. Work with a trained herbal practitioner under the supervision of your doctors. The following herbs are sometimes used to treat gallbladder disease:

• Green tea (Camelia sinensis). For antioxidant effects. You may also prepare teas from the leaf of this herb. Note: green tea extracts may contain caffeine. Look for decaffeinated products.
• Milk thistle (Silybum marianum). For liver and gallbladder detoxification support. Patients with allergies to ragweed or a history of hormone-sensitive cancers should take milk thistle with caution.
• Globe artichoke (Cynara scolymus). For support of gallbladder and liver function. Due to its ability to increase bile production, globe artichoke could trigger a gallbladder attack if there is bile duct obstruction. Talk to your doctor.
• Turmeric (Curcuma longa) standardized extract. For support of liver function. High doses of turmeric can have blood thinning effects. Care should be taken if you are on other blood-thinning medications.

Homeopathy

Few clinical studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for gallbladder disease based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Some of the most common remedies are listed below. A common dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms improve.

• Colocynthis. For colicky abdominal pains that are lessened by pressure or bending double.
• Chelidonium. For abdominal pain that moves to the right shoulder area.
• Lycopodium. For abdominal pain that is worse with deep breaths.

Physical Medicine

Castor oil pack. Apply oil to a clean, soft cloth and place on abdomen. Cover with plastic wrap, place a heat source (hot water bottle or heating pad) over the pack, and let sit for 30 to 60 minutes. For best results, use for 3 consecutive days. Apply to abdomen, especially the gallbladder area, to help reduce swelling.

Acupuncture

Acupuncture may be especially helpful in pain relief, reducing spasm, easing bile flow, and restoring proper liver and gallbladder function.

Following Up

Early surgery usually ends symptoms and recurrence. Stones may appear again in the bile duct, however.

Special Considerations

If you have diabetes or are pregnant, you have a higher risk of complications from gallbladder attacks. If you are pregnant, use choleretic (bile-stimulating) herbs with caution. Milk thistle and dandelion root are safe in pregnancy. Talk with your health care provider before you take any medication or supplement.

Supporting Research

Allan PL, Baxter GM, Weston MJ, eds. Clinical Ultrasound. 3rd ed. St. Louis, MO: Elsevier Churchill Livingstone; 2011.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Etminan M. Oral contraceptives and the risk of gallbladder disease: a comparative safety study. CMAJ. 2011:183(8):899-904.

Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Altern Med Rev. 2009:14(3):258-67.

Jeong SU, Lee SK. Obesity and gallbladder diseases. Korean J Gastroenterol. 2012;59(1):27-34.

Jiang ZY, Sheng X, Xu CY, et al. Gallbladder gallstone disease is associated with newly diagnosed coronary artery atherosclerotic disease: a cross-sectional study. PLoS One. 2013;8(9):e75400.

Ko, CW. Prefac: Gallbladder disease. Gastroenterol Clin North Am. 2010;39(2):xiii.

Liu B, Beral V, Balkwill A. Childbearing, breastfeeding, other reproductive factors and the subsequent risk of hospitalization for gallbladder disease. Int J Epidemiol. 2009;38(1):312-8.

Liu B, Beral V, Balkwill A, et al. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: a prospective cohort study. BMJ. 2008;337:a386.

Marx J, Hockberger R, Walls R, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia PA: Elsevier Saunders; 2014.

Rai A, Tewari M, Mohapatra SC, et al. Correlation of nutritional parameters of gallbladder cancer patients. J Surg Oncol. 2006;93(8):705-8.

Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96.

Tsai CJ, Leitzmann MF, Willett WC, et al. Long-Term Effect of Magnesium Consumption on the Risk of Symptomatic Gallstone Disease Among Men. Am J Gastroenterol. 2007; [Epub ahead of print].

Venneman NG, van Erpecum KJ. Gallstone disease: Primary and secondary prevention. Best Pract Res Clin Gastroenterol. 2006;20(6):1063-73.

Völzke H, Baumeister SE, Alte D, et al. Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion. 2005;71(2):97-105.

Walcher T, Haenle MM, Mason RA, et al. The effect of alcohol, tobacco and caffeine consumption and vegetarian diet on gallstone prevalence. Eur J Gastroenterol Hepatol. 2010;22(11):1345-51.

Wang F. Oral contraceptives and risk of gallbladder disease. CMAJ. 2011:183(13):1517.

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Review Date: 4/1/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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