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When we think of the digestive tract, the gallbladder is often an afterthought compared to the big heroes like the stomach and intestines. But, without the gallbladder, the entire process of digestion can change, as can how we experience digestion. The signs and symptoms can be pretty obvious (and unpleasant) when something is off with the gallbladder. And sometimes, gallbladder issues can become quite painful. Gallstones cause over one million Emergency Room visits annually, and gallbladder removal surgery is one of the most common procedures performed today. So, it pays to understand what can be behind gallbladder problems and how you can best support this digestive organ's health.
The gallbladder is a small but important organ that helps facilitate digestion. Its role is to store bile until the stomach sends hormones indicating that bile is needed to help break down certain foods. Bile is a liquid substance made by the liver that helps break down fat during digestion. Bile has a greenish color and is comprised of cholesterol, phospholipids, water, and bile salts.
When the stomach signals that food has entered the digestive tract, the gallbladder releases bile down the common bile duct, emptying into the duodenum or the first part of the small intestine.
Sometimes, gallstones (or cholelithiasis) can form in the bile duct from cholesterol and other substances in the bile. Gallstones are hardened deposits (or stones) that can be as small as a piece of sand to as large as a golf ball. You can have just one stone or many, and some pass without any symptoms, whereas others can cause excruciating pain.
Gallstones can form for various reasons, but we don't fully understand the mechanism behind the formation of these stones. Some stones are caused by too much cholesterol or bilirubin. Other times, stones appear because the gallbladder does not empty correctly.
Certain factors increase a person's risk for gallbladder problems, including:
- Being female
- Being over age 40
- Being overweight or obese
- Lack of exercise
- Eating a high fat, high cholesterol diet
- Not getting enough fiber
- Having diabetes
- Rapid weight loss
- Being Hispanic or Native American
- A history of liver disease
- Taking certain medications, such as those containing estrogen
Many people have gallstones and don't have any symptoms, but some people can experience tremendous pain when a stone blocks the bile path. This pain is often described as feeling sharp and almost knife-like under the right ribcage or in the center of the abdomen. Because of its location and the severity of the pain, many people mistake it for a heart attack.
Typically, the pain from gallstones (also referred to as a gallbladder attack) lasts for several hours and is more severe after eating. The timing makes sense because the stomach sends hormones trying to get bile to empty at mealtimes.
Other symptoms can accompany the expected pain of gallstones, including fevers, chills, nausea, and vomiting. Gallstones can also lead to color changes in certain body systems and processes, including:
- Brownish urine
- Light-colored or clay-colored stool
- Yellow-tinged skin and whites of the eyes
Any of these symptoms, coupled with sharp pain, fevers, chills, and vomiting, all require immediate medical care.
For some time, we have known there is a relationship between hypothyroidism and cholelithiasis. Research has confirmed this relationship. For example, in a 2018 study, subjects with Hashimoto's thyroiditis (an autoimmune condition that can cause hypothyroidism) were at an increased risk for gallstones and gallbladder removal.
There are many theories as to why the thyroid may affect gallbladder function. Firstly, some sources suggest that thyroid hormones may affect bile composition, thus interfering with its natural ability to flow without blockage. A decrease in T4 (thyroxine) may hinder cholesterol metabolism in the liver, causing bile to thicken. Recall that cholesterol is one of the main components of gallstones.
Decreased bile flow can also slow down the wavelike contractions that help move food through the digestive tract (called peristalsis). Thus, constipation can become more of a problem, which is also a symptom of hypothyroidism.
What is more, bile is necessary for fat digestion and absorption. There are many essential fat-soluble vitamins we need, including vitamins A, E, D, and K. Vitamin deficiency, such as low vitamin D, may be more likely in people with Hashimoto's, which could be related to fat malabsorption from an underactive thyroid.
Based on the risk factors above, you will see that there are certain risk factors that you cannot change. However, there are plenty of risk factors that you may be able to change with lifestyle adjustments. One of the best things you can do to improve your gallbladder (and overall) health is to follow a healthy diet that includes good sources of protein, healthy fats, and nutrient-dense vegetables and fruits. We know that a high-fat diet is a significant contributor to gallstones, so minimizing processed, unhealthy fats is a good first step.
Simultaneously, being sedentary, and to that extent being overweight and obese, increase your risk. Regular exercise and increasing your daily movement can help improve your weight profile. Even opting to carry your groceries, walk the dog, or sweep the sidewalk can all increase your non-exercise activity thermogenesis (NEAT) to support a healthy weight and metabolism.
Finally, because gallstones are positively correlated with hypothyroidism, it is important to check your thyroid hormone levels regularly. Thyroid disease can appear at any point in a person's life, but it is more common in women, people over age 50, and those with a family history of thyroid disease.
Testing your thyroid is easy with the Paloma at-home thyroid test kit, and follow-up with a doctor specializing in hypothyroidism and Hashimoto's is at the tip of your fingers. Treating thyroid disease can help improve numerous other symptoms and ward off other health conditions, including gallstones.
Although diet and lifestyle can have a significant impact in preventing certain conditions, it is important to always being in tune with your body. By understanding what your body needs or how it feels can make the difference in finding a conditions early enough for treatment which can lead to greater health and overall emotional and life satisfaction. Talk to your provider today if you feel you are experiencing any of the symptoms above.