The gallbladder is an essential part of the biliary tract that plays a crucial role in digesting and absorbing fats. It is a small pear-shaped organ just beneath your liver on the right side of the abdomen that stores bile produced by the liver and secretes it in response to ingestion of fats to allow dietary fats, fat-soluble vitamins A, D, E, and K, and cholesterol to be more readily absorbed by the body. Bile is mostly made up of water with a small percentage of bile acids, cholesterol, phospholipids, bilirubin, inorganic salts, and trace minerals.
Gallstones are formed when these normally soluble components of bile become supersaturated and precipitate. Gallstones can range in size from very tiny to as large as a golf ball and can occur once or throughout life. Though symptoms can vary and come and go, gallstones can cause pain usually located in the upper right side of the abdomen, along with potential yellowing of the skin, nausea, vomiting, and radiation of pain through the back.
A functional medicine approach to gallstones uncovers and addresses root causes like inflammation, gut permeability, obesity, and dietary factors that make the formation of gallstones more likely.
Symptoms of Gallstones?
About 20 to 25 million Americans are affected by gallstones overall, with females more frequently impacted. Despite how commonly they occur, most people with gallstones do not experience severe symptoms or can remain asymptomatic.
When symptoms occur, they most commonly include abdominal pain in the upper mid- or right side of the abdomen that comes in waves. This pain is often described as gripping or gnawing and can radiate to the back or right shoulder blade and last several minutes to a few hours.
Symptoms most commonly occur if a gallstone lodges in a bile duct and causes a blockage, leading to:
- Sudden and rapidly intensifying pain in the upper right part or center of the abdomen
- Pain radiating between the shoulder blades and into the right shoulder
- Nausea or vomiting
With long-standing gallstones, inflammation of the gallbladder (cholecystitis) may occur. Acute cholecystitis is caused when bile becomes trapped in the gallbladder, usually by a gallstone, leading to irritation, inflammation, and pressure. Left untreated, it can lead to infection and perforation with fevers, chills, nausea, vomiting, yellowing of the skin (jaundice), and light clay-colored stools.
What Causes Gallstone?
The biliary tract includes the liver, gallbladder, and bile ducts, which work together to make, store, and secrete bile. The liver produces bile which then travels to the gallbladder for storage via the common bile duct. Once you eat fat and it enters the small intestine, the hormone cholecystokinin is released, which signals the gallbladder to contract and release bile into the small intestine. There, bile helps to emulsify fats to make them more easily broken down and absorbed and assists with the absorption of fat-soluble vitamins A, D, E, and K and cholesterol.
Types of Gallstones
Cholesterol stones account for around 80% of gallstones. They contain mainly cholesterol (70%), bile salts, pigments, and inorganic calcium salts. Cholesterol stones are caused by the excess secretion of cholesterol relative to bile acids and phosphatidylcholine into the bile, which causes it to contain more cholesterol than the bile salts can break down. If the liver excretes more cholesterol into the bile than can be dissolved, excess cholesterol can crystallize and form stones in the gallbladder. This is due to how the liver functions and related factors and is not correlated to the amount of cholesterol in the blood.
Black pigment stones are less common and are made up of calcium bilirubinate in the bile (a type of bilirubin) that occurs in certain disorders where red blood cells are abnormally broken down in the body (hemolytic disorders).
Brown pigment stones usually occur due to bacterial or helminthic (parasite) infection within the biliary tree.
Overall, Gallstones are More Common In:
- People over 40
- Those who are overweight or obese
- Those who eat a diet high in processed fats and sugars and low in fiber
- People with a family history of gallstones or gallbladder disease
Conditions That Make Gallstones More Likely to Develop
- Bone marrow or solid organ transplants
- Liver disease
- Inflammatory bowel disease and cystic fibrosis
- Biliary tract infections (pigmented stones)
- Medical conditions that cause too many red blood cells to be destroyed (pigmented stones)
- Rapid weight loss
- Medications that contain estrogens like oral contraceptives or hormone therapies
- Receiving nutrition through a vein for an extended period (intravenous feedings)
Gluten and other irritating substances can impair the integrity of the gut wall and the blood-biliary barrier. When the gut lining becomes compromised and leaky, it creates inflammation within the intestinal tract and throughout the body. This inflammation can impair critical transport systems of bile and allow microbes that generally stay in the gut to leak into the bloodstream, where they can provoke the immune system and contribute to gallbladder disease.
This gut-biliary connection goes both ways, with leaky gut and intestinal permeability provoking inflammation in the biliary system and a lack of proper bile flow into the gut, contributing to an imbalanced gut microbiome.
SIBO and Imbalanced Microbiome
Due to this two-way connection, gallbladder disease results in reduced bile flow into the gut, causing an increase in the risk of small intestinal bacterial overgrowth (SIBO) and bacterial, fungal, and parasitic infections of the gut. Conversely, mixed-type SIBO also increases inflammation, making gallstones more likely to form.
The risk of gallbladder disease, including gallstones, increases with a diet high in refined carbohydrates, processed vegetable oils, and other additives and low in fiber.
Imbalanced methylation impairs detoxification and can cause the bile to thicken up, making it less effective at breaking down fats and forming gallstones.
In general, increased biliary cholesterol secretion occurs with increasing age due to changes in cholesterol processing and decreased biliary salt excretion.
Estrogen stimulates the liver to uptake and synthesizes greater amounts of cholesterol which can overburden the gallbladder and create a sludge that eventually forms gallstones. Therefore gallstones are more common in females than males, and the risk of gallstones increases when taking certain hormone replacement medications.
Similarly, being overweight or obese can stimulate the liver to secrete higher amounts of cholesterol and contribute to the risk of gallstones. On the other hand, rapid weight loss, weight cycling, and prolonged fat-restricted diets can also raise the risk of gallstones since the gallbladder is not being regularly stimulated to release bile, and stasis occurs, allowing stones to form.
Having higher levels of serum triglycerides also increases this risk.
Functional Medicine Labs to Test for Root Cause of Gallstones
Liver and gallbladder function can be assessed through several blood markers to look for signs of impaired gallbladder function.
Liver function tests measure liver enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), proteins, and bilirubin (a substance in bile) in the blood, which may show elevations with liver or gallbladder disease.
Unaddressed food sensitivities, a highly-processed diet, and other factors contribute to a leaky gut barrier that allows food and other substances to enter the bloodstream, where they provoke an inflammation that taxes the liver and inflames the gallbladder. A Comprehensive Stool Test measures gut bacteria, inflammatory markers, leaky gut, and pathogens to assess the state of the gut and guide treatment aimed at restoring balance.
Small intestinal bacterial overgrowth (SIBO)
Since SIBO can contribute to the formation of gallstones and sluggish bile flow makes SIBO and other forms of dysbiosis more likely to occur, a breath test can evaluate the overgrowth of bacteria that do not usually belong in the small intestine.
The 3-hour SIBO assessment is a non-invasive breath test that measures hydrogen and methane to evaluate bacterial overgrowth in the small intestine.
Blood Sugar, Triglycerides, and Metabolism Markers
Since diabetes, metabolic dysfunction, and obesity often increase the risk of gallstones, an evaluation of metabolic health can help to uncover underlying issues contributing to risk. NutraEval FMV provides insights into cellular health, toxin exposure, and how the body handles oxidative stress.
Several tests assess how the body handles sugars. These can identify insulin resistance when sugars remain in the blood, causing inflammation and damage to blood vessels, which leads to heart disease, type 2 diabetes, and gallstones.
- fasting glucose
- hemoglobin A1c measures the average blood sugar level over the previous six weeks
- fasting Insulin
- C-peptide, a marker that the body is producing Insulin
A lipid profile including total cholesterol, HDL (“good” cholesterol), LDL (“bad” cholesterol), and triglycerides can help assess the balance of fats in the blood. At the same time, lipoprotein(a), LDL particle number, and ApoB-containing lipoproteins (ApoB) can provide a more specific risk assessment.
Bile is one way that the liver gets rid of toxins from the bloodstream and secretes them into the bowels for excretion out of the body. Balanced methylation is required for detoxifying toxins like chemicals, estrogens, and heavy metals that are secreted into the bile and can contribute to thickening. Different variations of MTHFR genes seem to be associated with the risk of more sluggish bile flow, gallstones, and the impact of detoxification function in the body.
Other Lab Tests to Check
The most common test for visualizing gallstones is an abdominal ultrasound that uses sound waves to image the structure of the gallbladder and look for stones or obstructions. Alternative tests may include:
- Oral cholecystography or percutaneous transhepatic cholangiogram (PTCA), x-ray visualization of the gallbladder
- A hepatobiliary iminodiacetic acid (HIDA) scan where a radioactive tracer is injected into the bloodstream and taken up by bile-producing cells to allow the biliary tract to be looked at with a scanner
- Computerized tomography (CT)
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP), a procedure using x-ray imaging and an endoscopic tube to allow for the removal of stones as well
Conventional Treatment for Gallstones
In most cases, gallstones are managed by controlling pain and other symptoms and aiming to prevent further stone formation. If complications like inflammation and infection occur, conventional treatment may involve:
- Medications like oral bile acids (ursodeoxycholic acid/Ursodiol) to help prevent the formation of and dissolve gallstones over months or years
- Extracorporeal shock wave lithotripsy (ESWL) is an outpatient procedure that uses high-energy sound waves to produce shock waves that fracture and disintegrate gallstones
- Surgery to remove the gallbladder (cholecystectomy)
Natural Treatments for Gallstones and Gallstone Prevention
Diet and Nutrition
Overall, an anti-inflammatory diet emphasizing whole natural foods and minimizing processed foods, refined carbohydrates, fried foods, trans fats, and common food allergens like gluten help reduce inflammation, heal a leaky gut and gallbladder, and prevent gallstones.
A gluten-free diet has been shown to help restore normal gallbladder emptying in those with celiac disease. Eating regular meals and avoiding prolonged fasting or rapid weight loss can also help prevent gallstones.
An adequate intake of dietary fiber helps to prevent and reverse gallstones by increasing the solubility of bile salts and facilitating the excretion of cholesterol from the body, so it does not overwhelm the bile and form stones. Dietary sources of both soluble and insoluble fiber, including oat bran, psyllium, chia, flaxseeds, and a variety of fruits and vegetables or soluble fiber supplements like psyllium and pectin increase the solubility of bile salts and facilitate excretion of cholesterol in the bile. This should be personalized to individual needs and may need to be adjusted until the gut is healed and any underlying SIBO is resolved.
Since bile is made up of mostly water, it is also important to stay well-hydrated to keep bile flowing well by consuming enough water for your needs.
Certain supplements can help increase the solubility, emulsification, and excretion of cholesterol to prevent gallbladder stasis and the formation of gallstones. These include lecithin/phosphatidylcholine, choline, methionine, and glycine.
Other supplements can help stimulate bile production to keep it flowing and prevent stones. These include Vitamin C and Vitamin E.
Bitter herbs also stimulate the gallbladder and are known as cholagogues or choleretics. These include globe artichoke, milk thistle, dandelion root, ginger, greater celandine, barberry, yellow dock, turmeric, gentian, goldenseal, and agrimony. Some common bitter foods include radicchio, chicory, arugula, lemon, grapefruit, lime, and cranberries. When the bitter taste stimulates receptors on your tongue, it sends messages via the vagus nerve to the brain and gastrointestinal tract, which prepare the gallbladder and pancreas to release bile and Insulin for proper handling of food.
Other herbal remedies are sometimes used to help dissolve gallstones, such as d-limonene, gravel root, hydrangea, crataeva, and peppermint oil (enteric-coated).
In particular, d-limonene found in lemon essential oil has been shown to reduce and even entirely dissolve gallstones effectively. Overall, it can help improve cholesterol levels and insulin sensitivity and reduce the accumulation of fat in the liver, which can help balance overall inflammation and heal the gut.
All of these should be assessed under the qualified guidance of a practitioner to determine an individualized protocol. For example, increasing bile flow may be harmful when bile ducts are already obstructed.
Although not well studied in the literature, castor oil packs involve placing a cloth soaked in castor oil on the abdomen with gentle heat and have traditionally been used to help improve the flow of bile and prevent gallstones.
Acupuncture has also been utilized for alleviating back pain and nausea while regulating the volume of the gallbladder.
The gallbladder is part of the biliary tract that makes, stores, and secretes bile to help digest and absorb fats. Gallstones occur when the make-up of the bile inside of the gallbladder becomes imbalanced due to liver issues, cholesterol imbalances, inflammation, gut microbiome overgrowth, or other problems.
Gallstones are common and can cause intermittent colicky abdominal pain radiating to the shoulder, nausea, vomiting, and yellowing of the skin. Risk factors include being female, over 40, overweight, consuming a diet high in processed foods and inflammatory fats, and having underlying issues like liver disease, metabolic imbalances, or a leaky gut.
A functional medicine approach to gallstones looks at these underlying factors and works to correct imbalances in inflammation, gut health, and methylation to restore balance. An anti-inflammatory diet and supplements that can improve bile flow and break up gallstones like bitters, dandelion, lemon oil, and phosphatidylcholine can help reduce inflammation and prevent gallstone formation.