In cases of biliary stasis, detoxification can be problematic for the client and the therapist, so improving biliary flow should be a consideration. Biliary tract disease is on the increase with cholangiocarcinoma occurring in 65% of cases with recurring symptoms from gallstones in the over-65s. Patients who fall into the “fair, fat, forty and fertile” category are also at increased risk. Alteration of serum lipid profiles, history of contraceptive use, pregnancy, rapid weight loss, organ transplantation and total parenteral nutrition also increase risk.(1) Even in children it is becoming recognised.(2) Aberrant fat metabolism has been linked to a number of autoimmune and inflammatory conditions, from Crohn’s disease (3) through to neurological conditions and mitochondrial disease. The clinical course of biliary sludge can wax and wane, progress to gallstones and cancers or even resolve, so here we are with a mechanism we can tap into and use to really make a difference. It is true that a cholecystectomy is sometimes necessary and unavoidable, but the risk of colonic adenoma then increases (4), as it does with gallstones.
The role of the gall bladder and bile acids
It is outside the scope of this article to review the role of bile acids in its entirety, so I will direct the reader to a Mike Ash paper that does this well.(5) For our purposes, we need to know that bile acts as a detoxifying surfactant. (6) There is evidence to suggest that it has antimicrobial qualities (7) that may prevent and treat viral infections such as herpes and parvovirus, also sepsis. In addition, bile improves gut motility. All told it is very important to ensure patency of the biliary tree for effective detoxification.
How will we achieve patency and adequate flow of bile?
Western medicine advocates a low-fat diet for those with gallbladder stasis. While this may alleviate symptoms in the short term, reducing fats per se only serves to prevent stimulation of the gallbladder to contract. This in turn may exacerbate the sluggishness, increasing the risk of gallstones. So how can the practitioner help? A 2013 study in the European
Journal of Nutrition compared ten different food ingredients and their effects on gall bladder emptying.(8) Researchers used the cholecystokinin dose response to these foods and found that 20ml of emulsified fat produced the largest gall bladder volume change, which correlated with increased plasma CCK levels. Curcumin is also noted for its ability to stimulate bile flow.(9)
Now it’s one thing to stimulate bile flow, but if there are small stones present that could be dangerous, as stones can become lodged in the biliary tree, necessitating cholecystectomy. In addition, swelling of the gallbladder and/ or stomach in response to stimulation may induce panic attacks as a result of hiatal hernia syndrome/vagus nerve imbalance as depicted by Steven Rochlitz.(10) So it is really important to thin the bile for one to three months before any gallbladder stimulation.
Taurine (11), beets, phospholipids, peppermint, lemon, apple and vitamin C have all been shown to dissolve stones or reduce their impact.(12) Once a programme to address a reduction in bile consistency has commenced, stimulating the gallbladder safely either with the use of a liver/gallbladder flush or intravenous lipid replacement therapy can make a major difference when used appropriately.
Even if the patient has undergone cholecystectomy, this doesn’t necessarily mean the problem of stones has resolved. The patient still makes the stones if the underlying pathology has not been addressed. Sadly these may still cause a problem.
Having a handle on some aspects of Chinese medicine enabled me to work effectively with a patient of mine. Aged 62, she presented with a long history: a previous cancer and a multitude of other health issues, seemingly unrelated (frozen shoulder, right side migraine, IBS, hypercholesterolaemia, skin rashes, incessant tiredness, panic attacks). The radiotherapy she underwent was successful in eradicating her cancer, however it did seriously reduce her thyroid function. When she came to me she was following a vegan diet to reduce cholesterol. Over the course of the next few months it became apparent that most of her health issues were occurring along the gallbladder meridian, despite having undergone the cholecystectomy three years previously. Armed with all the information on risks and imponderables she was keen to try the gallbladder flush. Her first flush produced stone excretion for a total of four days and her second flush gave her relief from all these seemingly unrelated symptoms and improved her liver enzymes.
It was a tough call to make with this lady, and I won’t say I wasn’t a little panicked myself until I heard from her again. So if I’ve given you food for thought, err on the side of caution and use a far less dramatic approach.
- Pazzi P et al. Biliary sludge: the sluggish gallbladder. Dig Liver Dis 2003, 35 Suppl 3:S39-45.
- Svensson J and Makin E. Gallstone disease in children. Semin Pediatr Surg. 2012, 21 (3): 255-65.
- Geerling BJ et al. Fat intake and fatty acid profile in plasma phospholipids and adipose tissue in patients with Crohn’s disease, compared with controls. Am J Gastroenterol 1999, 94 (2): 410-7.
- Elick GD et al. Gallstones are associated with colonic adenoma: a meta-analysis. World J Surg 2012, 36 (9): 2202-9.
- Ash M. Bile acids make you live longer. In Bile acids – ‘A new understanding’. White Paper Researched Leadership 2008, Bile Acids set available at www.nleducation.co.uk
- Shangchao Lin and Daniel Blankschtein. Role of the bile salt surfactant sodium cholate in enhancing the aqueous dispersion stability of single- walled carbon nanotubes: a molecular dynamics simulation study. J Phys Chem 2010, B 114 (47), 15616-25.
- Bajor A et al. Bile acids: short and long term effects in the intestine. Scan J Gastroenterol 2010, 45, 645–64.
- Marciani L et al. Effects of various food ingredients on gall bladder emptying. Euro J Clin Nutr 2013, 67, 1182-7.
- Yang C et al. Advances in clinical study of curcumin. Curr Pharm Des. 2013, 19 (11): 1966-73.
- Patricia Kane, PhD: personal communication, October 2013.
- Guertin F et al.Effect of taurine on total parenteral nutrition-associated cholestasis. J Parenter Enteral Nutr 1991,15 (3): 247-51.
- Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Alter Med Rev 2009, 14 → (3): 258-67