Stone-Free Gallbladder Disease Commonly Misdiagnosed

Cathy, a 62-year-old California housewife, complained endlessly about her digestive symptoms — she was nauseous, had gas, bloating and frequent pain in the upper right side and middle of her abdomen. Much to her embarrassment, Cathy also found herself burping a great deal. Her discomfort prompted her to see a gastroenterologist who ordered blood work, abdominal scans and ultrasounds of her gallbladder and liver. The tests showed no abnormalities so the doctor sent her on her way. However, the tests were wrong… Cathy did have gallbladder disease.

Gallbladder problems are extremely common, affecting more than 20 million Americans each year. The classic description of a gallbladder patient is “4F”: fertile, fat, female and forty — it sounds sexist for sure, but it’s true that twice as many women as men develop gallstones, and patients are often overweight, and middle-aged or older.

As for Cathy, she ended up in the office of naturopathic physician Mark Stengler, ND, who specializes in natural approaches to treating illness. Dr. Stengler says that Cathy’s belching was an immediate indication that she was suffering some kind of digestive imbalance — and the fact that she was overweight, plus her description of symptoms and her lifestyle, made him think that she probably did have a gallbladder problem. The only part of Cathy’s story that didn’t fit neatly into the profile was that unlike nearly all other gallbladder disease patients, she didn’t have digestive distress after eating fatty foods. But when Cathy mentioned that she’d taken synthetic hormone replacement therapy (HRT) for several years, it heightened his suspicion. Studies have linked HRT with an increased risk of gallstones.

A COMMON PROBLEM

The gallbladder, which sits adjacent to the liver, acts as a storage unit for the bile made by the liver, which gets sent out to help digest fatty foods. Bile emulsifies fat, helps with the absorption of fat-soluble vitamins and helps the gastrointestinal tract reabsorb cholesterol. However in people who eat an excessively fatty diet or who have gastrointestinal issues, including irritable bowel syndrome or gastritis, and especially in those who often use proton pump inhibitors, the bile can concentrate and thicken. The bile duct or gallbladder may then become inflamed and painful. An ultrasound revealed that while she didn’t have gallstones that this was indeed what triggered Cathy’s digestive difficulties — and, Dr. Stengler told me, thickened, sludgy bile is not uncommon.

Given that Cathy had just had extensive testing, Dr. Stengler decided to start her immediately on therapeutic treatment to see how she would respond. Dr. Stengler told her to eliminate fried foods and reduce her intake of sweets, which would take off weight. He also prescribed a whey meal replacement protein powder that she drank for breakfast as a simple way to reduce calories and replace carbs with protein. To improve her digestion, Dr. Stengler gave Cathy a supplement of bile acids — similar to those produced by the gallbladder — to take with each meal, in order to support what the gallbladder was unable to do at that moment. Finally, he gave her the homeopathic remedy Cinchona officinalis (China), advised for people prone to belching because of gallbladder problems.

THE RESULTS

Cathy carefully followed Dr. Stengler’s treatment plan and she improved quickly. In just one month, she described her symptoms as mostly better and her belching was now “very occasional.” Eighteen months later, Cathy’s gallbladder issues are nearly gone. She continues to watch her diet carefully, both to protect her gallbladder and to keep her weight in line. Dr. Stengler told Cathy she could discontinue taking the bile acid supplement.

Dr. Stengler says he is disturbed that doctors, such as the one Cathy had seen, don’t pay much attention to symptoms that point to sub-optimal functioning gallbladders — although the usual tests do not show sluggish bile flow, having symptoms of poor digestion make it a strong possibility even in the face of negative test results, especially for people who have risk factors. These include being overweight, having a diet of fatty foods and processed foods, and, for women, having high estrogen levels (such as in pregnancy). High stress levels can also cause gallbladder problems, as can rapid weight loss.

As seen by Cathy’s experience, gallbladder disease responds well to natural treatment. It is important to consider possible food allergies and sensitivities, which some experts believe cause inflammation and swelling of the bile duct. Trigger foods are most often eggs, pork and onions, as well as chicken and turkey, citrus fruits and juices, milk, coffee, corn, beans and nuts.  A high-fiber diet is most helpful for promoting  gallbladder health, says Dr. Stengler, and indeed vegetarians are known to be at lower risk for developing gallstones, which underscores the importance of eating plenty of fruits, vegetables, whole grains and oat bran. In addition, certain foods are known to improve bile flow. These include beets, fresh artichokes, organic dandelion greens and olive oil. Flaxseeds help reduce inflammation in the gallbladder and are easy to add to the diet in juices, salads or by using flaxseed oil in salad dressing.