Your gallbladder and why it’s important

Yesterday I had a video coaching session with one of my patrons, and the last thing we talked about was the gall bladder. They recently had an ultrasound done to check out the insides of the abdomen—obviously to make sure everything looks good. The kidneys looked good, the liver had a small benign lump of 1–2 mm  in size (angioma sounds so much more serious), and the gall bladder had a bunch of little stones. I asked what the doctor recommended.

“There’s nothing to worry about. Let’s check again in half a year.” That was it. Nothing more. So, they asked me if there was anything that could be done to help in some way.

What do you think? Is there not always something that can be done to help—to help the body cleanse itself, repair itself, heal itself, improve its physiological and metabolic functions?

We’ll take the time to study and explore the liver and its functions in greater detail later—the liver is a lot more complex. The gall bladder is quite simple, and so, I just wanted to share with you what I explained yesterday, and at the same time, take the opportunity to expand a little on that.

First the Anatomy

Looking at the abdomen from the bottom of the sternum (the bone between the pectorals) to below the hips, after having removed the skin and layers of muscle, cut out the front part of the ribs, and changed the appearance to make it cartoon-like, without any blood, veins, arteries, or nerves, and thus not so shocking to look at, we would see something like this:

abdomen-front-labels

Digestive system: front view with labels

The large, dark red organ that is the liver sits at the very top of the abdomen with its largest lobe located on the right side of the body. On the left, below the liver’s smaller left lobe, is the stomach that curves back towards the middle where it connects to the small intestine (duodenum). The gallbladder—the small dark green pouch—is nestled between the bottom of the liver’s right lobe and the first part of the duodenum. Below the stomach, sweeping across the abdomen from one side of the body to the other is the transverse part of the large intestine (colon). The entire lower portion of the abdomen is filled with the longest segment of the intestines.

If we zoom in on the upper abdomen,

upper-abdomen-front-nolabels

Upper digestive system: close up front view

and then hide the liver,

upper-abdomen-front-noLiver-nolabels

Upper digestive system: close up front view without liver to show bile ducts

we see all of the little green ducts embedded into the liver whose function it is carry the bile from the different parts of the organ to the main bile duct and gallbladder.

Taking a look at the same part of the abdomen from the back,

upper-abdomen-back-top-labels

Upper digestive system: close up back view with labels

we see how the gallbladder sits between the liver and duodenum, and how the main bile duct sweeps down behind the pancreas to connect to the main pancreatic duct such that the bile from the liver and gallbladder can be injected into the small intestine together with the enzymes, insulin, glucagon, and bicarbonate from the pancreas. We also see from this side the dark red, bean shaped, right and left kidneys, and the yellow adrenal glands sitting on top of them.

And then the physiology

Why do we need bile and what does it do? Why is there a gallbladder? And what is bile anyway?

Bile is 97% water, 0.7% bile salts (sodium and potassium), 0.5% cholesterol, fatty acids, and lecithin, 0.2% bilirubin, and a tiny bit of inorganic salts. In human adults the liver produces 400–800 ml of bile per day (Wikipedia).

The liver produces bile continuously but slowly. When we eat, depending on how much fat there is in the meal, the digestive system may need quite a bit of bile to handle the fat that was just ingested. Hence the need for storage and thus the function of the gallbladder.

The purpose of bile is to emulsify fat. Emulsifying means making into tiny droplets that can mix into another liquid to form a smooth homogeneous solution. For example, a bit of mustard works very well to emulsify the oil and vinegar that would otherwise not mix into a smooth creamy vinaigrette. After emulsification, fat droplets are typically 15–30 microns in size.

We need bile to emulsify the fats that we eat so that the pancreatic enzyme lipase can then break these triglycerides down into monoglycerides and free fatty acids. This is done in the small intestine where the bile and enzymes are secreted from the pancreas with the bicarbonate solution. This in turn allows the fat to be transported through the intestinal wall before being reassembled into triglycerides and absorbed into the lymphatic system. Without bile, fat could not be absorbed. It would go straight through the gut and be excreted undigested.

Why would stones form in the gallbladder? Is there a way to prevent the formation of gallstones? And what actually are these gallstones?

Gallstones are basically little hard lumps of cholesterol. One of the functions of the gallbladder is to concentrate the bile which comes in quite diluted, as we saw earlier, being 97% water. But when the concentration grows too high, then cholesterol precipitates out and forms little lumps. These are what we call gallstones.

Given that we know that stones form out of precipitated cholesterol when the concentration of the bile is too high in the gallbladder, it is simply logical that if the concentration can be kept low enough, below the threshold at which cholesterol will precipitate, then no stones would form. But why does the concentration of bile grow to the point of precipitation?

Let’s ask another question: what happens if we don’t eat much fat? The liver produces bile continuously, between 400 and 800 ml per day. This bile is stored into the gallbladder until it is needed after a meal in which fat was ingested. If we don’t eat much fat in a meal, then, naturally, not much bile will be needed, and most of the available bile will therefore remain in the gallbladder. Because the liver continues to produce it, the gallbladder needs to make room for it, and thus concentrate its contents further.

So, what happens if we never eat very much fat, and if actually, every meal is a relatively low fat meal? Well, what happens in a pool of water if the water does not flow out, and is by this not renewed by fresh water? Stagnation. In the case of the pool of water, we all know what happens: it grows dirty, then thick, then greenish, then totally filled with lumpy green gelatinous stuff. In the case of the gallbladder, we can imagine that something analogous takes place, and that the lumps of cholesterol are like the lumps of green gelatinous stuff in the water.

The solution is simple: eat plenty of fat on a regular basis. This way, the gallbladder can empty itself out regularly, and the bile does not stagnate, grow more concentrated, and eventually lumpy with gallstones.

Your gallbladder and why it’s important

Here’s what we learned:

The gallbladder sits between the right lobe of the liver and the first part of the small intestine. It stores and concentrates bile which is mostly water with small amounts of salts, bilirubin, lecithin, and cholesterol. The liver produces bile continuously in the amount of 400 to 800 ml per day.

The function of bile is to emulsify the fat we eat to make it absorbable. Without bile, fat just go through and gets excreted undigested. The same is therefore true for all fat-soluble minerals and vitamins, including some of the most important of them all, the crucial vitamins A, D, E, and K2.

If we don’t eat fat, there’s no need for bile. If we don’t eat much fat for a long time, the bile will get more and more concentrated. Eventually, the concentration will be high enough for cholesterol to precipitate out of the bile and form little lumps. These lumps of cholesterol are called gallstones.

Imagine that this continues for years and even decades, following a good “heart-healthy” low-fat diet. What do you think will eventually happen based on what we’ve just discussed? More stagnation, more highly concentrated bile, more gallstones, and then at one point, this whole thing explodes into acute infection, acute inflammation, excruciating pain, and emergency surgery to remove the infected gallbladder.

And then what? I’ll you finish this exercise in deductive reasoning which you now have all the necessary background to complete.

 

Become a proud sponsor of healthfully! Join our patrons today!

Why every undigested protein is an allergen

We come out of our mother’s womb, and we are very soon thereafter given a bottle to suckle on. In the bottle there’s a powdered ‘infant formula’ mixed with water, or milk, or both. “The most commonly used infant formulas contain purified cow’s milk whey and casein as a protein source, a blend of vegetable oils as a fat source, lactose as a carbohydrate source, a vitamin-mineral mix, and other ingredients depending on the manufacturer” (source: Wikipedia). The water is municipal tap water with residues of agricultural and industrial chemicals, of prescription drugs of various kinds, fluoride that suppresses the immune system and makes the bones and teeth brittle, and chlorine that kills the bacteria and destroys the flora of the gut. The milk is most likely UHT, which stands for ultra high temperature pasteurised, cow’s milk from cows that have never set food outside, have never eaten a blade of grass, have only ever eaten soy, oats, and corn, and have their whole lives received antibiotics preventatively to lower the probability infection due to the fact that they are sick and immunosuppressed from the living conditions they are subjected to. How’s that for a start?

We start teething and we are given ‘teething cookies’ to nibble on. Cookies, like Gerber’s classic arrowroot cookie, made wheat and arrowroot flours, dairy proteins and solids, vegetable oils, sugars, and other stuff like stabilisers, preservatives, texture and flavour enhancers, and some added vitamins and minerals, of course.

We don’t need to have teeth to have ice cream. In fact, parents are encouraged to give cold things like ice cream teething infants to soothe their gums aching from the teeth pushing through them. And we love it, of course! We’re still far from being able to speak, but we eagerly await the next spoonful, which, if delayed too long, makes us impatient, and soon angry enough to cry out and let our parents know we want more.

Naturally, we never make a fuss when we are fed apple sauce, or pear sauce, or pureed bananas, peaches, or apricots, nor when we are are given mixes like banana-strawberry, or strawberry-kiwi, or even apple-carrot-parsnips. We also like sweet potatoes, squash, and even regular mashed potatoes with our pureed meals. But the green things like mashed pees or broccoli, that we like less—quite a lot less.

We always start the day with orange juice. In fact, this is so much a part of our upbringing that we can’t even imagine a morning with having orange juice. And as soon as we can chew, our breakfast is made of those delicious, sweet and crunchy cereals served in a big bowl of milk. This is another part of our upbringing that is so much a part of us that we  often consider it a normal part of life, and can’t imagine a life with it.

We snack on cookies, on muffins, on granola bars, and particularly like the chocolate covered ones. We snack on chips, crunchy and salty—on Doritos, Pringles, and all sorts of different kinds of chips—and we love them too. We love our regular home pasta dinners, our pizza dinners, our hot dogs, our burgers, our fries. When we’re hungry in the afternoon, we make ourselves those delicious peanut butter and raspberry jam sandwiches on ultra moist slices of white bread, and they’re so good we have a hard time to stop eating them one after another. And what about our Nutella, that amazing chocolate spread we can never have enough of? We really could eat the whole jar if we didn’t force ourselves to stop. It’s so delicious we even eat it by the spoonful when we don’t feel like having bread with it. And they tell us it’s good for us, that’s a good source of nutritious milk and hazelnuts. Wow! How great!

We get sick pretty often as school children, but not more than anyone else, about ten times a year or so. Our parents seem to get colds less often than we do, only about 4 or five times per year. Sometimes it’s worse than others, and we are given antibiotics. We take them because our parents give them to us. And they give them to us because our family doctor tells them to. We get loose stools for a while, and we don’t understand why. After some time, things kind of get back to normal.

We go on like this for years. Actually, usually for at least two or three decades. Everything we do destroys our gut flora. All the foods, the chemicals, the drugs, destroy the essential health-promoting bacteria and the balance between the different varieties that are meant to populate the gut, and at the same time promote the overgrowth of specific kinds of pathogenic bacteria and yeasts that take over our gut.

All the foods we eat are loaded with lectins that damage the lining of our gut, making it thinner, less functional, less protective, and more vulnerable to further damage. This damaged gut with its damaged lining and damaged glycocalyx becomes leaky. Not only do we not digest food properly, not only do we not absorb nutrients properly, not only do we not excrete wastes properly, but all sorts of stuff starts leaking from our gut into our blood. And possibly the worst thing that can happen is to have a leak into our bloodstream of undigested proteins.

The reason is that undigested proteins in the blood trigger the immune system that responds to them as allergens. As this is the result of a degenerative process, and is therefore a chronic condition that grows more severe with time, the dysfunction eventually manifests itself into auto-immune disease conditions. Those ‘incurable’ disease conditions on which modern conventional medicine has given up. This is how serious it is.

Proteins from out food are not meant to enter the bloodstream—ever. So much so that the kidneys will completely clog themselves up trying to remove proteins from the bloodstream to the point of kidney failure. Proteins are meant to be broken down into the much smaller units of which they are made called amino acids. And breaking down proteins into amino acids is meant to be done by the stomach before entering the intestines. Hence, having not fully broken down proteins in the gut can only really happen if they haven’t been broken down while they were in the stomach. Clearly, it isn’t therefore only the gut that is dysfunctional and damaged: the stomach must also be dysfunctional in some way to allow these undigested proteins to pass into the intestines in the first place.

We have previously looked in detail at the process of digestion in Understanding digestion. The essence of what we need to know is that the stomach has specialised cells whose purpose is to secrete hydrochloric acid to break down proteins; that acid is produced when these cells detect the presence of protein in the stomach; that as proteins are broken down, the pH rises and the stomach secretes more acid to keep the pH low in order to continue breaking down the protein; that when the pH stays low for a few hours or so, this signals that all the proteins have been properly broken down, and that the chyme (the processed contents of the stomach) can be transferred to the small intestine; and that at which point the stomach valve opens, the acidic chyme moves through, and the pancreas injects into the small intestines a concentrated solution of bicarbonate to neutralise the acid which would otherwise damage the lining of the intestines. This is how it’s supposed to work.

But if there isn’t enough bicarbonate in the system, the pancreas cannot do this properly. If there isn’t enough water, the pancreas cannot do this properly. If the stomach doesn’t produce enough acid, the proteins are not broken down properly. And if the acid producing cells of the stomach are not regularly exposed to high concentrations of hydrochloric acid, they lose their ability to produce it. This happens when little or no concentrated sources of protein are eaten, like when we are vegetarian or vegan for a long time. But it also happens when the lining of the stomach, which is supposed to be protected by a thick layer of mucus while digesting protein, is instead exposed to and damaged by its own hydrochloric acid. This happens when there isn’t enough water to make that protective layer of mucus, and it is why we should drink water before meals.

So, here’s what we get: not enough water or bicarbonate—loss of acid-neutralising function of pancreas, and damage to intestines; not enough protein in the diet—loss of acid production ability, and undigested proteins; not enough water—damage of stomach lining, loss of acid production ability, and undigested proteins; undigested proteins—chronic immune response to circulating allergens and autoimmune disease conditions. This is compounded with the damage that results from exposure to chemicals and antibiotics, from the overload of sugars and starches, and from the destruction of the cells lining the gut by the lectins in our diet.

The end result is, as expected, precisely what we observe: a population where basically everyone has, to some extent, compromised digestion, and therefore, a population where everyone is, to some extent, sick. Because we don’t know any of this, because we don’t know how food affects the body, because we don’t know how the organs of the body function, because we don’t now how digestion works, and because nobody else around us knows any of it either, we believe everything is normal and everything is just fine, just as it should be, just as it always has been. But the truth is that it isn’t.

What’s actually hard to believe is how simple the solution is: 1) avoid as much as possible exposure to chemicals and antibiotics, and adopt measures to systematically help the systems of the body cope with and recover from the exposure we cannot entirely avoid; 2) avoid as much as possible the overload of sugars and starches, and focus on animal protein and fats from free range animals, and green vegetables. This will automatically lead to a nutrient-dense, whole foods diet that also minimises exposure to gut-damaging lectins; 3) drink plenty of clean water to ensure good hydration, especially with enough time to replenish the stomach’s and pancreas’s reserves before meals, and take a little extra bicarbonate on an empty stomach with your first glass of water in the morning to maintain a good alkaline buffer and balance.

 

This strategy is so simple, and yet it is both preventative and curative. The extent to which we need to be strict depends on the extent of the damage from which we need to recover. And as it true for everything, it’s far easier to prevent damage than to recover from it. That’s obvious but it’s good to remind ourselves of it when our motivation weakens or strength of will falters. The amazing news is that, as shown by doctors Terry Wahls and Steven Gundry who specialise in the treatment of autoimmune disease conditions, recovery from even the most severe cases is virtually guaranteed and only a matter of consistency, patience, and time. I hope this is enough of a motivation for you. Enough of a motivation to at least start to make the effort to regain and then preserve the health of your gut and digestive system—the system on which everything about your health depends.

Oh, and breakfast? Just skip it and have your first meal at lunchtime. Breakfast is not, as we have been told over and over again, the most important meal of the day. It’s actually the most important meal of the day to skip. We’ll get back to this point some other time.

Every undigested protein is an allergen

If someone asked you what you thought was the most fundamental, the most essential, the most important health challenge that we face as modern human beings living in industrialised countries, what would you tell them?

Take a moment. Shift your gaze away from this text, and think about it.

When we read or hear something about health and nutrition in the news, on websites, on blogs, on social media, or even in books, the information we encounter is almost always biased and directed  in some way. It is also always restricted in scope. In fact, it is usually very restricted in scope. All this is perfectly natural and expected: whenever we sit down to write, it is usually about something in particular, something specific, some topic we want to address or explore. It’s hard to think of circumstances where this would not be the case.

Moreover, basically everybody who writes anything, does so in order to be read, and therefore naturally attempts to appeal as much as possible to their readership, both in content and in style. But maybe the most influential factor is that we have grown accustomed to information packets, to bite-size bullets of information: quick-to-read, quick-to-scroll-through, and quick-to-either-share-or-forget. And this has above everything else shaped the way information is being presented by all those people out there trying to appeal to more readers. Little can be done to counter this tendency. It’s just how it is at this time.

As a consequence, for all these reasons, we are—the whole world is—migrating away from the mindset that encourages inquiry into the global, the general, the underlying aspects of things. Instead, we are migrating towards an evermore concentrated, focused, laser-beam approach to basically everything. This is true in all fields of study and inquiry to some extent. In matters of nutrition, it is particularly noticeable, and the reason is surely at least in part because we tend to be at the same time very interested and highly sensitive to advice about what we should or should not eat. We take such advice very personally, and often react strongly to it.

Our relationship to food is very deep because it is so constant and continuous, so intimately related to our survival. This relationship starts when we come out of our mother’s womb, and persists throughout each day, every day of our life, until this life of ours itself comes to an end. What in addition makes this relationship so close and so intense is that if we don’t drink or eat, usually even for a few hours, we get headaches and stomach aches, we get light headed, weak, and unable to concentrate and function, we get grumpy and irritable. It is very clear and naturally understandable that we therefore tend to be—that we are—very sensitive to advice about what to eat, but immensely more so to advice about what not to eat, especially if we happen to eat those foods about which the advice is given.

Hence the movement to superficial, non-contentious, bite size bullets of information: ‘blueberries are excellent: they are low in sugar and full of antioxidants’; ‘avocados are amazing: they are not only full of healthy fats but they are also alkalising’; ‘hydrogenated vegetable oils are very bad: they are full of toxic trans fatty acids.’

But what about the essential, the fundamental, the underlying aspects of things?

You have had more than a few minutes to think about it. What would you say, then, to this question of what is most fundamental to the health, to what constitutes the most fundamental health challenge we face? I would say it’s digestion.

Digestion is where everything about us begins and ends. It is in and through the digestive system that we absorb all the nutrients from our food and excrete all solid wastes. It is through the digestive system that we absorb all the constituents of everything that we call body, and excrete all that is toxic, be it produced from the environment or from within through healthy digestive and metabolic processes. Do you find this sufficient to illustrate why digestion is so fundamental? For me it is. But we can go a lot further.

Evolutionary considerations, arguments, and observational evidence, are always useful, and usually very powerful in guiding clear thinking about matters of health. One of the main questions that has and continues to preoccupy evolutionary biologists is that of the growth of the human brain. In this, one of the most compelling ideas put forward to explain its evolutionary history is called The Expensive Tissue Hypothesis. I plan to, in the future, devote much more time to it. But I must refer to it here because of its relevance to digestion.

The Expensive Tissue Hypothesis is based on the fact that there is a strict minimum to the amount of calories any animal requires to survive, the observation that the brain is the most metabolically expensive organ in the body, and the conclusion that it would be very hard for any large complex animal to sustain two systems as energetically expensive as the brain. Because the gut is the second most metabolically expensive, and because both the brain and gut together account for a disproportionately large fraction of the body’s caloric needs, an increase in the size of the brain would necessarily be at the expense of that of the gut, and vice versa. It simply would not be possible to sustain both a large brain and a large gut. And thus, the growth of the brain would have to be accompanied by a shrinking of the digestive system. This is what is observed.

However, it is important to emphasize that it is the shrinking of the digestive system that allowed for the growth of the brain; not the growth of the brain that precipitated the shrinking of the gut. The growth of the brain would only be possible with a surpluss of calories for it to growth and have its increased activity sustained. It is even more important to emphasize that this evolution was the unintended consequence of a shift from a high-fibre, nutrient-poor, plant-based diet, to one consisting mainly of low-fibre, nutrient-rich, animal-based foods.

Number two Silverback Mountain Gorilla (Gorilla gorilla beringei) of Kwitonda Group, Akarevuro, Virunga Mountains, Rwanda

Male mountain gorilla of the berengei berengei subspecies of eastern gorillas in Ruanda (Source: Time). As you can see from the chest muscle definition, this adult male’s bodyfat is low. The huge bulging belly that is apparent when they are seated and relaxed is the consequence of having it hold the very long gut required to process each day approximately 20 kg of fibrous roots, leaves, and stocks of the plants they eat.

It is very interesting—and it is surely related to this evolutionary history—that the gut has by far the largest number of nerve endings, second only to the central nervous system. Moreover, unlike other organs and systems of the body, all of which are entirely controlled by the brain, it is the only one with directive nervous signalling to the brain. Because of this, it is the only organ with a direct influence on the brain. Thus, besides the physical implications, some of which we’ll explore soon, it is quite literally the case that a happy gut means a happy brain. And conversely, a sad, unhappy, depressed brain is very likely to be caused by a dysfunctional gut.

It is a sick, dysfunctional, damaged gut that is the primary characteristic underlying states of disease. This is why I would say that it is a sick, dysfunctional, damaged gut that is the most fundamental health challenge we face today as modern human beings.

I know this might leave you hanging. Especially because we have not yet made any reference to the title. But I promise, we’ll pick up from here next time.

 

Become a proud sponsor of healthfully! Join our patrons today!