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.

 

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Why we should drink water before meals

We all need to drink at least about two litres of water every day. Not juice, not sodas, not coffee, not tea: plain water. None of these other liquids have the properties of water, nor do they have the desirable effects of water on the body. Most of us don’t however, and so we are chronically dehydrated. Whether it is 75% or as high as 90%, it is evident that a very large portion of the population is chronically dehydrated.

The digestive system can be viewed as the most fundamental because everything used to sustain life in the body goes through it. In a very real sense, we are a digestive system, supplemented by a central nervous system and refined sense organs to allow us to devise ways to get food (and avoid being eaten), coupled to a refined locomotor system to allow us to gather the food (and run away when it is needed). Since every component of every cell in the body is made from the nutrients in our food, it is obvious that everything in the body depends on the digestive system. And for the digestive system, the single-most important element is the presence of ample amounts of water.

cropped-glass-of-water

As soon as we even think about eating, the digestive system starts to get ready. The pancreas secretes a little jolt of insulin just in case carbohydrates come in, and the stomach starts to produce the highly acidic digestive gastric juice (pH of 1-2). This gastric juice is composed of only a little bit (0.5%) of hydrochloric acid (HCl) and a lot of salt, both sodium chloride (NaCl) and potassium chloride (KCl). The stomach has sensor cells to know exactly how much protein, fat and carbohydrates are present at any given time, and thus can adjust the production and composition of the gastric juice.

Although present in very small amounts, the hydrochloric acid is the essential compound for activating the enzymes responsible for breaking down protein, which is its main purpose because both fats and carbohydrates are mostly broken down in the intestine. But to make it to the stomach without causing any damage along the way, the two constituents of this highly corrosive acid, the hydrogen (H) and the chlorine ions (Cl), are produced separately and transported to the inside of the stomach where they combine to form the acid.

The delicate lining of the stomach with all its different kinds of highly specialised cells, is protected from the acidic gastric juice by an alkaline layer of mucus. This mucus is between 90 and 98% water, with some binding molecules and a few other components. It can be regarded as a blanket of water whose primary role in the stomach is to protect its lining from the gastric acid. The very thin mucosa that produces and maintains the mucus layer, also secretes sodium bicarbonate that sits in it, and neutralises the acid upon contact when it penetrates the layer, leaving only sodium chloride (salt), water and carbon dioxide. The neutralisation reaction is simple: HCl + NaHCO3 -> NaCl + H2O + CO2.

As we get progressively more dehydrated, not only are the stomach cells incapable of releasing adequate amounts of water into the stomach in order to allow for the proper mixing of the food and acid into chyme with the optimal consistency, but the thickness of the protective mucus layer decreases, thus allowing the acidic contents to damage the fragile lining. This is what eventually leads to stomach ulcers, according to a well known specialist in the matter, Dr Batmanghelidj, author of Your Body’s Many Cries for Water.

The contents of the stomach are churned and blended between one and three hours depending on the amount and composition, until the chyme is liquified and smooth, at which point it is poured into the duodenum, the first part of the small intestine. It is in the small intestine that the real work of the break down and absorption of nutrients into the bloodstream takes place over a period of about 24 hours. The sensor cells in the duodenum will immediately determine the pH and composition of the chyme in order to send the messenger hormones to the pancreas to secrete the right amount of the alkaline, watery sodium bicarbonate solution necessary to neutralize the acid, and to the liver to secrete the right amount of bile needed for the breakdown of fats.

And even though the pancreas is known primarily for its role in producing and secreting insulin needed to clear the bloodstream of sugar, it is arguably its role in secreting this alkaline solution that is the most important. Indeed, as the duodenum does not have a protective layer of mucus as the stomach, it is this sodium bicarbonate solution that protects it and the rest of the small intestine from the devastating effects that the highly acidic chyme can have on it.

However, just as even partial dehydration causes the protective mucus layer in the stomach to dry out and shrink, making it permeable to the gastric acid that eats away at the delicate soft tissues, dehydration also causes the pancreas to be unable to secrete as much of the watery sodium bicarbonate solution as is required to fully neutralise the acidic chyme that, therefore, also damages the intestine. In fact, that there are several times more cases of duodenal as there are stomach ulcers attests to the reality that the lining of the intestine is all that much more fragile as it is unprotected and thus directly exposed to the excessively acidic chyme.

Therefore, water is of the utmost importance in protecting the lining of the stomach and intestine from the acid required for the break down of proteins into amino acids. Water is of the utmost importance for proper digestion and absorption of the nutrients in the food. And hence, water is of the utmost importance in maintaining a healthy digestive system meal after meal, day after day, and year after year throughout our life.

We must make sure that the body and digestive system are properly hydrated before eating. And for this, all we need to do is drink half a litre of plain water 30 minutes before meals, and not drink during nor after the meal for two to four hours.

Drinking during or soon after a meal will only dilute the chyme, making it excessively watery. This will not lower the pH, because water does not neutralise acid. It is best to ensure proper hydration prior to the start of the digestive process, providing the water necessary for the mucosa and pancreas to function optimally, and allow the stomach to adjust the water content of the chyme on its own. I personally usually wait two hours after a snack or small meal, and at least three to four hours after a large meal.

The time needed for the chyme to leave the stomach through the pyloric sphincter and enter the duodenum depends on its amount and composition. For example, fruit or any other food consisting mostly of simple sugars eaten on an empty stomach will make it into the intestine, and the sugar into the blood, in a matter of minutes: Since there is no protein, no acid is required for its breakdown in the stomach; and since there is no fat, no bile is required to break it down in the intestine.

Naturally, the time needed for the stomach to process a small meal will be less than that needed to process a large meal of more or less equal composition. In fact, given that our stomach is a very small pouch with an empty volume of about 50 ml, and a full volume of about 1 litre (up to a max of 2-3 litres when it is really extended),  the time needed for large meals increases substantially and disproportionately compared to smaller meals.