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The Gall Bladder

Biliary sludge, in reality, happens inside our bodies—our gallbladder, in particular—that little pear-shaped organ that tucks up under the liver and stores bile produced and delivered by the liver.

“Bile works in a similar manner to dish soap in a greasy pan,” says Angela Foreman, Registered Dietitian with Memorial Hospital-UC Health. “The gallbladder releases bile into the small intestine to emulsify/break down fat into smaller particles for digestion.”

If all goes as designed, we never really give a thought to our trusty gallbladder. But once sludge starts to develop, things can change. Scot Lewey, D.O. and partner with Peak Gastroenterology Associates, says, “Bile in the gallbladder can become thick and crystals can form that precipitate into actual stones. Sludge and stones can cause irritation of the gallbladder. When the gallbladder is inflamed it is called cholecystitis. This can be acute or chronic. The only definitive treatment for symptomatic gallstones is surgical removal of the gallbladder, a surgery known as cholecystectomy.”

According to the Merck Manual, gallstones grow at a rate of about 1 or 2 millimeters a year, taking 5 to 20 years before becoming big enough to cause problems. And even though 10 to 20% of Americans will develop gallstones at some point in their lives, up to 80% are symptom-free.

So who gets gallstones in the first place? 

“Diet affects the gallbladder,” says Dr. Lewey. “Rapid weight loss and high protein liquid diets can precipitate development of gallstones. Hormonal changes influence the gallbladder. It’s common to develop sludge in the gallbladder during pregnancy, and some women develop symptomatic gallstones during pregnancy.”

“Nutrition-related risk factors,” says Foreman, “include prolonged high dietary fat intake, being overweight, obesity, rapid weight loss, very restricted low-calorie diets and a sedentary lifestyle. Individuals who have diabetes or inflammatory bowel disease are more likely to have gallbladder issues. Other factors that may predispose an individual to gallbladder issues include family history, being female, especially if pregnant, taking oral contraceptives or hormone therapy, older age and certain populations, including Mexican-Americans, Scandinavians and Pima Indians.”

Foreman says gallbladder removal may become necessary due to complications including pain, fat malabsorption and involvement of important surrounding organs such as the liver or pancreas.

Once we start experiencing pain and symptoms with gallstones, says Dr. Lewey, removal of the gallbladder is recommended because the symptoms and inflammation almost always progress. “Laboratory and/or imaging signs of severe gallbladder disease, a question of gallbladder cancer or persistent inflammation or malfunction are indications for removal,” he says.

Interestingly enough, once the gallbladder has been removed, we should be able to live without it just fine. As Foreman explains, “The body adapts to the lack of a gallbladder. Bile is secreted from the liver into the small intestine. Over time the biliary tract forms a pouch that acts similar to the gallbladder and acts as a reservoir for bile.”

Foreman says following gallbladder removal, patients typically start with a low-fat diet and advance to a regular diet as tolerated. “Some patients may experience diarrhea initially following the surgery,” she says, “due to the presence of additional bile in the large intestine. Medications and/or a high-fiber diet can help with diarrhea control.”

Dr. Lewey says in his practice, he has seen an increase in young patients, especially in children. “I’ve seen more men [than women] with gallbladder disease. It’s more common in celiac patients, a population that is increasing and is increasingly recognized.”

Lewey says some of the things we can do to keep our gallbladder functioning properly are eating a low-fat high-fiber diet regularly, avoiding prolonged fasting or regular skipping of meals and avoiding rapid weight loss and liquid protein diets. “Some natural remedies are popular,” he says, “including apple cider vinegar and apple juice. Mix one part apple cider vinegar with two parts organic apple juice or cider, and drink two to three times daily.”