Gallstones and the biliary system
As we discussed last issue, gallstones don't start in the gallbladder; they are related to cholesterol metabolic defects originating in the liver itself. They also happen to be associated with obesity and pregnancy. Essentially, if the cholesterol produced in your liver is too thick and becomes too concentrated in the bile and sits too long in the gallbladder, it can crystallize and form gallstones. It is estimated gallstones result in some 600,000 hospitalizations and more than 500,000 operations each year in the United States alone. Bottom line: it's one of the most prevalent digestive disorders known.
The usual treatment is laparoscopic surgery to remove the gallbladder. The surgery itself has now become so routine that it can be completed in about an hour and the patient leaves the same day -- back to work the next day.
However, because it does not address the underlying cause of the problem (metabolic issues in the liver), gallbladder surgery often does not resolve the patient's discomfort. And because it eliminates the body's regulating mechanism for the release of bile when needed, it often creates new digestive problems of its own. In fact, after gallbladder removal, some 13% of patients report persistent pain. Another 17% report chronic diarrhea, and another 20% report intermittent digestive problems and pain. The bottom line is that although surgeons will report an almost 100% success rate for the surgery, patients will report a 50 % failure rate. It's all a matter of perspective. The surgeon considers the surgery successful if the patient survives, there are no immediate problems, and she collects her fee without a lawsuit. The patient, unfortunately, has to live with the long term results.
The biliary tree
The biliary tree is the anatomical term for the treelike path by which bile is secreted from the liver on its way to the duodenum.
It is referred to as a tree because it begins with a multitude of small branches coming from the thousands of liver lobules which empty into the common bile duct, which is sometimes referred to as the trunk of the biliary tree. Hanging off the trunk, tucked up into the liver is the gallbladder. It is a secondary outpouching, if you will -- an outpouching of the bile duct coming from the liver, which is itself an outpouching of the digestive tract. The gallbladder lies in a groove under the liver, between the two lobes, and is a soft, thin-walled sac, shaped like a fat carrot, with its narrow end pointing toward the bile ducts.
Liver duct system
Bile drains from the ultra small bile ducts (ductiles) that service each of the liver's tens of thousands of lobules into progressively larger ducts, culminating in the common bile duct. The right and left hepatic ducts join just outside the liver to form the common hepatic duct.
Bile passing through the common bile duct exits and enters the gallbladder through the cystic duct. Most physicians refer to the gallbladder as a vestigial organ (as they do the appendix) -- meaning that it's lost most of its original function and now pretty much "gets in the way." To them, this explains why the gallbladder does not usually empty completely, which allows gallstones to form -- leading to pain, infection, inflammation, and even cancer. This also explains why they remove upwards of half a million gallbladders a year in the United States alone.
They are wrong!
The gallbladder serves a definite function. It is not vestigial. It regulates the flow of bile so that it can "push out" into the digestive tract in bursts as needed to assist in the digestion of fats. In fact, the gallbladder will contract to squeeze out stored bile when stimulated by a fatty meal. Without the gallbladder, bile merely dribbles out in a constant flow, thus being present when not required and insufficiently present when needed. This can lead to a whole series of digestive problems including poor digestion, intestinal distress, diarrhea, and an inability to fully break down fats. In fact, many people, as they age, need to take an ox bile supplement (available at all health food stores) with their meals to compensate for insufficient bile in their digestive tracts. If you have digestive problems after eating fatty meals, it's one of the first things you (and your doctor) should look at.
It is important to understand that problems with the gallbladder rarely stem from the gallbladder itself. They stem from the liver, which if not functioning properly will manufacture bile that is prone to "stoning." Thus removing the gallbladder does not eliminate the problem; it merely eliminates ONE place problems can manifest. Where else can problems manifest? If you follow the biliary tree down past the gallbladder, you will find that the common bile duct joins the pancreatic duct before entering the duodenum through the ampulla of Vater. And there's the problem. Although stones and sludge formed in the liver can no longer get trapped in the gallbladder (if it's been removed), they can still quite easily get lodged in the pancreatic duct and ampulla of Vater. This causes the digestive juices secreted by the pancreas to back up into the pancreas itself and start inflaming and digesting pancreatic tissue. This is called pancreatitis.
In other words, by merely removing the gallbladder and not addressing the underlying problem of "bad bile" being formed in the liver, you may potentially merely be moving symptoms from the gallbladder to the pancreas. Fortunately, there are alternatives. Dietary changes will often help. But the best way to optimize the health of your liver, gallbladder, and pancreas is to regularly cleanse and flush the liver and gallbladder.