22. Sep, 2017

What does the gallbladder do anyway?

It isn't until something goes wrong that we find ourselves pondering the role of body parts we can't see. The gallbladder is a little pouch for storing and excreting bile which is made by the liver. 

A quick Google search would reveal that bile contains cholesterol, bilirubin (a pigment from red blood cells) and bile salts (essential for the digestion and absorption of fats and fat-soluble vitamins in particular). But did you know that it also contains immunoglobulins (antibodies) which support intestinal mucosa integrity - vital for normal gut function, including permeability (commonly known as 'leaky gut' when it goes awry). 

Gallbladder removal is surprisingly common in Australia. What isn't common knowledge, unless you've had some anatomy and physiology training, is the inter-relatedness of gallbladder, liver and pancreatic diseases. Removal of a gallbladder can lead to complications of the other two organs, particularly pancreatitis. As seen in the image from one of my anatomy colouring books, the liver, gallbladder and pancreas lie very close together and are connected by a series of tubes or ducts, which all feed into the small intestine (duodenum). 

Gallbladder disease terminology

Cholelithiasis = gallstone formation

Choledocholithiasis = when stones slip into bile ducts, causing obstruction, pain and cramps

Cholecystitis = gallbladder inflammation

Cholecystectomy* = gallbladder removal.  

 

So what happens if your gallbladder has to be removed?  The human body, being the incredible thing that it is, adapts. The liver secretes bile directly into the small intestine. Over time, the duct from the liver expands, forming a 'simulated pouch', to allow bile to be stored similarly to how it was in the gallbladder. 

Given the inter-relatedness of the liver and pancreas to the gallbladder, you are well advised to be careful with your diet following surgery. Alcohol should be avoided in the short term (as is advised following any surgery), and some patients experience bile-salt diarrhoea, or reflux and gastritis (inflammation of the stomach). The easiest (and most enjoyable) way to attempt to deal with this, as well as support that intestinal mucosa integrity we discussed earlier, is by increasing your soluble fibre intake.  

Soluble fibre can sequester and bind bile in the stomach in between meals to minimise reflux/gastritis. In addition, it is a food source for beneficial gut bacteria, who use it to produce short-chain fatty acids - the preferred fuel source for intestinal mucosal cells (responsible for intestinal mucosa integrity - remember that from earlier?).

 

It always comes back to the gut, I keep telling anyone who will listen!

 

Good sources of soluble fibre include: 

Oats and oat bran, psyllium, whole flaxseeds

Bananas, strawberries, pears, figs, oranges and plums

Onion, garlic, beans (kidney, lima, black, navy), butternut squash/pumpkin, chickpeas, asparagus, parsnips, brussels sprouts and broccoli 

 

*Note: This is a predictor of the development of cirrhosis, and associated with increased serum liver enzymes.

 

References: 

Krieger, PA 2009, A Visual Analogy Guide to Human Anatomy & Physiology, Morton Publishing Company, Englewood

Mahan, LK, Escott-Stump, S, Raymond, JL & Krause, MV 2012, Krause's Food & the Nutrition Care Process, 13th edn, Elsevier/Saunders, St Louis. 

Slavin, JL, Martin,i MC, Jacobs Dr, Jr, & Marquart,  1999, 'Plausible mechanisms for the protectiveness of whole grains', American Journal of Clinical Nutrition, vol.70, no.3 suppl, pp.459-63S.