THE GALLBLADDER HORMONE CONNECTION

We typically don't give much thought to our gall bladder when we think about digestion or hormones for that matter. While critical to more than just digesting fats, the importance of this tiny organ sitting tucked below our liver is often overlooked. Unless you’ve had gallstones or experienced some form of gallbladder disease, you might not even be aware of its function. ​ While originally thought to be a disorder brought on later in life by obesity and a high saturated fat diet, I’m seeing more and more young, thin and otherwise healthy women in my practice with disease of the gall bladder; from sludge to stones, to full cholecystectomy (removal) by the time they’re 30. This presents questions surrounding the variables causing gall disease and brings us back to their relationship to hormones.

​What is the gallbladder, and what does it do? The liver produces the bile that helps you digest fats, and the gallbladder stores it until it's required for digestion. Because it’s been stored, the bile in your gallbladder is more concentrated than the bile secreted by the liver. Symptoms of gallbladder dysfunction often include:

• Sudden onset pain just underneath your right ribcage, in your abdomen, occasionally associated with heartburn, nausea, gas, and fullness

• Pain between your shoulder blades

• A chronic ache in your abdomen that intensifies after eating

• complete blockages will result in pale, greasy, floating stools, and dark amber colored urine

While it is thought that most of us will develop gallstones at some point in our lives, many of us won’t notice that we have them until we experience intense pain, usually after a rich meal high in fat. But stones are not the other concern. Cholestasis, also known as ‘biliary sludge’, is characterized by a reduced flow of bile into the duodenum from the gall bladder and/or liver, resulting in thicker, more concentrated bile. This increases the chances of stones, biliary colic, and acute pancreatitis. So where do hormones come into play? Well, like any other organ in our body, the gall bladder relies on hormones to regulate its physiological functioning. It is most notably influenced the following hormones: Melatonin, aka our sleep hormone. It regulates our biological clock in response to darkness. It helps prevent gallstones by reducing cholesterol levels in the bile, and by improving the conversion of cholesterol into bile salts (1). Furthermore, studies also show melatonin aids gallbladder contraction by strengthening the neuromuscular junction of the gallbladder walls and may make for a great therapeutic intervention to aid in the recovery of gallbladder attacks. Thyroxine, aka the inactive thyroid hormone. According to a 2016 study, women with thyroid disorders also notably have a higher incidence of gallbladder issues (1). This is because low, or suboptimal, levels of thyroxine (T4) are related to under-functioning bile acid flow and the loss of its resultant effects on the gallbladder. If bile output is compromised, so is lipid absorption and metabolism, leading to a higher likelihood of stone formation in the gland. Estrogen and Progesterone, aka female sex steroid hormones. We know pregnancy, oral contraceptives, and hormone replacement therapy all contribute to the formation of gallstones. This is because estrogen and progesterone lead to slower emptying and increased cholesterol to bile ratio in the gland, leading to supersaturation of bile and more sludge. What’s often overlooked (in my opinion) is bile’s influence on hormone metabolism. Bile is an important component in the elimination of estrogen and its metabolites through the liver, so sluggish function (or even worse, no gallbladder at all) often leads to sluggish hormone elimination and resultant hormone symptoms. This may attribute to high estrogen symptoms like cramping, breast tenderness, water retention, and acne. Cortisol, the stress hormone. When the brain sends stress stimuli down to the adrenal glands, cortisol is produced. Cortisol causes the liver to release glucose. It does this in order to provide energy for the body’s increased needs during stress or in cases of hypoglycemia. Interestingly, evidence shows that blockages in bile flow are also associated with states of dysfunctional communication between the hypothalamus, pituitary, and adrenals (all responsible for and influenced by cortisol)(2) What other variables contribute to gallbladder dysfunction? Eating less often throughout the day can actually lead to gallstones. Since the gallbladder stores bile during fasting states, it becomes super concentrated — along with the cholesterol contained in bile. Gallstones are generally crystallized bits of cholesterol. By eating more frequently throughout the day, your gallbladder has to secrete bile to help digest your food — and flush out stored cholesterol. Rapid weight loss can lead to gallstones, too. While it may be tempting to quickly shed winter pounds, if you want to avoid developing gallstones — or exacerbating the symptoms of an existing gallbladder disorder — try to stick to losing one-to-two pounds a week. Women are more likely than men to develop gallbladder disease or gallstones. Pregnancy, birth control pills, and the natural fluctuations of the menstrual cycle can cause a slowing down of the contractions of the gallbladder, causing bile to sit longer than normal. If you’re currently on hormonal birth control and are experiencing pain, indigestion, burping, gas, nausea, and/or bloating, discuss with your doctor or naturopath if these symptoms may be a result of your contraception method. Maintaining Gallbladder Health A heart-healthy diet is a gallbladder-healthy diet. If you have been diagnosed with gallbladder disease, or gallstones, or just want to minimize your risk of developing gallbladder disease, sticking to a diet that is low in saturated fats and high in mono and polyunsaturated fats is the way to go.

• Heart-healthy nuts like almonds, brazil nuts, or cashews

• Avocados

• Fatty fish like salmon, tuna, or sardines (small spaced out servings, since fish can still be fatty)

• Flaxseeds

• Fresh fruits and vegetables

• Foods rich in fiber, like broccoli, lentils, and legumes

If you’re on hormonal contraceptives or hormone replacements therapy, you may want to discuss alternatives. There is some evidence that your coffee habit may help prevent gallstones. Skip the dairy creamers, if you want to keep your coffee gallbladder-friendly, and opt for almond milk instead. If you suspect you might have gallbladder dysfunction, you should visit your MD or ND. You’ll likely need some blood work and imaging. Gallstones can usually be detected on an ultrasound, but other disorders such as biliary dyskinesia (a motility disorder where the gallbladder does not eject bile properly) or cholecystitis (inflammation of the gallbladder) may require additional testing. For more information about maintaining your gallbladder and digestive health, or to discuss its potential influence on your hormones, please contact your Toronto Naturopathic Doctor, Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today! References:

1. Mohammadi-Sartang, Mohsen, Mohammad Ghorbani, and ZohrehMazloom. “Effects of melatonin supplementation on blood lipid concentrations: A systematic review and meta-analysis of randomized controlled trials.” Clinical nutrition 37.6 (2018): 1943-1954.

2. Swain MG, Patchev V, Vergalla J, Chrousos G, Jones EA. Suppression of hypothalamic-pituitary-adrenal axis responsiveness to stress in a rat model of acute cholestasis. J Clin Invest. (1993) 91:1903–8.