The gallbladder also known as "il-marrara" in Maltese is a pear-shaped organ on the upper right side of the abdomen, just beneath the liver. It may be one of those organs that one may not think about as often unless it starts causing problems. Although this organ is small it is an essential accessory organ of digestion.

Apart from the liver's various functions like detoxification and metabolism, it also produces bile. Bile is a thick greenish-yellow fluid that constitutes of water, bile acids, cholesterol, phospholipids, bile pigments (ex. bilirubin) and electrolytes. Bile aids in the absorption of fat and fat-soluble vitamins, the excretion of bilirubin and excess cholesterol, neutralises the acidic pH of the food that comes from the stomach and aids in the proper digestion of fat via emulsification. Emulsification is a process in which bile breaks down large fat molecules into smaller fat molecules called micelles to increase the rate at which enzymes can digest the fat into glycerol and fatty acids. Thus, once the liver produces bile, it is transported to the gallbladder where it is stored. Then following the digestion of food in the stomach via a series of chemical reactions and stimuli, the gallbladder will secrete bile into the duodenum (i.e. the first part of the small intestines) via the biliary tree to further aid digestion.

The biliary tree is a system composed of small, hollow ducts that direct secretions like bile from the liver, gallbladder and pancreas to the duodenum. Therefore, gallbladder diseases like gallstones can not only impair the proper functioning of the gallbladder but also impact organs that are in close relation to it.

Cholecystitis is the inflammation of the gallbladder due to irritation of the gallbladder walls. This is the culprit for many gallbladder diseases. One of the commonest causes of cholecystitis is gallstones. When gallstones are in the gallbladder itself, they are called cholelithiasis. However, if they are in the bile ducts (i.e. part of the biliary tree), it is known as choledocholithiasis. There are two main types of gallstones:

1) Cholesterol stones - such stones are normally yellow-green and form due to too much cholesterol and bilirubin but not enough bile salts. These are the most common, making up to 80% of gallstones.

2) Pigment stones - such stones are smaller in size, darker and composed of bilirubin. These tend to form in cirrhosis, biliary tract infections and hereditary blood disorders like sickle cell anaemia.

Although most gallstones cause no symptoms, when they become larger or begin to cause obstruction of the biliary tree, individuals can become symptomatic. Such "attacks" of gallstones normally occur after eating a fatty meal and at night. Some of the symptoms may include: pain in the right shoulder, severe pain in the upper abdomen that can increase rapidly and may last from 30 minutes to several hours, jaundice (i.e. yellowing of the skin and eyes), fever and vomiting.

Several factors can contribute to the formation of gallstones. Unfortunately, women are twice as likely to develop gallstones than men. This may be due to increased exposure to oestrogen. As excess oestrogen from pregnancy, hormone replacement therapy or birth control medication, can increase cholesterol levels in bile and decrease gallbladder contractions, contributing to gallstone formation. Furthermore, fasting decreases gallbladder activity causing the bile to become overconcentrated with cholesterol, increasing the risk of developing gallstones. Rapid weight loss can also impose as a risk factor. This is because as the body metabolises fat during this weight loss, it causes the liver to secrete more cholesterol than normal into bile. Diabetics usually have high levels of fatty acids which can increase the probability of forming gallstones. Unsurprisingly, obesity is also a major risk factor for gallstones.

Naturally, if gallstones cause no symptoms, medical intervention is unnecessary. Though, if the pain persists, individuals may be given drugs that can aid in dissolving the stones or a surgical procedure to remove the gallbladder (i.e. cholecystectomy) can be performed amongst others. However, lifestyle modifications can prevent gallbladder diseases and it all starts with our eating habits!

 

Foods to eat

Fruits and vegetables are undoubtedly a way to improve one's overall health.  They are full of nutrients and fibre, with the latter being essential to a healthy gallbladder since fibre helps speed up the digestive process, reducing the risk of gallstone disease. Studies have shown that whole fruits and vegetables rich in vitamin C like kiwi and broccoli, citrus fruits and leafy green vegetables like kale are particularly great in supporting gallbladder health.  Plant-based foods are also a good source of antioxidants. Antioxidants aid the body get rid of toxic molecules known as free radicals which develop in the body as a result of natural processes and environmental stresses, including processed foods. If these free radicals go unchecked and are not eliminated, they can lead to oxidative stress and consequently cause cell damage, leading to various diseases, including cancer.  

As previously mentioned, a high-fibre diet promotes digestive health. It is believed that fibre enhances the movement of food through the gut and lowers the production of secondary bile acids. Furthermore, fibre reduces the amount of biliary/gallbladder sludge produced. Gallbladder sludge accumulates in people who fast or lose weight rapidly and can predispose them to gallbladder disease. Foods that are high in fibre include fruits, vegetables, legumes, nuts, seeds and whole grains.

It is essential to ensure that when consuming protein, it is lean. Protein is vital for the repair and growth of body tissues. Whilst red meat and dairy products are good sources of protein, they are high in fat and added salt which increases the stress on the gallbladder. Thus, low-fat protein should be consumed. Such products include: poultry, fish, soy products, beans, lentils and zero-fat dairy products.

Cold-water fish, walnuts, flaxseed, oils from fish, avocados, coconut oil and sunflower oil are good sources of unsaturated fats that may promote a healthy gallbladder too. Unsaturated fats are fats that come from plants and improve one's blood cholesterol levels, ease inflammation and stabilise heart rhythms amongst other benefits.

 

Herbs to eat

Additionally, a number of herbs can aid in promoting gallbladder health. Some of them are:

Milk thistle also known as Silybum marianum is a flowering herb related to the daisy and ragweed family. It is native to the Mediterranean countries. The active ingredient, silymarin, in milk thistle, has antioxidant properties and reduces cholesterol levels in bile too. This aids in reducing gallstone formation as well as promoting gallbladder health.

Turmeric is also known to prevent gallstones. This herb stimulates the formation and flow of bile from the gallbladder, improving fat digestion in the body. It also decreases cholesterol levels and other gallstone-forming components.  Furthermore, it acts as an anti-inflammatory agent too, reducing gallbladder pain.

Moreover, the bioactive compound, taraxacerin, in dandelion root promotes the secretion and flow of bile from the gallbladder. This aids the liver to detoxify more efficiently.

Similarly, other herbs like fenugreek, barberry, globe artichokes and psyllium are known to promote gallbladder health too.

 

Mushrooms to eat

The Ganoderma lucidum (reishi) mushroom has hepatoprotective, antioxidant and anti-inflammatory properties. This species is rich in triterpenoids and polysaccharides which decreases the oxidative stress in the liver. Consequently, this improves the functioning of the biliary system.

Whilst Polyporus umbellatus is known to promote urination due to its draining agent properties, it is used as an adjuvant in urinary disorders, acute nephritis and gallstones too.

Similarly, Cordyceps sinensis is known to lower cholesterol and triglycerides levels aiding in regulating the metabolism of lipids. It also helps in dissolving gallstones.

 

Foods to avoid

As there are foods that promote a healthy gallbladder, there are foods that must be avoided due to them increasing the risk of developing gallbladder diseases.

One should try to limit their intake of saturated and trans fats since a diet rich in fat increases the strain on the gallbladder. This can be done by avoiding the following: red, fatty meats, processed foods, fast food, fried food, full-fat dairy products, chocolate, premade salad dressings and ice cream.

As previously mentioned, the number of fried foods consumed should be limited. This is not only due to their high saturated and trans fat content but also since being fried in vegetable or peanut oil makes them very hard to digest. Even though these oils are plant-based and often unsaturated, at high temperatures, polyunsaturated fats become very unstable and can produce toxins.

Avoiding high-sugar foods and refined carbohydrates like cakes, biscuits, white flour and refined grains is essential as they are known to increase the risk of gallstone formation.

 

A final word

In conclusion, apart from maintaining a healthy balanced diet, one should try and maintain a healthy weight by avoiding rapid weight loss, stops smoking, keeping alcohol intake to a minimum and trying not to miss any meals. The list can go on and on, on what to do and what not to do. In the end, the choices you make are up to you but do keep in mind that you only have one body and thus one gallbladder.

 

Renald Blundell is a biochemist and biotechnologist with a special interest in Natural and Alternative Medicine. He is a professor at the Faculty of Medicine and Surgery, University of Malta.

Emma Camilleri is currently a medical student at the University of Malta.