The Functional Medicine Approach To Gallbladder Disease with Dr. George Papanicolaou

Coming up on this episode of the Doctor's Pharmacy.

Everybody says, you know, a lot of people now, oh yeah, it's my gallbladder, now I'm gonna have to get it taken out. Their thought is the only cure for their gallbladder is to take it out. There's no thought to their lifestyle, their nutrition, and the impact that bile is having on the gut microbiome, which might.

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Within a Place for Conversations that Matter. If you have ever suffered from gallstones or gallbladder disease, this is gonna be a great conversation for you, 'cause it's gonna help you figure out why you got 'em, and how to get rid of 'em, and how to actually deal with this problem, which affects so many people. And today, our guest on this special edition of Doctor's Pharmacy called House Call, is none other than my friend and colleague at the Ultra Wellness Center, Dr. George Papam: Nikolaou.

Welcome back, George. Mark, it's always a pleasure. I love talking about functional medicine and how we work with our patients at Ultra Wellness Center to get to the root cause of what's keeping them from optimal health.

Of course. So, you know, gallbladder is such a common problem. It's one of the most common surgeries. It's such a common problem in America. Tell us about gallbladder disease and what is it, who gets it, how many people have it, and what are the symptoms and why is it such a big deal? what do we know about who's getting it and all that? So, kind of let's take us down the whole rabbit hole of gallstones and then we're going to get into how conventional medicine treats it and what functional medicine approach might be that might be worth trying.

Yeah, sure. So, it's almost so common that it's invisible. And, what I mean by that is that people don't really think about it. They don't think about their gallbladder. why would they think about their gallbladder until it hurts? So gallbladder disease affects 6% to 9% of adult age people between 20 and 70. And all of those people, they've either had gallbladder disease or had the gallbladder taken out. So it's a pretty large problem. It's a huge health care expenditure. It's very, you know, it's a fairly expensive surgery. So it has a big drain on our system. [Failed to load the specified image. ]Gallbladder disease, people really don't know that there's anything going on with the gallbladder until they have the symptoms, which is going to be what we call biliary colic. That's when you've eaten a meal and then within half an hour to an hour, you begin to feel really bad pain in your right upper quadrant. Where's that? That's going to be below your ribs. to the right, and it's going to be really, really painful. And you're not going to like it at all. You're thinking you're having a baby and it's not coming out. It's really painful. And then you can end up in the emergency room, and then you're going to be given some medications that will, you know, hopefully relieve your pain. And then if it is a gallstone, then hopefully it will pass. on its own. And hopefully there will be no complication and then you'll leave the emergency room, you'll see your primary care, the primary care will confirm that you're feeling better and then tell you to take that and send you on your way. And then we're missing so much. I mean, we've just lost, like, okay, it's not just that you had a stone that didn't pass and you had pain, Get to the root cause. Why did it happen?

What is the root cause?

Why did the stone end up there in the first place? [No speech ] Where does it come down to? It comes down to what we always start. Almost every conversation you and I have, it starts with diet. It starts with the foods that you eat. Yes, there's genetic predisposition. Yes, you can be a female, you can be overweight, you can be pregnant, you can be 40, you can be a diabetic, you can have other chronic underlying diseases that predispose you to gallbladder disease, particularly gallstones. But when it comes down to it, a lot of it's going to have to do with your diet. Are you eating a high fiber diet? Are you eating a nutritious diet where you're getting all of the, are you getting all of the nutrients that actually keep your gallbladder healthy? Are you drinking enough water in your day? Because the bile that's in the gallbladder is 95% water, and then it's made up of bile acids, bilirubin, fats, amino acids, proteins, enzymes, hormones like estrogen, toxins. Your bile plays a very important role in the the detoxification process in your body. If you're not getting what you need to make good bile, then you're going to put your gallbladder under pressure. If you're not drinking enough water, here's what happens. Where's the gallbladder in the first place? It sits right under the liver on the right side. Your liver makes bile, and then that bile goes into the into the gallbladder where it's stored. And then when you're eating, when fat that you've eaten enters your small intestine, it triggers something called cholecystokinin, which then sends a message or is the messenger to the gallbladder to release the bile. The bile is released and it will then start breaking down your fat so that you can get all the nutrients that you need out of your fat. and so that's what happens, that's what the gallbladder does. And you need healthy bile to then do its job to breaking down fats. And so where does the problem become? These stones are actually the compounds that are in the bile in the gallbladder that begin to precipitate out. So they start to connect to each other and form crystals. And then these crystals can get really big. So when those crystals get big enough, and they become stones, or they become hundreds of thousands of little crystals that sit in your gallbladder, and on an ultrasound that will be done, will just look like sludge. It will look like sand at the bottom of the hourglass sitting in your gallbladder. And so, That's how you get the gallstone. Interestingly, this is very interesting. What's the other thing we talk about all the time? The immune system. Yeah. The immune system. So, when you start creating these crystals, because you're not supporting a healthy gallbladder, or you have a disease process that slows the gallbladder so it doesn't empty, it gets filled up with bile, the bile can't get out, and that's going to trigger again the precipitation out of these compounds that are in your bile, and they'll form the crystals. But here's the interesting thing. There's been research that shows that you have an immune response to these crystals. Your immune system actually sees them as foreigners and sends eosinophils, which are white blood cells, to attack the crystals. The azinophils get broken down in the acidic environment, and when they become damaged, they begin to form this matrix around the crystal that exponentially increases the precipitation and the formation of the crystals. And then you can get these huge stones that won't pass or get stuck in the duct that leads from the gallbladder into the intestine. Pretty fascinating.

Amazing.

That's how we did it.

Well, you know, a lot of, a lot from a functional medicine perspective, you know, we see a lot of this in diabetics. Yeah. A lot of, this has to do with insulin resistance and poor metabolic health, which affects, you know, 88 of Americans. So that's why gallbladder disease is such a big deal. And the problems that people suffer from are miserable, pain, vomiting, nausea, just severe issues, and they can't digest their food. And often the traditional treatment is just surgery. But from a functional medicine perspective, what do we think about, how do we begin addressing this? What are the ways that we support these patients and how do we sort of get them better? And sometimes they do need surgery, but talk about the approach we would take in terms of what diagnostics we would use and how you would help people.

Yeah, sure. Just for sake of contrast, I would say that just doing my research for this podcast is really fascinating that the gallbladder and bile play a really important role in the body. I think this is one of the classic examples or the differences between functional medicine and conventional medicine. Because in conventional medicine, it's the stone, it's the pain, it's the complications of the stone. And so if you continue to have stones, we'll take your gallbladder out. If you have a complication to the stone, you have an infection, then we'll take your gallbladder out. And that's it. That's it. There's absolutely no thought as to the role, what got you there, and what the role of bile is in the rest of the process, because it just doesn't break down fat. Because of the contents of bile, which spills into your intestine, it can have a huge impact on your gut microbiome. So I just wanted to emphasize that, you know, that's why I said earlier, it's sort of like it's so common, it's invisible, and because, you know, we just take it out, there's even more reason to not think about it because that's, everybody says, you know, a lot of people, no, it's my gallbladder, now I'm gonna have to get it taken out. Their thought is the only cure for the gallbladder is to take it out. There's no thought to their lifestyle, their nutrition and the impact that bile is having on their gut microbiome, which might be causing some other symptoms in their GI tract.

Talk about that connection between the microbiome and the gallbladder.

Well, yeah, that's okay. So, all right, I can enter that highway from multiple routes. So, I will I will go at it from this perspective that when the bile, if it's too acidic, if you have too many toxins in it, and it enters into the, and your nutrition is poor, So, you don't have enough amino acids in it. You don't have enough proteins or enzymes that actually can be an aid to the bacteria in the gut microbiome to do their job. Then it will start to alter the environment of the gut microbiome. And then you'll end up with what we call dysbiosis. The bile will cause damage to the gut microbiome. when that happens, then the organisms that are really healthy start to decline. They become destroyed. Then you start to develop some organisms like Candida that will alter the gut microbiome even more. And some of those commensals that live there, they've been hanging on in the poop party where it's nice for bacteria to grow, they will start to grow. Now all these bad bacteria take over. You get inflammation, you have a breakdown of the mucosal lining. that plays a very important role of protecting your immune system and allowing for the healthy bacteria in your gut microbiome to communicate to the immune system in a very precise way because that happens and it's very important. And when that communication system breaks down because the gut mucosa has been damaged, then the immune system begins to be overwhelmed and starts to have inappropriate responses leading to autoimmunity and leading to inflammation throughout the body. That then triggers this inflammation. Then it affects the gallbladder. The gallbladder then will be affected. I'll give you an example. Let's say you have a gluten sensitivity. and you don't know it. You eat gluten. Gluten is a real strong potentiator for creating autoimmunity against your thyroid, and it can create Hashimoto's thyroiditis. There have been studies that show a very strong connection between Hashimoto's and gallbladder disease.

Interesting.

Right, and so, okay, so what happens? Well, gluten has antigens on it very similar to the thyroid. So when the immune system makes antibodies against the gluten, it also can confuse and those antibodies can attack the thyroid. Okay, what happens? Well, now that's called Hashimoto's. And Hashimoto's, in its end game, stops your thyroid from working, your thyroid loses function, we call it hypothyroidism. Hypothyroidism slows down the gallbladder's ability to move the bile out. That becomes the first step in your stones developing because if you can't get the bile out in the sluggish gallbladder, then the bile builds up and now you set up that environment for all those compounds to precipitate out. The threshold for that precipitation to occur lowers as you have more and more bile sitting there under pressure. So, that's, you know, you can see there's a cycle there. That's why I said you can't just ignore the fact that somebody's got a stone. You've got to look for root causes. You've got to look for other disease processes that may have predisposed them to form that stone. The stone's just the end of the process. And the disease process things like insulin.

Resistance and diabetes is a big one, which is such a big factor that we deal with. And often it's not really addressed as a way of treating Stones. We also deal with the whole gut issues. And what have you seen in your patients with us? You, you've had a patient who was, you know, over 40, a woman, she was gaining weight, had gut issues. Tell us about her and your approach. What did you do diagnostically? How did you treat her? What was the outcome?

Sure. So, and as we've learned in medical school, it's the, it's the four or five F's, depending on how you think about it. But unfortunately, it has a lot to do with women. And it has to do with the fact that, you know, when they're pregnant, which is fertile, they're 40. Those are two things that, you know, are high. They're, they're associated with not overweight, right? Yeah. Fertile. I don't want to say fertile fat.

Fertile fat. It was bad in medical school. We learned all this stuff, like fertile fat and 40. That was what we learned.

Yeah. Yeah.

George didn't want to say it, but I didn't.

Yeah.

So.

This woman came and her concerns were that she was really feeling fatigued, she had sudden weight gain, she had gone to her PCP, she was told that her thyroid looks fine, the numbers are okay, not to worry, you still got kids, this same old, you're getting older, you have kids, you're running around, you're busy. And so she was just living with this fatigue and this weight gain. And then she started having gut issues. She started having bloating and distension. And so she just couldn't take it anymore and she came to visit us. She had, I think, one episode of pain that sounded like it was gallbladder disease. And, she had lasted for an evening. It was after having a really fatty meal. And, she hadn't gone to the doctor. She sort of suffered through the night. And, so that she never really dealt with it. So, part of our—after our first visit, I told her, I really want you to go get an ultrasound of your gallbladder. I said, you, have a lot of things going on, but one of the things I need to really find out is if you do have gallbladder disease. It turned out that she did. She has some stones, and she probably did have an episode of a stone that passed and caused her some pain. The complete workup for her involved looking at her hormones, looking at her thyroid, and looking at her microbiome and food sensitivities. When I got her thyroid numbers back, her TSH was 3.9. Okay, so now, you know, doctors in a prime, you know, will look at that and say that's within the normal range because traditionally they've been taught that anything from, you know, 0.45 to 4.5 can be considered normal. But we've learned more and more that that's not the case. When you see a 3.9, you see a 4.2, You start to think, I don't think that thyroid really is an optimal function. Well, I also, when I check the thyroid, I also check for antibodies. And when you know her antibodies against her thyroid were sky high, she had Hashimoto's thyroiditis. On her food sensitivity panel, she had gluten sensitivity. She did not have celiac disease. but she had gluten sensitivity, Hashimoto's, hypothyroidism, which then set her up for a couple of different things. But certainly it slowed her gallbladder down and set her up for having a stone by the mechanisms I've already explained. And she was estrogen dominant, meaning that relative to progesterone, she had more estrogen than she needed. And she had a history of a cycle that had been irregular, a cycle that she had a lot of breast tenderness, she had a lot of water retention around her periods, she had PMS around her period.

And.

That just screams estrogen dominance. And she's had that most of her life. So, what did I do? Step by step, we just started to deal with the underlying issues. I started to treat her thyroid, treat her Hashimoto's thyroiditis. I treated her, she had SIBO, by the way. First thing we did, we stopped the gluten. She was off of gluten, and that's going to, you definitely want to do that because if you have sensitivity to it and you get one autoimmune disease like Hashimoto's, then you're going to set yourself up for more because it's more likely that you'll get another one once you have one. Gluten and then we addressed her SIBO, SIBO small intestine bacterial overgrowth. We put her on a low FODMAP diet, which helped address that. I used some antimicrobials that were botanicals that addressed that.

And how did she do?

She did great, obviously. It took a while to get her hormones under control and balance those out. It took a little while to to get her SIBO under control. But once we had the SIBO under control, we got her thyroid function down from, what would I say, it was 3.9.

3.9.

Got it down to 1.2. Her energy was back. She felt great. And then as we work with her diet and we clean up her SIBO, she was back to normal in a very short course of time, within three months.

It's amazing. So, we really can affect people's course and she really didn't need surgery then.

She did not need surgery. As I said before, and I explained this to her, I said, the stones are just enigmatic of the bigger problem. They're the canary in the coal mine of your nutrition not being where it needs to be and you may be having excess toxins in your system and the estrogen dominance Estrogen needs to be metabolized, and it is in the liver, and it ends up in the gallbladder. But if it's in too higher concentrations, it can have a very negative impact on gallbladder function. So dominance, her SIBO, her thyroid, she was just, it was just, it was a matter of time before she had SIBO. If she had had that stone and gone to the emergency room, and hadn't passed it, she would have had her gallbladder taken out and nobody would have ever addressed these other issues.

Absolutely. I think that, you know, I've seen patients who really been able to turn things around by correcting them and correcting their diet and their lifestyle and taking the right supplements. And, you know, it's not an easy condition for sure, 'cause if you already have big stones, this blocking things, sometimes you need to have it dealt with. And after people have surgery, I mean, are they restricting or know they can eat? so often people say, why can't I eat fat? Is that true? Can they use enzymes? What are the sort of consequences of actually having the surgery?

Well, you know, the consequence of the surgery is that now the gallbladder can no longer store the bile. So the bile can freely flow into the small intestine. And so, you know, in regards to the ability for the bile to do its job, it's not going to be being triggered appropriately. It's really important that if you've had your gallbladder out, that you take something called ox bile with your meals so that you can appropriately break down your fats. It can have a significant role because you may not break your fats down completely and you need as important fatty acids, your omega-3s, your DHA, your EPA that you get from your fat. And if you can't get them, then it's going to have a huge impact on you. In regards to foods you can eat, it's more of what you should eat. I think there are restrictions, but they're not always necessary. It's really making sure that you're getting a higher fiber diet, you're getting foods that are going to be favorable to your gallbladder, celery, what are some of the other ones? Help me out here, Mark. You're gonna come up with foods. Bitters, bitters are great. Green leafy vegetables, things that they can be very helpful. So, absolutely. The key thing becomes staying away from all the processed carbohydrates, staying away from meats that are not organic, that have lots of toxins in them. And if you do that, you take your ox bile, increase your fluid intake, add in some bile salts, which you can do through supplementation. You should be able to live pretty healthy. Yeah. Even more healthy because we're going to change your diet because we're going to say, look, these are the things that got you to the stones. And now you're going to have a really good leverage point on getting people to start to eat a healthier diet.

That's fantastic. Well, you know, the truth is that there's so much we can do, and it's such a hopeful message for those who have gallbladder disease and can actually make a difference in the course. Maybe they'll need surgery, but maybe they won't if they try some of these other things that we use in functional medicine and we take care of all sorts of patients like this at the Ultra Wellness Center in Lenox. We have a great team of five docs and five nutritionists and a great support staff and we really love to see you. So come visit us. And of course we have a long waiting list, but hopefully we'll get you in soon. And if you like this podcast, please share with your friends and family on social media. If you had gallbladder disease and you've.

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