Most surgeons on call on Thanksgiving or Christmas Day are not surprised when they get called into the ER to see a patient with right upper abdominal pain and tenderness radiating through to the back. There are also no surprises when an abdominal ultrasound shows a dilated gallbladder, possibly with a thickened wall, and gallstones ranging from the size of a pebble to the size of a marble or even an egg. At this point, the appropriate next step would be laparoscopic cholecystectomy, or removal of the gallbladder. This is one of the most common surgical procedures in the Western world today.
So how does a person find themselves in the operating room on Thanksgiving night? First of all, it didn’t just happen all at once. Gallstone formation takes months or even years. It is believed that low-fiber, high-cholesterol diets high in processed starchy foods contribute to the formation of cholesterol stones. Over-consumption of fatty and fried foods and refined sugar, as well as inadequate intake of vitamins B, C and E, are also factors thought to contribute to gallstone formation. Inadequate water intake and lack of exercise also play a role.
With the above diet, a bacterial imbalance in the gut will develop. The effect in the gut of this imbalance will be increased intestinal permeability (also known as leaky gut). As a result of leaky gut, more toxins are delivered to and processed by the liver. These toxins are sent from the liver to the gallbladder, where they are stored and concentrated along with the bile, which can lead to gallstones.
So how do the holidays fit into this? Very simply – a large meal high in fat and sugar will release the hormone cholecystokinin (CCK) from the duodenum (upper small intestine). CCK triggers the gallbladder to begin contracting and may move the stones into the cystic duct (which drains into the common duct and then into the duodenum) causing gallbladder obstruction, swelling, more inflammation, and severe right upper quadrant pain.
Many people do not realize they have gallstones. They may go years without symptoms and only discover the gallstones in an emergency room visit such as I described above. Other people do experience periodic attacks and are able to recover from them and choose not to have surgery. In either case, it’s prudent to take extra care at major holiday meals. A combination of gravy, ham, buttery mashed potatoes, candied yams and alcohol, followed by pumpkin pie and ice cream is the perfect recipe for a gallbladder stress test. The following recommendations could help you avoid that ER visit this holiday season:
• Eat smaller portions of any high fat, high-sugar foods
• Chew thoroughly
• Eat slowly, taking the time to enjoy the meal and company
• Take digestive enzymes with the meal
• Limit alcohol consumption
Most importantly, as a preventative measure, follow up with a high-fiber, plant-based, antioxidant-rich diet low in processed foods and saturated fats, fried foods and sugar. In addition to getting regular excise and having regular bowel elimination to reduce toxins, it is important to have a healthy balance of intestinal bacteria. This can be achieved by eating fermented foods (which are naturally high in beneficial bacteria) and taking high-quality probiotic supplements every day.