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All content in this area was uploaded by Margaret M Moga on Jan 29, 2018
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Alternative treatment of
gallbladder disease
M. M. Moga
Terre Haute Center for Medical Education, Indiana University School of Medicine, Terre Haute, IN, USA
Summary Major risk factors for gallbladder disease include a sedentary lifestyle and a diet rich in refined
sugars. In genetically prone individuals, these two factors lead to an abnormal bile composition, altered gut
microflora, and hyperinsulinemia, with resulting gallstone formation. As a large percentage of gallbladder patients
have continued digestive complaints following cholecystectomy, the author examines complementary and
alternative medicine (CAM) treatments to counteract gallstone formation. Herbal medicine such as turmeric,
oregon grape, bupleurum, and coin grass may reduce gallbladder inflammation and relieve liver congestion.
Elimination of offending foods, not necessarily ‘fatty’ foods, is often successful and recommended by many holistic
physicians. Regular aerobic exercise has a beneficial effect on hyperinsulinemia, which is often associated with
gallbladder disease. Dietary changes that lower plasma insulin levels, such as a change in dietary fats and
substitution of unrefined carbohydrates for refined carbohydrates, may also be helpful.
ª2002 Elsevier Science Ltd. All rights reserved.
INTRODUCTION
Cholecystectomy (surgical removal of the gallbladder) is
one of the most common elective surgeries in the US
with approximately 500,000 new cases each year. The
introduction of laparoscopic techniques to cholecystec-
tomy has significantly reduced the length of hospital
stays and patient recovery time, leading to the wide
adoption of this surgical method. Presently in the US,
laparoscopic cholecystectomy (LC) is the primary rec-
ommended treatment for symptomatic gallbladder dis-
ease (18). Complications from LC are infrequent (3–6%),
but can be significant, and include bile duct injuries and
the escape of gallstones into the peritoneum (39,58).
More troubling is the continued presence of preopera-
tive symptoms following LC in 10–47% of patients
(5,49,50). Postcholecystectomy symptoms are often
attributed to ‘irritable bowel syndrome’ (18), but the
author hypothesizes that, at least for some patients,
cholecystectomy does not correct the underlying liver or
GI dysfunction that elicited gallstone formation. The
author examines the etiology of gallbladder disease and
reviews some alternative treatments for gallstones.
GALLBLADDER DISEASE
What factors predispose a person to develop gallstones?
Three major risk factors have been identified so far,
namely (1) genetic background, (2) a sedentary lifestyle,
and (3) a diet rich in simple sugars (e.g., monosaccha-
rides, disaccharides). The incidence of gallbladder dis-
ease is particularly high among first degree relatives of
gallbladder patients (e.g., parent and child; siblings);
among certain Native American tribes; and in those of
Hispanic origin (12). An early review by Heaton (20)
described, ‘the sweet road to gall stones’. Gallstone pa-
tients consume significantly more sugar than controls
(44). Raised plasma insulin and reduced tolerance to
glucose are strongly predictive of gallstones (21,40). The
risk of gallstone formation is significantly increased in
individuals with both a sedentary lifestyle and a diet rich
in refined sugars (40,41). Recreational physical activity is
associated with a decreased risk of cholecystectomy
(31,32).
Medical Hypotheses (2003) 60(1), 143–147
ª2002 Elsevier Science Ltd. All rights reserved.
doi:10.1016/S0306-9877(02)00351-1, available online at http://www.idealibrary.com
143
Received 11 March 2002
Accepted 12 July 2002
Correspondence to:Margaret M. Moga PhD, Indiana University School of
Medicine, 135 Holmstedt Hall, Terre Haute, IN 47809, USA.
Phone: +1-812-237-3420; Fax: +1-812-237-7646;
E-mail: mmoga@medicine.indstate.edu
Cholesterol gallstones are the most common type of
stone (18). How are these formed? Three major stages
are recognized in stone formation. First, bile secreted
by the liver is altered in its composition, either due to
genetics, diet and/or other environmental causes. In
particular, the bile becomes supersaturated with cho-
lesterol. Supersaturation of the bile with cholesterol
increases the chances of cholesterol precipitation and
crystallization. Cholesterol supersaturation is present in
most patients with gallbladder disease, but is also
present in 40–80% of normal subjects with no gall-
stones (24). More significant differences in bile com-
position between patients and controls involve the bile
acids and bile phospholipids. Bile secreted by gall-
bladder patients contains a higher percentage of a
secondary bile acid, deoxycholic acid (DCA), and more
arachidonic acid-rich phospholipids than the bile of
healthy controls (7,38,57). At high concentrations, DCA
and arachidonic acid act as irritants of the gallbladder
epithelium, leading to increased mucus secretion by
the gallbladder mucosa (30,43). In the second stage of
gallstone formation, the gallbladder shows signs of
acute inflammation, and gallbladder emptying is im-
paired, resulting in bile stasis and the formation of
biliary sludge (45,51). In the final stage, cholesterol
crystallizes around ‘pronucleating factors’, proteins
such as mucin and immunoglobulins that accelerate
crystallization (19,51). Some useful strategies for re-
versing gallbladder disease may include reducing gall-
bladder inflammation and restoring normal bile
composition.
As some treatment alternatives are based on Tradi-
tional Chinese Medicine (TCM), it may be worthwhile to
briefly examine gallbladder disease through a TCM
perspective. In TCM, the liver and gallbladder are con-
sidered paired Yin and Yang organs, respectively (26).
The liver is responsible for ‘flowing and spreading’both
energy (Qi, Blood) and bodily substances in all direc-
tions to every part of the body. The gallbladder stores
and secretes bile which, according to TCM, is produced
by surplus Qi of the liver. Any disruption of the liver’s
flowing and spreading activity will affect the gallblad-
der’s bile secretion. Liver disharmonies typically involve
stagnation and congestion, and are evident as digestive
problems (indigestion, flatulence, diarrhea), disruption
of bile production (jaundice, pale stools), emotional
upsets (anger, irritability, sleep disturbances), and low
vitality. When liver-Qi stagnates, bile is not secreted
properly, leading to an accumulation of damp heat in
the gallbladder (37). Damp heat over a period of time
will result in stone formation. Thus, the two TCM pat-
terns most often recognized in gallbladder disease are
‘stagnation of liver-Qi’and ‘damp heat in liver and
gallbladder’.
ALTERNATIVE TREATMENT OF GALLBLADDER
DISEASE
In both Western holistic medicine and TCM, mild cases
of gallbladder disease may be treated with a variety of
methods, including herbal medicine, diet, and acu-
puncture (2,37,61).
Dietary changes
An early study found that gallbladder patients show no
recurrence of symptoms while on an allergy elimination
diet (9). The foods most frequently found to provoke
gallbladder symptoms were eggs, pork, onion, fowl,
milk, coffee, oranges, corn, beans, nuts, apples, and to-
matoes. Treatment with antihistamines accelerated pa-
tient recovery suggesting a food allergy rather than a
food intolerance underlying the disease (9). Positive re-
sults have been obtained by others using this approach,
with patients reporting a cessation or marked lessening
of their symptoms (2,61). Mast cells, which play a key
role in allergic responses, are present in the gallbladder
mucosa (22). Guinea pig gallbladder epithelium is
strongly positive for histamine N-methyltransferase, an
inactivating enzyme for histamine (54), suggesting that
histamine release by mast cells may be part of normal
gallbladder physiology. As an alternative hypothesis, we
speculate that increased biliary concentrations of DCA in
gallbladder disease may elicit an allergic-type response.
Hydrophobic bile acids such as DCA cause histamine
release from cultured mast cells in a dose-related manner
(46). In summary, results suggest the possibility of food
allergy or an allergic-type response in gallbladder pa-
tients, most likely mediated by mast cells in the gall-
bladder mucosa.
The inclusion of more fruits and vegetables and less
refined carbohydrates in the diet may lower biliary DCA
in gallbladder patients. Investigators have observed that
with a refined carbohydrate diet, bile contains less cholic
acid and more DCA, and the cholesterol saturation index
is higher, than that observed with an unrefined carbo-
hydrate diet (55). DCA is a microbial product formed in
the intestines by 7a-dehydroxylation of cholic acid.
Gallstone patients have higher and more active levels of
7a-dehydroxylating colonic bacteria, which may ac-
count for the higher percentage of DCA in their bile acid
pool (59). Of the 7a-dehydroxylating bacteria present in
these patients, virtually all are of the genus Clostridium
(59). Clostridium is relatively nonspecific in its fermen-
tation of carbohydrates, whereas, colonic bacteria of the
genus Bifidobacterium, for example, specifically ferment
fructose oligosaccharides (b-
DD
-fructans) such as oligo-
fructose and inulin, which are abundant in fruits and
vegetables (16,17). Inclusion of b-
DD
-fructans-rich foods
144 Moga
Medical Hypotheses (2003) 60(1), 143–147
ª
2002 Elsevier Science Ltd. All rights reserved.
in the diet selectively enhances beneficial microflora
populations (e.g., bifidobacteria), while reducing the
percentages of other bacteria types (e.g., Clostridium)
(17). Thus, the lower biliary DCA percentages observed
with an unrefined carbohydrate diet may be due, in part,
to beneficial changes in the gut microflora.
Simply lowering total dietary fat is not an effective
treatment for gallbladder disease (9), but a change in the
type of dietary fat ingested may improve bile composi-
tion. Investigators have long recognized an association
between dietary fat and glucose metabolism (33). Plasma
insulin levels are significantly elevated in individuals
with gallstones, despite normal serum glucose and no
clinical diagnosis of diabetes (40,52). In normal rats,
plasma insulin is elevated with high dietary cholesterol
(60). Dietary cholesterol is not a significant risk factor for
gallbladder disease (20); however, gallbladder patients
seem to have an altered cholesterol metabolism. In
gallstone patients but not in healthy controls, high di-
etary cholesterol significantly increases biliary choles-
terol and decreases cholic acid synthesis, resulting in a
more lithogenic bile (27). As a possible explanation for
the altered cholesterol metabolism, many patients with
gallstones show reduced activity of a key liver enzyme,
cholesterol 7a-hydroxylase, which converts cholesterol
to primary bile acids (3). High plasma insulin levels de-
press cholesterol 7a-hydroxylase activity (53), which
could account, at least in part, for the altered bile com-
position of gallbladder patients with hyperinsulinemia.
Dietary strategies to lower plasma insulin levels, similar
to those recommended for patients with mature-onset
diabetes, may be helpful and include: substituting
monounsaturated fats (e.g., olive oil) for cholesterol-rich
saturated fats (e.g., butter, cheese), decreasing trans fatty
acids (hydrogenated oils), increasing consumption of
omega-3 fatty acids (e.g., fish), and substituting unre-
fined carbohydrates (fruits/vegetables) for refined car-
bohydrates (sugar, white flour) (13,33).
Physical activity
Physical activity may play an important, if not essential,
role in the treatment of gallbladder disease. The risk of
gallstone formation is significantly increased in individ-
uals with a sedentary lifestyle (40,41). Loss of muscle bulk
is associated with gallstones in men (21). Two to three
hours of recreational exercise per week reduces the risk of
gallstones in women by approximately 20% (32). The
protective effect of physical exercise may be due to its
actions on glucose metabolism. Fasting plasma insulin
levels are significantly reduced following an exercise
training program (10,28). In non-diabetic individuals,
plasma insulin levels during an oral glucose tolerance test
are lowest in men with the highest physical activity (13).
Herbal medicine
Individuals with gallbladder disease may benefit from a
variety of herbal compounds. Turmeric root (Curcuma
longa) has a long history as a digestive aid and choleretic
in Asian, Ayurvedic, and Western herbal medicines (4,8).
In a clinical study in Thailand, turmeric root significantly
reduced flatulent dyspepsia (8), a frequent symptom in
gallbladder disease (18). The active constituents of tur-
meric, namely curcumins and turmerin, have choleretic,
antioxidant, and antiinflammatory activities (8,35). Oral
curcumin administration stimulates bile flow in rats (1)
and has antiinflammatory mechanisms similar to those
of phenylbutazone (35). In the dog, intravenous sodium
curcuminate increases the water content and volume of
bile (47), producing a more dilute bile secretion. In TCM,
Curcuma longa (‘Yu Jin’) is known for its ability to dis-
perse liver energy and is included in the gallbladder
remedy Li Dan Pai Shi Pian (4,15). Turmeric may be
combined with Oregon grape root to release congestion
in the liver as effectively as Chinese bupleurum (56).
Oregon grape (Mehonia aquifolium) is recommended
by some herbalists for gallbladder disease (14,56).
Berberine alkaloids isolated from Oregon grape have
strong lipoxygenase-inhibitory and antioxidant proper-
ties (14). Lipoxygenase catalyzes the conversion of
arachidonic acid to leukotriene A4(23). Leukotrienes are
known mediators of allergic responses and inflamma-
tion, and are preferentially excreted in the bile (23,48). A
recent study found that a novel 5-lipoxygenase inhibitor
significantly decreases the rate of cholesterol stone for-
mation in the prairie dog (25). Studies are needed to
determine whether Oregon grape is effective in pre-
venting gallstone formation and/or relieving gallbladder
inflammation in humans.
Bupleurum (Bupleurum chinense) is a well-known Chi-
nese herb (‘Chai Hu’) with an affinity for liver (4,6,34,56).
Bupleurum root disperses liver energy, clears heat, and
relieves congestion (4,6,34,56). This herb is included in
several classical Chinese herbal formulas such as Xiao Yao
Wan (for stagnation of liver-Qi), Long Dan Xie Gan Wan (to
purge heat from the liver and gallbladder), and Li Dan Pian
(resolves damp heat of the liver and gallbladder) (15).
Researchers have detected anti-inflammatory saponins in
a variety of Bupleurum species (42,62).
In Chinese folklore, an herb called ‘coin grass’was
discovered to have gallstone-dissolving properties (34).
Coin grass may refer to one of three different species with
similar names, morphology and properties: Lysimachia
christinae (Szechwan gold coin grass), Desmodium strya-
cifolium (copper coin grass) or Glechoma hederaceae
(golden coin grass) (4,34). Lysimachia has antiinflamma-
tory and hepatoprotective effects, and is used in cases of
mushroom and/or drug poisoning, infections, snakebites,
Alternative treatment of gallbladder disease 145
ª
2002 Elsevier Science Ltd. All rights reserved. Medical Hypotheses (2003) 60(1), 143–147
and stones of the urinary and biliary tracts (4). Desmodium
is recommended for urinary and gallbladder stones, and
for hepatitis (4). Lysimachia and Desmodium are included
in several Chinese herbal patent formulas for gallstones,
including Li Dan Pian (15,37). The pinyin pronunciation
term, ‘Jin Qian Cao’, has been variably used for Desmo-
dium (4), Lysimachia (15), and Glechoma (34). Glechoma,
also known as ‘Lian Qian Cao’, is commonly prescribed
for cases of inflammation, such as influenza, traumatic
injuries, and swollen sores (4).
Acupuncture
Acupuncture facilitates the expulsion of gallstones in
70% of cases (37). Stagnation of liver-Qi is treated with
acupuncture at the LIV-14 and GB-34 points. Damp heat
in the liver and gallbladder is treated by acupuncture at
points GB-24, GB-34, Du-9, and SP-9. In a golden ham-
ster model of cholelithiasis, acupuncture at GB-34, LIV-
14, and GB-24 reduced the formation and number of
gallstones; reduced the cholesterol content of bile and
plasma; and significantly increased levels of biliary
cholic acid (36). The combination of reduced biliary
cholesterol and increased biliary cholic acid would make
the bile less lithogenic. These results suggest that acu-
puncture may have a beneficial effect on bile composi-
tion.
SUMMARY
For individuals with a mild or early case of gallbladder
disease, the following recommendations may restore
normal bile composition and reduce gallbladder in-
flammation.
1. Eliminate any foods that provoke acute symptoms.
Evidence suggests that food allergies may be involved
in gallbladder disease.
2. Use herbal medicine to relieve gallbladder inflamma-
tion and liver congestion. For patients in the U.S., tur-
meric extract (capsules) and oregon grape root
(alcoholic tincture) are readily available, and taken to-
gether are quite potent.
3. Adopt an insulin-lowering lifestyle and diet. Regular
aerobic exercise, a change in dietary fat, and a reduc-
tion in dietary refined carbohydrates together have a
beneficial effect on glucose metabolism.
Acupuncture is another option, where available. With
the use of herbal medicine, lifestyle and dietary changes,
the gallbladder patient may be able to avoid possible
long-term health consequences of hyperinsulinemia and
increased dehydroxy bile acids, which are associated
with gallbladder disease and which are not necessarily
corrected with cholecystectomy (11,29).
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