Understanding how the gallbladder works and its connection to hormonal changes during perimenopause is crucial for maintaining overall health and well-being.
Many people are completely oblivious to the gallbladder's importance and surprising power over digestion and hormone balance. During perimenopause, its significance can often increase.
Unless you've had gallstones or experienced some form of gallbladder disease, you might not even be aware of its function. While initially 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 gallbladder diseases, ranging from sludge to stones.
The Gallbladder: Function and Importance
The gallbladder is a small, pear-shaped organ that stores and then releases bile produced by the liver.
The Role of Bile
Bile, a greenish-yellow fluid, is pivotal in the digestive process and overall metabolic health.
Its primary functions:
Fat Digestion: Released into the small intestine to emulsify fats, breaking them into smaller particles for easier absorption.
Nutrient Absorption: Facilitates the absorption of fat-soluble vitamins such as A, D, E, and K.
Waste Elimination: Helps eliminate waste products, including bilirubin (a byproduct of red blood cell breakdown) and excess cholesterol.
Antimicrobial Properties: Maintains gut health by inhibiting the growth of harmful bacteria – due to its pH.
But there are other lesser-known functions.
Hormone Regulation: This plays a crucial role in managing oestrogen levels, impacting conditions like oestrogen dominance, perimenopause, and premenstrual syndrome.
Gut Health: Insufficient bile can lead to dysbiosis and intestinal permeability, causing undigested foods to become inflammatory and serve as food for pathogens, leading to an irregular inflammatory response.
Efficient bile production and flow are crucial for maintaining our overall health.
Bile Flow
Bile will only be released when we eat fats – so no fat – no bile.
This causes two issues.
The body is highly efficient and recycles about 95% of bile. If bile is not regularly moved around, it can become dirty and contribute to the body's toxic burden.
Plus, if bile sits in the gall bladder for extended periods, it can become concentrated and form sludge. This can then contribute to cholestasis.
Cholestasis refers to reduced or blocked bile flow. When cholestasis occurs, conditions like gallstones can onset. This can create a vicious cycle where individuals avoid fats, exacerbating bile flow issues.
Contrary to what many believe, eating healthy fats and nutrient cofactors is essential for maintaining healthy bile flow.
Symptoms of Gallbladder Dysfunction
Gallbladder dysfunction can lead to various symptoms, including:
- Pain under the right ribcage, often with heartburn, nausea, gas, and fullness.
- Pain between the shoulder blades.
- Chronic abdominal ache, especially after eating.
- Pale, greasy, floating stools; grey, white, or clay-coloured stools.
- Altered bowel movements (too fast or too slow).
- Stubborn weight gain.
- Gallstones or reduced bile flow (cholestasis).
- Discomfort when eating fats.
- Bacterial overgrowth in the small intestine.
If you're experiencing persistent infections, toxicity issues, immune dysregulation, or constipation, consider evaluating your bile flow.
Why Do Women Develop Gallbladder Problems During Perimenopause?
The probability of developing gallbladder diseases, especially gallstones, increases with age.
Here's why:
1. Hormonal Changes:
The gallbladder relies on hormones to regulate its physiological functions. During perimenopause, many of these hormones are reduced or impaired, disrupting normal gallbladder function.
Oestrogen and Progesterone
Changes in oestrogen and progesterone can change the composition of bile and influence its movement out of the gall bladder.
- Oestrogen: Oestrogen increases the absorption of cholesterol in bile. This can be positive, but equally – it can clog up the gall bladder, causing biliary sludge.
- Progesterone: Progesterone can slow down the emptying of the gallbladder, again contributing to the accumulation of sludge.
Oral contraceptive pills and pregnancy (both times of high oestrogen) have long been recognised as contributors to gall bladder issues.
Perimenopause can equally create problems, with or without HRT.
Thyroxine and Gallbladder Health
Thyroxine (T4) plays a significant role in gallbladder health - women with thyroid disorders have a higher incidence of gallbladder issues.
Low or suboptimal thyroxine levels are linked to reduced bile acid flow, leading to delayed gallbladder emptying and a higher prevalence of stone formation.
During menopause, the eventual decrease in oestrogen heightens the risk of thyroid dysfunction, affecting cholesterol metabolism and bile production, composition, and flow.
2. Diet and Lifestyle:
While poor diet and lifestyle choices are often blamed, many women experience gallbladder issues despite no changes in their diet or lifestyle.
However....
A low-fat diet is considered a primary contributor to gallbladder issues.
Without sufficient dietary fat, the gallbladder does not receive signals to release bile. This can lead to poor absorption of fat-soluble vitamins, increased dysbiosis (microbial imbalance), digestion issues, and heightened inflammatory responses.
Ensuring a balanced intake of healthy fats is crucial for maintaining proper gallbladder function and overall digestive health.
Extended fasting can also be an issue (for 16-18 hours).
Eating less frequently throughout the day can lead to gallstones. During fasting states, the gallbladder stores bile, causing it to become super concentrated along with the cholesterol it contains. Gallstones often form from these crystallised bits of cholesterol.
By eating more regularly, your gallbladder is prompted to secrete bile to aid digestion and flush out stored cholesterol, helping to prevent the formation of gallstones.
Supporting Gallbladder Function During Perimenopause
Maintaining a healthy gallbladder is crucial during perimenopause. Here are some comprehensive strategies to support your gallbladder health:
Balanced Diet
Healthy Fats (Omega 3):
Include healthy fats such as olive oil, avocados, nuts, seeds, and fatty fish. These fats help stimulate bile production and flow and are needed to absorb fat-soluble vitamins. Olive oil helps your gallbladder to empty itself of bile acids and manage cholesterol levels in the blood.
Avoiding fats altogether is not sustainable and won't address the underlying issue.
Fibre-Rich Foods:
Increase fibre intake to prevent and reverse gallstones. Fibre helps keep your digestive system moving, increases the solubility of bile salts, and facilitates the excretion of cholesterol/bile. Consume plenty of fibre from fruits, vegetables, whole grains, and legumes to bind and eliminate bile acids, reducing the risk of gallstones.
Vitamin C:
Stimulates the metabolism of cholesterol into bile acids. Found in citrus fruits, dark leafy vegetables, and crucifers.
Bitter Foods and Herbs
Bitter foods and herbs like rocket, dandelion root, parsley, coriander, lemons, and vinegar help, as do warming spices like ginger, turmeric, and cinnamon. Prebiotic foods like artichokes, radishes, asparagus, and garlic increase bile flow and digestive enzymes, aiding in digestion and bile secretion.
Healthy Proteins
Red meat can raise cholesterol and is linked to digestive issues affecting the gallbladder. Reduce red meat consumption and opt for fish and plant-based proteins such as beans, tofu, and other vegetarian options high in fibre and low in saturated fat.
Hydration
Ensure proper hydration with clean water, essential for bile synthesis, flow, and function. Bile is about 95% water, so staying hydrated is crucial.
Increase water intake to at least 2 litres daily to maintain optimal liver and gallbladder function and help flush out toxins.
Regular Meals
Eat smaller, more frequent meals to encourage regular bile secretion and prevent bile from becoming overly concentrated.
Avoid Fasting: Long periods without eating can lead to bile stasis, so avoid prolonged fasting.
Exercise
Exercise helps improve liver and gallbladder health by promoting better blood flow, reducing inflammation, and aiding in detoxification.
Stay active and maintain a healthy weight to reduce the risk of gallstones. If weight management is an issue, seek support and avoid losing weight too quickly.
Avoid Foods and Drinks That Are Hard on the Gallbladder
Fried Foods
Reduce Refined Sugars and Carbs
Limit Saturated Fats
Avoid Excessive Alcohol Consumption
Conclusion
The gallbladder and bile play crucial roles beyond fat digestion, impacting nutrient absorption, detoxification, hormone regulation, and overall digestive health.
Maintaining gallbladder health is particularly important for women to prevent conditions like gallstones and cholestasis, ensure optimal digestive function, and improve overall well-being.
Incorporating these strategies into your lifestyle can support your gallbladder function and overall digestive health during perimenopause.
Reviewing your gallbladder health is a good idea especially if you are suffering from digestive issues, bowel movement variations, or symptoms of oestrogen dominance.
Remember, that I am here, should you want support, more information or accountability.
Start with small steps each day, and you'll notice the benefits over time.
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