We all know someone who has had or will have a gallbladder attack. There are some common questions about the gallbladder, bile and biliary stones that patients repeatedly ask me. I’d like to answer these questions and give you some practical information so you know how to handle gallbladder troubles.
The Gallbladder And Bile
The gallbladder is a small bag (3 inches to 4 inches long) that acts as a catch basin for bile made by your liver. It also concentrates bile and secretes mucus into this bile. Bile, which has an alkaline pH of 7.6 to 8.6, contains salts, water, cholesterol, bilirubin (blood hemoglobin by-product) and other compounds. Bile is a marvelous substance that serves two main functions. First, it carries away the by-product of your liver’s detoxification process, collecting it into larger and larger ducts until it finally empties via the common duct into your small intestine. Then, the bile in your small intestine allows you to digest and absorb fatty foods that don’t get fully dissolved by your stomach and pancreatic digestive enzymes.
Bile is a very strong substance that makes the stomach contents yellowish green and turns stool brown or green. Well, toxic compounds sit in the gall bladder and can coalesce to form small (2 mm to 7 mm) or large (8 mm to 20 mm) stones. Since the gallbladder neck is only 6 mm in diameter, a large stone can get stuck in there when the gallbladder contracts to push out bile, the natural action triggered when a high fat content is detected in your intestinal tract. Stones may consist of 80 percent or more cholesterol (cholesterol stones) or 20 percent or less bilirubin and calcium (pigment stones). Cholesterol stones are five times more common than pigment stones.
Why do stones form? Problems start when the cholesterol (or pigment) gets too concentrated and there are not enough bile salts and water to keep them soft. This happens largely because the gallbladder does not contract firmly, doesn’t empty completely or doesn’t contract frequently enough (kind of like a constipated condition in the gut). You can see how a cleansing diet can improve this. Other contributing factors include a concentration of proteins that promote cholesterol crystallization into stones as well as conditions that produce too much bilirubin, such as sickle cell anemia or liver cirrhosis.
Painless stones are the norm. They cause adverse symptoms only when a stone is pushed into the narrow gallbladder outlet (cystic duct) where it connects to the large common duct. The classic biliary colic (gallstone attack) is a rather rapid (30-minute) onset of right upper abdominal pain, nausea and possibly vomiting. The gallbladder may also become swollen and then infected (cholecystitis), adding fever to the symptoms of pain and nausea.
Conservative Management Of Gallbladder Pain
What can a person do who is experiencing these symptoms? Most people will go to a hospital emergency department for pain control and also to get clear on the diagnosis. If a simple ultrasound does not show stones with dilated cystic duct or gallbladder wall, then a cholescintigraphy scan (HIDA scan), in which a radioactive tracer attached to iminodiacetic acid is watched as it gets excreted into bile and then observed for normal gallbladder uptake, can be done. This scan detects acute gallbladder infection or obstruction in more than 90 percent of cases, but it is not so accurate if it is a chronic problem.
For people who avoid hospitals at all costs, it is important they watch for signs (jaundice) and symptoms (fever) of cholangitis and pancreatitis. If gallstones block the common bile duct (backing up the liver) and infection develops, it is called ascending cholangitis, which leads to a drop in blood pressure and mental confusion. If gallstones block the pancreatic duct, then pancreatitis develops.
However, the pains of acute or recurring gallstone attacks are quite easy to pinpoint because they are localized to the right upper quadrant of the abdomen and they occur after fatty meals. The simple remedy at first is to fast from fatty food and stay well hydrated so the gallbladder will not contract to expel bile. Best would be to go on a fresh juice fast for two days and ease back slowly into solid foods over the next five days. The more permanent solution, if you want to avoid surgical removal, is to shift your diet away from cholesterol (animal fat), saturated fat, trans-fatty acids and refined sugar toward raw veganism. Then dissolve and/or expel the stones naturally. There are various ways to dissolve them, but results are variable:
- Take prescription Actigall (ursodeoxycholic acid) for many months to reduce cholesterol absorption and help dissolve cholesterol stones. A clinical study  showed it worked quite well in about half of subjects to reduce or eliminate chronic cholesterol stones.
- Take ascorbic acid (vitamin C) tablets to help convert cholesterol to bile acids. While high-dose vitamin C has been shown to reduce the risk of gallstones, it only marginally helps gallstones to naturally dissolve. 
- Consume soy lecithin supplements. Reportedly, they help dissolve gallstones, though I could not find any clinical trials reported in scientific literature.
- Eat food high in fiber, which binds cholesterol in the intestinal tract and potentially could bind and break down gallbladder stones, too.
There are ways to expel them, as reported by many testimonials, but without rigorous scientific proof. Here is the “flush” protocol I recommend:
You Will Need:
2 cups cold virgin olive oil
1 cup freshly squeezed lemon juice
Peppermint oil (from your health food store)
Pineapple or V8 juice
Measuring cup or tablespoon-sized measuring spoon
Pitcher of water
Noon: Stop eating all solid food.
6.30 p.m.: Stop drinking all fluids.
7 p.m.: Drink ¼ cup of olive oil followed immediately with 1 or 2 tablespoons of fresh lemon juice. Lie down and relax for 15 minutes and get ready to repeat this again.
7:15 p.m.: Repeat the exact dosage (¼ cup olive oil and 1or 2 tablespoons of fresh lemon juice) and continue repeating every 15 minutes until you have swallowed the entire pint of olive oil. If there is any lemon juice left, then drink it all.
Several hours later: When you have finished the olive oil and lemon juice, lie on your right side and go to sleep for the night. You can expect to have an urge for a bowel movement around 2 a.m. or not until the next day. Your stool will likely contain stones.
If you have terrible nausea or vomiting sensations, use peppermint oil in the olive oil, or chase the olive oil with a small amount of V8 or pineapple juice until you can resume taking the plain olive oil and lemon juice. Try waiting 30 minutes between doses if it gets hard to swallow the olive oil and lemon juice. In some individuals, the powerful action of the lemon juice causes the stones to dissolve before they are passed out of the body. If you have only greenish liquid bowel movements, the treatment has been effective.
To feeling good for life,
Michael Cutler, M.D.
Easy Health Options
 Thistle JL, Hofmann AF. Efficacy and Specificity of Chenodeoxycholic Acid Therapy for Dissolving Gallstones. N Engl J Med 1973; 289:655-659. Online at: http://www.nejm.org/doi/pdf/10.1056/NEJM197309272891303
 Gustafsson U, Wang FH, et al. The effect of vitamin C in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones: prolongation of the nucleation time. Eur J Clin Invest. 1997 May;27(5):387-91.
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