There is a very important connection between gallbladder function and hormone balance. In Western Medicine, the gallbladder is treated like a useless organ that we can easily remove without consequence. This is Wrong. Many women I see in my practice develop hormone problems after having their gallbladders removed as well as it is also true gallbladder dysfunction can result from hormone imbalances.
What is the gallbladder and what does it do?
The gallbladder is a small organ that sits just under the liver on the right side of the body. The gallbladder stores biles, that is produced by the liver, which is used to digest fats. Symptoms of gallbladder dysfunction include pain or tenderness under the right rib cage or can present as indigestion post meals which patients describe as fullness, gas, nausea, burping or greasy stools. These symptoms mostly occur post meals may be worse with a fatty meal but can also occur after a meal even if it is lower in fats.
When gallbladder dysfunction is mentioned many jump to the conclusion of gallstones. While gallstones most commonly cause these issues, they can also arise from a sluggish or low-functioning gallbladder. It is important to pick up on a sluggish gallbladder right away because it is the low-functioning aspect that can lead to gallstones in the first place.
How are hormones connected to the gallbladder?
Hormones are signaling molecules produced by glands that travel in circulation to target distant organs to regulate physiology and behaviour. There are many hormones that impact the functioning of the gallbladder and any imbalances in hormones create a cascade of events.
1) Melatonin: This is often known as our sleep hormone. Melatonin is produced by the pineal gland from tryptophan in response to darkness. It not only regulates our biological clock and thus sleep-wake cycle but is also a free radical scavenger, anti-inflammatory, and antioxidant. In relation to the gallbladder, melatonin may inhibit gallstone formation by reducing cholesterol in the bile by inhibiting cholesterol absorption and increase the conversion of cholesterol to bile salts (1).
A 2018 metanalysis showed a significant decrease in triglycerides was found at doses ≥8 mg/d and when trials last ≥8 weeks. In addition, a significant decrease of total cholesterol was found at doses ≥8 mg/d and when total cholesterol baseline levels were ≥200 mg/dL (1).
Further studies show that melatonin allows the gallbladder to contract more fully by strengthing the neuromuscular junction of the gallbladder walls. This effect is seen because in acute gallbladder attacks, inflammation is produced. This inflammation impairs proper contractility of the gallbladder suggesting that melatonin is a therapeutic intervention in the recovery of gallbladder neuromuscular function.
2) Thyroxine: This is a thyroid hormone which helps to carry out many functions in the body including metabolism, heart rate, digestive function, brain development, lipid metabolism, and gallbladder function. Low or suboptimal levels of thyroxine are connected with low gallbladder function and low bile flow. When the gallbladder bile flow is low and lipid metabolism is impaired one is predisposed to the formation of gallstones.
A 2016 study concluded “Thyroid dysfunction is more common among patients with gallstones and it may be a risk factor for biliary stone formation. This may be attributed to the absence of the pro-relaxing effects of thyroid hormones on the sphincter of Oddi and influence of thyroid hormones on the synthesis, absorption, and usage of cholesterol.” (3)
The sphincter of Oddi must relax in order to allow for the release of f bile into the small intestines and this sphincter has receptors for thyroid hormone. When the sphincter is relaxed free flow of bile can occur but a lack of thyroxine seen in those with low thyroid function results in a contracted sphincter. The above research hypothesizes that this contributes to the formation of common bile duct stones that form from leftover bile sitting in the duct.
3) Motilin: This is a hormone found in the intestinal cells. It is released when we consume fats or due to acidity in the small intestine. Motilin causes the gallbladder to contract and thus empty the bile into the intestines. In pregnancy, motilin is reduced which may be why we see constipation, indigestion, and gallbladder disease increase during the second and third trimesters.
4) Cholecystokinin (CCK): This is another hormone that causes the gallbladder to contract as stimulates the pancreas to release enzymes to assist in nutrient digestion and absorption. This is the hormone used during gallbladder studies to measure the gall bladder contractility as well as the amount of bile that is secreted.
What happens after your gallbladder is removed?
It is well known that those who have their gallbladders removed often have issues digesting fats. If you have to wipe multiple times after a bowel movement or notice the feces sticking to the toilet bowel this is a clear sign and you may benefit from a digestive enzyme that contains ox bile or liver/gallbladder support.
What is often not discussed is the hormone-related side effects that arise post surgery. Many patients report “just not feeling the same” since or “weight gain suddenly became an issue”. Surgery on its own is a major stress on the body that produces both hormonal and metabolic changes. The stress of surgery increases sympathetic nervous system activity as well as the hypothalamic-pituitary axis. Hormones such as ACTH, cortisol, epinephrine, norepinephrine, and glucagon all play a role in the response to this stress. This stress, as well as inflammation, can bring on latent conditions like an autoimmune disease such as Hashimoto’s.
The gallbladders connection to sex hormones (estrogen and progesterone)
We know that pregnancy as discussed above, as well as oral contraceptives and hormone replacement therapy, contributes to the formation of gallstones. These side effects are often not discussed when women start on the pill or hormone replacement. Women report feeling pain, indigestion, burping, gas, nausea, bloating and yet the medication as the root causes are often overlooked and the solution is rather to remove the gallbladder.
Estrogen and progesterone impact the gallbladder and bile system in the following ways
- Creates supersaturation of bile due to higher cholesterol to bile salt ratio. Think of the bile as looking more sludgy vs watery.
- Bile tends to clump together becoming more sticky
- Slower gallbladder emptying leaving bile to sit longer in the gallbladder
- Estrogen dominance. Bile is important to excrete hormones and their potentially harmful metabolites so women with a sluggish gallbladder or no gallbladder often have estrogen dominance leading to a vicious cycle making the problem worse.
What can you do about it?
- Choose a non-hormonal form of birth control and ways to optimize hormones.
- Only use hormone replacement if absolutely necessary and the benefits outweigh the risks
- Use herbs such as adaptogens to support the adrenals and thyroid
- Instead of masking the symptoms of hormone imbalances, perimenopause, menopause look to the root cause and address underlying issues
- Optimize your gut. Read about the gut-thyroid connection here.
- Support bile thinning and bile flow with liver detoxification
- Support the breakdown of fats by considering a digestive enzyme with ox bile.
- Eat whole foods that come from the ground or have a mother
- Do not overeat – eat until you are 80% full
- Remove food sensitivities -most commonly gluten, dairy, soy, eggs
- Consume healthy fats in reasonable amounts for your both
- Get proper hormone testing. Read more here.