Archive for August, 2012

Don’t throw the baby out with the bath water. Try to keep your gall bladder if at all possible. While it is not technically necessary to digest food, it is very helpful in proper digestion and nutrient absorption. Chances are that you WILL miss it (as the symptoms of not having one pile up), and once it is gone, it is gone forever.

The following is a chapter from my book, on gallstone treatments:

Gallstone treatments

If you are fortunate enough to have caught your gallstone problem before your gall bladder was ruined, you have a few options for treatment.

ERCP:

If this sounds familiar from the diagnostic list that’s because it is the same procedure involving the same equipment, only this refers to using it to treat the stones after they are found. ERCP or “Endoscopic Retrograde Cholangio-Pancreatoscopy” (say that 5 times fast!) can be used not only to assess the situation in your gall bladder but can be used to treat the problem as well. Using this procedure, some stones can be removed from the gall bladder or bile duct without the need for surgery. Basically the doctor runs a fancy endoscope down your throat and then up through the ducts from which your bile flows, and dissolves the stones with chemicals injected by the scope. With this procedure, you do not need to be opened up with knives, and the doctor will have a camera’s-eye view of the inside of your bile ducts and gall bladder, by which he/she can further assess just how bad the situation may be.

Bile Acid Supplementation:

Some stones can be treated with oral ingestion of bile acid. This has a roughly 75% rate of success on cholesterol-based stones, but 15% of the patients of this treatment still end up with recurring gallstones within 2-3 years.

Lithotripsy:

The use of sonic shock waves, or Lithotripsy, to break up gallstones can be very effective . This treatment is good in that it does not require the patient to be anesthetized, however repeated treatments will be necessary to ensure that the stones have all been broken down into small enough pieces that they can be passed through the bile duct without getting stuck. Patients with a single large stone have much higher success rates than patients with multiple smaller stones. 95% of stones treated this way are passed within 12-18 months. This treatment does increase the risk of pancreatitis and gall bladder inflammation (acute cholecystitis) because the small pieces still need to pass through the bile ducts and can cause irritation along the way.

Contact Dissolution:

Another more meat-and-potatoes way to get rid of gallstones is “contact dissolution” which involves injecting chemicals directly into the gall bladder by way of a percutaneous catheter (a really long needle) to dissolve the stones. In cases with multiple gallstones, this method is the most effective, with a 95% success rate. MTBE (methyl tertiary-butyl ether) is commonly used as the solvent. Side effects are caused by the body’s absorption of the MTBE and can include vomiting, difficulty breathing, drowsiness, and bad breath. Of course you also have to deal with having a needle stuck into you for 5-12 hours for the treatment; Anesthesia, while preferable, is not mandatory. But you get to keep your gall bladder.

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This is an excerpt from my book (see links for editions in print and Kindle, in English and Spanish). Studying the search-terms that bring traffic to the blog, I thought it might be a good idea to post this information to the general public.

The Coeliac Connection

Coeliac Disease (spelled Celiac in the USA) is an autoimmune disorder caused by a reaction to gliadin, a gluten protein found in wheat. The reaction causes inflammation of the small intestine, which leads to atrophy of the vilii (surface cells), which then causes malabsorption of nutrients. Coeliac Disease is not a symptom of gall bladder dysfunction, but it can definitely be a cause. If you are suffering from gall bladder problems you should definitely be screened for Coeliac Disease. It affects about 1% of the population in the USA.

Coeliac Disease gets in the way of proper gall bladder function by dampening or canceling out the Cholecystokinin (CCK) signal sent from the duodenum. If the duodenum can’t sense fat content because its lining is inflamed or atrophied, it doesn’t know to send the CCK and call the gall bladder to action.

The gall bladder, not getting the proper signal, either sits idle waiting or does an inadequate job and doesn’t give 100% effort. Therefore bile doesn’t circulate properly, it has a greater opportunity to settle and crystallize, and the chance of gallstone formation is greatly increased.

Not only does Coeliac Disease cause malabsorption of nutrients in general due to its inflammatory nature, but its problems are further compounded by a double dose of malabsorption caused by reduced bile output from a lazy or unresponsive gall bladder. As the atrophy of the intestinal lining worsens over time, more symptoms and digestive disorders can result (such as lactose intolerance).

Symptoms of Coeliac Disease:

  • Diarrhea: often pale and foul-smelling

  • Abdominal pain and cramping

  • Bloating

  • Often misdiagnosed as IBS (Irritable Bowel Syndrome)

  • Vitamin A, D, E, and K deficiencies

  • Calcium malabsorption/deficiency

  • Bacterial overgrowth in the bowels

  • Dermatitis Herpetiformis (DH), an itchy skin rash

  • Mouth ulcers

  • Hypothyroidism

  • Iron deficiency

  • Chronic fatigue

  • Osteoporosis

  • Intestinal cancer

  • Sterility

Getting tested for Coeliac Disease:

Blood tests are the fastest way to screen for Coeliac Disease. The tests you should get are as follows:

  • IgA or tTG antibodies: Sensitivity 90%, Specificity 99%. IgA means anti-transglutamase antibodies. These antibodies are very specific, occurring 100% in people with Coeliac Disease, and 80% in people with DH (Dermatitis Herpetiformis). IgA is also called tTG (tissue trans-glutamase). If your test comes back IgA positive, there is a 97% chance that you have Coeliac Disease. This test does give occasional false-negatives; if you test negative, there is only a 71% chance that the negative result is accurate.

  • IgG anti-gliadin antibodies: Sensitivity 87%, Specificity 91%. This test shows positive results more readily but does not have as strong a correlation to proving Coeliac Disease. For ecample, IgG-positive results show up in 21% of people suffering from non-Coeliac digestive disorders. This test may not provide as good a test-positive result as the IgA/tTG but it provides less false-negatives, and therefore should be done at the same time.

Other testing methods:

  • Endoscopy with biopsy of duodenum or jejunum. Most Coeliac sufferers have a bowel that appears normal through the endoscope but inspection of a tissue sample viewed through a microscope reveals proof of the disease.

What to do if you have Coeliac Disease:

Presently, the only cure is to go on a gluten-free diet for the rest of your life. There are no miracle medications. Fortunately the solution requires only willpower, and costs nothing extra. In time, the intestinal walls will heal and the symptoms will abate or disappear completely.

Unfortunately, this means that you will have to stop ingesting anything containing gluten. The list of forbidden ingredients containing gluten is as follows:

  • Wheat

  • Spelt

  • Kamut

  • Rye

  • Barley

  • Triticale

  • Oats (if your oats are pure, you may not need to exclude them; normally they do not contain gluten but the machines that process oats are also used to process the other grains and may be cross-contaminated. There are also studies that show oats contain peptide sequences very similar to gluten which can cause problems in 10% of Coeliac patients)

The list does not stop there; all things derived from the above products must be avoided as well:

  • Bread and flour products of all kinds, with exception to pure corn bread.

  • Beer (Rest In Peace!)

  • Most types of Whiskey

  • Malts

A general list of things that are gluten-free:

  • Corn

  • Potatoes

  • Rice

  • Cassava

  • Yams

  • Chickpeas/garbanzo

  • Meats (be careful of sausages, as some use ingredients containing gluten as filler or flavor enhancers)

  • Wine, rum, brandy, sake, vodka, and other spirits derived from fruit, honey, sugar, rice, potatoes, or corn.

The particulars of following a gluten-free diet could easily fill their own book. There are a wealth of gluten-free diet books on the market. It is such a common problem that there is even a “Celiac Disease for Dummies” book in addition to a “Living Gluten-free for Dummies” and a “Gluten-free Cooking for Dummies.” All three are quite informative, and rated 4 stars or higher on that online bookstore everyone knows. Fortunately, many product manufacturers are more aware of dietary gluten problems, and label their ingredient list clearly as either containing gluten or being gluten-free.

Either traveling, or commuting, or anywhere you can’t be at home, it is tough to eat things that are compatible with a body which has no gall bladder (or has one, but it’s “out to lunch”).

I travel quite a bit, internationally. As such, it is very difficult to maintain a fresh refrigerator stocked with the things I need to eat. Need, as in “not want but need.” The things I want, I really shouldn’t eat. The things available to a traveler with no stocked refrigerator are usually all things which are incompatible with gall bladder patients: mostly bready, starchy things made with trans fats.

Bread and starch tends to puff us up and turn us into gas machines. Not good for polite company. Greasy starch even worse.

I offer the following solution which has served me well: eggs and apples.

Eggs can be prepared in multiple ways but the way they travel best is hard-boiled. Whenever I arrive in a new location the first thing I go to buy is 2 dozen eggs and a bag of apples. Then I hardboil a full dozen of the eggs.

Instant breakfast, just peel and eat. Take a few for lunch. Snacks, whatever. There are few things more excellent than a simple hardboiled egg with some salt and Tobasco or sriracha sauce. They are also filling. I’m a big guy and 2-3 hardboiled eggs will keep me fed for half a day before I start to feel hungry again.

The apples, well, they’re for variety 🙂 And they are also good for you and contain fiber and vitamins to go with the eggs.

Not only that, but eggs contain everything a gall bladder patient needs for nutrients and proper digestion. I have noticed that in cases where I have slipped out of a healthy routine and begin to suffer from new bouts of diarrhea (yes, I am prone to binges of pizza and burgers), a few days on eggs and fruit brings me quickly back to normal. Give it a try, the worst that can happen is that you get tired of eggs and fruit.

Thinking chemically, you could probably live forever on a diet of nothing but eggs, fruit, and greens.

To make a long story short, Hashimoto’s Syndrome is an autoimmune/thyroid disorder which can have similar results (and causes) to Celiac Disease. Basically unwanted protein infiltration through a leaky or compromised gut. Supposedly there are some 30 million undiagnosed cases of Hashimoto’s Syndrome in the USA. You can read all the specific details here on Wikipedia.

How does it relate to gall bladder problems? Well, the same problems from Hashimoto’s and Celiac Disease can also incapacitate your gall badder. If you are a gall bladder patient, you may want to test yourself for Hashimoto’s Syndrome.

The wife of my friend Bill (who is writing a book on the subject) has Hashimoto’s and has found successful treatment through dietary changes:

My wife has found that by partioning her meals – eating protein first and giving the stomach at least 30 minutes to break the protein down into assimilable fragments that can be digested by the upper gut enzymes before the fragments have a chance to leak through the gut wall, and then eating the vegetable portion of her meal, almost completely eliminated the auto-immune response.

Bill goes on further to say:

Second let me URGE any reader who has been diagnosed with any kind of gut issue – celiac, IBS, crohns, SIBO, etc – and ESPECIALLY gluten intolerance! – get yourself tested for Hashimoto’s. In most cases, Hashi’s is confirmed by two antibodies labs: anti-TPO and TgAb. The first antibody, anti-TPO, attacks an enzyme normally found in your thyroid gland, called the Thyroid Peroxidase, which is important in the production of thyroid hormones. The second antibody, TgAb, attacks the key protein in the thyroid gland, the thyroglobulin, which is essential in the production of the T4 and T3 thyroid hormones. If you have insurance you may find that your doc resists ordering the tests – though for the life of me I don’t know why. We have no insurance and the damn things only cost @ $60 – and they are absolutely diagnostic. SO – do not let your Doc tell you that since your T4 tests are normal there’s no need for the anti-body tests. MAKE them order the damn tests ( voice of frustrated experience here).Then, if it turns out that you do have Hashi’s, there are several well-established pathways back to health.

Last, let me say that after years of working on this together with my wife and having to do almost all our own research since docs just don’t seem to know or care ( gastroenterologists are the worst IMO) we are convinced that whole-body inflammation is the bottom-line, underlying issue not just in Hashi’s but in a huge range of disease – and most gut disease in particular. Get control of the inflammation and you get control of the disease. A quick story to illustrate this. Within a month of eliminating grain, dairy and eggs from her diet my wife, who had weighed 110 pounds all her life before all this began and then for years she see-sawed between 125-140 but the amount of food she was taking in did not vary and she never ate junk food, sweets etc – the stuff that “makes you fat” – within a month she was back down to 110. But here’s the kicker – she had zero loose skin, the way you do when you lose weight, especially in places like the back of your arms. That’s because her extra weight wasn’t fat – it was inflamed tissue. Once the inflammation was under control, the tissues returned to normal state, and there was no extra loose skin. None. So in my mind that is pretty good evidence that an awful lot of the obesity that’s around these days probably isn’t fat, but inflamation. Just an opinion.

Lots of people ask me how I can offer advice on gall bladder health when I no longer have a gall bladder. Well, that’s kind of the point. Been there, done that, killed it. Literally. And the search for solid poop afterwards occupied years. I know how to kill a gall bladder, trust me. And following a low-carb diet is definitely not something that will endanger your gall bladder. In fact, minimizing carbs is what finally ended the Age of Soft-Serve Poop for me. And, had I known better and not followed a low-fat diet for untold years (doctor’s recommendations due to hereditary high blood pressure), I might very well still have a gall bladder today.
If you have gall stones, whenever you eat fatty foods you may experience discomfort or fits of incapacitating pain. This is because the gall bladder is triggered to squeeze when your intestine signals the intake of fatty foods. This does not mean that low-carb eating is incompatible with gall stone sufferers or gall bladder amputees. Understanding which fats rebel and which ones comply with your system is key.  In fact, educated, controlled gall bladder activity can actually help eliminate existing stones.
The gall bladder is probably one of the body’s most, if not the most, poorly designed organs (think of it as the Yugo parked next to the Rolls Royce of your liver). It is designed to both store and squeeze out a portion of liver-manufactured goo down the biliary tree where it exits into the duodenum by the same pipe the pancreas uses to release digestive enzymes.
Not only does the gall bladder have an absurd curly valve mechanism (perfect for trapping granular material) to control its output, but it is also oriented with its exit near the top, which allows any particulate trash to settle to its bottom and eventually form stones. And trash it receives. Basically the garbage your liver can’t use or doesn’t want gets tossed down the bile chutes. Worn-out or surplus cholesterol, bilirubin, salts, etc. all combine into bile. This “fresh” bile is then further concentrated into a thick sludge within the gall bladder, by up to five times, increasing the odds of crystallization of whatever crud happens to be present.
Bile is used for two things: to emulsify fats and to increase the pH (reduce acidity) of the stomach acid. The pancreatic enzyme Lipase is used to break those emulsified fats into fatty acids your intestine can absorb, but it can’t work efficiently unless the bile has emulsified the fats and increased their surface-area-to-volume ratio. The two chemicals work as a team. Once the bile has done its job it is reabsorbed at the end of the small intestine and sent back to the liver, which usually cycles it straight back into the gall bladder. The same bile molecules can be re-used some 3 times in a single meal.
In a normal human diet, the gall bladder is able to cycle properly. What goes in, goes out, in a regular pattern. However, in a low-fat diet (or, in the case of celiac disease sufferers), the gall bladder is not called to action enough and bile stasis can occur. If you put garbage into a can, concentrate it, and empty only 80% of it every time, you will eventually end up with some really nasty junk stuck in the bottom of the can. This is the case with underactive gall bladders.
To further exacerbate the situation, diets high in sugars and trans fats will have the body working harder cycling its cholesterol in order to control cellular inflammation, in addition to having surpluses of chylomicrons, VLDL, and their resulting LDL blood cholesterol to get rid of, which means more trash tossed down the bile chute. Which means higher odds of gall stones.
Once you have gall stones, you will have a couple of growing problems. You will tend to shy away from fatty foods as they cause you digestive discomfort. This comes from the stone causing you pain when the bladder contracts, and also from the fact that the bladder cannot hold as much bile as it once did (especially if you have large or multiple stones), so it cannot issue enough bile to emulsify the volume of fat in hearty meals. This under-treated fat will cause havoc later down the tract; your pancreatic lipase will not be able to break it down as efficiently, so you will not be absorbing the fats you need, and what is left unprocessed will become food for gas-forming bacteria. And what they don’t eat, will come out in the form of soft-serve nastiness.
Less fat processing by bile and lipase means you absorb fewer fatty acids and fewer fat-soluble vitamins. You will have less energy and feel cravings to eat fatty foods. But you don’t want the discomfort or the diarrhea… until your body is so needy of fat that it screams for that bucket of wings you can no longer deny, and leaves you hugging the toilet all night with the pained sweats and dry-heaves of a gall stone attack.
Gall stones, long story short, are the result of over-concentrated chemical solutions in your bile. They can dissolve, given the right environment. Proper diet (paleo or low-carb) will bring the biliary, lymph, and cholesterol cycles to where they should naturally be and will have your liver pushing less-nasty junk out the exit. When your liver no longer needs to throw so much of its weight around your system taking care of sugar damage and oxidation, it no longer has the need to pour so much toxic waste down the garbage chute. The proper balance of bile chemicals will return in time.
Chemistry nerd joke: If you are not part of the solution, you are part of the precipitate. Joking aside, it’s absolutely correct. The right concentration of chemicals in your bile can and will shrink, break down, or dissolve those stones eventually and bring them back into solution, whereupon they can be flushed out with the rest of the trash. Taking dietary bile acid supplements has also proven fairly effective (85%) in getting rid of stones as they help return your bile to a healthy and balanced “formula” which will dissolve existing stones. I am not a doctor, but I would definitely recommend a paleo or low-carb diet with bile acid supplements to someone suffering from gall stones.
What if you have no gall bladder and want to do a low-carb diet, but you are afraid of uncontrollable grease-poop? Try it, you might find that it better suits you than whatever you were doing before. It worked for me. I am not strict about avoiding all carbs at all costs but I cut out almost all bread and wheat from my diet completely; despite the fact that I do not have celiac disease, my system returned to some semblance of normal and the unrelenting butt-volcano went dormant within a couple of weeks.
And you don’t have to eat grease to eat low-carb. A body without a gall bladder will tolerate animal fats better than vegetable fats, because their chain structures break down more easily, and because phytosterols (plant cholesterols) will slow and block absorption of animal cholesterol. Furthermore, phytosterols contain estrogen and progesterone precursors which, interestingly, contribute to gall bladder laziness and/or inactivity.
Even lean meat should contain enough fats to keep you healthy. What you want to avoid is heavy doses of vegetable oils (like salad dressing) and hydrogenated fats, which I can assure you a gall-bladder-less body does not tolerate. Pork fat, I am happy to say, is the most tolerable fat I experience without my gall bladder. I can now eat eggs fried in bacon fat, with the bacon, and not have to run to the bathroom in 15 minutes. Without a gall bladder, and without dietary supplements.
Milk from cows and goats (and horses, if you are into that) contain short and medium chain fatty acids that do not require lipase to break them down before absorption, meaning that the presence of bile is not required to digest and absorb them. These go nicely with low-carb and paleo, though ultimate low-carb nazis may take issue with the lactose content.

Here is a list of things to avoid while eating low-carb with gallstones or without a gall bladder:

  • Olive oil in excessive amounts; for cooking it’s ok, but do not use it for salad dressing.
  • Any other vegetable oil that is liquid at room temperature
  • Hydrogenated oils of any kind
  • Soybeans or derivative products
  • Margarine or fake-butter products

Things to encourage while eating low-carb with gallstones or without a gall bladder:

  • Cook your food in real butter, clarified butter (ghee), coconut oil, palm kernel oil, or pork fat.
  • Eggs from happy chickens (contains lots more Omega-3/6)
  • Grass-fed beef (contains 4x more Omega-3/6 than unhappy cows)
  • Pork from happy pigs (yes, surprise surprise it also contains higher levels of Omega-3/6)
  • Whole (not skim) milk from cows or goats
  • Cheese and yogurt (especially yogurt with active cultures)
  • Omega-3/6 Fish oil supplements, essental fatty acids
  • Plenty of dark leafy greens like cale, spinach, etc.
  • Avocados but don’t go overboard
  • Vitamin supplements of A, D, E, and K optional, don’t go overboard on them especially if you are eating plenty of dark greens
  • Do eat your greens in the presence of fats, otherwise their vitamin enrichment is wasted.

I first read about Cholestyramine during my research into Habba Syndrome. Dr. Habba has been successfully treating some of his patients with it, so I decided to give it a try.

Long story short: My results were excellent, to the point where I no longer need to take it.

That said, I did not exactly do a controlled experiment. I coupled my taking of Cholestyramine in combination with a gluten-free diet. Anyhow, my experience is as follows…

In order to bypass the absurd process of getting a Cholestyramine prescription through standard channels by seeing a doctor (who knows nothing about gall bladders nor nutrition) who may or may not agree with my dietary experiment, I enlisted the help of a friend of mine who is a naturepathic doctor. He wrote me the scrip and I went to get it filled at the local pharmacy (in this case I was in Portland, OR).

I had a choice of foil envelopes with individual doses, or a big can of powder with a scoop. I chose half envelopes and half self-serve scoop can. The sugar-free formula, which I would have preferred, was unavailable.

As it is, the sugar formula still tastes bad but not horrible, orangelike, reminiscent of a vitamin-C tablet but not as sweet. It would be passable if it was sweeter. Why bother putting sugar in it at all if you aren’t going to use it enough to make it palatable? One could possibly benefit by adding some sugar-free sweetener to your mix, but when it’s all said and done, it’s not bad enough to warrant the extra attention: you just chug your glass of yuck-tasting stuff and get on with your life.

Within a few hours, after my first dose, I was already cured of my instant-run-to-the-toilet problems. It worked so well that I did not need to defecate for a full 24 hours. When I did, it was more solid than I had seen in months, and it was a strange grey color.

I also found that I was much less hungry, and got fuller faster from smaller meals. Obviously I had more time to absorb those calories and nutrients. It makes me wonder how many wasted calories I was taking in that just flew through me.

I continued to take the Cholestyramine twice a day for the next month. The grey color eventually went away, and I ended up becoming so constipated that I had to reduce the dose by half after a week, and then to 1/2 dose once per day (1/4) after 2 weeks. I achieved a state of normalcy after that, and continued to take the Cholestyramine until it ran out 3 months later.

I would have continued to take it but I was then in Uruguay and it was not available there, nor could I find it in neighboring Argentina. Knowing full well the disaster that befalls anyone who ships in “drugs” or even vitamins to these countries, I opted to simply stop taking the Cholestyramine.

Fortunately, I found that I no longer needed it. The results of my digestion showed no difference after removing it from my daily routine. I assume what happened was that the Cholestyramine provided me with the break I needed for my bowels to heal up in the absence of gluten. I know, I should have done a more scientific study but I was tired of crapping my guts out every 20 minutes.

If you are one who suffers from diarrhea as a symptom of having your gall bladder removed, I highly recommend you give Cholestyramine a try. Cholestyramine is also sold under the name Questran, Questran Light (sugar-free), and Cholybar. Other bile acid sequestrants that do the same job are sold under the names Cholesevelam, Cholestagel, Welchol, Colestipol, and Colestid.

Greetings.

Posted: August 6, 2012 in Uncategorized

This is the first post of hopefully many more to come.
I just opened this blog on August 6, 2012, so obviously there isn’t anything here yet. I am presently at a loss as to what to write about at first, but I imagine once the brain is rolling again, words will spew from my fingertips in rapid fashion. In the meantime, please comment on subjects you would like to see covered or researched, and feel free to ask any questions. I’ll do my best to answer promptly and correctly.