The gallbladder works in tandem with the liver, which produces bile, a potent digestive juice – up to a litre (35 fl oz) a day.
This passes through a series of ducts to the gallbladder, which distils it – it can concentrate bile by as much as 10 times – and stores from 30 to 50ml of the liquid.
Bile’s most important role is breaking down fats, the hardest food group to digest, which requires a complicated chemical process before it is available as energy.
Gallstones are the most common cause of hospital admission for digestive problems in the West. They have plagued humankind for centuries.
The Museum of the Royal College of Surgeons in London once exhibited an Egyptian mummy (circa 1500 BC) with a gallbladder that contained 30 stones.
Professor Anthony Teoh of the Chinese University of Hong Kong says not everyone with gallstones or inflammation has symptoms. Photo: Chinese University of Hong Kong
While up to 12 per cent of the global population may have gallstones – according to statistics from Hong Kong’s Department of Health, 14,463 people were admitted to hospital in the city for gallstones and cholecystitis, inflammation of the gallbladder, in 2017 – 80 per cent never suffer any symptoms.
When they do, they may feel pain “over the right upper side of the tummy, especially after eating fatty foods,” according to Professor Anthony Teoh of the Chinese University of Hong Kong.
“It is a squeezing type of pain that can come and go. Occasionally, it could be associated with fever and yellowing discolouration of the skin.”
The liver will still secrete bile and the digestive functions won’t be seriously affected
The pain can be severe, described by some sufferers as 10 on a scale of one to 10. The pain often follows the consumption of a fat-laden meal, as fat triggers the gallbladder to empty. If stones are blocking the ducts, it can’t empty; diagnosis is usually through an ultrasound or CAT scan.
Gallstones are created when one of two substances – cholesterol or bilirubin – saturate in the bile and form crystals, or stones. Bilirubin is a brownish-yellow substance found in bile that is formed when old red blood cells in the liver break down.
Normally your body gets rid of bilirubin via the bowels – which explains the colour of faeces. But bilirubin-formed stones are rare; 80 per cent of gallstones are the result of cholesterol.
It’s not just what you eat, it’s also how you eat that can predispose you to gallstones.
Eating one large meal a day increases the chance of stone formation because the bile is inactive for a long stretch, which means there’s more chance for its composite parts – bilirubin and cholesterol – to distil and saturate.
These stones can present as a problem when they are large – the largest reported in medical literature, according to the Guinness World Records, weighed 6.29kg (13.8lbs) and was removed from an 80-year-old woman in London. They are also a problem when there are many of them. Two to 20 stones is not uncommon. The record holder, another woman in her 80s, had 23,530 stones removed.
It’s not surprising both cases were in women.
Singer Pink was in her early 30s when she had her gallbladder removed. Photo: AP
Teoh says there is a classic mnemonic for remembering risk factors for developing gallstones: fat, fair, female and 40.
“This is related to the cause of developing gallstones, which could be too much fat. For ladies who are around the age of 40, it may be related to sex hormones causing supersaturation of bile.”
But this isn’t a hard and fast rule: the pop singer Pink, after all, while female and fair, isn’t fat and was only in her early 30s when she had her gallbladder removed, in 2012.
Women are three times more prone to gallbladder problems – and gallstones in particular – on account of their hormones: oestrogen increases the amount of cholesterol in the bile and progesterone slows its emptying.
Research suggests this is more prevalent in Caucasian women. And there could be a heritable link, too, according to the latest research. This would add another “F” to the mnemonic: family history.
The first removal of gallstones was accidental. In 1687 in Germany, Stalpert van der Wiel operated on a woman who had been complaining of abdominal pain and found gallstones. Some reports suggest they popped out like bullets.
Aside from gallstones, says Teoh, the gallbladder can also be affected by polyps or cancer.
“Usually, these conditions are treated by cholecystectomy – surgical removal of the gallbladder – and most often by minimally invasive keyhole surgery. Acute inflammation of the gallbladder is sometimes treated via draining with an external tube or internal stent,” he says.
Gallstones are caused when cholesterol or bilirubin crystallises in the gallbladder. Photo: Shutterstock
The first cholecystectomy was performed in 1882 in Berlin, Germany. This procedure, says Teoh, is one of the most common operations.
While removal of the gallbladder will affect bile storage, “the liver will still secrete bile and the digestive functions won’t be seriously affected”.
“Some patients who have had this operation may experience diarrhoea after eating fatty foods, but the body usually adapts to this in a few months’ time,” Teoh says.
Think of it as a factory still being in production without a warehouse; there may be a slightly elevated risk of hepatic – liver – problems because of the impaired digestion of fats, but a largely healthy life is entirely possible.
A healthy diet will support a healthy gallbladder.
Some studies suggest drinking coffee may help prevent gallstones and insufficient vitamin C in your diet may prompt them.
In short, eat heart-healthy food and you will be well on your way to better gallbladder health, too.
