Wellness by Designs - Practitioner Podcast
Wellness by Designs is a place for healthcare practitioners to expand their knowledge base. A place to deepen your nutrition, herbal medicine, naturopathic, integrative medicine and business management expertise. Sit back, grab a cuppa. Wellness by Designs has your continuing education covered. Tune in as fellow practitioners, and researchers share their expertise and clinical pearls, taking you on their professional, sometimes personal journies. For show notes and references: www.designsforhealth.com.au
Wellness by Designs - Practitioner Podcast
Essential Insights into Gallbladder Function and Care with Amie Skilton
Join us as we dive deep into gallbladder health with the wisdom of Naturopath Amie Skilton.
In this episode, we uncover why we are seeing a surge in gallbladder diseases and removals, particularly among younger individuals.
We discuss how your daily choices and environmental toxins may be putting your gallbladder at risk, and learn the surprising ways estrogen itself plays a pivotal role in gallbladder function. We connect the dots between gallbladder issues and broader health concerns like diabetes and liver disease, emphasizing the dire need for a shift in awareness to safeguard this vital organ.
Navigating the murky waters of gallbladder management, Amie tackles the array of treatments available for those facing gallbladder distress.
This episode goes beyond the quick fixes, shedding light on the deeper causes of gallbladder woes. We highlight that, often, the real solution lies in preventative care and early intervention—strategies that could spare you from the operating room and promote long-term well-being.
About Amie
Amie Skilton – is a functional medicine practitioner of almost 20 years and a well-known educator in naturopathic medicine. For over 15 years, I’ve had the privilege of appearing on conference stages, TV sets and – more recently – laptop screens via Zoom. In that time, I’ve had the honour of presenting more than a thousand keynotes to functional medicine practitioners, integrative GPs, holistic pharmacists and the general public.
In 2017, I had the plot twist of my life. I developed an environmentally-acquired illness (CIRS or ‘mould illness’) and, amongst other discoveries, realised my naturopathic, nutritional and herbal toolkit was only as valuable as my environment was healthy.
I’m now a qualified Mould Testing Technician and continue studying building biology and the various ways in which the built environment has a profound impact on human health. So my educational repertoire has expanded to include environmental health hazards and functional medicine strategies.
Connect with Amie
Website: whatthenaturopathsaid.com
Shownotes and references are available on your local Designs for health website
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes o
Shownotes and references are available on the Designs for Health website
Register as a Designs for Health Practitioner and discover quality practitioner- only supplements at www.designsforhealth.com.au
Follow us on Socials
Instagram: Designsforhealthaus
Facebook: Designsforhealthaus
DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
Music. This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook, and joining us today is Amy Skilton, and we'll be discussing why the gallbladder is so important. Hi, amy, welcome to Wellness by Designs. How are you?
Speaker 2:Andrew, I'm very well, thank you, and thank you so much for having me.
Speaker 1:It's our pleasure, I gotta say. It's so great to see your smiling face and thank you so much for your time. Now we're going to be talking about the gallbladder today because you've got an upcoming seminar happening with Wellness by Design correct. Take us through this.
Speaker 2:Yeah. So the webinar that I'm going to be covering off, which includes gallbladder stuff, is all about the importance of detoxification and the different aspects of detoxification, but a lot of people understand the role of the liver and the gut and the kidneys, and so this particular educational piece is really going to be focusing on the importance of the gallbladder and how to support it, why it often runs into trouble and what to do about it. And the reason I wanted to chat with you today is gallbladder disease is on the rise. In fact, when you look at the statistics, it's terrifying how much of a problem it's becoming, and I say that in part because the main remedy for that tends to be just to cut the gallbladder out, but there are some significant consequences to that. So I thought you and I better need to have a chat and share with everybody why looking after your gallbladder is so important and why you want to try and avoid having it removed if you can.
Speaker 1:Well, let's talk about some statistics. What are we talking about here with regards to incidence, prevalence and, indeed, different types of gallbladder disease?
Speaker 2:Well, just focusing on having the gallbladder taken out for a second. We know that over about 15 years, so between 2004 and 2019, here in Australia there were almost 1.1 hospital admissions from symptomatic gallbladder associated disease and more than three quarters of those resulted in the gallbladder being cut out. In New Zealand it was not too dissimilar. So, proportionately speaking, over that same time period there were 163,000 plus admissions to hospital with gallbladder issues and just over 98,000 of those resulted in the gallbladder being removed. And we know when we look at statistics from other countries, for example England, the number of gallbladder surgeries happening there between 2000 and 2019 have actually increased by 80.4%, annually increased by 80.4%. And we also see other reports where gallbladder issues, in particular gallstones, were more an issue for someone in their 40s, 50s or 60s, and now it's more prevalent in those in their 30s and 40s, and even teenagers are having their gallbladders removed. Now, that was unheard of it's just it.
Speaker 1:It's amazing how, you know, back in my day of nursing and and I'm going to be politically incorrect here because we there's an acronym and that's the acronym. So forgive me, but the acronym back in my day of nursing was FAT40 FEMALE Fertile and Flatulent right, and that was this, you know, very probably misogynistically designed acronym. But the 40 has now gone down to 20s. That's what I think is really interesting. Um, it's just amazing how time progresses and I and I understand you know COVID, lockdown, things like that. People are more sedentary, but it's not just that we're talking from you know the 2000 way before COVID. So something else is right yeah, definitely there.
Speaker 2:there are a lot of things happening and I think it's a tricky one to unpack, although in the webinar I'm certainly going to go through a lot of that. But I guess, to point towards what you said, like in naturopathic college it it was fair, fat and 40. So, like light skin is typically is certainly where I was from at the time, a condition that affected Caucasians more predominantly, but certainly for female and fertile I think. Touching on that, we know that estrogen is a risk factor of that. So elevated levels of estrogen, and that can happen because of poor estrogen metabolism. It can be a result of xenoestrogen exposure, which, of course, we're getting increasingly more so through, you know, pesticides, herbicides, foods, personal care products and of course, a lot of women are opting for, you know, the combined oral contraceptive pill as a form of contraception or for other reasons, and then HRT at the other end of their fertile window in terms of a life chapter. So those are definitely increased risks.
Speaker 2:Certainly, age is an increased risk, but I think age is partly an increased risk because one of the things that contributes to cholestasis or sticky bile, sluggish gallbladder function, is toxicants. So, whether that's from personal care products or from agricultural industry or, you know, from any of the other hundreds of sources that we get that from. We know that those things, especially the lipophilic ones that are eliminated through the gallbladder, accumulate over time, and they accumulate also with the increase in weight, which is often something that occurs alongside aging. So you know those are issues. We know there are also dietary components that need to be addressed.
Speaker 2:You know the increased risk factors of things like diabetes and insulin resistance, any issues with cirrhosis or even liver infections and parasites, and one of the other areas I'm going to be touching on in the webinar is the impact of mycotoxins on the gallbladder and how that contributes to cholestasis as well. But certainly for women if all other you know confounding factors are equal women are more at risk than men because of the estrogen factor. In fact, women are diagnosed three times more often than men with gallstones like before the age of 40. But by the time they're 60, the risk is actually starting to draw closer, unless, of course, they're on estrogen therapy like HRT, and certainly anyone who's carrying extra weight, male or female, will have increased estrogen levels. Ironically, though, rapid weight loss also can trigger issues with gallstones and the gallbladder as well. So you know you have to really treat it with such respect and consider it to be, you know, a partner of the liver, as opposed to just a sack that sits there behind the liver collecting what the liver creates.
Speaker 1:Absolutely. I'm so glad back at the beginning there you were talking about toxicants, and one of the sort of issues I've been pondering myself is we always, as humans, we tend to go that equals that, that to that, rather than that to that, to that, to that, to that, to that, right. So now, forgive me, those people about, those of our listeners can't see me pointing around the room to various points before you know, instead of A to C, it's A to Z. So, for instance, in Australia we still have on our shelves an endocrine disruptor chemical called triclosan and it's been shown to affect thyroid function. It's been shown to affect thyroid function and thyroid function, if it's decreased, can lead to high cholesterol and high cholesterol can lead to a seed in the gallbladder. And do you see? So there's this whole thing about with the toxicants. It might not be a direct, that equals that. It might be around the sort of border bit still has an issue with gallbladder disease totally.
Speaker 2:You've got direct influences, you've got indirect influences and then you've got the cumulative effect of multiple influences. You know, we don't live in a pristine toxicology lab. When we're exposed, we were exposed to one thing at a time. We're being assaulted from multiple sources in the air and our water, and our food and our personal care products and our home cleaning products, with, you know, all kinds of toxicants, and some of those are willingly onboarded and some of them aren't. For example, pollution if you're living in a big city or near a main road and your liver and of course all of your detoxification organs have to deal with that.
Speaker 2:But, as you so eloquently pointed out, sometimes it's a direct inhibition of the autonomic nervous system and gallbladder contraction or an increase in, you know, the viscosity of bile.
Speaker 2:Or, in the example you gave, there's this domino effect that are, you know, multiple steps removed.
Speaker 2:That ultimately also influences the health of the gallbladder. And this is what makes functional medicine so wonderful and also so tricky to practice, because you have to be such a great detective and actually really put all of those like, elucidate all of those variables and address them all to have a successful result. And I think that's why removing the gallbladder seems to be such a popular choice in allopathic medicine because all of the other methods that address gallstones and of course gallbladder disease is not just gallstones but just using this example, you know tend to reoccur and that's because the underlying causes haven't been addressed and so they're like well, what's the point in removing the stones and leaving the gallbladder because they'll just come back. Sure, if you don't deal with the underlying cause and you know, I tell my clients surgeons can cut out everything but the cause. And I guess the sad reality is whatever was contributing to those gallbladder issues also doesn't get addressed when you remove the engine oil light. That's indicating, hey, we've got a problem here.
Speaker 1:Yeah, I have to disagree with you on one point. I explained it in the most fumbling way possible. You explained it eloquently. But notwithstanding that, just a point I'm pondering is I wonder if people, One of the possible I don't know to what degree, but I wonder if one of the possible factors involving why sorry, leading to why women more women have gallbladder disease than men, is simply because of the size of the tube of the common bile duct in men versus women Bigger bodies, bigger aortas, bigger vessels, bigger common bile duct.
Speaker 1:I don't know, but I just pondered that and I don't know why. Anyway, so when we're talking about, you know, why not cut it out? Like, I totally understand that if you've got a blocked common bile duct, it's not a medical emergency that you've got on your hands, it's a surgical emergency. Having said that, having said that, we should be taking care of an important I'm not going to say necessarily vital, but an important part of our bodies that's due to our normal function. You know, it's kind of like we used to just think, ah, cut out the appendix Now we don't.
Speaker 1:So is there any movement in the thinking of the importance of the gallbladder?
Speaker 2:It does vary country to country and I think it varies also depending on the patient population and how educated they are and perhaps also resources.
Speaker 2:You know every medical system is set up differently and there's, you know, likely in other countries, like it is here things that are covered by, you know, medicare and then other options you've got to pay out of pocket. So I think it's a combination of things, but I really think ultimately, what it comes down to is people are presenting in an acute state of distress that needs to be addressed and they are not getting appropriate care, either pre or post, to address how they ended up in there, and that's not the surgeon's job either up in there, and that's not the surgeon's job either. And so I can absolutely appreciate why a surgeon, when given the choice of just removing the stones and clearing out the common bile duct and leaving everything there versus because actually, by the way, you don't actually, you know, end up without gallstones after gallbladder removal and an. In actual fact, in some of the stats that I looked at, only 18% of patients who've had their gallbladder removed remain free of symptoms.
Speaker 1:Oh yeah.
Speaker 2:Yeah, and up to 72% of patients can end up with gallstones in the common bile duct after the gallbladder is removed, because the source of them wasn't addressed, and so I know if this was to happen to me, depending on you know, when it was discovered. If you've got the luxury of time and you're not in so much pain, you can obviously use things like lithotripsy or oral medications to dissolve the stones, or both, whilst you're addressing the underlying cause. If I was, to say, present at an emergency department with an acute gallbladder attack with gallstones, I would be begging to have the stones removed and everything else left intact. But the current, you know, state of medicine in the Western world is such that, you know, the people who are presenting to emergency for acute treatment don't know where to go to actually get the underlying causes dealt with, because they think that medical system is one and the same when it's not.
Speaker 1:Is there any advancements in medicine to preserve the actual bile, sorry, gallbladder, whilst expressing um, expressing, if you like, the gallstones, or is it? Yeah, is it that the endothelial lining is so, uh, impacted by whatever you know? It is whether it be inflammation, whether it be infection that they just go.
Speaker 2:No, let's take it yeah, look, I think there are variables there, that sometimes a surgeon isn't going to know about it until they get in there and, as you pointed out, endothelial tissue damage with a risk of infection can certainly present problems, make it more complicated, require antibiotic use and may end up resulting in the gallbladder being, you know, needed to be removed anyway. But look in terms of like the different options you'd have medically, there are oral medications that have been shown to dissolve some gallstones, and these are classic compounds found in bile, and so bare bile acid is another, I guess, natural version of that to thin the bile and allow the gallstones to dissolve, and those medicines are really well tolerated. But they can be slow to work, so totally not appropriate in an acute gallstone attack and of course, isn't treating the root cause either either. But someone with a grumbling gallbladder, that could certainly be part of their treatment plan. But, as you just alluded to, there is something called a percutaneous cholecystostomy tube which actually is essentially a drain where they can move galls, use it to move gallstones out of the area and kind of massage it out if the gallstones are bigger. So, as you said, they can be anything from the size of a grain of sand all the way through to a golf ball. Now, in terms of passing a stone like the common bile duct isn't big enough to pass.
Speaker 2:You know anything too, and essentially, if it's over one and a half centimetres, typically they'll use lithotripsy, which is a type of you know, ultrasound that actually waves that breaks the gallstones into smaller pieces so you can pass it.
Speaker 2:But there's also a and I don't know if I would opt for this one but they can also inject a solvent which, of course, is highly toxic, but in this case there's a one-off to actually dissolve the gallstones. It can cause a lot of pain, it can cause serious side effects as well, so, you know, and it's also a bit risky for the doctor administering it as well. So it's probably not anyone's top choice. But certainly endoscopic drainage, you know, a tube to actually move them out, or using ultrasound would be options that I would consider before going for surgery. And ideally, I think recognizing gallbladder issues earlier on is really kind of the way to go. And this is where preventative and naturopathic and functional medicine comes into its own. Decades of you know, earlier red flags and earlier signs that um have been pointing to that their gallbladders in need of help, um, so maybe we should have a chat about some of those I think that's.
Speaker 1:I mean, this is obviously where we need to go. I was going to say before we move over to that, with regards to the um, uh, the solvents that are used, I was going to make a glib comment about the degreaser that you get from the cheap shop, but I could understand the surgeon's issues safety issues regarding that with leakage around the insertion point into the gallbladder. Regarding that with leakage around the insertion point into the gallbladder. Obviously, that would be also dependent on the type of stone. Most of them are cholesterol, but there may indeed be salts that are in there as well, and so that requires a different approach. So I'm really interested in lithotripsy, because that used to be reserved for renal disease, but that's interesting. I wonder if they're using it in different sorts.
Speaker 1:So, moving on with regards to symptoms, we talk about the classic shoulder tip pain and things like that. That's more of a grumbling gallbladder. If you have a gallbladder attack, it's you'll know it. But let's talk about these nuanced symptoms. What are we looking at here?
Speaker 2:so I guess, um, as you mentioned that pain, there's a couple of places people can experience pain and it kind of depends if there's stones there and also what size they are. So, um, one of the classic places to experience discomfort is um underneath the bottom of the right shoulder blade and that's really sort of um directly over where the gallbladder sits. But we can also see pain radiating or actually presenting as a primary, like the top top of the right shoulder. For some people, if there's issues with stones and the common bile duct, it can be a bit more central, so sort of right at the bottom of that of the sternum, like behind the stomach where it sort of crosses over towards the pancreas. But there are other signs of poor gallbladder function or poor bile flow.
Speaker 2:So number one would be the color of your stool. So if you're having what we would call a perfect poo, it has a particular texture, a particular shape, a particular size and also a particular color, which is a dark brown and a dark brown is. The dark brown is is caused by the bile and the changes in the, in the pigments of the bile, through the like, the metabolism of digestion. Anytime we see any of those lighter colors, we know that we're either not producing good quality bile or there's something impeding the flow of bile and therefore it's not coming through and coloring the stool in the same way, and so that would be one big hint. A second big hint would be if the stool, or, like after a bowel motion, you're seeing a greasy film on the water in the toilet bowl. So obviously undigested or maldigested fats, in particular stools that are high in fat, will often float rather than sink. Now, that's not a definitive point, because we can also see that with microbial fermentation, but you know, if it's floating and you're seeing some of those other things, the red flags, know if it's floating and you're seeing some of those other things, um, the red flags, um, other red flags are. You feel unwell after fatty food, so you might feel nauseous, you might even vomit, um, you might feel a bit headachy or a bit off, you might find it really just sits in your stomach really awfully and affects your digestion and your bowel motions. And if that is you, it's likely that you now avoid fatty foods and fatty meals and eat more on the low fat side to avoid triggering those symptoms. So those would be sort of the big ones there.
Speaker 2:But also we can see issues with fat metabolism appearing on the skin. So we can see sclerosis in the sclera of the eyes. We can also see lipomas, often around the eye area but sometimes elsewhere on the body, and they're just, you know, technically a tumor, but they are basically just fatty tissue, so fat coming out of your body because it's not coming out through the gallbladder, where it's meant to come out. They would be sort of the main ones. There are other things like often, you know, chemical sensitivity, alcohol sensitivity.
Speaker 2:We can see on blood tests bilirubin being elevated, alp being elevated. You know there's a few other bits and pieces that we can sort of see occurring clinically speaking and I will go over all of that inside the webinar for clinicians that will be attending. But you know, if you've noticed that maybe your liver enzymes a little bit wonky, but there's no other real reason or your bilirubins, you know, over 10, I know that the reference range is a bit more generous than that, but anything over 10 to me would be, you know, indicative of some sort of sluggishness. And you know, these types of signs appear decades before you end up with, you know, in the emergency room with a gallstone attack. So you know, I certainly, as a clinician, wouldn't be allowing a client to write that off as acceptable.
Speaker 1:No, no, but With regards to bilirubin and raised amino sorry, alt, wasn't it?
Speaker 2:Well, actually.
Speaker 1:AST and.
Speaker 2:ALT, but also, yeah, alkaline phosphatase too, yeah.
Speaker 1:Right so, with regards to raised LFTs, right. So is that early or late stage, like how early can we pick this up?
Speaker 2:Look, it really depends because, as you know, you know it's not one variable that tends to be driving it, and so you know, if there is toxic in accumulation, would we see LFTs go up first and bilirubin come later? Sure, but sometimes I see LFTs looking fine but bilirubin starting to sneak up to 12, 13, 15, 16. And they're not having jaundice symptoms yet, they're not having light-coloured urine yet. But that, to me, is a sign that there is difficulty with elimination, which, of course, is predominantly through the bile.
Speaker 1:Yeah, so unconjugated bilirubin. Okay, and I'm just trying to think about patient pictures here. So when we're thinking about therapies, uh, how, how heroic do we start off here?
Speaker 2:do we go gently, gently or do you go, nah, let's go bullet a gate well, if you would like all the juicy details, you can come to the webinar, but what I would say is you do want to take a very systematic and considered approach, because the last thing we want to do is trigger a gallbladder attack, and I know there's a lot of. You know, gallbladder flushes online, but for every person who's found that helpful, I know someone else who that triggered a trip to the emergency department. So, again, if you're not in acute pain but you've got grumbling pain, or maybe you've got some of these earlier signs, and perhaps you're going to go have an ultrasound and just see what's happening and you discover something, but you're asymptomatic. Really, you actually want to start with the gut, because 25% of all detox starts there and any gastrointestinal inflammation down regulates detoxification in the liver, and so you can't really come from a liver or a top-down approach if you haven't already done some gut work and support and, given the state of most people's guts, skipping that part wouldn't be advisable. Even though it feels like an extra step and maybe not such a necessary one, I really do think it is. And then, from there, withdrawing anything alongside that, withdrawing anything that's contributing to toxic body burden inflammation.
Speaker 2:You know, for some people these issues can actually arise because they don't eat enough fat, because fat actually stimulates the gallbladder to contract, and so you know, if someone's on not eating enough fat, increasing dietary fat to start moving the gallbladder along. There is a lot around the autonomic nervous system and the vagus nerve and how that splenic branch actually operates, and so you know, is there anything structurally a chiropractor needs to address through the thoracics? Is it a nervous system communication problem? Is it that they lack, you know, bitters in their diet, because that's a primary stimulant of the gallbladder as well. You know there's so many moving pieces that you want to take a holistic approach, but I would also be including if stones have been identified, or I'd actually be encouraging clients to ask for an ultrasound to see whether they have them or whether it's just viscous bile. I would then be applying things that help to dissolve the gallstones before we do anything to try and stimulate the gallbladder to eject its contents.
Speaker 1:So I know we don't want to give too much away because of the seminar, but can you give us a couple of hints and tips here? So we've got things like, for instance well, we've got things like the. There's the cholesterol triad, where you look at the level of cholesterol, the amount of lecithins and the amount of gall, gall salt, bile salts. So we can do certain simple things there, like lecithins and taurine and vitamin E, tocotrienols, what else Well, I mentioned bitters, so bitters and dietary fat help to stimulate the gallbladder.
Speaker 2:So, you know, even just really gentle things like lemon juice and water, or apple cider vinegar and water before foods, increasing your bit of green vegetable intake would be helpful. We know that dietary lecithin and choline helps to emulsify those crystals. What else would I consider? I also be make checking someone's fiber intake. We know that only one and a half percent of australians eat the recommended amount of fruit and vegetables, and so whilst we're all meant to be getting around 30 grams of fiber a day, most people are getting roughly 9 to 12 grams, and then what we're seeing there is reabsorption of a lot of these things back into the liver, which is kind of double handling everything. So you know these things sound kind of flimsy and weak in the face of, you know, say, a gallstone attack. But these can all be, you know, contributors to, or the absence of them, contributors to why you ended up with, you know, a sluggish gallbladder, obviously for women, especially making sure they're not being exposed to endocrine disrupting chemicals, in particular xenoestrogens, making sure estrogen metabolism is operating as designed um supporting gut health, of course.
Speaker 2:And then there are bitter herbs that a herbalist might use Dandelion roots are really popular one, and certainly you can get dandelion root tea from the supermarket. But herbalists might call on things like gentian or globe artichoke. But again, those things you wouldn't touch until you knew there weren't gallstones or that they were small enough that they could be passed safely from the common bile duct. And you would use other manual therapies to help with that, like lymphatic drainage, castor oil packs. Um you know, enemas might be called upon as well okay, you know one herb that I.
Speaker 1:I totally take your point about confirming without a doubt that their gallstones are less than I had the cut off at one centimetre. So anything over a centimetre I wouldn't touch Goff, See ya, but particularly if it was gravel or sludge. But they were getting contraction pain, that sort of griping pain after meals, particularly a fatty meal. I used to love the use of wild yam. You know it was popularised back in the day. It was popularised as a sort of phytoestrogen. I used to use it for liver because it's a smooth muscle relaxant. It was brilliant yeah beautiful.
Speaker 2:I loved it.
Speaker 1:It's fantastic.
Speaker 2:Yeah, so any time you were doing some sort of active flushing or gallbladder stimulation, something like that would be imperative to use alongside that. And certainly you know there are essential oils like caraway and peppermint that also can relax smooth muscle that you could consider. So you know, as you can see, it does require a very coordinated and holistic approach and sort of in the right order as well, to avoid causing more problems.
Speaker 1:Beautiful Amy look forward to this seminar as usual. I know it's going to be comprehensive, but thank you so much for taking us through just some of the finer points, some of the more practical points of where we can help patients today. Thanks so much.
Speaker 2:Yeah, thanks, andrew.
Speaker 1:And thank you everyone for joining us today. Remember we'll have all the show notes and every other podcast up on Designs for Health website. I'm Andrew Whitfield-Cook. This is Wellness by Designs.