The gall bladder and how to manage without it.

If someone came in to complain about a sluggish bowel and queasiness after a meal, it became my habit to ask if they still had their gall bladder, as gall bladder removal seems to be really common in Ireland.

What does the gall bladder do?

The gall bladder stores the bile produced by the liver. Bile is made up of bile acids, needed to help break down fatty foods. The liver also uses the gall bladder to help eliminate unwanted toxins and wastes into the intestines so that they can be ejected along with our poo.

What happens when the gall bladder is removed?

When the gall bladder is removed, bile and toxins are still released from the liver directly into the intestines, but the system becomes less efficient. Without the gall bladder, the bile may not arrive in the small intestine alongside your cheese, fry-up or ice cream. Fat-soluble nutrients like vitamin D and Omega 3s may not be processed efficiently and may pass through, undigested and unabsorbed. Waste cholesterol may be harder to get rid of without a gall bladder, as fats are not broken down properly and because the bowel may not be moving as efficiently to get rid of it.

The digestive system acts like a clever domino act, each secretion and action triggering the next; for instance, anticipating food, chewing it and releasing enzyme-rich saliva tells the stomach that food is coming. The stomach then gets ready to mix in acid with the delivered food to break it down and churn it all up. Bile, as a secretion, triggers peristalsis - the muscle movement of the intestine and bowel. This pushes everything along the tract and helps us poo regularly.

Symptoms that may be experienced if you have sluggish bile flow:

• Difficulty digesting fatty foods.
• A slow digestive transit or a tendency to constipation.
• Queasiness after rich food or a heavy meal.
• Indigestion, bloating and wind.
• Trouble absorbing fat-soluble nutrients like Omega 3s, vitamin D and vitamin E.
• Increased cholesterol levels

What you can do about it:

• Eat small portions, chew and sit up straight so that your gut has room to manoeuvre the food.
• Eat fewer fatty foods like cheese, cream buns, fatty meats and fried foods.
• Eat lecithin with each meal. Lecithin is a food supplement that is often used as an ingredient in salad dressings and chocolate to stop the fats separating. It will emulsify fatty food and help break it down.
• Use bitter herbs like dandelion and artichoke to improve bile flow and to stimulate the production of digestive enzymes. Better bile flow may help break down fats and help regulate bowel movements. Bitter herbs are traditionally used to improve digestion and are taken before each meal. They are very bitter which is an acquired taste (like a Martini or an Aperol).

Remember to talk to your doctor if your symptoms are chronic or severe, or if you are worried about nutritional deficiencies.