Have you had your gallbladder removed, and you have digestive issues such as indigestion, gas, and bloating? Are you experiencing a slow but constant downward spiral in your health? You may have had your surgery a month ago or 30 years ago – you may suddenly have symptoms, or you may have been living with them for years. Doctors offer little assistance in dealing with these problems, because according to them, “you don’t have to change what you eat.” Unfortunately, having your gallbladder removed only treats the symptoms, not the underlying causes of the gallstones in the first place.
However, with thousands of patients suffering indigestion, bloating and a slow decline in health post-surgery, naturopaths have done their own research, and a lot of evidence points to a lack of bile salts. Find out about this supplement below and how it can benefit you.
Why Bile Salts?
Because the gallbladder aids in the digestion of fats, removal of the gallbladder can result in such symptoms as indigestion and gas due to improper absorption of fats. This is because bile, which includes bile salts, is no longer gushed into the intestines in adequate quantity to digest the amount of fat found in a large meal.
Bile is produced in the liver and stored in the gallbladder. When the gallbladder is removed, bile will continually trickle into the digestive system, whether you are eating or not.
Normally when you eat a heavy meal, the gallbladder responds by forcing a large amount of bile to efficiently digest the fats – not just fats from greasy foods, but healthy essential fats such as omega-3 fatty acids.
So, without a gallbladder, you are not only inefficiently digesting your meals, but your body is missing out on some of the healthy fatty acids and oils needed for your heart, nervous system, absorption of sugars and a healthy brain. Over the years, your body will wear down faster than it should be.
Bile Salts as a Solution
Much research has pointed to the use of bile salt supplements as an effective means of dealing with the digestive disorders common after gallbladder surgery. Taken with a meal, bile salts help to digest fats and aid in absorption of the fat soluble vitamins.
- Dosage – the dosage of bile salts will depend on the brand, the type of bile salt, and the milligram content of the supplement. Also, many people find that adjusting the amount of bile salts to their own comfort level is ideal. Bile salts are best taken with a meal, as they provide the acids needed to digest your food. One brand recommends taking two tablets with each meal, but this will vary depending on your specific dietary needs.
- Brands – a number of brands offer bile salts. These include Standard Process (Cholacol), Dews (Bile Salts), Swanson (Liquid Liver Extract with Bile Salts), NutriCology (Ox Bile), and Jarrow Formulas (Bile Acid Factors).
Although many people experience help from bile salts, there is one main side effect some people experience: diarrhea. This can be attributed to the fact that unabsorbed bile salts go directly into the colon and acts as a laxative. Some people have found the diarrhea related to bile salt supplementation can be painful. If this is the case, lower the dosage. You need just the right balance of your body’s production and the supplement. Everybody is different.
On the opposite side of the coin, if you experience constant diarrhea after you have had your gallbladder removed, you may have the opposite effect – bile salt diarrhea, where your liver is producing too much bile salt. This spills over into the colon, where it acts as a laxative.
Unfortunately, there is no cure for this, though you can take cholestyramine, a prescription cholesterol drug that also soaks up excess bile salts. It is estimated that 5% of people who have had their gallbladder removed will suffer from this. There seems to be no reason for this type of bile salt malabsorption (for instance, a blotched surgery) – it seems like just bad luck.
Other Supplements That Help
Taking bile supplements can be one part of your regimen for digestive health, but there are several others supplements that may be helpful as well.
- Calcium Carbonate – if you think that calcium is only for strong bones, think again. Calcium carbonate is commonly used to control the symptoms of diarrhea, and may be a great companion to deal with the side effect of bile salts.
- Fiber – not only will fiber absorb water and firm up the stool, it may also work as a digestive sweep; aiding in the digestion of fats and eliminating toxins.
- Probiotics – another great key to digestive health is probiotics. Made up of “good bacteria” commonly found in the intestinal tract, probiotics help maintain balance in the intestinal tract. They have been found helpful in dealing with gas and other digestive issues.
- Betaine – This is a supplement made from beets, and aid in the breakdown of fats, just as bile salts do. If you are experiencing constant diarrhea, swap the bile salts for betaine instead.
- Choline – Another aid in digestion. Choline supplements help absorb excess cholesterol and fats. They also help with the liver. Many people take bile salts and choline together, as they work well with each other.
Bile salts are produced in the liver. They are included in the bile and sent to the gallbladder, where the bile is concentrated and stored. When the stomach empties its contents into the upper intestines (duodenum) for further digestion, the gallbladder releases the bile into the duodenum to aid in the digestion of fats in the food.
If bile salts are not absorbed properly, they are passed into the intestine where they can cause diarrhea. If your gallbladder has been removed, bile constantly trickles into your duodenum and small intestine – while this is not usually a problem, a percentage of people without a gallbladder will have digestive problems – either because of too much bile (causing diarrhea) or too little (causing improper digestion of fats and indigestion – a bile salt supplement is recommended).
The diarrhea may be watery, and frequently occurs after meals. Testing of the diarrhea specimens will reveal excess amounts of bile salts (acids) present. While the disorder is not life-threatening, it can disrupt normal life due to the number of trips to the bathroom.
Causes of Bile Salt Malabsorption
Bile salt malabsorption is connected to two primary diseases: Crohn’s disease and Irritable Bowel Syndrome. However, it is difficult to determine if the malabsorption causes the diarrhea in those diseases, or if the diseases themselves trigger the malabsorption.
The lower part of the small intestine, called the ileum, is responsible for absorbing bile salts. In patients who have had part of their ileum removed, bile salt malabsorption is common.
Another possible cause of bile salt malabsorption is pancreatic insufficiency. In other words, improper function of the pancreas. This can be the result of alcoholism, but can have other causes as well.
If you have had your gall bladder removed, you may experience this as well – about 5% of patients report painful diarrhea after surgery, which does not abate. Studies show that the liver sometimes produces extra bile salts to compensate for the lack of a storage area for bile. This excess bile overwhelms the small intestine and spills over into the colon, where it acts as a laxative.
How Intestinal Bacteria Relates
Recent studies show that the malabsorption of bile acids may also be due to improper balance of intestinal bacteria. The body normally maintains about 400 types of good bacteria (called probiotics) in the intestinal tract. These flora can be killed off when antibiotics are taken for infection. The resulting imbalance of intestinal bacteria may contribute to failure to properly absorb bile salts. (Whenever I take antibitotics, I always take a probiotic supplement afterward.)
Treatment for Malabsorption
The most common treatment for bile salt malabsorption is bile salt binders, called sequestrants. The most common binders are cholestyramine and colestipol, which are both available by prescription. Even though these drugs are effective at stopping the diarrhea, they are often hard for patients to tolerate. Side effects can include abdominal pain and bloating. Other possible treatments may include:
- Welchol (Colesevelam) – a newer drug called Welchol – generic name of colesevelam, is said to be 4 times more potent than traditional binders. This drug has shown fewer side effects and greater likelihood of success. It is available by prescription.
- Probiotics – because some research points to an imbalance of intestinal bacteria, it may be helpful to supplement with probiotics. These supplements are natural, have few, if any side effects, and can be beneficial for dealing with other digestive disorders. They help gas, bloating, and diarrhea in certain cases. Because of their safety, probiotics may be an excellent way to support the digestive process and correct the cause of bile acid malabsorption. (Probiotics are also found in yogurt.)
- Pancreatic Support – because some bile salt absorption is linked to poor function of the pancreas, treatments that support the pancreas may help the problem. Pancreatic enzymes are readily available over the counter and help the digestion of proteins and fats.
If you are one of those people who are dealing with diarrhea while taking bile salts, you are not alone. Bile salts may help many people find relief from indigestion and other symptoms related to gall bladder removal, but they may face a few side effects. Diarrhea is one of them.
Nothing is more frustrating than taking a supplement to help one issue, only to have another one develop. However, there are steps you can take to combat the diarrhea and allow you to continue reaping the benefits of taking bile salts.
Why Do Bile Salts Cause Diarrhea?
Some people who take bile salts begin having issues with the loose, watery stools normally associated with diarrhea. These symptoms can also appear after gall bladder removal (called a cholecystectomy) in people who are not taking supplemental bile salts. The reason for both of these situations appears to be related: a more constant, less concentrated flow of bile into the intestines. In order to understand this, it is important to know a little about how the gall bladder functions.
Normally, the liver secretes bile, which is made up of bile salts, cholesterol, and phospholipids. When a person is not digesting food, the bile is directed to the gall bladder where it is concentrated and stored. When food enters the area below the stomach, called the duodenum, the gall bladder begins to pump bile in to break down fats in the food. This is an important part of digestion.
If a person has had their gall bladder removed, there is no storage for bile. Instead the bile runs continually into the intestine – this is caused by too much bile salts, which act as a laxative. About 5% of all patients who have their gall bladder removed will experience this. Unfortunately, there is no cure, but there is medication. Talk to your doctor.
Taking a bile salt supplement also increases the amount of these substances entering into the intestinal tract, which may produce a similar laxative effect.
What Can be Done to Help?
Loose, watery stools for any reason are not pleasant. Doctors sometimes prescribe medication that attempts to control diarrhea caused by the removal of the gall bladder. However, there are some natural steps that can be taken to help regulate diarrhea, whether it is caused by gall bladder removal, bile salt supplementation, or both.
- Calcium Carbonate – everyone knows that calcium is needed for strong bones. However, calcium is also used for indigestion and other digestive difficulties. It is also a common ingredient in medications for diarrhea. Some people have found that taking a calcium carbonate supplement has helped ease the diarrhea associated with bile salt supplementation. This may be due to the constipating effect it has on the bowels. Research has shown calcium carbonate is effective in easing diarrhea in other treatment regimens. It is important to find a supplement without magnesium, when taking it for this purpose as magnesium can act as a laxative, making the problem worse!
- Fiber – the addition of fiber in the diet can add more bulk to the stool, helping with diarrhea. Patients will want to add fiber slowly to the diet, to avoid additional gastrointestinal discomfort. Fiber works by soaking up excess water and firm up the stool. Everyone one needs at least 20 to 30 grams of dietary fiber per day, but extra will not hurt, as it will be eliminated from the body. Soluble fiber, such as the inside of beans, peas, apples, and pears, as well as oatmeal and oat bran may be better for the control of diarrhea than insoluble fiber. Fiber supplements are also available.
Other ideas for dealing with diarrhea include limiting fat intake, and eating smaller, more frequent meals. Eating more frequently will put food in the digestive track more often, using up more of the bile salts.
Also, some people trying to find a right balance of supplements to enjoy proper digestion have also tried choline and betaine. Read this article for information.
A common concern after gallbladder surgery is frequent indigestion, gas, and bloating. If you experience these symptoms, you know the discomfort they bring. You may not have found a lot of help from your doctor but understanding the cause of these issues may help find solutions. One possible solution is taking bile salts. But do they really help?
Those Awful Symptoms
Many people think that all their digestive problems will be over after their gallbladder is removed. Unfortunately, this is rarely the case. There are several reasons for this. One is the fact that gallbladder difficulties are often related to diet and obesity. Unless these factors change, a person may continue to have digestive issues, even without their gallbladder.
Another issue is how the body responds to the removal of the gallbladder. When the gallbladder is intact and functioning properly, it releases bile into the intestines to aid in the digestion of fats. The timing of this release is coordinated with the digestive process.
After the gallbladder is removed, bile flows in small, but steady amounts into the intestine. This may cause diarrhea in some patients, due to bile not being mixed with sufficient food. However, another, more common side effect can occur: gas, indigestion, and bloating. The reason for this is because there is not sufficient bile available to mix with the stomach contents when a large or high-fat meal is consumed. The result is improperly digested fats, which results in digestive upset.
Help – I need it!
People often wonder if it is possible to find relief from these difficult symptoms. Thankfully, the answer is usually yes. Sometimes these issues can be caused by other disorders such as peptic ulcers, irritable bowel syndrome, and pancreatitis. But many times they are easier to treat. Here are a few suggestions:
- Eat a low-fat diet – reducing the amount of fat your body has to digest is an easy to understand solution. The more fats you consume, the harder your body has to work to digest them. Because you do not have a gallbladder to dump larger amounts of bile, you can help your body by reducing fat intake.
- Eat smaller, more frequent meals – eating smaller meals means that your digestive tract has less content to deal with at a time. This means that the smaller, but constant amounts of bile can be mixed with the food better.
- Use probiotics – certain studies show that adding probiotics to the diet helps with digestive issues such as gas and indigestion. Your body normally maintains around 400 different strains of these “good bacteria” in the intestine, but they can be killed off by the use of antibiotics. Eating yogurt with live cultures or taking probiotic supplement may be a great help for your symptoms.
- Bile Salts – because the bile normally contains bile salts, these substances have been found to help break down fats. When the amount of bile salts is reduced due to gallbladder removal, supplementing the diet with bile salts can be helpful. Many suffers have found that cholacol (a mix of ox bile salts and collinsonia root, a diuretic) works better for them. Taken with meals, bile salts assist the absorption of the fats.
More on Bile Salts
Bile salts occur naturally in the body and are produced by the liver as part of bile. They are intended to help the digestion of fats in the body, and aid in absorbing fat soluble vitamins such as vitamins E, A, D, and K.
If these fat soluble vitamins and fatty acids are not absorbed, they are passed onto the colon, where they can contribute to diarrhea.
Most people produce adequate amounts of bile salts, but when the gallbladder is removed, fewer bile salts are available when food is digested. This can lead to indigestion, gas, and even deficiency of fat soluble vitamins. For these people, supplementing the diet with bile salts may improve their quality of life.
Other functions of bile salts include:
- Breaking down and eliminating toxins – the liver is the body’s primary toxin filter and sends most of the filtered toxins into the bile to be eliminated. In addition, bile continues to break down the walls of viruses and other substances in the digestive tract. When the body fails to properly break down these toxins they can cause skin problems, such as those found in psoriasis. Some research reveals successful treatment of psoriasis with bile salts. This demonstrates the powerful effects these substances can have on the body.
- Re absorption – bile salts are reabsorbed into the body for re-use in the liver. This ensures continual supply for optimal digestion.
The Good and Bad of Bile Salt Supplements
As with any supplement, it is important to evaluate the benefits and any negative effects of bile salts. Rather than quickly taking something and wondering about the results later, an informed decision will help prepare a person to observe how the substance effects their body.
- The Good – many people find relief from their digestive discomfort, indigestion, gas, and bloat while taking bile salts. In addition, some people have found other, seemingly unrelated symptoms clear up, including skin conditions, and toxicity of the blood.
- The Bad – a reported side effect of taking bile salts is more frequent diarrhea. This would be similar to the malabsorption of bile salts found in some people with conditions like Crohn’s and Irritable Bowel Syndrome. While diarrhea is never pleasant, steps can be taken to minimize it, allowing patients to find digestive relief without unpleasant side effects.
Since the main drawback to bile salt supplementation is diarrhea, it may be helpful to address how this can be managed. Two simple solutions have been found:
- Fiber – increased fiber intake bulks up the stool by absorbing excess water. Bile salts produce watery stools, so fiber is often an adequate solution. Fiber can be taken as a supplement, or may be acquired in the diet by eating high-fiber foods such as whole grains and vegetables.
- Calcium Carbonate – a common ingredient in medications for diarrhea, calcium carbonate has proven success in slowing diarrhea. It can be found in supplement form, and may help to reduce the diarrhea associated with bile salt supplementation.
If you are considering taking bile salts, it is recommended that you start slowly and add more as needed. Monitor your symptoms and only take as much as is needed to regulate digestion and provide relief. Too much can cause painful diarrhea.
After my gallbladder surgery, my doctor said I would have no troubles eating normally. However, this hasn’t happened. After continuous upset stomach and digestive problems after every meal (even eating healthy), I tried a bile salts supplement. What a difference! Stay tuned for more information on this product and what I did to help my digestion.