The Dr. Hyman Show - The Functional Medicine Approach To Gallbladder Disease with Dr. George Papanicolaou

Episode Date: September 6, 2021

The Functional Medicine Approach To Gallbladder Disease | This episode is brought to you by Essentia and Paleovalley The gallbladder is an organ we don’t often pay much attention to, but if you or a loved one has had gallstones, you know they can be very painful. About 6-9% of adults experience gallstones and their associated symptoms which can include nausea and vomiting. The gallbladder plays a vital role in our digestive process by storing bile which helps us break down fats. If your bile is imbalanced, gallstones may form. The conventional approach to relieving gallbladder pain and discomfort is through the use of medication or surgery to remove the gallbladder, whereas the Functional Medicine approach seeks to uncover the root cause of the problem and approaches treatment from that place. In this episode, Dr. Hyman discusses gallbladder disease with Dr. George Papanicolaou. They talk about how they work with patients to determine what is causing the disease, and how an imbalance in the composition of bile can also result in gut problems like dysbiosis and SIBO. They also provide tips on supporting your body to optimize digesting fats if you’ve had your gallbladder removed. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health—a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017. This episode is brought to you by Essentia and Paleovalley. Right now, you can take advantage of Essentia’s incredible Labor Day offer of 25% off with 2 free pillows (normally a $300 value) by going to learn.myessentia.com/DrMarkHyman.  Paleovalley is offering 15% off your entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal. In this conversation, Dr. Hyman and Dr. Papanicolaou discuss: The root cause of gallbladder disease, including gallstones What healthy bile is and why it’s so important in the role of digesting fats The difference between the conventional medicine and Functional Medicine approach to treating gallbladder disease How bile imbalances can lead to gut imbalances such as dysbiosis and SIBO The tie between Hashimoto’s thyroiditis and gallbladder disease and the role of gluten Consequences of surgery to remove the gallbladder Supporting the body if you don’t have a gallbladder Additional Resources: Digesting Fat, Optimizing Your Health, and My Daily Supplements https://drhyman.com/blog/2017/04/28/digesting-fat-optimizing-health-daily-supplements/ A New Roadmap for Treating Disease https://drhyman.com/blog/2018/05/16/a-new-roadmap-for-treating-disease/ Healing Psoriasis from the Inside Out with Dr. Todd LePine https://drhyman.com/blog/2020/10/16/podcast-hc27/ How to Prevent and Reverse Fatty Liver Disease with Functional Medicine https://drhyman.com/blog/2021/08/02/podcast-hc67/

Coming up on this episode of The Doctor's Pharmacy. Everybody says, you know, a lot of people know, oh yeah, it's my gallbladder, now I'm going to have to get it taken out. Their thought is the only cure for the gallbladder is to take it out. There's no thought to their lifestyle, their nutrition, and the impact that bile is having on their gut microbiome, which might be causing some other symptoms in their GI tract. Hey everyone, it's Dr. Hyman here. Now so many of my patients ask me how I manage to work multiple jobs, travel frequently, well not so much anymore, and spend time with my family and still focus on my health. I know it can seem hard to eat well

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F, a place for conversations that matter. If you've ever suffered from gallstones or gallbladder disease, this is going to be a great conversation for you because it's going to help you figure out why you got them and how to get rid of them and how to actually deal with this problem, which affects so many people. And today, our guest on this special edition of Doctors Pharmacy called House Call is none other than my friend and colleague at the Ultra Wellness Center, Dr. George Papanikolaou. Welcome back, George. Mark, it's always a pleasure. I love talking about functional medicine and how we work with our patients at the Ultra Wellness Center to get to the root cause of what's keeping them from optimal health. Of course. So gallbladder is such a common problem. It's like one of the

most common surgeries. It's such a common problem in America. Tell us about gallbladder disease and what is it, who gets it, how many people have it, and what are the symptoms and why is it such a big deal? And what do we know about who's getting it and all that? So kind of let's take us down the whole rabbit hole of gallstones. And then we're going to get into how conventional medicine treats it and what functional medicine approach might be that might be worth trying. Yeah, sure. So, you know, it's almost, you know, so common that it's invisible. And what I mean by that is, is that people don't really think about it. They don't think about their gallbladder. Why would they think about their gallbladder until it hurts? So gallbladder

disease affects 6% to 9% of adult age people between 20 and 70. And of all of those people, they've either had gallbladder disease or have the gallbladder taken out. So it's a pretty large problem. It's a huge healthcare expenditure. It's very, you know, it's fairly expensive out. So it's a pretty large problem. It's a huge healthcare expenditure. It's very, you know, it's fairly expensive surgery. So it has a big drain on our system. You know, when, you know, gallbladder disease, people really don't know that there's anything going on with the gallbladder until they have the symptoms, which is going to be what we call biliary colic. And that's when, you know, meal and then within half an hour to an hour, you begin to feel really bad pain in your right upper quadrant. And then where's that? That's going to be below your ribs to the right. And it's going to be really, really painful. And you're not going to

like it at all. You're thinking you're having a baby and it's not coming out. It's really painful. And then you're going to end up in the emergency room. And then you're going to be given some medications that will, you know, hopefully relieve your pain. And then if it is a gallstone, then hopefully it will pass on its own. And hopefully there will be no complication. And then you'll leave the emergency room. You'll see your primary care. Your primary care will confirm that you're feeling better and then tell you to use that and send you on your way.

Right. And then we're missing so much i mean we're we've just lost like okay it's not just that you had a stone that didn't pass and you had pain get to the root cause why what is the root cause yeah what why did the stone end up there in the first place right and so where does it come down to it comes down to what we always start almost every conversation you and i have it starts with diet it starts with the foods that you eat yes there's genetic predisposition yes you can be a female you can be overweight you can you know be pregnant you can be 40 you can be a diabetic diabetic. You can have other chronic underlying diseases that predispose you to gallbladder disease, particularly gallstones. But when it comes

down to it, a lot of it's going to have to do with your diet. Are you eating a high-fiber diet? Are you eating a nutritious diet where you're getting all of the, are you drinking, are you getting all of the nutrients that actually keep your gallbladder healthy? Are you drinking enough water in your day? Because the bile that's in the gallbladder is 95% water. And then it's made up of bile acids, bilirubin, fats, amino acids, proteins, enzymes, hormones like estrogen, toxins. Your bile plays a very important role in the detoxification process in your body. And so if you're not getting what you need to make good bile, then you're going to put your gallbladder under pressure. And so if you're not drinking enough water, here's what happens. Where's the gallbladder in the first place?

It sits right under the liver on the right side. Your liver makes bile, and then that bile goes into the gallbladder where it's stored. And then when you're eating, when fat that you've eaten enters your small intestine, it triggers something called cholecystokinin, which then sends a message or is the messenger to the gallbladder to release the bile. The bile is released, will it will then start breaking down your fat so you can get all the nutrients that you need out of your fat and so that's the that's what happens that's what the gallbladder does and you need you need healthy bile to then

do its job to breaking down the fats and so where does the problem become? These stones are actually the compounds that are in the bile, in the gallbladder, that begin to precipitate out. So they start to connect to each other and form crystals. And then these crystals can get really big. So when those crystals get big enough and they become stones or they become you know hundreds of thousands of little crystals that sit in your gallbladder and on an ultrasound that will be done will just look like sludge it will expand at the bottom of the hourglass sitting in your gallbladder and so you that's what that's how you get the gallstone. Interestingly, this is very interesting. What's the other thing we talk about all the time? The immune system.

Yeah. The immune system. So when you start creating these crystals, because you're not supporting a healthy gallbladder, or you have a disease process that slows the gallbladder so it doesn't empty, it gets filled up with bile. The bile can't get out, and that's going to trigger, again, the precipitation out of these compounds that are in your bile, and they'll form the crystals. But here's the interesting thing.

There's been research that shows that you have an immune response to these crystals. Your immune system actually sees them as foreigners and sends xenoph crystal that exponentially increases the precipitation and the formation of the crystals. And then you can get these huge stones that won't pass or get stuck in the duct that leads from the gallbladder into the intestine. Pretty fascinating. Amazing. That's how we get there. You know, a lot of, from a functional medicine perspective, you know, we see a lot of this in diabetics.

Yeah. A lot of it has to do with insulin resistance and poor metabolic health, which affects, you know, 88% of Americans. So that's why gallbladder disease is such a big deal. And the problems that people suffer from are miserable, you know, pain, vomiting, nausea, you know, just severe issues, and they can't digest their food. And often the traditional treatment is just surgery. But from a functional medicine perspective, what do we think about? How do we begin addressing this? What are the ways that we support these patients?

And how do we sort of get them better? And sometimes they do need surgery, but talk about the approach we would take in terms of what diagnostics we would use and how we would help people. Yeah, sure. I would say that, you know, just doing my research in this podcast, it was really fascinating that the gallbladder and bile play a really important role in the body. And to just look, I think this is one of the classic examples or the differences between functional medicine and conventional medicine. Because in conventional medicine, it's the stone, it's the pain, it's the complications of the stone. And so if you continue to have stones, we'll take your gallbladder out. If you have a complication to the stone, you have, you know, an infection,

then we'll take your gallbladder out. And that's it. That's it. There's absolutely no thought as to the role, what got you there, and what the role of bile is in the rest of the process, because it just doesn't break down fat. Because of the contents of bile, which spills into your intestine, it can have a huge impact on your gut microbiome. So I just wanted to emphasize that, you know,

that's why I said earlier, it's sort of like, it's so common, it's invisible. And, and, and because, you know, we just take it out, there's even more reason to, to, to not think about it, because that's, that's, everybody says, you know, a lot of people know, oh, it's even more reason to not think about it because that's, everybody says, you know, a lot of people know, oh, it's my gallbladder. Now I'm going to have to get it taken out. Their thought is the only cure for the gallbladder is to take it out. There's no thought to their lifestyle, their nutrition, and the impact that bile is having on the gut microbiome, which might be causing some other symptoms in their GI tract. And- Yeah, talk about that. Talk about that connection between the microbiome and the gallbladder.

Well, yeah, that's, okay. So, all right, I can enter that it from this perspective, that when the bile, you know, if it's too acidic, if you have too many toxins in it, and it enters into the and and your nutrition is poor so you don't have you know you don't have enough amino acids in it you don't have enough proteins or enzymes that actually can be an aid to the bacteria in the gut microbiome to do their job then it will start to alter the environment of the gut microbiome. And then you'll end up with what we call dysbiosis. You'll, you know, the bile will cause damage to the gut microbiome. When that happens, then the organisms that are really healthy start to decline. They become destroyed. Then you start to develop some organisms like candida,

that will alter the gut microbiome even more. And some of those commensals that live there, they've been hanging on, you know, in the in the poop party, where it's nice for bacteria to grow, they will start to grow. Now all these bad bacteria take over, you get inflammation, you have a breakdown of the mucosal lining that plays a very important role of protecting your immune system and allowing for the bacteria, the healthy bacteria in your gut microbiome to communicate to the immune system in a very precise way, because that happens and it's very important. when that communication system breaks down because the gut mucosa has been damaged then the immune system begins to be overwhelmed and starts to have inappropriate responses leading to autoimmunity and leading to inflammation throughout the body

and so that then triggers this inflammation. Then it affects the gallbladder. The gallbladder then will be affected. And I'll give you an example. Let's say you have a gluten sensitivity and you don't know it. And you eat gluten. So gluten is a real strong potentiator for creating autoimmunity against your thyroid and it can create Hashimoto's thyroiditis and there have been studies that show a very strong connection between Hashimoto's and gallbladder disease oh interesting right and

so okay so what you know what happens well gluten has antigens on it very similar to the thyroid. So when the immune system makes antibodies against the gluten, it can confuse, and those antibodies can attack the thyroid. Okay, what happens? Well, now that's called Hashimoto's, and Hashimoto's, in its endgame, stops your thyroid from working. Your thyroid loses function. We call it hypothyroidism. Hypothyroidism slows down the gallbladder's ability to move the bile out. And that becomes the first step in your stones developing.

Because if you can't get the bile out and sluggish gallbladder then the bile builds up and now you set up that environment for all those compounds to precipitate out the threshold for that precipitation to occur lowers as you have more and more bile sitting there under pressure so so that's you know you can see there's a cycle there. That's why I said you can't just ignore the fact that somebody got a stone. You've got to look for root causes. You've got to look for other disease processes that may have predisposed them to form that stone. The stone's just the beginning of the process. And the disease process, things like insulin resistance and diabetes, there's a big one, which is such a big factor that we deal with. And often that's not really addressed as a way of

treating stones. We also deal with the whole gut issues. And what have you seen in your patients with this? You had a patient who was over 40, a woman, she was gaining weight, had gut issues. Tell us about her and your approach. What did you do diagnostically? How did you treat her? What was the outcome sure so um and as we learned in medical school it's the it's the four or five f's depending on how you think about it but unfortunately it has a lot to do with women and it has to do with the fact that you know when they're pregnant which is hurdle they're 40 um those are two things that you know are high uh they're uh they're associated with an overweight, right?

Yeah. Fertile. I don't want to say fertile fat. That's bad in medical school. We learned all this stuff like fertile fat and 40. That was what we learned. Yeah. Yeah. George didn't want to say it, but I didn't. Yeah. So this woman came, and, you know, her concerns were that, you know, she was really, you know, feeling fatigued. She had sudden weight gain. You know, she had gone to her PCP. You know, she was told that her thyroid looked fine, the numbers were okay,

not to worry. You know, you still got kids, you know, the same old, you're getting older, you have kids, you're running around, you're busy. And so she was just living with this fatigue and this weight gain. And then she started having gut issues. She started having bloating and distension. And so she just couldn't take it anymore and she came to visit us. She had, I think, one episode of pain that sounded like it was gallbladder disease and she had lasted for an evening. It was after having a really fatty meal and she hadn't gone to the doctor. She sort of, you know, suffered through the night. And so that she never really dealt with it. So part of our,

after our first visit, I told her, I really want you to go get an ultrasound in your gallbladder. I said, you have a lot of things going on. But one of the things I need to really find out is if you do have gallbladder disease. And so it turned out that she did. She has some stones, and she probably did have an episode of a stone that passed and caused her some pain. So the complete workup for her involved looking at her hormones, looking at her thyroid, and looking at her microbiome and food sensitivities and so when i got her thyroid numbers back her tsh was 3.9 okay so now you know doctors in a prime you know will look at that and

say that's within the normal range because traditionally they've been taught that anything from, you know, 0.45 to 4.5 can be considered normal. But we've learned more and more that that's not the case. When you see a 3.9, you see a 4.2, you start to think, I don't think that that thyroid really is an optimal function. Well, I also, when I checked the thyroid, I also checked for antibodies. And wouldn't you know, her antibodies against her thyroid were sky high. She had Hashimoto's thyroiditis. On her food sensitivity panel, she had gluten sensitivity. She did not have celiac disease, but she had gluten sensitivity, Hashimoto's, hypothyroidism, which then set her up for a couple of different things.

But certainly it slowed her gallbladder down and set her up for having a stone by the mechanisms that I've already explained. And so, and she was estrogen dominant, meaning that relative to progesterone, she had more estrogen than she needed. And she had a history of, you know, a cycle that had been irregular, a cycle that she had a lot of breast tenderness, she had a lot of water retention around her period, she had PMS around her period. And that's just, that's just, you know, that just, And that just screams estrogen dominance. And she's had that most of her life. So what did I do? Step by step. We just started to deal with the underlying issues. I started to treat her thyroid, treat her Hashimoto's thyroiditis. I treated her. She had SIBO, by the way. So first thing we did,

we stopped the gluten. So she was off of gluten. And that's going to, you know, you definitely want to do that because if you have sensitivity to it and you get one autoimmune disease like Hashimoto's, then you're going to set yourself up for more because it's more likely that you'll get another one once you have one. Her gluten stopped, and then we addressed her SIBO. SIBO is small intestinal bacterial overgrowth. We put her on a low FODMAP diet, which helped address that. I used some antimicrobials that were botanicals that addressed that. How did she do?

She did great, obviously. It took a while to get her hormones under control and balance those out. It took a little while to get her SIBO under control. But once we had the SIBO under control, we got her thyroid function down from, what would I say, it was 3.9. 3.9, yeah. Got it down to 1.2. Her energy was back. She felt great. And then as we work with her diet and we clean up her SIBO, she was back to normal in a very

short course of time, within three months. It's amazing. So we really can't affect people's course. And she really didn't need surgery then she did not need surgery as i said before you know and i explained this to her i said the stones are just enigmatic of the bigger problem you know they're they're they're the canary in the coal mine of of your nutrition not being where it needs to be and you may be having excess excess toxins in your system and the estrogen dominance estrogen you know needs to be metabolized and it is in the liver and it ends up in the gallbladder but if it's in two higher concentrations it can have a very negative impact on gallbladder function so her dominance her SIBO her thyroid

she was just it was just she's you, it was a matter of time before she had a stroke. And if, you know, if she had had that stone and gone to the emergency room and hadn't passed it, she would have had her gallbladder taken out and nobody would have ever addressed these other issues. Absolutely. I think, I think that, you know, I've seen patients who really been able to turn things around by correcting them and correcting their diet and their lifestyle and taking the right supplements. And, you know, it's not an easy condition for sure because if you already have big stones and it's blocking things, sometimes, you know, you need to have it dealt with. And after people have surgery, I mean, are they restricted in terms of what they can eat? Often people say, well, I can't eat fat.

Is that true? Can they use enzymes? What is the sort of consequence of actually having the surgery? Well, you know, the consequence of the surgery is that now the gallbladder can no longer store the bile. So the bile can freely flow into the small intestine. And so, you know, in regards to the ability for the bile to do its job, it's not going to be being triggered appropriately. So it's really important that if you've had your gallbladder out, that you take something called ox bile with your meals so that you can appropriately break down your fats. It can have a significant role because you may not break your fats down completely and you need as important fatty acids, your omega-3s, your DHA, your EPA that you get from your fat.

And if you can't get them, then it's going to have a huge impact on you. In regards to foods you can eat, it's more what you should eat. I think there are restrictions, but they're not always necessary. It's really making sure that you're getting a higher fiber diet. You're getting foods that are going to be favorable to your gallbladder, celery. What are some of the other ones? Help me out here, Mark. You're going to come up with foods. Bitters, you know, bitters. Yeah, bitters are great. So, you know, green leafy vegetables, things that they can be very helpful.

Absolutely. So, the key thing becomes staying away from all the processed carbohydrates, staying away from meats that are not organic, that have lots of toxins in them. And if you do that, you take your ox bile, increase your fluid intake, add in some bile salts, which you can do through supplementation. You should, you know, you should be able to live pretty healthy. Yeah, even more healthy, because we're going to change your diet. Because we're going to say, look, these are the things that got you to the stones. And now you're gonna have a really good leverage point on getting people to start to eat a healthier diet. That's fantastic.

Well, you know, the truth is that there's so much we can do. And it's such a hopeful message for those who have gallbladder disease and can actually make a difference in the course. Maybe they'll need surgery, but maybe they won't if they try some of these other things that we use in functional medicine. And we take care of all sorts of patients like this at the Ultra Wellness Center in Lenox. We have a great team of five docs and five nutritionists and a great support staff. And we really love to see you. So come visit us. And of course, we have a long waiting list, but hopefully we'll get you in soon. And if you like this podcast, please share with your friends and family on social media.

If you have gallbladder disease and you've learned something about it that you want to share, please leave a comment. Subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do, and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses

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