What are “practitioner-only-products”?

Vitality

It can be confusing. Some “practitioner-only” brands are only available through qualified health care practitioners. Others are more easily available.

The idea behind the “practitioner-only” designation is simple. The majority of “practitioner-only” brands focus on producing higher quality, more potent products. Such products are manufactured to maximise impact and effectiveness, and therefore should only be accessed under the supervision of a qualified health professional.

Naturopaths and nutritionists for example, are trained in herbs and nutrients. They understand how the ingredients will affect you. Taking advice from a health professional on what products to take ensures safety risks are minimised and products are appropriate for your individual health needs.

This is not to say all “retail” products are inferior.

 

Quality

What does this mean? Practitioner products are generally of a higher quality, and more potent, but how is this defined? Within both the broad retail and “practitioner only” categories, quality can vary significantly due to many factors including active ingredients, encapsulation, dosage, molecular weight, excipients used, conditions a plant is cultivated in and supporting evidence (1). To keep things simple we’re going to focus on 3 key areas:

  • Ingredients
  • Bioavailability
  • Excipients

 

Ingredients 

Along with the importance of co-factors and ingredients being at a therapeutic dose, mineral absorption and bioavailability may be enhanced by the form the mineral comes in. Chelated minerals are minerals bound to a chelating agent which is designed to enhance their absorption in your body. An amino acid chelated mineral is a mineral (like calcium) that has been molecularly attached to an amino acid. Common amino acids used to make mineral chelates include aspartic acid, lysine and glycine. In general, animal studies indicate that chelated minerals are absorbed more effectively (2).

 

Bioavailability

Bioavailability is influenced by many factors from both the host (human) and from the supplement itself. Bioavailability refers to how efficiently your body can use a nutrient.  The commonly accepted definition of bioavailability is the proportion of the nutrient that is digested, absorbed and metabolised through normal pathways.

It has also long been recognised that gut microbes contribute to the biosynthesis and bioavailability of vitamins and nutrients.  Maintaining a healthy gut is vitally important for proper nutrient synthesis and absorption as the gut microbiota synthesises certain vitamins and nutrients (1).

Bioavailability is also influenced by other factors including diet, nutrient concentration, nutritional status, health, and life-stage (3).

 

Excipients

Excipients selected for product formulation vary across the pharmaceutical and complementary medicine industries. The role of the excipient should not be underestimated, particularly when it comes to generic pharmaceuticals. A number of pharmaceutical excipients are known to have side effects or contraindications. For example, excipients may make up to 90% of a product formulation and may be synthetic or sourced from plants or animals (4).

Depending on the medication/supplement type, excipients may be nil to low. Powders and capsules generally require fewer excipients than tablets due to binding and coating ingredients required for a tablet.

Each excipient serves a specific purpose for the proper performance of the supplement dose and form, i.e. capsule, tablet, powder or liquid.

 

Effectiveness and accessibility 

As practitioner products are generally more potent, this lends itself to supervised use under the instruction of a qualified health professional. As such, practitioner only products are not as accessible to the general public. Indeed practitioner only products are designed specifically for dispensing by a healthcare professional in accordance with section 42AA of the Therapeutic Goods Act 1989 (5).

 

How can I access “practitioner only products”? 

If you are not currently working with a healthcare professional, you can find a practitioner here via vital.ly platform.

 

References

1Pressman P, Clemens RA, Hayes AW. Bioavailability of micronutrients obtained from supplements and food: A survey and case study of the polyphenols. Toxicology Research and Application. January 2017.
2Goff JP. Invited review: Mineral absorption mechanisms, mineral interactions that affect acid-base and antioxidant status, and diet considerations to improve mineral status. J Dairy Sci. 2018 Apr;101(4):2763-2813. doi: 10.3168/jds.2017-13112. Epub 2018 Feb 4.
3Michael, Hambidge. (2010). Micronutrient Bioavailability: Dietary Reference Intakes and a Future Perspective. The American journal of clinical nutrition. 91. 1430S-1432S. 10.3945/ajcn.2010.28674B.
4Haywood, A., & Glass, B. (2011). Pharmaceutical excipients – where do we begin? Australian Prescriber, 34(4), 112–114.
5Australian Government. Department of Health. Therapeutic Goods Administration. Australian regulatory guidelines for complementary medicines ARGCM. Version 7.2, February 2018.[Internet] [ cited 2021. September 12th]. Available from:https://www.tga.gov.au/sites/default/files/australian-regulatory-guidelines-complementary-medicines-argcm.pdf

 

50 Small Ways to Transform your Hormonal Health

Woman in field of lavender
These are practical actionable’s & mindset shifts. Think of this like a checklist for the year, or health bingo! Choose one small thing per or week, without trying to do-it-all, for sustainability. It’s the small things that in combination, can and will make a massive difference in your health trajectory.
  1. Drink more water. It seems simple, but for most women whom I work with, this is a first step. Ensure to be drinking 1.5-2 litres of water per day. If you aren’t hitting that goal, this is your reminder to slowly increase your water intake.
  2. Eat slowly, chew your food. Do you really, truly chew your food? Or, are you eating in a rushed state? Slow down. Take your time and chew each mouthful to optimise digestion and improve your gut health.
  3. Focus on abundance not scarcity. When it comes to eating, focus on nourishment and getting as many good whole real foods in that you can, as opposed to a focus on restriction; leading to a scarcity mindset.
  4. Stop restricting food groups unless you have an intolerance. Cutting out major food groups is not ideal and is not sustainable. Balance and everything in moderation.
  5. Try drinking lemon water in the morning to help the liver cleanse itself and kickstart digestion.
  6. Remove guilt when it comes to eating or missing a workout. I once had a client label this the ‘Fuck-it mentality’. I encourage you to adopt this mentality as the guilt itself inside is worse than missing that workout or the treat that you ate.
  7. Look at yourself in the mirror and say ‘I love you’, just do it, trust me.
  8. Limit your screen time by using tools on your mobile phone. I personally use all of the tools available for the benefit of my own mental health.
  9. Add a greens & reds powder into your daily routine to get extra nutrients in with a quality organic food-based supplement.
  10. Throw out all of your old supplements & simplify your supplement regime to 1-2 things. Just because it’s in your cupboard, doesn’t mean it has to go into your body. Taking too many supplements isn’t ideal, speak to a professional about what you actually need.
  11. Turn off social media and email notifications on your phone, set a specific time to check them, you could even start a brand new email account with no spam or sales emails.
  12. Say no to things or events that you really don’t want to do or go to, to things that don’t serve your nature. Saying no is more authentic than an untrue yes.
  13. Start drinking green smoothies. Simply blend 1/2 a banana or an apple, organic dark leafy greens, coconut or filtered water, zucchini or cucumber together and voila, a nourishing green smoothie!
  14. Make your bed each morning. If you don’t already, this one small simple thing will have a big impact on your bedroom environment and how you feel.
  15. Stop drinking alcohol for a month. I recommend reading Quit like a Woman by Holly Whitaker if you’re curious about pausing drinking in a society in which social alcoholism is so deeply ingrained.
  16. Remove all accounts from your social media platforms that don’t serve you and replace them with ones who inspire you. After all, you are the sum of who you surround yourself with, even digitally.
  17. Cut your coffee intake down to 1 per day with food. Too much caffeine is not ideal for your female hormones, but one per day with food is ok.
  18. Season and roast a big tray of vegetables for the week ahead and have them in lunches, just add greens, grains and a form of protein.
  19. Eat dinner at the table, not on the couch. If you’ve fallen into habits, try migrating back to the table at dinner time so that you can focus on what you’re eating.
  20. Turn off the TV and your phone for no screen time an hour before bed. This will help you to fall asleep and improve the quality of your sleep.
  21. Develop a simple morning routine. 1-2 special little grounding things that you can do to set your day up each morning.
  22. Develop a simple night time routine. 1-2 little special restful things that you can do to support your body to wind down.
  23. Make big servings of soups, curries or stews and freeze the leftovers for lazy nights. Your future self will thank your past self!
  24. Put your clothes away to remove chaos. If you are a clothes-all-over-the-floor kind of person, spend an hour putting them away and maintain the tidiness.
  25. Present your meals in an aesthetically pleasing way, because you deserve the restaurant quality presentation and the care factor from yourself.
  26. Cry. Have a really good cry, whenever you can or need to, and feel the release. No one gets a medal for suppressing their tears.
  27. Reassess your diet and eating habits, you don’t have to stick to a way of eating that doesn’t work for you. I you have committed to a new way of eating, you can quit and reassess this at any time.
  28. Meditate, do this by walking, sitting down or lying down in silence and stilling the mind for 5 minutes.
  29. If you haven’t done so in a couple of years, go for a blood health check with your general practitioner to see where your nutrient levels are sitting, especially things like iron & vitamin D.
  30. Have a raw green side salad with lunch or dinner like rocket leaves dressed with EVOO & balsamic vinegar. This will support digestion and liver detoxification.
  31. Start a journal, write anything, let it be messy and unkempt, and lean into that. Try it and see what comes out when you put pen to paper.
  32. Shop at the local markets to get your hands on seasonal produce. This will ensure that your food is fresh and nutrient dense.
  33. Try new types of exercise or movement until you find something or even better, a community that you absolutely love. Invest in that, it’s priceless.
  34. Invest in personal development when it comes to mental, financial, or hormonal literacy. The most empowering thing that you can do is to invest in your own growth journey.
  35. Go outside for a walk in nature and get 20-30 minutes of sun per day to increase your vitamin D levels by synthesising the nutrient from the sun.
  36. Write a dot point inventory of everything good in your life, big and small, to foster an undeniable feeling of gratitude.
  37. Get creative, do something that the child in you loves like painting or making clay or boogie boarding in the ocean.
  38. Cook a pot of bone broth and use it as a base for your soups & stews to add nutrient density to your meals.
  39. Do something that is absolutely pointless, like running into the rain.
  40. Smile. Do it right now and see how it makes you feel.
  41. Make time to eat breakfast, seriously. It is the most Important meal of the day.
  42. Read a book, then another, then another. When self improvement is too much, lose yourself in a fantasy novel.
  43. Order takeaway when you just can not cook! I am giving you permission to order takeaway because a big part of holistic health is taking it easy on yourself.
  44. Do something random and kind for someone else. A random act of kindness.
  45. Focus on 3 nutrient dense main meals per day and try to cut out the snacking to support healthy blood sugar regulation and digestion.
  46. Put on a really good song and just dance alone, like no one is watching.
  47. Light a candle or use a warm light at night and stare at the blue sky in the morning to support your circadian rhythm. These simple practices active Serotonin (your wake hormone) and Melatonin (your sleep hormone).
  48. Listen to an inspiring podcast each week. Check out Chloe’s Clinic!
  49. Get professional help when you need it, this is easier said than done but there are so many people in this world that are here to support you.
  50. Work with me! There are several different capacities in which we can work together towards your thriving health. Learn more here.
I hope you are inspired to make small changes towards the bigger picture. It’s the little things in life!

Gut Health and The Microbiome

gut health

What is gut health?

Whilst ‘gut health’ is not clearly defined in scientific literature, the term has become an increasingly popular concept in modern medicine and the food industry. Gut health is undoubtedly complex encompassing both the upper and lower gastrointestinal tracts. It is core to overall health and involves five major criterion:

  1. Optimal digestion: normal nutritional status/absorption of food, regular and consistent bowels, and limited bloating/flatulence
  2. Absence of gastrointestinal (GI) illness: no reflux, inflammation, enzyme deficiencies, carbohydrate intolerances, IBD/coeliac, and colorectal/other GI cancers
  3. Stable, resilient, and diverse microbiome: no bacterial overgrowth, normal composition of commensal bacteria, no infections, or antibiotic-associated complications
  4. Systemic health and immune response: normal gut barrier function and immune response/tolerance
  5. Overall well-being: normal quality of life, balanced gut-brain function, and positive gut feeling

 

What is the microbiome?

Do you ever feel alone? Well don’t, because your gut microbiome (also termed microbiota) is home to hundreds of microbial cells (bacteria, viruses, and fungi) that happily coexist in your small and large intestines. These ‘bugs’ are uniquely diverse, have their own DNA, and are susceptible to change depending on one’s diet, environment, medication intake, and more.

The gut microbiome starts evolving from birth with rapid changes taking place in the first two to three years of life. These early changes are predominantly dependent on two things:

  1. Source of dietary intake – breastfeeding/bottle feeding/food
  2. Environmental exposure (including birth delivery)

After three years the infant microbiome becomes the blueprint of the adult microbiome.

Over recent years the gut microbiome has become a hot topic of research, mostly due to the accruing links to a plethora of health conditions. The microbiome can harbor both beneficial and harmful (at varying levels) microbes. Microbes have the ability to use what you consume (food) as a source of fuel and in turn produce certain metabolites such as short chain fatty acids, gases, and vitamins. Short chain fatty acids such as butyrate, propionate, and acetate have particularly key roles in influencing various body systems for e.g., immune, nervous, and cardiovascular.

 

What is a healthy microbiome?

Gut microbiome exploration is an ongoing endeavour. Thus far we only have gained a drop of knowledge when it comes to the sea of microbes within the human gut. What constitutes a healthy microbiome is subjective. One person’s considered ‘healthy’ microbiome may not be healthy for another person. A collective understanding among researchers is that ‘good’ microbes need a good amount of fibre as a fuel source. Increased dietary fibre intake has been long-established as an integral nutrient/ingredient with various health benefits. Hence, it comes to no surprise that our ‘bugs’ love fibre too. Low fibre diets have been linked with an altered gut microbiome composition including a reduction in beneficial bacteria and an increase in the production of not so beneficial metabolites.

 

How do we test the microbiome?

Thanks to rapid advances in microbiome testing technology, testing the microbiome has not only become affordable but also easily accessible. Most companies supply at-home non-invasive testing kits that require a small amount of faecal load. Microbiome testing involves elevated levels of DNA sequencing technology. Your poo has quite the potential; it can tell you a lot about your inner workings, i.e., how your gut microbes may behave, what they love to eat, and ultimately what they can produce. Shotgun metagenomics is top tier when it comes to microbiome analysis followed by meta-transcriptomics and metabolomics:

  • Shotgun metagenomics sequencing: sampling all microbe genes (DNA) (whole-genome) and their potential (species level) – who is there and what they can do
  • Meta-transcriptomic sequencing: sampling of microbes and their functional profile – which genes are collectively expressed under different conditions (i.e., conditions that are present within the host at time of testing) and what they do
  • Metabolomic sequencing: sampling of microbes at specific regions (genus level – e.g., 16s) under different conditions (i.e., conditions present at the time of testing) and their by-products – does not reveal which bacteria produced them, nevertheless a great method of discovering new metabolites

Whilst these tests are not diagnostic per se, they do supply great insight into the community of microbes that exist within you. Each approach in its singular sense provides a substantial amount of information, and a significantly more comprehensive picture when combined. Combined testing is not readily available yet, but it is something to be pursued from both a clinical and research lens.

 

References

Bischoff, S. (2011). ‘Gut health’: a new objective in medicine. BMC Med, 9:24. doi: 10.1186/1741-7015-9-24

Cronin, P., Joyce, S., O’Toole, P., & O’Connor, E. (2021). Dietary Fibre Modulates the Gut Microbiota. Nutrients, 13, 1655. doi: 10.3390/nu13051655

The Power of Whole Food Supplements

A large proportion of the Australian population take nutrient supplements with research showing 47% of women and 34% of men reporting that they regularly consume supplements. Supplementation use varies with different populations with the United States, United Kingdom and Denmark being the highest in supplement use, reported at between 35 and 60% of adults. 

There has been much debate over whether synthetic nutrients provide the same benefits as a natural nutrient such as those that are found in whole foods. The recent rise in the interest of supplements that may help to reverse or reduce the risk of disease has led scientists to investigate wholefood supplements and their potential ability to be absorbed better than traditional vitamin and mineral supplements (6).

 

What is meant by “whole food” supplements?

Nutrients (vitamins and minerals) can either come from natural sources or they can be synthesised. Synthetic nutrients are made in a laboratory setting or industrial process and natural nutrients are those found organically in whole foods.

Whole food supplements are typically made with plants that have been concentrated or dehydrated such as whole grains, fruits, vegetables, roots, and legumes. 

The important fact to remember about whole food supplements is that they contain “whole” and complex structures that are organically found in foods. This means you are not only consuming a particular vitamin or mineral but also the enzymes, co-enzymes, trace elements and antioxidants that are naturally found together in that plant.

The production method of synthetic nutrients is very different to the way plants and animals naturally create them. This means that even though they may have a similar structure, the body can react differently when ingesting synthetic nutrients. At present, it is still a little unclear how well the body absorbs and uses synthetic nutrients. Some may be more readily absorbed and used than others (7). 

Synthetic versus whole foods- what the research says

Synthetically made nutrients are often produced the way pharmaceuticals are. If there is not enough of the natural enzymes or cofactors in the end-product then the body might not be able to absorb and use the nutrients in that supplement. When we eat real food, we are not eating synthetically made, single nutrients, but instead we ingest an abundance of vitamins, minerals, enzymes, and co-factors that allow for optimal use by the body.

Recent studies have shown that the natural nutritional state of a plant is believed to be far superior to a synthetic supplement. Evidence is now showing that the best nutrition comes from whole foods; however, when nutritional supplementation is required then whole food nutritional supplements offer a more reliable delivery of nutrients (5). 

In 2014, a review investigated current clinical trials that had compared whole tomatoes with a single nutrient lycopene supplement (lycopene is a powerful antioxidant found in tomatoes) and how each improved the risk factors of people suffering with cardiovascular disease. The research showed that the best approach to improving cardiovascular health should firstly be to consume whole tomato-based foods as they provided more beneficial results than using only lycopene supplementation in this study (1). 

In 2011, researchers set out to compare the bioactivity of broccoli and broccoli containing supplements, specifically in their potential to reduce various forms of cancer. The study used a broccoli supplement that didn’t contain all the enzymes that broccoli in its natural state contains. The study focused on some specific plant chemicals that broccoli contains and found that broccoli as a whole food contained significantly higher levels of these important immune boosting plant chemicals that may help in the prevention of cancer (2). 

Thus, research so far tends to promote whole food sourced products as a more efficient way to deliver health enhancing nutrients to the body.

Choosing the right supplement for you

Choosing high quality supplements can be challenging, especially since there is an abundance of options and that many multivitamin supplements contain chemical preservatives and fillers. Not all supplements are equal and whole food supplements are proving to have a more beneficial therapeutic effect. This is because while synthetically based supplements are made to mimic the same activity of natural nutrients, the body may not be able to absorb or use them in the same way as whole food based, natural supplements (3, 4.)

In exceptional whole food supplements, great care is taken to make sure that the whole foods used in the product are organically grown, are as minimally process as possible, produced at low temperatures (proteins in foods are denatured by high heat levels) and contain the naturally occurring co-nutrients that support maximum absorption, disease prevention and optimal long-term health (5).

References:

1. Burton-Freeman BM & Sesso HD, (2014). Whole Food versus Supplement: Comparing the Clinical Evidence of Tomato Intake and Lycopene Supplementation on Cardiovascular Risk Factors, Advances in Nutrition;5;5,457–485.
2. Clarke J, (2011). Comparison of the response to broccoli sprouts or broccoli supplement consumption in human subjects. The FASEB Journal;25; S1, 234.7.
3. Nutri-Con: The Truth About Vitamins & Supplements. (2006). Retrieved from https://www.organicconsumers.org/news/nutri-con-truth-about-vitamins-supplements
4. Liu, R. H. (2003). Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. The American Journal of Clinical Nutrition, 78(3), 517S-520S. doi:10.1093/ajcn/78.3.
5. Rubin, Jordan, (2004). The case for whole food nutritional supplements. Townsend Letter for Doctors and Patients;247-248, Gale Academic OneFile, Accessed 27 Jan. 2022.
6. Burnett AJ, Livingstone KM, Woods, JL & McNaughton SA (2017). Dietary Supplement Use among Australian Adults: Findings from the 2011-2012 National Nutrition and Physical Activity Survey. Nutrients, 9(11), 1248.
7. Yetley EA, (2007). Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr; 85(1):269S-276S.

Support a healthier Gallbladder & support healthier digestion following gallbladder removal

The gallbladder is one of the unsung heroes of the digestive system and is an organ that is often overlooked when it comes to digestive health. Our modern Western diet greatly impacts gallbladder health, leading to problems such as gallstones, an issue that affects up to 30% of Australians over 50. Here we look at the role of the gallbladder in health and disease and learn some of the diet and lifestyle changes that can help to support a healthy gallbladder and overall digestive health.

What is the Gallbladder?

The gallbladder is a small, pear-shaped organ that lies attached to the underside of the liver. The gallbladder’s primary function is to store and concentrate bile, a fluid produced by the liver, and to release bile into the small intestine during digestion. Because of their shared role in the production and secretion of bile, the function and health of the gallbladder is closely linked to that of the liver, and many of the common health issues of the gallbladder are related to (or worsened by) poor liver function and particularly altered bile secretion.

What is Bile and How is it Made?

Bile is one of our “digestive juices”, a fluid substance that is secreted by the body to facilitate digestion and absorption of vital nutrients. Bile is the primary digestive juice used for digesting and absorbing fats and the fat-soluble vitamins A, E, D, and K. It is typically a dark green to yellow colour and has a thick, sticky texture. It is made up of a mixture of water and various dissolved solids, including bile salts, cholesterol, enzymes, and even waste products ready to be excreted, such as bilirubin (a by-product of red blood cell metabolism). Bile salts are one of the key components of bile. They are produced by the liver from cholesterol via a process known as oxidation.

The human body produces around 1 litre of bile per day. Around 90% of bile is transferred to the gallbladder for storage and concentration, while the remaining 10% is deposited directly into the small intestine from the liver. Just before we start a meal, our bodies enter the cephalic phase of digestion, which is where our bodies become primed for digestion – the onset of salivating is an indicator that your body has entered this phase. It is during this phase that neural pathways signal to the pancreas to produce a hormone called cholecystokinin. This hormone stimulates the gallbladder to start contracting, releasing bile into the small intestine. Bile salts are very efficiently reabsorbed by our intestinal cells and are then transported back to the liver for reuse. About 95% of bile salts are reabsorbed, with the remainder being excreted through the bowels. This recycling of bile salts occurs 6 to 8 times a day, every day, and is known as enterohepatic recycling.

Bile, and particularly the bile salts, are vital for the absorption of fat and fat-soluble vitamins. They emulsify fats so that they can be absorbed, acting like a kind of detergent to break larger fat molecules into smaller droplets. These droplets can then be broken down by enzymes in the intestine, and ultimately absorbed through the gut wall. We know that fats are vital to good health, being used for everything from cell walls to hormones, so it is no wonder that having liver and gallbladder issues can so greatly impact how we feel.

In addition to helping with fat digestion and absorption, bile has other important functions for the body, including:

  • Elimination of metabolic waste products and toxins, including bilirubin, heavy metals (lead, mercury and arsenic), drugs and medications, hormones, and chemicals
  • Helps to neutralise excess stomach acid in the small intestine, preventing symptoms like heartburn and damage to the intestinal wall
  • Helps to kill certain harmful bacteria in the gut, while promoting the growth of beneficial bacteria

Bile and the Gut Microbiota

You may be surprised to learn that bile and the gut microbiota are closely linked, and have a relationship that influences digestion, liver function, and even our immune system. Bile acids act like a modulator of gut bacteria, helping to keep the balance of good bacteria over bad. Special enzymes in certain good gut bacteria can metabolise bile acids. Healthy bile flow promotes higher levels of these bile-metabolising bacteria because they use bile acids as a food source with bile acids also inhibiting the growth of other, harmful types of bacteria. The emulsifying, detergent-like activity of bile acids damages the cell walls of certain bacteria species, keeping population sizes of these harmful bacteria in check.

Health Conditions of the Gallbladder

Gallbladder conditions are increasingly common and can often be related to our modern Western diet and lifestyle.

Gallstones

Gallstones (AKA cholelithiasis), are a very common health issue, affecting up to 30% of Australians over the age of 50. The “stones” in gallstones are formed when bile sits stagnant in the gallbladder, allowing for crystallisation of bile salts. People with high cholesterol are particularly susceptible to gallstones. This is because 90% of gallstones are made of cholesterol. If the liver excretes too much cholesterol into bile it becomes supersaturated, making it much more likely for crystals to form. These crystals bind together to form larger stones which can become lodged in the gallbladder.

Obesity, even when otherwise metabolically healthy, increases the risk of gallstones. Other risk factors for developing gallstones include:

  • Being aged over 40
  • Being female
  • Being overweight, or experiencing a rapid shift in weight (either gaining or losing)
  • Having insulin resistance, type 2 diabetes, or metabolic syndrome – insulin increases the production of cholesterol in the liver
  • Eating a diet high in calories and high in carbohydrates
  • Eating a low fibre diet
  • Having liver disease

Gallstones are asymptomatic in the majority of cases, but some people will experience symptoms such as intermittent bloating, pressure, or pain in the upper right abdominal area, particularly after eating fatty foods. This intermittent pain can indicate that a stone may be lodged in the neck of the gallbladder.

Cholecystitis – gallbladder inflammation

If the ducts of the gallbladder become blocked due to gallstones, inflammation (known as cholecystitis) can occur. This inflammation can be acute or chronic, and typically includes symptoms such as abdominal pain, nausea, and fever. When symptoms are sudden and severe, it is considered acute cholecystitis. This almost always indicates that the person has gallstones. Chronic cholecystitis, on the other hand, lasts for much longer and is less severe, but may have periods of acute inflammation and pain (known as biliary colic).

Biliary Insufficiency and Poor Liver Health

Whilst not directly related to the gallbladder, insufficient bile production by the liver can produce similar health issues. Signs that you may not be producing enough bile include:

  • Pale stools
  • Flatulence and diarrhoea
  • Floating, foul smelling stools
  • Heartburn (due to lack of alkalising effect of bile salts on stomach acid)
  • Symptoms are worse after fatty meals

Bile is an important means of eliminating harmful toxins from the body, so insufficient production can lead to issues with many other health conditions, including menstrual condition like PMS and endometriosis that can be affected by hormone levels.

Testing

If gallstones or inflammation are expected, you may be referred for an ultrasound, as well as liver function tests. Naturopaths often refer you for additional testing, including cholesterol, insulin, and a hormone profile, too. These additional tests can help to uncover what is happening with your health and can unlock information about underlying drivers of your condition, so that an effective treatment strategy can be made for you.

Supporting a Healthy Gallbladder

Treatment of gallbladder issues is always a long-term strategy – there are no quick fixes when it comes to gallbladder health! Likewise, prevention of gallbladder conditions also requires long term healthy lifestyle strategies. Naturopathically, treatment strategies for gallbladder conditions almost always include support for the liver, and it’s easy to see why – the two organs are so closely linked both physically and functionally, so when one isn’t working well, the other also suffers.

Medical treatment of gallbladder issues is often focused on removal of the gallbladder once pain becomes unmanageable. The treatment strategies in this section are instead focused on improving your liver and gallbladder function before reaching this point in your condition. But if you have already had your gallbladder removed, read on – there is a section with tips for optimising health post-gallbladder removal below.

Diet and Lifestyle Strategies

Eat Plenty of Fibre-Rich Foods

Fibre-rich foods are so vital for good health for so many reasons, including for gallbladder health. Insoluble fibre, found in foods such as oats and wheat bran, have been found to reduce the level of cholesterol found in bile, which in turn helps to reduce the formation of cholesterol crystals and stones.

Reduce Saturated and Trans-Fat Intake

Saturated and trans fats have been shown to increase the risk of developing gallstones, so saturated fats should be reduced and trans fats eliminated altogether from the diet.

  • Choose lean cuts of meat to reduce your intake of saturated fat
  • Eliminate foods that contain trans fatty acids, such as margarine, deep fried foods, commercially baked products like cakes and pastries, and frozen potato products such as chips and potato “gems”

Reduce Intake of Refined Sugar

High intake of refined sugars and carbohydrates increases insulin levels, which prompts the liver to produce extra cholesterol. Excess refined sugar intake has been shown to significantly increase the risk of developing symptomatic gallstones, so should be eliminated from the diet.

When eliminating refined sugar from the diet, be aware that sugar goes by many names! Here are just some of the names you might find on the ingredients list of packaged foods and drinks: sugar, table sugar, white sugar, granulated sugar, brown sugar, raw sugar, syrup, molasses, agave syrup, honey, barley malt, malt syrup. And there are so many more! Always read food labels and choose options that don’t have added sugars and sweeteners.

Don’t Skip Meals

Eat regular, healthy meals and avoid skipping main meals. Fasting can increase the risk of gallstones, as bile sits stagnant in the gallbladder for too long. Aim for 3 main meals and one or two small snacks each day.

Eat Mindfully

As we discussed above, bile release is triggered when we enter the cephalic phase of digestion. You can help to make sure you are in this digestive phase by:

  • Sitting at the table to eat (rather than eating on the couch or while driving)
  • Using a knife and fork and taking your time to eat and experience your meal
  • Avoiding distractions during mealtimes, particularly TV and phones

Maintain a Healthy Weight (or Lose Weight Slowly!)

Gaining weight and being obese are associated with an increased risk of gallstones because of higher levels of cholesterol. Similarly, losing weight very quickly increases circulating cholesterol levels because of the cholesterol being released from fat stores. At the same time, bile may sit stagnant in the gallbladder due to reduce food intake, which allows for crystals and eventually stones, to form. If you wish to lose weight, be sure to seek naturopathic guidance before embarking on a weight-loss plan, as they can help you to develop a gallbladder-friendly plan that will help you to lose weight slowly and steadily – which will also help you to keep the weight off long-term.

Gallbladder Removal –Life After Cholecystectomy

Gallbladder removal is a common treatment for gallstones, but it fundamentally changes your body’s digestive functioning and requires careful dietary management for the long term. Because the gallbladder acts as the storage chamber for bile, its removal means there is no longer a place to store bile as the liver is producing it, so a lesser amount is available at mealtimes. This means less bile overall is available for fat digestion, and a greater reliance on the bile that is injected directly into the intestine from the liver itself. This means your body will not be able to digest and absorb fats the same way it used to. Whilst this doesn’t mean you can no longer eat fats at all, it does mean making some changes to what you eat and how. Post-gallbladder removal, it is also important to support the liver, as the lack of gallbladder places additional burden on the liver to maintain health. Below are some tips for maintaining good health after cholecystectomy.

Be mindful of fat consumption

  • Avoid high-fat meals, as your body will no longer be able to supply sufficient bile for proper digestion of high amounts of fat – that means no keto diet! A lower fat diet is a much better choice for optimal digestion. Aim for no more than 30% of your calories to come from fats. High fat foods will cause abdominal discomfort and digestive issues.
  • When you do eat fats, focus on heart-healthy polyunsaturated and monounsaturated fats from sources such as extra virgin olive oil, hemp seed oil, nuts and seeds, oily fish, and avocados. We still need good quality sources of fatty foods in our diet for healthy cells, brain health, and for fat-soluble vitamins A, D, E, and K.
  • Eat fats in small amounts throughout the day, instead of eating them all at once. This reduces how much bile is needed for proper digestion.
  • Avoid saturated fatty acids, trans fats, and hydrogenated oils such as soybean and canola oil, which can be detrimental to liver health.

Eat plenty of fresh fruits and vegetables

  • Aim for 5 or more serves of vegetables and 2 serves of fruits per day, choosing a variety of colours each day to maximise your nutrient intake.
  • Fruits and vegetables provide an abundance of vitamins and minerals, as well as antioxidants which are crucial for optimal liver health.
  • These foods also provide plenty of fibre to feed healthy gut microbiota. As discussed above, bile is important in maintaining a healthy microbiome, so providing additional support for healthy gut bacteria is important once your gallbladder has been removed.

Utilise bitters before meals

  • Bitter foods and drinks encourage the liver to produce and secrete bile into the small intestine, ready to digest our food. Having bitters around 10-15 minutes before sitting down to eat can help ensure our digestive system is primed and ready for optimal digestion and absorption.

Try a small salad of dandelion greens or rocket as an appetiser or mix the juice of a lemon in 250ml of lukewarm water. Alternatively, herbal bitter remedies can be prescribed for a more potent effect.

Herbs and Supplements for Gallbladder Health

Herbs – Cholagogues

Cholagogues can be used to support healthy gallbladder function and prevent health issues, as well as to treat gallbladder conditions. However, they can be contraindicated, especially if there is a history of bile duct obstruction – always seek naturopathic guidance for a herbal prescription. Cholagogues include herbs such as globe artichoke and agrimony.

Herbs – Bitters

Bitters are a wonderful class of herbs that can be used to help with so many health issues. As the name suggests, these herbs contain lots of bitter principles and have a very strong bitter taste. It is the bitter taste of the herbs that gives them their therapeutic effect. Our bodies have bitter taste receptors not only on the tongue, but throughout the digestive system, increasing saliva, enzyme, and bile production. Bitter herbs activate these receptors and improve digestive function, and even shift the body into the parasympathetic nervous system to reduce issues associated with stress and anxiety. Gentian, wormwood, and globe artichoke are all well-known bitter herbs.

Herbs- Choleretics

Choleretics are herbs that stimulate the production of bile in the liver and promote its secretion into the gallbladder. They’re very commonly used for any conditions associated with the liver or gallbladder. Some commonly known choleretic herbs include milk thistle, calendula, and globe artichoke.

Lipase

Lipase is a type of enzyme that helps to break down fats, making them easier to absorb. Supplementing with additional lipase helps to ease the burden of reduced bile on the gastrointestinal tract after gallbladder removal, or when your gallbladder or liver health is impacting bile production and secretion.

Probiotics & Prebiotics

As discussed above, bile is important for a healthy microbiome. When insufficient bile is being produced, either due to gallbladder issues or removal, a good quality probiotic supplement can help support healthy microbial populations in the gut however prebiotics are more appropriate for many people as they are a food source for your own species.  However, it is important to note that many over the counter probiotics available are poor quality and may not provide you with beneficial amounts of probiotics so it is best to seek naturopathic guidance on choosing a probiotic that will be of benefit to you.

References

Boyer, J. L. (2013). Bile formation and secretion. Comprehensive Physiology3.

Crawford, M. (2013). Biliary pain work-up and management in general practice. Australian Family Physician42(7). https://www.racgp.org.au/afp/2013/july/biliary-pain

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Housset, C., Chretien, Y., Debray, D., & Chignard, N. (2016). Functions of the Gallbladder. Comprehensive Physiology6.

Lammert, F., Gurusamy, K., Ko, C. W., Miquel, J.-F., Mendez-Sanchez, N., Portincasa, P., van Erpecum, K. J., Laarhoven, C. J., & Wang, D. Q. H. (2016). Gallstones. Nature Reviews Disease Primers2.

Maldonado-Valderrama, J., Wilde, P., Macierzanka, A., & Mackie, A. (2011). The role of bile salts in digestion. Advances in Colloid and Interface Science165(1), 36–46.

Man, S., Gao, Y., Lv, J., Tong, M., Yin, J., Wang, B., Ning, Y., & Li, L. (2022). Metabolically healthy obesity was significantly associated with increased risk of gallstones. European Journal of Endocrinology186(2), 275–283.

Tian, Y., Gui, W., Koo, I., Smith, P. B., Allman, E. L., Nichols, R. G., Liu, Q., & Patterson, A. D. (2020). The microbiome modulating activity of bile acids. Gut Microbes11(4)