Functional Testing for GallBladder Health
Bile is a key digestive fluid that is made by the liver and is stored in the gallbladder. Bile has several important roles but most significantly it emulsifies fats so they can be absorbed and used as a fuel source for the body. When the body is under stress, it reduces the functional capacity of the liver and can lead to a thick and sluggish bile production and poor gallbladder contractability.
There are a number of major symptoms associated with a sluggish gallbladder. The most common one includes pain after a fatty meal (especially in right shoulder blade region or liver area of the stomach. Other more subtle clues include constipation, tiredness and bloating after having a fatty meal and fat in the stools. Here is a whole list of possible symptoms:
Poor GallBladder Function:
Poor gallbladder function can lead to a number of serious health problems including the formation of gallstones. Unfortunately, the mainstream medical system has no solution for sluggish bile production which is also termed “biliary stasis.” They just watch and wait until the gallbladder gets so log jammed with gall stones that it needs to be removed. This process takes years and is completely avoidable.
A review study in the British Medical Journal found that 50% of patients who had a gallbladder surgery didn’t see improvement in their digestive health complaints (1). This article goes over the best ways to test the functionality of the hepato-biliary (liver-gallbladder) system.
Reflexology and Meridian Centers:
Chinese medicine has the body mapped into specific zones called meridians. These meridians are used as the foundation for therapies such as reflexology and acupuncture. Pain and stiffness can occur when energy in the body is stuck and not flowing properly. The gall bladder points include the following (2):
Pain in Web Between Right Thumb and Forefinger: This is the reflexology center for the gallbladder. If you non-trauma or overuse related pain when you press in this area, you may have issues with your gallbladder.
Pain in the Ilial Tibial Band: This is another part of the gall bladder channel, from the buttock area all the way down to the foot and into the 4th toe, although it is often most painful on the outer side of the thigh.
Pain Between Shoulder Blades: This is a referral pain based on the nerves that innervate the gall bladder. Especially under the right shoulder blade region.
Cramping in 4th Toe, Knees and Thighs: One may have unique cramping patterns that affect the 4th toe along with the knees and thighs.
GallBladder Meridian Time: In traditional Chinese medicine, every organ has a specific 2 hour period of time where it is most active. The gallbladder is most active between 11pm – 1am and the liver is between 1am – 3am. Consistently waking during these periods are signs of poor gallbladder and/or liver function.
The GallBladder Emotion: In Chinese medicine the gall bladder can be a seat where the body can hold onto anger, frustration and bottled up resentment.
Emotional Responsibilities: Decision making, determination and action. The liver is the emotional seat of our drive to plan our life while the gallbladder is the emotional seat for our capacity to make decisions.
HIDA Scan: The Gold Standard
A Hepatobiliary Imino Diacetic Acid (HIDA) scan is a nuclear imaging test that shows pictures of the liver, gallbladder, bile ducts and duodenum. It uses a radioactive tracer to enhance the bile ducts in order to see how well the bile is moving into the small intestine.
An ultrasound scan is most commonly used tool for imaging gallstones in the medical world. Unfortunately, an ultrasound scan will not show how well the bile ducts and gallbladder are functioning. One can have a normal result on an ultrasound scan but the bile ducts and gallbladder may still be functioning very poorly (3).
The HIDA scan gives an overall percentage of the bile ejection from the gallbladder. A normal ejection fraction is between 33-40%.
The radiation is a risk, but very small compared to an undiagnosed and poorly functioning gallbladder. There is a small radioactive tracer that is injected for this scan, it gives off radiation for a few hours and then becomes inactive. The gamma camera used in this does not give off any radiation.
Cost: $794 (4) Insurance Coverage: Usually covered if ordered by a physician
Comprehensive Metabolic Panel:
You can get some routine lab work that is typically done as part of a comprehensive metabolic panel that most medical professionals are familiar with and is often covered by standard insurance.
Alkaline Phosphatase: This is a liver enzyme that is made by the mucosal cells that line the bile system of the liver. The free flow of bile through the liver and down into the biliary tract to the gallbladder is what is responsible for maintaining the proper blood levels of this enzyme.
*High Alk Phos is one of the most sensitive markers for sluggish gallbladder or gall stones. If you see this elevated (over 90) and high bilirubin and liver enzymes than think gallbladder problems.
Normal Levels: For an adult the optimal level should be between 50-75 mg/dl (44-90 is functionally normal) Children or individuals who are recovering from broken bones will always be higher because their bones are in active growth stages.
High Bilirubin Levels: This is the byproduct of hemolysis (RBC destruction) and the result of the breakdown of hemoglobin. It is excreted in bile and urine, and elevated levels may indicate certain diseases. It is responsible for the yellow color of bruises and the yellow discoloration in jaundice and the brown color of feces.
Increased levels typically indicate liver, gallbladder or spleen dysfunction. High levels can be broken down into conjugated and unconjugated with additional testing to determine cause. High conjugated bilirubin and elevated liver enzymes are signs of gall bladder problems. High unconjugated bilirubin is a spleen disorder or hemolytic anemia.
Elevated bilirubin with normal liver enzymes is a genetic disorder called Gilbert’s syndrome which is a harmless condition where liver has poor bilirubin processing and a mild state of jaundice.
Normal Range: 0-1.2 mg/dL
High GGTP: Gamma-Glutamyl Transpeptidase is an enzyme in the liver, pancreas and kidneys. It is elevated in all forms of liver disease. It is functionally increased due to alcoholism and/or sluggish gallbladder or gallstone obstruction.
Normal Range: 10-60 IU/L
High AST: Aspartate transaminase is an enzyme present in the liver. It spills out during times of increased liver stress. Someone with a sluggish gall bladder may present with elevated AST levels. Check Alkaline phosphatase first though
Normal Range: 10-21 IU/L
High ALT: Alanine aminotransferase is a liver enzyme. When the liver is stressed these enzymes go up. Someone with a sluggish gall bladder may present with elevated AST levels.
Normal Range: 10-21 IU/L
GallBladder Infection: This would manifest with high white blood cells and possible fever like symptoms along with high levels of alkaline phosphatase, bilirubin and liver enzymes.
You can get all of these tests and vitamin D, homocysteine, C Reactive Protein, full blood panel, full thyroid panel and more in the Total Thyroid Test here
Certain types of parasites like to house in the bile ducts. This usually takes place after the bile is already sluggish and it allows them to get in and nest. The primary parasites include flatworm flukes and ascarides which can inadvertently migrate into the bile ducts and cause biliary obstruction (5).
Another form of parasite, protozoa, love the gallbladder. Several common protozoa infections that can get into the gallbladder include giardia, blastocystis hominis and Entamoeba histolytica (6). Some pathogenic forms of bacteria such as Salmonella and E coli can also infect the gallbladder.
One can get a full comprehensive stool analysis if concerned about these possible parasites.
If you are having any of the above symptoms, or are experiencing the various Chinese medicine pressure points, it would be wise to get some functional testing to examine your gallbladder. A simple comprehensive metabolic panel would be the first step with the
To help restore your gallbladder or to prevent issues with bile flow in the future, follow the action steps in this article.
Sources For This Article Include:
- Bateson MC. Gallbladder disease. BMJ : British Medical Journal. 1999;318(7200):1745-1748.
- Gallbladder Meridian Link Here
- Kaoutzanis C, Davies E, Leichtle SW, Welch KB, Winter S, Lampman RM, Arneson W. Abdominal ultrasound versus hepato-imino diacetic acid scan in diagnosing acute cholecystitis–what is the real benefit? J Surg Res. 2014 May 1;188(1):44-52. PMID: 24556232
- HIDA Scan Link Here
- Lim JH, Kim SY, Park CM. Parasitic diseases of the biliary tract. AJR Am J Roentgenol. 2007 Jun;188(6):1596-603. PMID: 17515382
- Halliez MC, Buret AG. Extra-intestinal and long term consequences of Giardia duodenalis infections. World Journal of Gastroenterology : WJG. 2013;19(47):8974-8985.