Positive Health Online

Client age, Gender, Background Information

The patient is a 47 year old man who previously consulted his GP with a history of biliary pain of several months duration, pain in the upper right abdomen, flatulence and dyspepsia.

He has no previous history of gallstones or any associated liver problems. He habitually drank 6-7 units of alcohol weekly. His diet contained a high degree of saturated fat and cholesterol from a relatively high proportion of processed foods and animal products, i.e. meat, eggs, cheese and milk. His intake of fresh fruits and vegetables was minimal. His lifestyle was mostly sedentary and his Body Mass Index (BMI) of 35 placed him in the obese category.

Diagnosis

Blood tests arranged by his GP revealed elevated bilirubin levels. X-rays revealed the presence of non-calcified, cholesterol gallstones.

The patient was offered stone dissolution therapy with oral ursodeoxycholic acid (bile salts). Evidence has documented that about 25% of patients receiving this conventional oral therapy experience a recurrence of gallstone within a year. The patient wanted to try a holistic therapy that would attempt to correct the dysfunction, rather than just treat symptomatically. He was also keen to include effective, long-term strategies such as dietary and lifestyle changes.

Treatment Protocol

The protocol was determined by the origin, cause, signs and symptoms of the disease, specifically in an attempt to reverse and eradicate the disease process by creating a corrective, holistic strategy around that. For long term effective strategies, dietary and lifestyle changes must also be included, as diet plays a large part in the maintenance of health.

Gallstones do not originate in the gallbladder. Problems with the gallbladder rarely arise from the gallbladder itself, but from the liver, which if not functioning correctly, will manufacture bile that is prone to 'stoning'. Their formation is caused by metabolic defects originating in the liver. The liver produces cholesterol, which if too thick can becomes overly concentrated in the bile. If it remains too long in the gallbladder, it can create gallstones.

The gallbladder serves a definitive purpose. It regulates the flow of bile so that it can push out into the digestive tract at intervals as needed to assist in the digestion of fats when stimulated by a fatty meal.

If the gallbladder is malfunctioning or has been removed, there will be a problem absorbing fats, as well as the fat-soluble vitamins, E, D, K and A.

Laparoscopic surgery to remove the gallbladder is fairly common. However, it does not address the underlying cause of the problem which is as stated, metabolic issues arising from the liver. The gallbladder is the body's regulating mechanism for the release of bile when needed; its removal will often create other chronic digestive problems.

Objectives

• Prevent the recurrence of gallstones by correcting liver dysfunction;
• Improve the patient's diet;
• Effective weight loss strategy;
• Exercise regime.

Treatment Strategy

To employ the use of herbs with appropriate actions and properties to treat liver and gallbladder dysfunction as follows:

Hepatic Herbs

Hepatic is a general term for an herb whose activity influences the liver and indirectly the gallbladder. Hepatic herbs tone and strengthen the liver and increase the flow of bile.

Cholagogues

Cholagogues are remedies that specifically increase the discharge of bile into the duodenum. Most often these are bitter herbs, such as Dandelion Root. Cholagogues are agents that stimulate the release of bile that has already been formed in the biliary system.

Choleretic Herbs

These herbs reduce cholesterol levels by excreting cholesterol. They also cause bile to flow freely. Choleretics stimulate bile production by liver cells and most have effective cholagogue properties as well.

Prescription for Gall-stones   

The patient was given the following prescription:

Milk Thistle (Silybum marianum)

Milk thistle has choleretic activity, reduces both biliary cholesterol concentrations and bile saturation. The main active constituents identified are silymarin, silybin, silydianin and silychristin.
   

Dandelion Root (Taraxacum radix)

Dandelion root has cholagogic activity. It is well known for its ability to stimulate bile ducts, countering the tendency to form gallstones.

Globe Artichoke (Cynara Scolymus)

The leaves of the globe artichoke are used in herbal medicine for stimulating bile flow from the liver, as well as restoring liver function and lowering cholesterol. Cynarin has been identified as one of the main active constituents. In contradiction to other conventional choleretics such as bile salts, cynarin stimulates bile production without impairing the excretory function of the liver.

Peppermint (Mentha piperita)

Peppermint improves gallbladder motility and helps reduce spasms. The herb significantly reduced the size of gallstones by dissolution and reduced the incidence of stone calcification while lowering cholesterol saturation of bile.

Herbal Prescription for Gallstones

A tincture made of the following herbs was given:

    
Dose: 5ml three times a day before meals with water or juice. Choleretics and cholagogues are best taken before meals. Clinical experience shows that for maximum benefit, they are best given for a short duration of up to 2 weeks at a time.

Diet and Lifestyle

The patient was encouraged to reduce his intake of cholesterol-rich foods and increase those foods high in fibre, namely, fresh fruit and vegetables. As bile is often supersaturated before breakfast, he was encouraged to drink a glass of diluted lemon juice every morning before eating, as a liver and gallbladder stimulant. He also reduced his alcohol intake and began to take some gentle, but regular exercise.

Treatment Outcome

The patient took the medication for five months, at intervals of two weeks duration and two weeks without. Five years after completing his treatment the patient's symptoms have disappeared. He has lost weight bringing his BMI into the normal range. His diet has changed significantly and he has experienced no recurrence of gallstones and remains well.

Bibliography:

Carter Michael A. Pathophysiology made Incredibly Easy. Springhouse Corporation. Pennsylvania. 1998.
Eldin Sue and Dunford Andrew. Herbal Medicine in Primary Care. Butterworth-Heinemann. London. 1999.
Rottblatt Michael and Ziment Irwin. Evidence-based Herbal Medicine. Hanley and Belfus. Philadelphia. 2002.
Bartram Thomas. Bartram's Encyclopedia of Herbal Medicine. Robinson Publishing Ltd. London. 1998.
Hoffman David. Complete Herbal. Element Books. Dorset. 1996.
British National Formulary. British Medical Association and Royal Pharmaceutical Society of Great Britain. London. 2003.
Mills Simon and Bone Kerry. Principles and Practice of Phytotherapy. Churchill Livingstone, London. 1999.