What’s the Gallbladder Got to do with it?

by Dr. Susan Tanner, MD

Supporting liver function as one of the main organs of detoxification should be a priority for anyone and everyone and is especially important in patients with mold and mycotoxin illness.  The liver carries out many biochemical functions to help remove toxins from the body, which may include mycotoxins, chemicals, heavy metals, viruses, infections, and hormonal breakdown byproducts. Overexposure to any of these toxic substances or combinations of them can render the liver less effective at doing its job, and then the very organ responsible for detox is then not assisting the body as it should. What is often not considered, though, are the roles of both the gallbladder and bile in assisting and optimizing liver function and the detoxification process itself. Digging into the gallbladder/bile piece of the equation can often illuminate a forgotten essential of liver support.

The Gallbladder

The gallbladder is a small sack that is located just under the lower edge of the liver.  Its main function is to regulate the flow of bile into the small intestine for digesting and emulsifying fats.  In a properly regulated system, the flow is appropriate and there are no problems.  However, when bile becomes thick and sludgy, and the gallbladder is not emptying well, stones and even infections can form, necessitating removal of the gallbladder in many instances.

Sludgy Bile

Gallstones or infections may be explained by toxicity. When toxins inhibit bile salt and phase 3 transport proteins within the liver, bile salts, and toxins accumulate in liver cells. This accumulation of bile acid and toxins causes inflammation and damage to liver cells. Additionally, as the flow of bile is hindered, this not only causes toxins to build up, but it has a huge effect on digestion, motility, and microbial balance in the small intestines.

Mycotoxins and Bile

When the liver is overwhelmed by toxins, including mycotoxins emitted by some molds, then the liver cells themselves become inflamed and bile production may be slowed.  This, as you can see, then becomes not just a gallbladder problem but a liver detoxification problem.

There are several clinical and laboratory signals that may be indicative of liver/bile/gallbladder problems.  Clinically, symptoms may include pale stools or bowel movements that are floating or greasy.  Lab results may show elevations in liver enzymes such as AST and ALT, and serum bilirubin levels may be elevated. The presence of gallstones on ultrasound is a sure sign that the liver is struggling with bile production and excretion.  If small intestinal bacterial overgrowth or SIBO has been diagnosed, then an assessment of liver and bile flow should absolutely be included in the work up.


SIBO causes inflammation body-wide, affects nutrient absorption, and has also the symptoms of chronic infection, affecting one both GI-wise and systemically.

Poor bile flow is a huge problem in the analysis of SIBO. You cannot have a healthy gut without proper bile flow.  Two ways in which poor bile flow impacts SIBO is, first, the antimicrobial function of bile which helps keep undesirable bacterial levels low in the gut.  Secondly, bile stimulates motility of the gut.  With poor bile flow, foods sit in the gut and are fermented by the SIBO bacteria, which can cause gas, bloating, and pain. Some patients after gallbladder surgery develop recurrent diarrhea, especially if they eat fats, because there is a sudden surge of bile from the liver as the gallbladder is not present to regulate the flow.

Building Bile and Helping the Liver

With liver and bile compromise, there are several steps to take in restoring good function and they are essential to good health. First and foremost, the exposure to toxins must be stopped or minimized to whatever extent possible.   The air you breathe is the most important part of this.  It is truly hard, if not impossible, to regulate and optimize detoxification function when the influx of toxins is continual or regularly recurrent.

Second, toxins need to be bound up with an inert material to carry them out of the body so that they do not continue to recirculate. I think of binders as a sponge, collecting and wiping up so as to clean the area.  Some good ones may contain clay or charcoal. I like both the Bio-Active Binder and the MicroChitosan products made by Micro Balance Health Products. The Bio-Active Binder is broad-spectrum, but gentle, while the MicroChitosan also has natural antifungal properties. Also, remember to take any binder away from other supplements or medications so as not to bind up them as well!  To me, midafternoon seems to work well for timing.

There are several supplements which can help with liver and bile support, one of the most important of which is glutathione.  This is considered an antioxidant, but it does so much in helping liver detoxification!  Taking it as a supplement, at least until things normalize and there is not more influx of toxins is a good rule of thumb.  Glutathione may be increased naturally in the body but being sure to eat good quality protein, polyphenols, such as the brightly colored vegetables and fruits   Food containing gelatin or collagen are also helpful in glutathione production and no, this does not mean jello!  Quality matters when it comes to foods and supplements.  Bitter herbs, such as milk thistle, are helpful in improving bile flow; if you don’t eat it, then MycoDetox Liver Support is a great supplement to help in that respect.

Finally, the use of ox bile and phosphatidylcholine may be very helpful in overcoming both SIBO and toxicity induced by poor biliary/liver function.  The combination can help create an internal environment in which SIBO cannot flourish.  A normalized microbiome can lead to stronger immunity and resistance to illness, along with better absorption.  Doses of ox bile are best taken on an empty stomach usually before a meal containing some fat. Doses can vary widely, I would start with about 125 mg and work up from there.  If you get diarrhea, reel back the dose.   Phosphatidylcholine has so many functions having to do with neurologic health and primary liver detoxification which I will not revisit in the article, but specifically taken for improvement of bile flow and normalization of the microbiome is only one of its very important functions.  The rule of thumb is 1-2 twice daily, empty stomach, before a meal.  It can be taken with the ox bile.

Gallbladder function and bile flow are all a subset of liver function and detoxification, but I hope this helps you understand that their importance goes well beyond digestion!  If you have had your gallbladder removed, please take special care in assisting the liver with proper bile flow and overall detoxification.

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