Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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This photo taken during laparoscopy shows the gall bladder (small white organ in middle) surrounded by yellow fat. Liver (dark red organ) is overlying.
What Is Impaired Gall Bladder Motility?
Impaired gall bladder motility means the gall bladder is slow to empty or is dysfunctional.
The functional disorder of the gallbladder is caused initially either by metabolic abnormalities or by an alteration in its muscular ability to contract (motility dysfunction).
The diagnostic criteria based on symptoms of motility dysfunction of the gallbladder are episodes of moderate to severe steady pain located in the epigastrium and right upper abdominal quadrant that last at least 30 minutes.
Gallbladder motility disorder is suspected after gallstones and other structural abnormalities have been excluded.1
Q: What does the gallbladder do?
A: The gallbladder is a small pouch-like organ about the size of a pear that receives bile produced by the liver and stores it until needed during digestion. It lies just under the liver.
Bile is a complex fluid containing water, electrolytes and many organic molecules including bile acids, cholesterol, phospholipids and bilirubin. Bile acids are critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine. Many waste products, including bilirubin, are eliminated from the body by secretion into bile and elimination in feces.2
Before a meal, the gallbladder is usually full of bile. In response to fat in the diet, the gallbladder squeezes stored bile into the small intestine through a series of ducts. When emptied after meals, the gallbladder is flat.
What Is Impaired Gall Bladder Motility In Celiac Disease and/or Gluten Sensitivity?
- Impaired gall bladder motility is an associated disorder of celiac disease.
- Untreated celiac disease patients show low postprandial (after eating) cholecystokinin hormone levels and increased fasting somatostatin hormone levels.
- In a study by Fraquelli et al., the gall bladder fasting volume and post prandial residual volume were significantly higher in celiac disease than in controls, and gall bladder emptying constant was slower in celiac disease than in controls. During gluten free diet, gall bladder emptying reverted to normal, but mouth to cecum transit time remained unchanged (229 min give or take 69 min) and more prolonged in celiac disease than in controls.3
- In a study by Krums et al., celiac disease patients were found to have an inert type of gall bladder hypokinesia (low motility) or atony. The gall bladder contracted only after intravenous injection of cholecystokinin hormone.4
- In the study by Marciani et al., fasting gall bladder volume and the volume of bile ejected by the gall bladder after meals were increased in celiacs. Three celiac patients with severe postprandial dyspepsia and total villous atrophy had pathologically delayed gastric emptying and increased fasting gall bladder volume, meaning the gall bladder did not fully empty.5
How Prevalent Is Impaired Gall Bladder Motility In Celiac Disease and/or Gluten Sensitivity?
Impaired gall bladder motility has increased frequency in patients with celiac disease.3
What Are The Symptoms Of Impaired Gall Bladder Motility?
-
Gallstones.
Impaired gall bladder motility is marked by cramping pain after ingesting fatty foods.
- Possible development of gallstones.
How Does Impaired Gall Bladder Motility Develop In Celiac Disease and/or Gluten Sensitivity ?
- Impaired gall bladder motility results from gluten sensitive enteropathy.3
Does Impaired Gall Bladder Motility Respond To Gluten-Free Diet?
Yes. Celiac disease-related gall bladder motility reverts to normal on a gluten free diet.6
6 Steps To Improve Impaired Gall Bladder Motility In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.7
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.8
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.9
- Bad Fats. Includes deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.9.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.9
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.9
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.9
- Fruits Containing Phytochemicals. Includes cherries, grapes, and apples and others.
- Non-Starchy Vegetables. Includes lettuce, kale, onion, broccoli and garlic and others.
- High Quality Complex Carbohydrates. Includes brown rice, quinoa, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets and others that provide needed vitamins and minerals while boosting serotonin levels to help you relax and feel calm.
- Antioxidants. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries to help us handle stress and reduce irritability. Vitamin E-containing foods such as nuts and seeds. Cocoa is good, too.
- Fish Containing Omega-3 Fatty Acids. Includes tuna, salmon and cod.
- Probiotics and Prebiotics. Yogurt, kefir, and unpasteurized apple cider vinegar are good probiotics meaning they supply normal microbes needed for colon health and health of the body. Any food with fiber is prebiotic, meaning it keeps our population of colonic microbes healthy.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications and Nutritional Supplements Safely:
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminatives are plant sources that tone muscle and improve peristalsis, and thus aid in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort. Puree any foods that cannot be thoroughly chewed. Cook vegetables and meats well or make them into soups and stews.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets stimulate and improve digestion and are easily digested.
- Cabbage stimulates and improves digestion and is also a liver decongestant.
- Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
- Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
- Parsley relieves colic, gas and indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Nutmeg is also useful for abdominal bloating, indigestion and colic.
- Ginger also supresses inflammation.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Impaired Gall Bladder Motility In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Slow gallbladder emptying reverts to normal but small intestinal transit of a physiological meal remains slow in celiac patients during gluten-free diet.” This study aimed to quantitate non-invasively small intestinal transit time and gallbladder emptying during administration of a physiological and palatable solid meal (539 calories) in 19 celiac disease patients before diagnosis, 14 patients during gluten free diet, and 24 healthy volunteers to assess the effect of gluten-free diet. Researchers simultaneously measured mouth-to-cecum transit time (MCTT) using a validated H(2) breath test, and gallbladder motility using ultrasonography. Mouth-to-cecum transit time was more prolonged in celiac disease. The gall bladder fasting volume and post prandial (after meal) residual volume were significantly higher in celiac disease than in controls, and gall bladder emptying constant was slower in celiac disease than in controls. During gluten free diet, gall bladder emptying reverted to normal, but MCTT remained unchanged (229 min ± 69 min) and more prolonged in celiac disease than in controls. During gluten free diet, duodenal infiltration with lymphocytes and mast cells persisted higher than that in controls, and the number of mast cells lying in proximity of nervous endings did not change.
Conclusion: Slow postprandial MCTT in response to a physiological meal does not revert to normal during gluten free diet, an effect mirroring incomplete histopathologic recovery.10
“Functional condition of the stomach, pancreas, liver and gallbladder in celiac disease.” This study investigating the condition of the stomach, gallbladder, pancreas, liver in celiac disease and contribution of their dysfunction to clinical presentation of celiac disease symptoms found marked hypokinesia (low motility) of the gallbladder.
A total of 215 celiac disease patients and 25 healthy volunteers entered the study. Acid-forming function of the stomach, blood serum gastrin level were studied. Bile for biochemical test was obtained at duodenal intubation using 40 ml of 40% glucose solution or 25% magnesium solution as food stimulators, and intravenous injection of cholecystokininpancreosimin. Cholic acid was assayed in bile portions B and C. Two-channel probe was used to obtain duodenal content before meal and after intravenous injection of pancreosimin for tripsin, amylase and lipase assay. Clinical and biochemical blood tests were made as well as puncture biopsy of the liver with histological study of biopsy material.
Celiac disease patients were found to have high basal and stimulated acid-forming function, high gastrin concentration in the blood. The morphological examination detected lymphocytic gastritis. There was an inert type of pancreatic enzyme secretion, gallbladder hypokinesia (low motility) or atony. Gall-bladder contracted only after intravenous injection of cholecystokinin. Changes in the liver were characterized by hypertransaminasemia, steatohepatitis.
Marked hypokinesia of the gall-bladder, hyperenzymemia, and steatohepatitis as manifestations of hepatic pathology result in dramatic disorder of digestion and absorption of food substances.11
“Gallbladder contraction, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI.” Study assessing gal lbladder contraction, gastric emptying, and antral motility in untreated celiac patients and healthy controls using a single MRI examination found that using MRI, multiple parameters related to upper gastrointestinal function in celiac disease can be measured in a single noninvasive study, whereas previously three separate visits would have been required. Celiacs have increased fasting gallbladder volumes and tend to have slower gastric emptying.
Fasting gall bladder volume and the volume of bile ejected after meals were increased in celiacs. Gastric emptying tended to be slower in celiacs. Three celiac patients with severe postprandial dyspepsia and total villous atrophy had pathologically delayed gastric emptying and increased fasting gall bladder volume. Antral contractions were absent in five out of 14 patients (36%) five minutes after the meal, but in none of 10 volunteers in whom the antrum could be visualized.12
- Behar J, Corazziari E, Guelrud M, Hogan W, Sherman S, Toouli J. Functional gallbladder and sphincter of oddi disorders. Gastroenterology. 2006 Apr;130(5):1498-509. [↩]
- http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/bile.html [↩]
- Fraquelli M, Pagliarulo M, Colucci A, Paggi S, Conte D. Gallbladder motility in obesity, diabetes mellitus and coeliac disease. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. Jul 2003;35(Suppl 3):S12-6. [↩] [↩] [↩]
- Krums LM, Sabel’nikova EA, Parfenov AI. Functional condition of the stomach, pancreas, liver and gallbladder in celiac disease. Ter Arkh. 2011;83(2):20-4. [↩]
- Marciani L, Coleman NS, Dunlop SP, Singh G, Marsden CA, Holmes GK, Spiller RC, Gowland PA. Gallbladder contraction, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI. J Magn Reson Imaging. 2005 Nov;22(5):634-8. [↩]
- Benini F, Mora A, Turini D, Bertolazzi S, Lanzarotto F, Ricci C, Villanacci V, Barbara G, Stanghellini V, Lanzini A. Slow gallbladder emptying reverts to normal but small intestinal transit of a physiological meal remains slow in celiac patients during gluten-free diet. Neurogastroenterol Motil. 2012 Feb;24(2):100-7, e79-80. doi: 10.1111/j.1365-2982.2011.01822.x. Epub 2011 Nov 20. [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an
- interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩]
- Benini F, Mora A, Turini D, Bertolazzi S, Lanzarotto F, Ricci C, Villanacci V, Barbara G, Stanghellini V, Lanzini A. Slow gallbladder emptying reverts to normal but small intestinal transit of a physiological meal remains slow in celiac patients during gluten-free diet. Neurogastroenterol Motil. 2012 Feb;24(2):100-7, e79-80. doi: 10.1111/j.1365-2982.2011.01822.x. [↩]
- Krums LM, Sabel’nikova EA, Parfenov AI. Functional condition of the stomach, pancreas, liver and gallbladder in celiac disease. Ter Arkh. 2011;83(2):20-4. [↩]
- Marciani L, Coleman NS, Dunlop SP, Singh G, Marsden CA, Holmes GK, Spiller RC, Gowland PA. Gallbladder contraction, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI. J Magn Reson Imaging. 2005 Nov;22(5):634-8. [↩]
