November 12, 2017 at 10:59 am #1023Archived PostsModerator
Gall bladder removal and excess nausea and vomiting
I have just seen a new male client aged 47yrs, weight 86Kg (6’4″) who had urgent gall bladder removal surgery in October 2016 following a year or so of unknown pains that he just kept taking painkillers for. He has a high profile, extremely high pressure job and was unfortunately ‘too busy’ to get the problem addressed. However, since then and the surgery, he experiences severe pains in the upper abdomen, under the site of the scar for which he is taking 100mg Palexia to keep pain under control additionally he is taking Pregabalin 250mg which he is trying to replace with the Palexia. He had a history of diverticulitis for which the symptoms had improved following removal of lactose. Since the GB surgery, and the main reason for him coming to see me, he has been unable to tolerate any fats and many foods cause him to experience severe nausea with occasional vomiting. However, he explained that he often tastes the ‘sick’ in his mouth and his Gastroenterologist has diagnosed Bile Reflux and provided him with 8g Cholestyramine to help with the over production of bile symptoms which it does.
He is also taking Ranitidine as the Gastro has suggested it may be acid reflux too.
He is very low in energy as he has reached a point where he no longer knows what to eat, so survives on Porridge, Soups and Chicken or Fish with vegetables – snacks on rice cakes and has occasional pasta meals. His immunity has also become a problems with frequent colds and coughs which take a long time to go away – they linger with a lot of mucus production.
He was a keen runner but since this event has been unable to maintain any exercise due to energy levels being so low plus whenever he runs, he vomits.I would really appreciate any advice on where to begin with this client, given the complexity of his case and the meds. I have suggested a CDSA to establish bacteria/inflammation etc but any additional advice would be welcomed.
Posted by Andrea Baylis on 11.12.17
March 6, 2019 at 11:01 am #1024Christine BaileyModerator
Many thanks for your question about your client who has had his gallbladder removed and is experiencing nausea and vomiting. We have spoken about gallbladder removal previously on Linked In.
The gallbladder serves as a storage vessel for bile, which is used in the digestion of food. Once removed this can lead to issues with the amount of bile and emulsification of fats. With no gallbladder (cholecystectomy) it is likely that he needs gallbladder replacement therapy for the rest of her life, and it is possible to do this without medication. As your client starts a supplement such as Beta Plus they may find they can reduce the intake of Cholestyramine.
Gallbladder removal can lead to Post-cholecystectomy syndrome (PCS) which is defined as a complex of heterogeneous symptoms, consisting of upper abdominal pain and dyspepsia, which recur and/or persist after cholecystectomy. This paper discusses biliary issues post-surgery, including bile duct injury & bile leakage.
Girometti R, Brondani G, Cereser L, Como G, Del Pin M, Bazzocchi M, & Zuiani C. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. Br. J. Radiol., Apr 2010; 83: 351 – 361. http://tinyurl.com/nqnskbf
Without the gallbladder, the bile is not as readily secreted in the body, and the liver can become overwhelmed when faced with large amounts of any fats, especially saturated fats and hydrogenated fats. And for some people even small amounts of fats can cause discomfort. I would therefore suggest watching fat intake generally particularly saturated fats. So, your client will have to reduce fat intake overall.
One of the side effects of gallbladder removal can be the dumping of bile which is now not as easily regulated and can send someone running to the bathroom immediately after eating, or after hours of running perhaps. This urgent need to visit the bathroom after cholecystectomy is quite common. This also often speeds transit time which means that absorption of nutrients may be impaired too.
With removal of the gallbladder there can be a decline in digestive function, particularly of fat and fat-soluble nutrients. For this reason you may wish to run some vitamin testing particularly fat soluble vitamins A, D , E and K. Biolab run these blood tests.
Johnston I, Nolan J, Pattni SS, Walters JR. New Insights into Bile Acid Malabsorption. Curr Gastroenterol Rep. 2011 Jul 30. http://tinyurl.com/3qzdl2q
Walters JR, Pattni SS. Managing bile acid diarrhoea. Therap Adv Gastroenterol. 2010 Nov;3(6):349-57. http://tinyurl.com/3dc3sc6
For reflux I would consider the use of clinically trialled lozenge called Sano Gastril (ARG).
Sano Gastril is designed to support digestion in the stomach and neutralise excess hydrochloric acid to a physiologically more appropriate level without the use of alkalinising agents. It is a quick-acting concentrated formula that supports the delicate physiological balance of the stomach and the entire GI tract, essential for normal gastric function.
I agree with you, however, that running a comprehensive stool test would also be valuable to rule out any infection and include Helicobacter pylori as well. Gluten is a common aggravating food so I would suggest removing gluten 100% or you could consider testing for coeliac and non-coeliac gluten sensitivity via array 3 cyrex panel. If you consider other aggravating foods you could run array 4 – cross reactive foods.
I would also suggest that your client tries eating small amounts of food and rather than 3 meals he may find it easier to eat more frequently but smaller amounts with limited fat initially – he may find with the digestive enzymes and Beta Plus he can tolerate a little more fat in time.
In view of the limited diet I would consider a multi vitamin and mineral formula and amino acid support. Additional fat-soluble vitamins may be needed but you may wish to check levels first.
Kowdley KV. Lipids and lipid-activated vitamins in chronic cholestatic diseases. Clin Liver Dis. 1998 May;2(2):373-89. https://tinyurl.com/y7cabz58
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Gallbladder support and Digestive enzyme support
Beta Plus (BRC) – 2 with each meal – http://tinyurl.com/3ymvge2
Full Spectrum Digest (ARG) – take 2 with each meal – digestive enzyme
Sano Gastril (ARG) – suck 1 before and after meals or when feeling sore or sickness – https://tinyurl.com/h3mttmd
Multi Vitamin & mineral formula
Aqueous Multi-Plus (BRC) – 1 tablespoon a day (in divided doses if necessary) – http://tinyurl.com/33d8tun.
Amino Sport (BRC) – take 2 capsules twice a day
I hope this helps with your client
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