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It all starts with stomach acid

The pathological cascades that can form with unhealthy conditions and choices are interesting in their simplicity and enormity. One such snow ball effect involves the digestive and detoxification processes which I see commonly. Central to this cascade is the gall bladder and its important functions contributing to maintaining homeostasis (overall wellbeing). This cascade begins commonly with stress and non-optimal diet and ends with the deterioration of the nervous system, the liver, the cardiovascular system and overall wellbeing.

Our nervous system is the control centre, switchboard and innovation of every process in our body. It has two modes or programmes which once activated, set in motion all manner of physiological processes. The primary mode is parasympathetic, controlling rest and digest functions. This is activated by slow controlled breathing, relaxation and release of tension. The secondary mode is sympathetic and controls what is referred to as fight or flight. It is activated upon the recognition of stress and sets into motion the release of cortisol and adrenaline to get us up and moving quickly. These two modes are polar opposites and do not function at the same time. When the nervous system is sympathetic dominant, digestion and rest are inhibited.

The typical western diet consists of meat and starchy vegetables which require high amounts of stomach acid and enzymes to digest. We also love refined sugars and stimulants which cause a rise in toxins, oxidation, inflammatory metabolites and cortisol. Already this creates a difficult scenario for the digestive and nervous system. Additionally, we tend to put ourselves under immense pressure trying to achieve our goals, hold down work and juggle the many obligations of independent adult life. Most people tend to eat quickly, chew little and have sympathetic dominant nervous systems. This all causes the inadequate stimulation of the vagal nerve, low production of stomach acid, under stimulation of the pancreas and gall bladder which causes low digestion and absorption of food. A few of the most important nutrients utilized for balancing stress, producing energy and assisting healing include; B group vitamins, vitamin C, magnesium and potassium. The most abundant dietary source for these nutrients is green leafy vegetables which most westerners call rabbit food and tend to avoid.

The Gallbladder is not an expendable organ

The gall bladder is a small glandular organ connected to the liver which feeds into the duodenum at the start of the small intestine. Its function involves concentrating bile (which the liver produces) and releasing it in response to the presence of fat and cholecystokinin (CCK). Cholecystokinin stimulation requires high levels of acid coming out of the stomach. Only when there is enough stomach acid does CCK get produced, stimulating gallbladder contraction and therefore the release of bile. Without this simple function, living a healthy life becomes fairly difficult. It is essential for the digestion of fat, gastric motility and the balance of good bacteria in the intestines which is vital for overall health.

Bile is the major antimicrobial in the gastrointestinal tract and is essential in preventing infections and conditions such as small intestinal bacterial overgrowth (SIBO). When stomach acid production and bile release is low, the intestines are extremely vulnerable to infections of pathogenic bacteria. The regular flow of bile is important as it is one of the livers primary routes for the elimination of toxins. If its flow is slowed or restricted, gall stones can develop which disrupts many essential processes.

Choline and its role in liver and gallbladder function

Choline is a micronutrient important for many processes in the body and is integral to this syndrome. It is a major component of cellular membranes, assists with cellular metabolism, is involved with neural transmission and is vital for the slimy consistency of bile. Whilst it is found in many dietary sources, studies have shown that in the west we do not tend to eat enough of it. In pregnancy, the demand for choline increases greatly as the placenta and foetus develop. Pregnancy provides the optimal environment for this cascading condition to develop (National Institutes of Health, 2017).

Choline makes up over 50% of cellular membrane material, which gives you an idea of the demand building a baby puts on a mothers choline stores. When the body becomes deficient, it views essential processes such as methylation and cellular repair as high priority and begins robbing lower priority cellular membranes of choline through hydrolysis. When this happens it can break down muscle and nerve tissues causing wide spread damage. It also puts a hold on choline used to lubricate bile and process toxins which can lead to gall stones, liver damage and leaves the intestines vulnerable (Zeisel & Costa, 2009). When bile flow into the intestines is reduced, it allows bacterial infections to develop. Studies have shown that intestinal infections of various pathogenic microbes can reduce and inhibit the absorption of choline, causing deficiency states. This shows the potential for a vicious cycle to develop.

How this causes cardiovascular disease

The colonization of various pathogenic microbes has been shown to cause the production of a toxin called trimethylamine (TMA) through their digestion of amino acids. Upon absorption, TMA is converted by the liver to trimethylamine-N-oxide (TMAO). This toxin has recently been indicated as a major contributor to the development of numerous conditions including atherosclerosis and therefore cardiovascular disease which is the leading cause of death and disability worldwide (Romano, Vivas, Amador-Noguez, et.al. 2015).

The gallbladders alarms

Considering all these factors, it is easy to see how stress, poor dietary choices and digestion can lead to a range of conditions. Obviously prevention is the best case scenario but most people won’t realise they are susceptible to this until they develop symptoms. Some of the first symptoms to develop can include: difficulty digesting fats and proteins, gastric reflux, pale floating stools, B12 deficiency, depression, lethargy, nausea, jaundice, SIBO, constipation, candidiasis and “gall bladder” headaches. Symptoms can vary between individuals and may present as one or all of the above simultaneously.

Gall bladder headaches are an interesting phenomena which can seem unrelated at first until taking into account traditional Chinese medicine (TCM). The gallbladder meridian identified by TCM flows from the eye, across and into the temple, around the ear, down the neck, halfway along the shoulder and down the back, legs and ends at the small toe. When the gallbladder becomes sluggish and congested, a headache is commonly experienced in the temples, accompanied by a tight neck and shoulders. TCM acknowledges the emotions relating to gallbladder imbalance and therefore liver imbalance which usually manifests as indecision, anger and frustration.

When the gallbladder becomes sluggish, liver detoxification is disrupted. This can cause nausea and cholesterol imbalances. It can also cause bilirubin metabolism defects and therefore jaundice which is usually first noticed as a yellowing in the sclera (whites) of the eyes.

Once this condition has fully manifested, often gallstones have begun to develop which can cause significant abdominal pain. Gallbladder removal (cholecystectomy) is a common surgery nowadays and is usually deemed to be low risk. The implications of having the gallbladder removed are far reaching and contribute to the development of a plethora of conditions.

Many nutrients require stomach acid

Zinc and Iron are two important minerals which require stomach acid for absorption. Zinc deficiency causes low immunity, poor wound healing, methylation imbalances and can lead to a myriad of conditions. Iron deficiency causes low energy, immune deficiency and reduced oxygenation. Magnesium and calcium are also prone to deficiency relating to reduced secretion of stomach acid.

Another nutrient which is reliant on high levels of stomach acid for digestion and absorption is vitamin B12. Vitamin B12 is vital for the health of the nervous system and cellular function and energy. With a deficiency of B12; depression, low energy and neural damage occur.

B12 deficiency will commonly manifest in depression and lethargy. As B12 absorption relies on intrinsic factor production which relies on adequate stomach acid production, digestion is paramount in treating deficiency. B12 deficiency does not always show up in blood tests clearly and consultation with an integrative doctor or naturopath is recommended to clarify results. It should be noted that gluten and other inflammatory molecules can damage the parietal (stomach acid and intrinsic factor producing) cells and therefore cause hypochlorhydria (lack of stomach acid) and deficiencies.

It all starts with stomach acid

Adequate stomach acid secretion is such a vital defence for maintaining our general health it is difficult to pay it necessary respect here. Without it we are left vulnerable to infections throughout the GIT and therefore the rest of the body too. Helicobacter pylori is a bacteria which has been attributed to the development of stomach ulcers. With adequate levels of acid secretion in the stomach, its colonisation is almost impossible. However once defences are down it can corkscrew into the stomach wall and interfere with hormonal signalling involved with inhibition of stomach acid secretion after a meal. This can cause chronic inflammation of the stomach and oesophageal sphincter and is why proton pump inhibitors (PPIs and ant acids) are prescribed for gastric reflux, gastritis and peptic ulcers (KEL Mcoll, E El-Omar & D Gillen, 1998). This approach makes partial sense in reducing the chronic inflammation and therefore the probability of contracting gastric and oesophageal cancer although it does not treat the cause or the infection. In order to eradicate a H. Pylori infection, antimicrobial or antibiotic treatment is necessary. In order to prevent re-infection, stomach acid secretion must then remain adequate to keep defences effective. Use of PPIs are not recommended for longer than 8 weeks as long term use can cause a wide array of side effects and conditions (The Rx list, 2017).

If you have abdominal pain, it is necessary to have breath, urine, stool or endoscopic tests conducted before jumping to conclusions. Without the necessary tests, it is easy to jump to conclusions and have unnecessary treatments and surgeries performed. Gallstones and appendicitis are two potentials which are commonly seen as possibilities and are considered expendable by many surgeons. I have personal experience in watching a young lady go through the process of being highly stressed, developing abdominal pain, being prescribed PPIs for longer than 6 months and then having a cholecystectomy and appendectomy. All before any breath, urine, endoscopic or stool tests were conducted. After all this, her pain was worse than ever and finally an endoscopy revealed H. pylori infection. I assume all she had needed was antimicrobial therapy in the beginning to prevent this cascade.

With cholecystectomy (surgical removal of the gallbladder) so common today, it is critical to look into the reasons behind gall stone formation. Once conducted, bile supplementation may be necessary to assist defences against pathogenic infection and digestion of fatty meals.

Bile salt production deficiencies and sluggish gallbladder can be caused by a variety of things and the causes spoken about here are only a few of the most common. It can also be due to methylation and trans-sulfuration imbalances as these pathways are necessary for taurine, choline and phosphatidylcholine production which are important components of bile.

Concluding thoughts

This digestion catastrophe is rife in the western world and I see its symptoms in many cases every day. When caught early, it is simply a case of taking bitter herbs or a digestive before each meal. Once it has developed into gallstones, depression, peripheral neuropathy, high cholesterol, chronic constipation, SIBO and cardiovascular disease though it is no longer to be taken lightly. Consultation with a healthcare professional who recognises the manifestation of this condition is essential. Dietary, lifestyle and supplemental factors are all crucial to rectifying the end result of this simple cascade.



KEL Mcoll, E El-Omar, D Gillen. 1998 British Medical Bulletin. Interactions between H. pylori infection, gastric acid secretion and anti-secretory therapy. Retrieved 2nd July, 2017 from,



National Institutes of Health. (2017). Choline Fact Sheet for Health Professionals. Retrieved 2nd July, 2017 from, https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/)

Romano, K.A, Vivas, E.I, Amador-Noguez, D., et.al. (2015). Intestinal Microbiota Composition Modulates Choline Bioavailability from Diet and Accumulation of the Proatherogenic Metabolite Trimethylamine-N-Oxide. Retrieved 2nd July, 2017 from, http://mbio.asm.org/content/6/2/e02481-14.full

The Rx list 2017. NEXIUM® (esomeprazole magnesium). Retrieved 2nd July, 2017 from, http://www.rxlist.com/nexium-drug.htm

Zeisel, S.H., Costa, K.D. (2009). Choline: An Essential Nutrient for Public Health. Retrieved 2nd July, 2017 from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782876/

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Dean Gainsford

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