All Posts tagged fat

Gallbladder Blues

Gallbladder Blues

“Toe in, toe in!  Come on, retract, I can’t see what I’m doing!”
These were the commonly heard urgings by gallbladder surgeons when I was a med student nearly thirty years ago.  Gallbladders were removed through large incisions followed by long recovery periods.  We students would scrub in and stand for a few hours in the OR pulling on wound retractors to keep open the incisions so the surgeons could have good visibility.  Boredom or fatigue occasionally caused us to slacken at our duty and the surgeon would quickly chide us. Happily for med students, surgeons, and especially for patients, most gallbladders are now removed laparoscopically through small incisions with much more rapid recovery and far less suffering.
Some things haven’t changed though – when there’s pain in the upper abdomen, especially if it’s the right upper abdomen, the gallbladder is still one of the suspects considered.  This isn’t surprising since in the U.S. about 20 million people have gallstones, and each year about 700,000 patients have their gallbladders removed to relieve troublesome symptoms.  The gallbladder follows the appendix as the other sack-like organ next most frequently removed due to disease or malfunction.
So what does the gallbladder do when it’s working correctly?  The gallbladder is a 3 to 4 inch long pouch-like organ tucked up into a pocket of the liver in the right upper abdomen.  Bile and other digestive enzymes are secreted and stored by it.  When we eat a meal, especially a large fatty one, this little sack contracts, squirting its digestive enzymes through a little duct or tube into the intestine where the enzymes help digest the meal.
So far, so good.  But things can go wrong.  The gallbladder can develop gallstones of varying sizes.  Then when the gallbladder contracts one of these stones can become wedged in the duct leading to the intestine.  Depending on where the obstruction occurs, this can sometimes also block off the pancreas causing still more problems.  Either way, there is tremendous crampy pain, usually in the right upper abdomen or upper mid abdomen and sometimes radiating through to the back.
The pain typically starts shortly after a meal and may last for a couple of hours or more, until the stone passes into the intestine or falls back into the gallbladder after it finally stops contracting.  Occasionally the pain persists and a trip to the emergency department, sometimes followed by emergency gallbladder removal (cholecystectomy) is the only solution.  An ultrasound of the gallbladder and lab work are usually able to diagnose this problem.
Gallstones are not the only problem that can arise in the gallbladder.  A situation can arise in which it excretes less and less effectively even though it has no stones.  In this condition, the gallbladder may look OK on ultrasound and a special scan is needed to identify the problem. Or, even more dangerous, the gallbladder can become infected with bacteria, often due to one of these other malfunctions already mentioned.   This requires urgent treatment with antibiotics and eventual surgery.  And like most organs in the body, cancer can occasionally occur in the gallbladder.
Anyone can have problems with their gallbladder, but certain groups are more at risk.  The most common group would be Caucasian females around their forties who are overweight.  Also, during weight loss there is a temporary increase in gallbladder attacks as the person processes their own fat.
For these reasons and more, the gallbladder may sometimes have to be removed.  Often this affords a huge amount of relief for the person.  However, besides infrequent complications of residual stones, infection or problems with wound healing, about 10-15% of people have ongoing symptoms after the gallbladder is removed.  This has been given the long name post cholecystectomy syndrome (PCS).  This is not surprising since God puts things in place for a reason; when we have to remove them, sometimes there are issues to deal with.  The loss of the gallbladder can cause symptoms such as heartburn, indigestion, loose stools or cramping.  These can be managed but are certainly a nuisance.
So if you’re getting symptoms that make you wonder about this little 3 inch sack, see your doc and get it checked out.  It’s helpful when it’s healthy; but if it’s betraying you, it just might have to go.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835

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Bigfoot, Loch Ness monster, and Carbohydrate Deficiency

It is interesting to think about food in its three basic constituents: Fat, Protein, and Carbohydrates.

For each of these three constituents one can imagine a situation where there is excess or deficiency. In fact, over the centuries of recorded medical literature these states have been identified.  Well, five of the possible six states have been identified.

Fat:

Intake of excessive amounts of fat can lead to malabsorption.  Your intestines can’t absorb the fat quick enough.  This produces bloating and loose, frequent oily stools.

Deficiency of fat intake typically results when you have deficiency of particular essential fats. The omega 3 fats, long touted for their health benefits and found commonly in deep water fish, are types of fat that humans cannot manufacture. That is, if we don’t eat omega 3 fats we will not have them in our body to use.  A lack of omega 3 leads to increased inflammation, reduced arterial flexibility, and overall worse outcomes in cardiovascular disease.  In one recent study, over 90% of patients who were evaluated at an emergency room for cardiovascular disease had a very low omega 3 blood level.  Omega 6 is another type of essential fatty acid but is found in more types of food products such as plant oils.

Proteins:

Excessive protein intake has been known to cause many gastrointestinal symptoms as well as a general feeling of malaise.  The Inuit people have a native diet that is very high in fat.  When the young hunters try and take the easy way out and eat rabbits, the older, more wise hunters know this is not a good idea.  The young hunters develop a weakness and malaise given that rabbits are high in protein and very low in fat.  In fact, this has been called “Rabbit Malaise”.

Deficiency of general protein intake causes a condition called Kwashiorkor. This is the most common malnutrition syndrome seen as it is the prevalent disease of children starving in impoverished countries.  Additionally, of the twenty amino acids that make up all proteins twelve of them can be manufactured from other molecules by humans if they are needed.  Eight of the amino acids are unable to be manufactured.  That is, they must be eaten if we are to have them available in the body.  It is interesting to me that all animals have all eight of these essential amino acids available in their meat.  Whereas, there is only one plant on the entire planet that has all eight amino acids contained within it.  It is possible to eat a variety of plants and get all the essential amino acids however.

Carbohydrates:

Excessive carbohydrate intake can lead to sudden issues such as bloating and diarrhea.  Chronic excessive intake of carbohydrates can lead to hyperglycemia, impaired fasting glucose, insulin resistance, fatty liver disease, and ultimately diabetes.  We see this all the time in day-to-day life.

There has never been a disease discovered for failing to eat enough carbohydrates.  In fact, our body has a plan through our liver to manufacture all the glucose required every day.  So there is no such thing as a carbohydrate malnutrition.  It is impossible to eat so few carbohydrates as to cause disease for the ordinary person.

Why then do we base our food and nutrition guidelines on products made out of something that isn’t necessary in life?  Why is the bottom level of the food pyramid breads and pasta?

We teach patients to limit their carbohydrate intake to a level appropriate for their physiology.  By doing so, we have seen monumental reversal of disease, weight loss, reduction in medication use, and overall improved health and well-being.

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