Full Transcript for Essential Insights into Gallbladder Function and Care with Amie Skilton

of gallbladder surgeries happening there between 2000 and 2019 have actually increased by 80.4%, annually increased by 80.4%. 00:03:26.680 --> 00:03:46.421 And we also see other reports where gallbladder issues, in particular gallstones, were more an issue for someone in their 40s, 50s or 60s, and now it's more prevalent in those in their 30s and 40s, and even teenagers are having their gallbladders removed. 00:03:46.421 --> 00:03:51.230 Now, that was unheard of it's just it. 00:03:51.512 --> 00:04:02.246 It's amazing how, you know, back in my day of nursing and and I'm going to be politically incorrect here because we there's an acronym and that's the acronym. 00:04:02.246 --> 00:04:22.427 So forgive me, but the acronym back in my day of nursing was FAT40 FEMALE Fertile and Flatulent right, and that was this, you know, very probably misogynistically designed acronym. 00:04:22.427 --> 00:04:27.973 But the 40 has now gone down to 20s. 00:04:27.973 --> 00:04:30.360 That's what I think is really interesting. 00:04:30.360 --> 00:04:37.860 Um, it's just amazing how time progresses and I and I understand you know COVID, lockdown, things like that. 00:04:37.860 --> 00:04:44.630 People are more sedentary, but it's not just that we're talking from you know the 2000 way before COVID. 00:04:44.630 --> 00:04:50.548 So something else is right yeah, definitely there. 00:04:50.608 --> 00:04:57.452 there are a lot of things happening and I think it's a tricky one to unpack, although in the webinar I'm certainly going to go through a lot of that. 00:04:57.452 --> 00:05:02.985 But I guess, to point towards what you said, like in naturopathic college it it was fair, fat and 40. 00:05:02.985 --> 00:05:17.230 So, like light skin is typically is certainly where I was from at the time, a condition that affected Caucasians more predominantly, but certainly for female and fertile I think. 00:05:17.230 --> 00:05:22.086 Touching on that, we know that estrogen is a risk factor of that. 00:05:22.086 --> 00:05:27.324 So elevated levels of estrogen, and that can happen because of poor estrogen metabolism. 00:05:27.324 --> 00:05:52.360 It can be a result of xenoestrogen exposure, which, of course, we're getting increasingly more so through, you know, pesticides, herbicides, foods, personal care products and of course, a lot of women are opting for, you know, the combined oral contraceptive pill as a form of contraception or for other reasons, and then HRT at the other end of their fertile window in terms of a life chapter. 00:05:52.360 --> 00:05:55.226 So those are definitely increased risks. 00:05:55.327 --> 00:06:09.869 Certainly, age is an increased risk, but I think age is partly an increased risk because one of the things that contributes to cholestasis or sticky bile, sluggish gallbladder function, is toxicants. 00:06:09.869 --> 00:06:18.672 So, whether that's from personal care products or from agricultural industry or, you know, from any of the other hundreds of sources

that we get that from. 00:06:18.672 --> 00:06:32.605 We know that those things, especially the lipophilic ones that are eliminated through the gallbladder, accumulate over time, and they accumulate also with the increase in weight, which is often something that occurs alongside aging. 00:06:32.605 --> 00:06:34.831 So you know those are issues. 00:06:34.831 --> 00:06:38.685 We know there are also dietary components that need to be addressed. 00:06:40.249 --> 00:06:58.144 You know the increased risk factors of things like diabetes and insulin resistance, any issues with cirrhosis or even liver infections and parasites, and one of the other areas I'm going to be touching on in the webinar is the impact of mycotoxins on the gallbladder and how that contributes to cholestasis as well. 00:06:58.144 --> 00:07:08.454 But certainly for women if all other you know confounding factors are equal women are more at risk than men because of the estrogen factor. 00:07:08.454 --> 00:07:17.031 In fact, women are diagnosed three times more often than men with gallstones like before the age of 40. 00:07:17.031 --> 00:07:34.273 But by the time they're 60, the risk is actually starting to draw closer, unless, of course, they're on estrogen therapy like HRT, and certainly anyone who's carrying extra weight, male or female, will have increased estrogen levels. 00:07:34.273 --> 00:07:42.629 Ironically, though, rapid weight loss also can trigger issues with gallstones and the gallbladder as well. 00:07:42.629 --> 00:07:57.146 So you know you have to really treat it with such respect and consider it to be, you know, a partner of the liver, as opposed to just a sack that sits there behind the liver collecting what the liver creates. 00:07:58.629 --> 00:07:59.110 Absolutely. 00:07:59.110 --> 00:08:16.250 I'm so glad back at the beginning there you were talking about toxicants, and one of the sort of issues I've been pondering myself is we always, as humans, we tend to go that equals that, that to that, rather than that to that, to that, to that, to that, to that, right. 00:08:16.250 --> 00:08:27.122 So now, forgive me, those people about, those of our listeners can't see me pointing around the room to various points before you know, instead of A to C, it's A to Z. 00:08:27.122 --> 00:08:43.615 So, for instance, in Australia we still have on our shelves an endocrine disruptor chemical called triclosan and it's been shown to affect thyroid function. 00:08:43.615 --> 00:08:55.855 It's been shown to affect thyroid function and thyroid function, if it's decreased, can lead to high cholesterol and high cholesterol can lead to a seed in the gallbladder. 00:08:55.855 --> 00:08:56.437 And do you see? 00:08:56.437 --> 00:08:59.389 So there's this whole thing about with the toxicants. 00:08:59.389 --> 00:09:01.317 It might not be a direct, that equals that. 00:09:01.317 --> 00:09:08.546 It might be around the sort of border bit still has an issue with gallbladder disease totally. 00:09:08.605 --> 00:09:15.551 You've got direct influences, you've got indirect influences and then you've got the cumulative effect of multiple influences. 00:09:15.551 --> 00:09:19.562 You know, we don't live in a pristine toxicology lab. 00:09:19.562 --> 00:09:22.749 When we're exposed, we were exposed to one thing at a time. 00:09:22.749 --> 00:09:36.821 We're being assaulted from multiple sources in the air and our water, and our food and our personal care products and our home cleaning products, with, you know, all kinds of toxicants, and some of those are willingly onboarded and some of them aren't. 00:09:36.821 --> 00:09:46.581 For example, pollution if you're living in a big city or near a main road and your liver and of course all of your detoxification organs have to deal with that. 00:09:46.681 --> 00:09:58.993 But, as you so eloquently pointed out, sometimes it's a direct inhibition of the autonomic nervous system and gallbladder contraction or an increase in, you know, the viscosity of bile. 00:09:59.332 --> 00:10:04.711 Or, in the example you gave, there's this domino effect that are, you know, multiple steps removed. 00:10:04.753 --> 00:10:07.753 That ultimately also influences the health of the gallbladder. 00:10:07.753 --> 00:10:23.225 And this is what makes functional medicine so wonderful and also so tricky to practice, because you have to be such a great detective and actually really put all of those like, elucidate all of those variables and address them all to have a successful result. 00:10:23.225 --> 00:10:52.083 And I think that's why removing the gallbladder seems to be such a popular choice in allopathic medicine because all of the other methods that address gallstones and of course gallbladder disease is not just gallstones but just using this example, you know tend to reoccur and that's because the underlying causes haven't been addressed and so they're like well, what's the point in removing the stones and leaving the gallbladder because they'll just come back. 00:10:52.083 --> 00:10:58.811 Sure, if you don't deal with the underlying cause and you know, I tell my clients surgeons can cut out everything but the cause. 00:10:58.811 --> 00:11:08.447 And I guess the sad reality is whatever was contributing to those gallbladder issues also doesn't get addressed when you remove the engine oil light. 00:11:08.447 --> 00:11:11.024 That's indicating, hey, we've got a problem here. 00:11:11.044 --> 00:11:15.068 Yeah, I have to disagree with you on one point. 00:11:15.068 --> 00:11:18.769 I explained it in the most fumbling way possible. 00:11:18.769 --> 00:11:20.527 You explained it eloquently. 00:11:20.527 --> 00:11:56.471 But notwithstanding that, just a point I'm pondering is I wonder if people, One of the possible I don't know to what degree, but I wonder if one of the possible factors involving why sorry, leading to why women more women have gallbladder disease than men, is simply because of the size of the tube of the

common bile duct in men versus women Bigger bodies, bigger aortas, bigger vessels, bigger common bile duct. 00:11:56.532 --> 00:12:00.234 I don't know, but I just pondered that and I don't know why. 00:12:00.234 --> 00:12:06.398 Anyway, so when we're talking about, you know, why not cut it out? 00:12:06.398 --> 00:12:14.547 Like, I totally understand that if you've got a blocked common bile duct, it's not a medical emergency that you've got on your hands, it's a surgical emergency. 00:12:14.547 --> 00:12:31.687 Having said that, having said that, we should be taking care of an important I'm not going to say necessarily vital, but an important part of our bodies that's due to our normal function. 00:12:31.687 --> 00:12:36.197 You know, it's kind of like we used to just think, ah, cut out the appendix Now we don't. 00:12:40.549 --> 00:12:46.171 So is there any movement in the thinking of the importance of the gallbladder? 00:12:48.427 --> 00:12:57.695 It does vary country to country and I think it varies also depending on the patient population and how educated they are and perhaps also resources. 00:12:57.754 --> 00:13:09.394 You know every medical system is set up differently and there's, you know, likely in other countries, like it is here things that are covered by, you know, medicare and then other options you've got to pay out of pocket. 00:13:09.394 --> 00:13:36.330 So I think it's a combination of things, but I really think ultimately, what it comes down to is people are presenting in an acute state of distress that needs to be addressed and they are not getting appropriate care, either pre or post, to address how they ended up in there, and that's not the surgeon's job either up in there, and that's not the surgeon's job either. 00:13:36.330 --> 00:13:51.751 And so I can absolutely appreciate why a surgeon, when given the choice of just removing the stones and clearing out the common bile duct and leaving everything there versus because actually, by the way, you don't actually, you know, end up without gallstones after gallbladder removal and an. 00:13:51.751 --> 00:14:02.650 In actual fact, in some of the stats that I looked at, only 18% of patients who've had their gallbladder removed remain free of symptoms. 00:14:03.533 --> 00:14:03.774 Oh yeah. 00:14:05.105 --> 00:14:19.855 Yeah, and up to 72% of patients can end up with gallstones in the common bile duct after the gallbladder is removed, because the source of them wasn't addressed, and so I know if this was to happen to me, depending on you know, when it was discovered. 00:14:19.855 --> 00:14:32.739 If you've got the luxury of time and you're not in so much pain, you can obviously use things like lithotripsy or oral medications to dissolve the stones, or both, whilst you're addressing the underlying cause. 00:14:32.739 --> 00:14:43.032 If I was, to say, present at an emergency department with an acute gallbladder attack with gallstones, I would be begging to have the stones removed and everything else left intact. 00:14:43.032 --> 00:15:01.716 But the current, you know, state of medicine in the Western world is such that, you know, the people who are presenting to emergency for acute treatment don't know where to go to actually get the underlying causes dealt with, because they think that medical system is one and the same when it's not. 00:15:03.985 --> 00:15:20.447 Is there any advancements in medicine to preserve the actual bile, sorry, gallbladder, whilst expressing um, expressing, if you like, the gallstones, or is it? 00:15:20.447 --> 00:15:26.458 Yeah, is it that the endothelial lining is so, uh, impacted by whatever you know? 00:15:26.458 --> 00:15:30.495 It is whether it be inflammation, whether it be infection that they just go. 00:15:30.514 --> 00:15:55.427 No, let's take it yeah, look, I think there are variables there, that sometimes a surgeon isn't going to know about it until they get in there and, as you pointed out, endothelial tissue damage with a risk of infection can certainly present problems, make it more complicated, require antibiotic use and may end up resulting in the gallbladder being, you know, needed to be removed anyway. 00:15:55.427 --> 00:16:23.398 But look in terms of like the different options you'd have medically, there are oral medications that have been shown to dissolve some gallstones, and these are classic compounds found in bile, and so bare bile acid is another, I guess, natural version of that to thin the bile and allow the gallstones to dissolve, and those medicines are really well tolerated. 00:16:23.398 --> 00:16:32.897 But they can be slow to work, so totally not appropriate in an acute gallstone attack and of course, isn't treating the root cause either either. 00:16:32.897 --> 00:16:38.091 But someone with a grumbling gallbladder, that could certainly be part of their treatment plan. 00:16:38.091 --> 00:16:59.072 But, as you just alluded to, there is something called a percutaneous cholecystostomy tube which actually is essentially a drain where they can move galls, use it to move gallstones out of the area and kind of massage it out if the gallstones are bigger. 00:16:59.072 --> 00:17:04.090 So, as you said, they can be anything from the size of a grain of sand all the way through to a golf ball. 00:17:04.090 --> 00:17:10.228 Now, in terms of passing a stone like the common bile duct isn't big enough to pass. 00:17:10.669 --> 00:17:28.834 You know anything too, and essentially, if it's over one and a half centimetres, typically they'll use lithotripsy, which is a type of you know, ultrasound that actually waves that breaks the gallstones into smaller pieces so you can pass it. 00:17:29.904 --> 00:17:43.580 But there's also a and I don't know if I would opt for this one but they can also inject a solvent which, of course, is highly toxic, but in this case there's a one-off to actually dissolve the gallstones. 00:17:43.580 --> 00:17:54.498 It can cause a lot of pain, it can

cause serious side effects as well, so, you know, and it's also a bit risky for the doctor administering it as well. 00:17:54.498 --> 00:17:56.732 So it's probably not anyone's top choice. 00:17:56.732 --> 00:18:08.740 But certainly endoscopic drainage, you know, a tube to actually move them out, or using ultrasound would be options that I would consider before going for surgery. 00:18:08.740 --> 00:18:17.720 And ideally, I think recognizing gallbladder issues earlier on is really kind of the way to go. 00:18:17.720 --> 00:18:22.709 And this is where preventative and naturopathic and functional medicine comes into its own. 00:18:22.709 --> 00:18:44.412 Decades of you know, earlier red flags and earlier signs that um have been pointing to that their gallbladders in need of help, um, so maybe we should have a chat about some of those I think that's. 00:18:44.511 --> 00:18:46.378 I mean, this is obviously where we need to go. 00:18:46.378 --> 00:19:11.698 I was going to say before we move over to that, with regards to the um, uh, the solvents that are used, I was going to make a glib comment about the degreaser that you get from the cheap shop, but I could understand the surgeon's issues safety issues regarding that with leakage around the insertion point into the gallbladder. 00:19:11.698 --> 00:19:13.424 Regarding that with leakage around the insertion point into the gallbladder. 00:19:13.424 --> 00:19:21.159 Obviously, that would be also dependent on the type of stone. 00:19:21.159 --> 00:19:32.439 Most of them are cholesterol, but there may indeed be salts that are in there as well, and so that requires a different approach. 00:19:32.439 --> 00:19:39.413 So I'm really interested in lithotripsy, because that used to be reserved for renal disease, but that's interesting. 00:19:39.413 --> 00:19:41.571 I wonder if they're using it in different sorts. 00:19:43.569 --> 00:19:49.511 So, moving on with regards to symptoms, we talk about the classic shoulder tip pain and things like that. 00:19:49.511 --> 00:19:52.144 That's more of a grumbling gallbladder. 00:19:52.144 --> 00:19:54.634 If you have a gallbladder attack, it's you'll know it. 00:19:54.634 --> 00:19:58.196 But let's talk about these nuanced symptoms. 00:19:58.196 --> 00:19:59.480 What are we looking at here? 00:20:01.868 --> 00:20:13.733 so I guess, um, as you mentioned that pain, there's a couple of places people can experience pain and it kind of depends if there's stones there and also what size they are. 00:20:13.733 --> 00:20:26.794 So, um, one of the classic places to experience discomfort is um underneath the bottom of the right shoulder blade and that's really sort of um directly over where the gallbladder sits. 00:20:26.794 --> 00:20:34.453 But we can also see pain radiating or actually presenting as a primary, like the top top of the right shoulder. 00:20:34.453 --> 00:20:48.070 For some people, if there's issues with stones and the common bile duct, it can be a bit more central,

so sort of right at the bottom of that of the sternum, like behind the stomach where it sort of crosses over towards the pancreas. 00:20:48.070 --> 00:20:55.211 But there are other signs of poor gallbladder function or poor bile flow. 00:20:55.272 --> 00:20:58.826 So number one would be the color of your stool. 00:20:58.826 --> 00:21:15.977 So if you're having what we would call a perfect poo, it has a particular texture, a particular shape, a particular size and also a particular color, which is a dark brown and a dark brown is. 00:21:15.977 --> 00:21:25.105 The dark brown is is caused by the bile and the changes in the, in the pigments of the bile, through the like, the metabolism of digestion. 00:21:25.105 --> 00:21:43.327 Anytime we see any of those lighter colors, we know that we're either not producing good quality bile or there's something impeding the flow of bile and therefore it's not coming through and coloring the stool in the same way, and so that would be one big hint. 00:21:43.327 --> 00:21:54.453 A second big hint would be if the stool, or, like after a bowel motion, you're seeing a greasy film on the water in the toilet bowl. 00:21:54.453 --> 00:22:03.058 So obviously undigested or maldigested fats, in particular stools that are high in fat, will often float rather than sink. 00:22:03.058 --> 00:22:17.769 Now, that's not a definitive point, because we can also see that with microbial fermentation, but you know, if it's floating and you're seeing some of those other things, the red flags, know if it's floating and you're seeing some of those other things, um, the red flags, um, other red flags are. 00:22:17.769 --> 00:22:34.050 You feel unwell after fatty food, so you might feel nauseous, you might even vomit, um, you might feel a bit headachy or a bit off, you might find it really just sits in your stomach really awfully and affects your digestion and your bowel motions. 00:22:34.050 --> 00:22:44.612 And if that is you, it's likely that you now avoid fatty foods and fatty meals and eat more on the low fat side to avoid triggering those symptoms. 00:22:44.612 --> 00:22:49.147 So those would be sort of the big ones there. 00:22:49.248 --> 00:22:54.439 But also we can see issues with fat metabolism appearing on the skin. 00:22:54.439 --> 00:22:59.156 So we can see sclerosis in the sclera of the eyes. 00:22:59.156 --> 00:23:17.015 We can also see lipomas, often around the eye area but sometimes elsewhere on the body, and they're just, you know, technically a tumor, but they are basically just fatty tissue, so fat coming out of your body because it's not coming out through the gallbladder, where it's meant to come out. 00:23:17.015 --> 00:23:19.439 They would be sort of the main ones. 00:23:19.439 --> 00:23:25.401 There are other things like often, you know, chemical sensitivity, alcohol sensitivity. 00:23:26.182 --> 00:23:31.593 We can see on blood tests bilirubin being elevated, alp being elevated. 00:23:31.593 --> 00:23:43.249 You

know there's a few other bits and pieces that we can sort of see occurring clinically speaking and I will go over all of that inside the webinar for clinicians that will be attending. 00:23:43.249 --> 00:24:01.807 But you know, if you've noticed that maybe your liver enzymes a little bit wonky, but there's no other real reason or your bilirubins, you know, over 10, I know that the reference range is a bit more generous than that, but anything over 10 to me would be, you know, indicative of some sort of sluggishness. 00:24:01.807 --> 00:24:09.651 And you know, these types of signs appear decades before you end up with, you know, in the emergency room with a gallstone attack. 00:24:09.651 --> 00:24:18.013 So you know, I certainly, as a clinician, wouldn't be allowing a client to write that off as acceptable. 00:24:19.568 --> 00:24:26.758 No, no, but With regards to bilirubin and raised amino sorry, alt, wasn't it? 00:24:28.046 --> 00:24:28.586 Well, actually. 00:24:28.666 --> 00:24:29.308 AST and. 00:24:29.348 --> 00:24:32.797 ALT, but also, yeah, alkaline phosphatase too, yeah. 00:24:33.218 --> 00:24:36.672 Right so, with regards to raised LFTs, right. 00:24:36.672 --> 00:24:41.173 So is that early or late stage, like how early can we pick this up? 00:24:42.945 --> 00:24:55.848 Look, it really depends because, as you know, you know it's not one variable that tends to be driving it, and so you know, if there is toxic in accumulation, would we see LFTs go up first and bilirubin come later? 00:24:55.848 --> 00:25:03.691 Sure, but sometimes I see LFTs looking fine but bilirubin starting to sneak up to 12, 13, 15, 16. 00:25:03.691 --> 00:25:08.972 And they're not having jaundice symptoms yet, they're not having light-coloured urine yet. 00:25:08.972 --> 00:25:17.515 But that, to me, is a sign that there is difficulty with elimination, which, of course, is predominantly through the bile. 00:25:19.086 --> 00:25:20.964 Yeah, so unconjugated bilirubin. 00:25:20.964 --> 00:25:25.954 Okay, and I'm just trying to think about patient pictures here. 00:25:25.954 --> 00:25:35.517 So when we're thinking about therapies, uh, how, how heroic do we start off here? 00:25:35.557 --> 00:25:56.712 do we go gently, gently or do you go, nah, let's go bullet a gate well, if you would like all the juicy details, you can come to the webinar, but what I would say is you do want to take a very systematic and considered approach, because the last thing we want to do is trigger a gallbladder attack, and I know there's a lot of. 00:25:56.712 --> 00:26:05.211 You know, gallbladder flushes online, but for every person who's found that helpful, I know someone else who that triggered a trip to the emergency department. 00:26:05.211 --> 00:26:17.935 So, again, if you're not in acute pain but you've got grumbling pain, or maybe you've got some of these earlier signs, and perhaps you're going to go have an ultrasound and just see what's happening and you discover something, but you're asymptomatic. 00:26:17.935 --> 00:26:42.790 Really, you actually want to start with the gut, because 25% of all detox starts there and any gastrointestinal inflammation down regulates detoxification in the liver, and so you can't really come from a liver or a top-down approach if you haven't already done some gut work and support and, given the state of most people's guts, skipping that part wouldn't be advisable. 00:26:42.790 --> 00:26:48.211 Even though it feels like an extra step and maybe not such a necessary one, I really do think it is. 00:26:48.211 --> 00:26:59.500 And then, from there, withdrawing anything alongside that, withdrawing anything that's contributing to toxic body burden inflammation. 00:27:00.984 --> 00:27:15.407 You know, for some people these issues can actually arise because they don't eat enough fat, because fat actually stimulates the gallbladder to contract, and so you know, if someone's on not eating enough fat, increasing dietary fat to start moving the gallbladder along. 00:27:15.407 --> 00:27:28.848 There is a lot around the autonomic nervous system and the vagus nerve and how that splenic branch actually operates, and so you know, is there anything structurally a chiropractor needs to address through the thoracics? 00:27:28.848 --> 00:27:32.297 Is it a nervous system communication problem? 00:27:32.297 --> 00:27:38.965 Is it that they lack, you know, bitters in their diet, because that's a primary stimulant of the gallbladder as well. 00:27:38.965 --> 00:27:55.051 You know there's so many moving pieces that you want to take a holistic approach, but I would also be including if stones have been identified, or I'd actually be encouraging clients to ask for an ultrasound to see whether they have them or whether it's just viscous bile. 00:27:55.051 --> 00:28:04.648 I would then be applying things that help to dissolve the gallstones before we do anything to try and stimulate the gallbladder to eject its contents. 00:28:06.292 --> 00:28:11.836 So I know we don't want to give too much away because of the seminar, but can you give us a couple of hints and tips here? 00:28:11.836 --> 00:28:16.596 So we've got things like, for instance well, we've got things like the. 00:28:16.596 --> 00:28:23.750 There's the cholesterol triad, where you look at the level of cholesterol, the amount of lecithins and the amount of gall, gall salt, bile salts. 00:28:23.750 --> 00:28:43.019 So we can do certain simple things there, like lecithins and taurine and vitamin E, tocotrienols, what else Well, I mentioned bitters, so bitters and dietary fat help to stimulate the gallbladder. 00:28:43.625 --> 00:28:54.730 So, you know, even just really gentle things like lemon juice and water, or apple cider vinegar and water before foods, increasing your bit of green vegetable intake would be helpful. 00:28:54.730 --> 00:29:01.128 We know that dietary lecithin and choline helps to emulsify those crystals. 00:29:01.128 --> 00:29:04.296 What else would I

consider? 00:29:04.296 --> 00:29:07.583 I also be make checking someone's fiber intake. 00:29:07.583 --> 00:29:29.369 We know that only one and a half percent of australians eat the recommended amount of fruit and vegetables, and so whilst we're all meant to be getting around 30 grams of fiber a day, most people are getting roughly 9 to 12 grams, and then what we're seeing there is reabsorption of a lot of these things back into the liver, which is kind of double handling everything. 00:29:29.369 --> 00:29:37.056 So you know these things sound kind of flimsy and weak in the face of, you know, say, a gallstone attack. 00:29:37.056 --> 00:29:59.699 But these can all be, you know, contributors to, or the absence of them, contributors to why you ended up with, you know, a sluggish gallbladder, obviously for women, especially making sure they're not being exposed to endocrine disrupting chemicals, in particular xenoestrogens, making sure estrogen metabolism is operating as designed um supporting gut health, of course. 00:29:59.838 --> 00:30:09.612 And then there are bitter herbs that a herbalist might use Dandelion roots are really popular one, and certainly you can get dandelion root tea from the supermarket. 00:30:09.612 --> 00:30:14.153 But herbalists might call on things like gentian or globe artichoke. 00:30:14.153 --> 00:30:24.048 But again, those things you wouldn't touch until you knew there weren't gallstones or that they were small enough that they could be passed safely from the common bile duct. 00:30:24.048 --> 00:30:30.010 And you would use other manual therapies to help with that, like lymphatic drainage, castor oil packs. 00:30:30.010 --> 00:30:37.614 Um you know, enemas might be called upon as well okay, you know one herb that I. 00:30:37.775 --> 00:30:46.699 I totally take your point about confirming without a doubt that their gallstones are less than I had the cut off at one centimetre. 00:30:46.699 --> 00:30:53.413 So anything over a centimetre I wouldn't touch Goff, See ya, but particularly if it was gravel or sludge. 00:30:53.413 --> 00:31:00.674 But they were getting contraction pain, that sort of griping pain after meals, particularly a fatty meal. 00:31:00.674 --> 00:31:03.894 I used to love the use of wild yam. 00:31:03.894 --> 00:31:08.394 You know it was popularised back in the day. 00:31:08.394 --> 00:31:11.595 It was popularised as a sort of phytoestrogen. 00:31:11.595 --> 00:31:16.375 I used to use it for liver because it's a smooth muscle relaxant. 00:31:16.375 --> 00:31:19.172 It was brilliant yeah beautiful. 00:31:19.211 --> 00:31:19.712 I loved it. 00:31:20.173 --> 00:31:20.796 It's fantastic. 00:31:21.096 --> 00:31:31.000 Yeah, so any time you were doing some sort of active flushing or gallbladder stimulation, something like that would be imperative to use alongside that. 00:31:31.000 --> 00:31:39.846 And certainly you know there are essential oils like caraway and peppermint that also can relax smooth muscle that you could consider. 00:31:39.846 --> 00:31:51.549 So you know, as you can see, it does require a very coordinated and holistic approach and sort of in the right order as well, to avoid causing more problems. 00:31:52.954 --> 00:31:55.948 Beautiful Amy look forward to this seminar as usual. 00:31:55.948 --> 00:32:05.189 I know it's going to be comprehensive, but thank you so much for taking us through just some of the finer points, some of the more practical points of where we can help patients today. 00:32:05.189 --> 00:32:05.971 Thanks so much. 00:32:06.553 --> 00:32:07.757 Yeah, thanks, andrew. 00:32:08.945 --> 00:32:10.794 And thank you everyone for joining us today. 00:32:10.794 --> 00:32:16.192 Remember we'll have all the show notes and every other podcast up on Designs for Health website. 00:32:16.192 --> 00:32:17.496 I'm Andrew Whitfield-Cook. 00:32:17.496 --> 00:32:19.151 This is Wellness by Designs.