Comprehensive Guide to Gallbladder Health and Enzyme Support

So hello, good afternoon everyone. Um, thank you for joining us for today's bunch webinar. My name is Alma Ahmed. I

will be your host for today. And before we start, like always, I just want to go through some housekeeping. So the

webinar is recorded and I've just double checked. Um, it will be available from the band website along with the slides

in in a couple of days. So you will be able to watch it again. Um if you do have any uh questions please

do type them in the Q&A box or chat box and we will go through them at the end uh of today's presentation. So today's

education is provided by enzyme science um in collaboration with band and our presenter today is our beloved Ila

Elmudin. Um Leila is a practicing naturopath, head of education for enzyme science UK and Europe, contributing

editor to Iken and director of digestive research group. So um in today's webinar, Leila will be exploring all

things related to gallbladder health and the enzymes that can be used to support clients with gallbladder problems. So

the gallbladder plays a significant role in digestive, hormonal and cardiovascular health. And people with

history of gallstones, gallbladder sludge, missing gallbladder, um bile reflux or reactions to um oxalates can

indicate a fat digestion issues. And other people can present with cholesterol imbalance, hormonal

dysregulation, energy problems and appetite issues. So we will learn all about that in today's presentation. And

um once again, Ila, please welcome. >> Thank you, Alma. Um and thank you for joining me everybody on this uh typical

uh British summer day. Um so if you don't know about Enzyme Science, Enzyme Science is the practitioner arm of a

consumer brand called Enzyica. Um they're a multi-awward-winning global brand who have been creating enzyme

products uh for about 24 25 years by now. Um everything is vegan, veget and vegetarian in origin. So we have no

animal products and no animal testing, no artificial fillers, no artificial binders. And everything that we claim

about the products are verified by a third party that that have nothing to do with us. Um so if you want a really good

efficacious enzyme product, uh check out the range um and contact us with any enzyme questions.

So in our range we have like maybe 30 different enzyme products and the most common question is the most common

interaction I get from practitioners is my client has X or Y and I'm confused as to which of your uh enzyme products are

most relevant for this person. Um so for gallbladder I would say that our superstar product is lipoimize which

basically replaces the digestive activity of the gallbladder. So if a person has a gallbladder problem and

subsequently a fat digestion problem then they will need a lipase enzyme. Um and alongside that we have a really good

mucus support uh product called enzyme defense pro. So this is to uh thin mucus and make healthier mucus which of course

is very important in gallbladder very important in lung tissue and things like that very important in the nose. So I

would say for gallbladder that's a really good pick. Um, and then for motility issues, we have uh this GI

motility complex, which both stimulates the if you take it on an empty stomach, it stimulates the migrating motor

complex and it's really good at also stimulating uh the gallbladder as well. Um, and then for just generic digestive

support, we have Digest Gold, which is basically uh assisting a person with digesting or all of the food groups as

long as they're eating like a normal amount of everything and they're not on a particular type of diet such as keto

or vegan. Now what is our gallbladder rescue toolkit? So when we're working with

clients and they come in and they're expressing kind of like a symptomology that we suspect is to do with the

gallbladder then what what is our kind of you know kit here. So I would say that if you identify that your client

needs support with bile flow. So this is like a sludgy gallbladder sluggish digestion. There may be uh contributing

factors to the sluggishness. So for example, they might have an underactive thyroid or they might have be following

a low-fat diet or something like that. Then we want to support them with bile flow. And for that we can use

phospatidal choline, things like tudka, lethosine, torine, glycine, we can use bitters and then in the enzyme science

range we could use our enzyme defense product for thinning the mucus that tends to accumulate in an unhappy

gallbladder. And then we can use GI motility as well. Now, if we're suspecting a blockage that there's some

kind of blockage going on with our client, then we want to thin we want to thin the mucus. We want to thin mucus

and we want to kind of stimulate uh kind of the flow in a kind of different way and we want to be very anti-inflammatory

in what we do. So for that we can use things like milk thistle, artichoke, ginger is is very very good. Now for

some people with gallbladder problems and gallbladder flow problems, it's not actually the gallbladder or the biliary

tree. It's more the sphincta. So the sphincter of bodi which I'm going to go through in a moment but the sphincter of

bodi is essentially the valve that lets bile into the giodinum. So when a person consumes a fatty meal they release a

hormone that will contract the gallbladder and then the sphincta has to dilate to release the the bile. And so

we see these kind of sphincta s sphincta problems uh in people who have had a gallbladder removal and they continue to

have symptoms and for that we can use things like lavender oil with meals and that will relax the kind of sphincter

robodi and further support flow and then we can use things like magnesium to things like that to help them. Now with

the enzymes we're talking about specifically fat digestion. So uh if a person is not digesting fat as a

consequence of whatever is going on with their gallbladder, so they might have gall stones, they might have sludgy

bile, they might have gallbladder removal or something like that, then they probably won't be digesting fats

and that will manifest itself as like kind of floaty, greasy stools, sometimes there's something like um constipation

or something like that. They're just not absorbing that fat and that will of course manifest in lots of different fat

deficiencies. And for that we would give an enzyme. So we would give a lipase high lipase enzyme in our range it's

called lipo optimize and we would give that with every single meal. Now when we're talking about kind of

malabsorption. So when we're talking about bile acid malabsorption. So this could be either the liver is producing

too much bile there's a missing gallbladder there's hyper secretion something is affecting the way that the

person absorbs bile. Then we want to go in with bile acid sequesterance. So these are basically um things that

absorb the bile and then so so it can't be continuously recycled. So these is things tends to be like very fibrous

things. So chan is a very effective fiber for that. Pectin, apple pectin, psyllium husk oats. Um anything that's

good for lowering cholesterol is really good for sequestering bile. So when when we're talking about bile acidic

malabsorption, we're not talking about uh facilitating fat digestion. we're more kind of mopping up the the bile and

making sure that it doesn't hang around for too long to erode the intestinal tract. And then we have uh people who

are suffering with stones. So there isn't a lot of really good evidence on kind of natural interventions for

stones, but there is kind of anecdotal anecdotal evidence that supporting with B flow from column one and helping them

with like kind of citric acid, vitamin C is tends to be can be helpful, but really stones are a result of too much

cholesterol. So there's oversaturation of cholesterol in the bile and that's creating uh that's creating the stones.

So I would say it's worth giving it a shot. So you might be able to minimize pain or help the person a little bit.

But I would say if somebody has uh is is coming to you and they have gallstones and they're having corresponding

terrible symptoms, then probably there's very little that we can do supplementally to my knowledge at that

stage. But just as an aside, um these things are really really good for kidney stones. So for kidney stones, there's a

hell of a lot we can do, but for bile gallbladder stones, it's much much more challenging.

So when we're talking about the bile the gallbladder, what we're essentially talking about is the body's backup

digestion mechanism. So the whole purpose of bile is to help us to digest and absorb fats. Now it the bile doesn't

do this on its own. It activates a sequence of events that leads to fat digestion. And without bile, we see all

kinds of fat deficiencies. So we will see difficulty in absorbing omega-3s and things like that. Now um when we don't

absorb fats we get kind of fatty stools, sticky stools, things like that. Um and without our gallbladder we have no

excretion route for cholesterol because 50% of the liver's cholesterol is converted into bile. So bile is a

significant exit point for the body's cholesterol. So with people having gallbladder problems, we might see

hypipidmia. We might see derangement in blood triglycerides and cholesterols and

things like that. The bile is also very very alkaline in its nature and that is very important because when when acidic

chime comes into the giodinum from the stomach we have the pancreatic release of bicarbonate of soda which alkalizes

that that acidic chime and then we have gallbladder contraction which further alkalizes that acidic chime and we need

the chime to be alkalized for our digestive enzymes to work. So whenever we swallow a meal we have um we have

acidic chime and then we have a sequence of events of digestive enzyme uh release and activation. So we have pancreatic

enzymes, we have brush border enzymes and then we have all sorts of enzyme activation going on which is all

coordinated by pH. So if the giodinum is too acidic we get uh problems and if it's not alkaline enough we get problems

and so on and so forth. Bile is also incredibly bacteriaidal. So what if we swallow a meal and we don't have good

stomach acid, we have this kind of secondary defense mechanism in the form of pancreatic proteases which the

bacteria have to survive and then they have to survive bile acid. So so it's a it's part of our innate antimicrobial

defense system. So when we have a problem with the gallbladder, we therefore have f problems with fat

digestion, general digestive enzyme activation, blood lipids

and uh easy opportunities for bacteria to enter to where they don't want to enter. So sluggish bile flow or

gallstones can arise when there is an imbalance in the composition of bile or bile releases compromised. So when we're

supporting people with their gallbladder, we want to from a therapeutic angle, we want to improve

flow and we want to improve bile quality. And those are our two kind of therapeutic goals. And when we can do

those things, we will restore the person's healthy gallbladder functioning. And that process can take

around about two months. So while we're working on the underlying factors that are leading to a sluggish gallbladder or

a stony gallbladder or gallbladder colleague or anything like that, we want to symptomatically help our client

digest fats. And we can do that very easily with enzymes while we work on the underlying mechanisms that have led to

to where they're going. Oh, okay. So you can hear me. Excellent. Okay. So so what are the processes that

we're we're talking about here? So when we're talking about lipotropics, we're essentially talking about supplemental

products that we can use to help escort fat out of the liver. So when we're talking about lipotropics like choline,

inosol and things like that, we're talking about fatty liver. So that doesn't really have a lot to do with

bile. So if somebody has a fatty liver, it's got very little very little to do with the gallbladder and very little to

do with bile. Now when we're talking about bile itself, we want a good quality of bile and we want to enable

the conversion of bile to bile acid. So the liver secretes bile and then it undergoes something called conjugation

whereby the bile is converted to bile acid and that bile acid is what's in our gallbladder. Bile acid is infinitely

more potent at um in terms of alkalinity and it's infinitely better at digesting fats. So we want bile acid in the

gallbladder rather than bile and we do that with torine and glycine. So if we're working to improve a p the quality

of a person's bile then giving them things like torine and glycine is very very helpful. Now that bile has to then

flow through the canaliculi. I don't know if I'm saying that word right, but it's basically a little canal that uh

where the bile goes under goes further conversion to become more effective. And the way and the way that the the bilary

tree does that is that it takes phospatidal choline from liver cells. So our liver cells contain phosphatidal

choline and as bile is traveling through it donates phospatidal choline to thin the bile and make it flow more more

freely. So another really good thing we can do to enable bile flow is to give phosphatidal choline. So when we're

talking about sludgy bile, thick bile, poor bile release, we phosphotidal choline is a really really good

intervention. Now uh when it comes to the giodinum, the bile is going to go through this

biliary tree. So this is called the biliary tree and then it's going to be uh released by this sphincter of odi. So

what can happen in some people is that they could get a blockage. They could get stones in any part of this canal.

Um, but usually if they're having an issue with digesting fats and they're having an issue with flow overall, we

need to somehow be able to relax that sphincta. And that sphincta relaxes in the presence of lavender oil. And also

some studies say that magnesium can be helpful, but I find lavender oil like 80 milligrams is really good. Now one of

the other contributing factors to all bile pro gallbladder problems so this is stones sludgy bile things like that is

the mucus. So we might want a nice thin mucus because thickened mucus in the gallbladder will increase stone risk. So

the thicker and stickier the mucus the thick the higher the likelihood of things sticking and coagulating and

turning into stones. Now one other thing we need to be uh mindful of when we're working with people who are presenting

with any kind of gallbladder problem or any consequence of a gallbladder problem is that bile is bile release is

triggered by CCK which is only triggered by protein and fat. So if the client is uh you know vegan or vegetarian or

something like that then they could end up developing a a bile acid bile problem or a gallbladder problem if they're not

consuming enough protein and enough fat. So that's another kind of contributing factor to de developing a gallbladder

problem. Now once bile exits from the gallbladder. So we're here. So we get dietary fats or protein and we eat we

consume our fats in kind of like a complete form. So we can in a triglyceride. So it's a kind of chain of

fatty acids that are all stitched together into what we refer to as fat. So once that's registered in the

stomach, we get CCK release from the giodinum and that contracts the gallbladder. So the gallbladder knows,

oh, there's fat, there's protein, we're going to need bile. And it stimulates this contraction. Now that contraction

corresponds with pancreatic enzyme secretion. So we get, you know, protein, lipase enzyme, and amalayise enzyme

coming from the pancreas and then we get gallbladder contractions and this happens very slowly. So it's we get a

drip of chime contraction contraction and it goes all the way through. Now what that gallbladder secretion is doing

is that it's emulsifying the fat fat. So what that means is it takes a a go g goule of oil and it kind of unfolds it

to increase the surface area and then that surface area is then attacked by enzymes and the enzymes that are used

are collipes which is secreted from the pancreas and lipes. So bear with me. I know it's very very confusing. So when

we get this gallbladder contraction, what happens is lipes and collipes come together to break down the fat and then

release free fatty acids which then could be absorbed. So there should really be no fats in store. There should

not be any shiny stool. There should not be any floating stall and things like that. Now once those free fatty acids

are absorbed, bile acids are reabsorbed in the latter part of the small intestine and they go back to the liver

and this goes on and on in a nice little uh cycle. Now every single beneficial oil relies on this process to be

absorbed and I've written a list of all the beneficial oils that rely on this on this process to be absorbed. So if a

person is having a difficulty with their gallbladder or they're having a difficulty with bile secretion or

they're having a difficulty with their sphincter bodi all of the things that we do to help them for example all the

anti-inflammatory things we do all the hormonal balancing things we do is not going to work. So they're going to be

having all of these beneficial oils and those beneficial oils will just be excreted in their store instead of going

and doing all the lovely things that we're trying to deliver to our client. So the big takeaway is where there's a

gallbladder problem there's highly likely to be a fat digesting problem and wherever there is a fat digesting

problem we can just simply in the early stage just give the client lipase enzyme and we temporarily alleviate that

problem while we work on the underlying drivers. So all sorts of things can affect the

gallbladder. Um and I think the things that we we're likely to see the most of is weight loss. So if somebody rapidly

loses weight and this is I'm thinking about all thesempic people. If somebody's rapidly losing weight there's

more cholesterol. More cholesterol means more cholesterol going into bile which means pressure into the gallbladder

which means sludge and thickening and things like that. Um there is a strong risk of uh gallbladder issues if

somebody's hypothyroid. So because there's a slowing down of motility and that slowdown will then result in um

sphincta issues and things like that. And then of course we have like all the typical things any kind of hormonal

imbalance obesity everything tends to put people at risk for gallbladder issues but in my experience in my

practice it's classically weight loss hypothyroidism and a lot of people who have um been diagnosed with reflux but

actually they have a gallbladder issue. So they're having a bile acid reflux rather than a different type of rather

than acid reflux. So we can change bile composition. So if you wanted to really go away and screw

up your bile composition, um eat bad foods, uh live on carbohydrates, don't address uh constipation and things like

that. Um it tends to run in families. So bile problems, gallbladder problems can run in families. And of course,

metabolic dysfunction, cardiovascular disease, hormone imbalances, stress, all of these things increase stress on the

gallbladder. So, um, just as any other part of the body, if we're not taking good care of it, and if we're not

mindful of it, then we can end up with a problem. And I see, uh, mo most of the time, it's in my practice, it's really,

um, hormonally driven. It's hormonally driven and weight loss driven. So, we can decrease bar flow. So the

gallbladder needs to empty frequently and if it doesn't empty frequently we get stasis, we get stagnancy. And just

the same way that you will get kind of um exudate and horrible things building up in like a glass if you imagine a

glass of water that's been left alone for you know a month. It's going to be it's going to coagulate. It's going to

have a lot of waste product in it. It's not going to look the same. It's going to leave kind of like staining on the

glass. And the gallbladder is exactly the same. So if we're never ever emptying the gallbladder, we increase

the risk of gallstones and it becomes overly concentrated in cholesterol and things like that. Now how do we empty

the gallbladder? We empty it with dietary fat and dietary protein. So we need to make sure that our clients are

having fat and protein with every single meal to continuously stimulate that bile flow so that there's no opportunity for

stagnancy and things like that. Um there are medications that can affect bowel flow but I find more common is uh

imbalances in sex hormones. So estrogen progesterone. So we get a lot of gallbladder pregnant females for example

and things like that. So uh progesterone slows everything down. Estrogen increases pressure in the gallbladder.

So all of these things can affect the bile duct and eventually lead to decreased bile secretion.

um insufficient stomach acid can contribute because if somebody has low stomach acid then they're not going to

be uh triggering uh CCK in the same way they're not going to have good acidity when chime comes into the geodenum and

also they're not going to have the uh amino acids in the chime that are going to be triggering all of these signaling

and then if they have a food sensitivity or something like celiac disease the localized inflammation can indirectly

contribute to delayed gallbladder emptying blah blah blah. Okay, so I'm just going

to answer these questions as we go through. So, lavender oil 80 milligrams in a capsule with meals or after a meal,

but I give my clients 80 milligrams with meals. Um, and that's that's very very effective. That's really really good.

Um, so enzyme defense pro as a mucalytic. Would it be useful for moving mucus off the lungs? Yes, very very much

so. Very very much so. It's very very good for all of those kinds of things. Nasal passages, soft tissues. Do statins

impact bile production? Um, statins could impact bile production, but as statins lower cholesterol and as bile is

um an exit route for cholesterol, I don't think that statins could affect bile and gallbladder in a negative way.

But there is a correlation between uh not having a gallbladder and then consequently having high cholesterol.

And there is a correlation between uh gallbladder removal and all all types of cardiovascular disease. So statins are

reducing cholesterol and bile is reducing cholesterol. So I don't think statins would reduce bile production.

No, because the liver does continuously produce bile. Um it's just that it's an exit route for the available cholesterol

and we need cholesterol for all sorts of things. So every single sex hormone began as a a cholesterol. So um there's

no shortage of cholesterol that the liver liver can synthesize. Um so what what factors affect CCK

production? So CCK is released when we swallow a meal and it's released by the giodinum in response to the contents of

the stomach. So longchain fatty acids will provide the strongest stimulation. So that means the stronger we stimulate

CCK, the stronger the contraction of the gallbladder. So we want so if we're trying to encourage bile flow and things

like that then longchain fatty acid foods are a really good way to go. Proteins and peptides provide a strong

stimulation but not as much as fats and carbohydrates minimal. So and larger meals as well. So

we want to make sure if when we're working with clients with gallbladder problems so if they have a gall stone

for example then we may not want to stimulate boil because we don't want to displace the stone. Whereas if somebody

is just having kind of like a sludgy a sludgy bile then we may want to uh stimulate bile bile secretion to clear

clear away the sludge and thin it and and get it flowing more healthily. So when we know how to stimulate

gallbladder contraction and how not to then we can use that information therapeutically depending on the

presentation of the client. And I would say that when the client has recently lost their gallbladder or when the

client um has stones and you know it's is getting to a stage where they're getting you know frequent collic and

things like that then we don't want to stimulate the gallbladder because we might dislodge dislodge and displace

things and create a lot of pain and inflammation. Now what do hormones have to do with it? So high levels of

estrogen and progesterone can lead to a reduced motility. Um and cholesterol gallstones are more common in pregnant

ladies. Um when a client is hypothyroid, we get sluggishness all throughout the digestive tract. So people with

hypothyroid, they might be constipated. They might have a very slow dig digestion. They won't be responding to

satiety signals. So they might find themselves very very hungry all the time. And of course that that will

affect whatever affects motility will also affect gallbladder motility. Um, and I see this a lot in hypothyroidism.

A lot of constipated ladies with hypothyroid. Um, hormonal changes. So, this could be

that the client is taking a uh, you know, contraceptive medication or something like that. Um, they might have

high progesterone because they're supplementing with progesterone. I have a lot of kind of 40year-old clients who

have read online that progesterone is really good for pmenopause and things like that and then they haven't really

consulted with anyone and they're taking progesterone and subsequently reducing gallbladder contraction and gut

motility. Um insulin resistance is bad for everything uh including bile composition and further increases the

risk of stones. Obesity the same and gallbladder motility. So wherever there's a gallbladder problem, we get

the bile stasis problem. And if the person is undergoing rapid weight loss, then there is a heavy release of

cholesterol into the bile and that can over pressure the gallbladder and then that could lead to a blockage or a stone

or something like that. So I'm just going to check the Q&A. Um, how does the citric acid work? Um,

so how does the citric acid work? So stones in the kidney and in the gallbladder

um are very very spiky. They're very jaggedy and it's those jagged edges that pierce and create pain and create

inflammation. So in the kidneys, the citric acid kind of blunts those sharp edges. So instead of having like a spiky

icicle type of stone, you get more of a a blunted stone. Now I haven't seen it work in the gallbladder. I haven't

experienced it directly myself but I have seen it work um with kidney stones because if you're taking citric acid of

course it's going through through your water system through your kidney so I can understand the mechanism there

however anecdotally when I'm talking to other practitioners about what they do for gallstones and gallbladders and

things like that citric acid is mentioned quite a lot um please expand of no gallbladder and increase in

cardiovascular disease yes so cholesterol the higher a person's cholesterol the less nitric oxy oxide

the endothelium increas creates. Right? So in our blood vessels, our blood vessels are very similar to the gut.

Think of the blood vessel as a gut and just as the gut has a mucous defense layer. So too does the endothelium of

our arteries and things like that have defense layer. Now one of the defenses is that they produce nitric oxide. So

when blood pressure goes up the the blood vessel dilates and when nitric oxide goes down it contracts again. And

we need nice stress stretchy dilating blood vessels for cardiovascular health. So as cholesterol goes up, we get a

decrease in natural nitric oxide production. And of course, that can increase all forms of cardiovascular

disease. So it's not so much the HDL cholesterol, but it's the VLDL cholesterol and the LDL cholesterol and

things like that. So if the body has no exit route for cholesterol, I mean you can facilitate the exit of cholesterol

with fiber, good diet exercise and things like that, but if a person is doing nothing at all and they have no

gallbladder, then their risk of cardiovascular instance are tremendously increased because there's no exit route

at all for all of that excessive blood lipids, triglycerides, and cholesterol. Um, could supporting bar production help

reduce cholesterol? 100%. Yes. So I would say to reduce cholesterol, you support bile production, you support

bile flow and you combine it with fiber. So bile, it's like a little formula. Bile plus fiber equals cholesterol

reduction. And of course, you know, you have to be mindful of the diet and things like that, but high fiber diets

have a really good evidence on on referring on um reducing cholesterol. Are you able to expand on how hormonal

changes around menopause affects gallbladder health? So I think around menopause we have just this massive

slowing down of every single part of the digestive system including motility. So uh so it's it's a motility thing that's

being affected by hormonal changes. And you'll also see this in women around the time of menop uh of period and things

like that. So they will have some women are constipated in the five days leadup. Some women are have diarrhea in the 5

days leadup because progesterone and estrogen are affecting motility. Um so progesterone slows down motility. Uh

estro high estrogen will affect motility as well. Um and so if we have no motility we have no flow and if we have

no flow we get stasis. And when we have stasis we have the opportunity for stones and infections and all sorts of

things that go on with the gallbladder. Uh Anna that's absolutely fine. I hope you don't mind me doing it in this way.

I just find it more effective. Um, Sylvia is asking, "What would you suggest for a client with hypothyroidism

suffering constipation?" Yes, that's a really difficult one and I've got a case study coming up on that.

So, with hypothyroidism and constipation, I do all of the fibers and I do all of the bile stuff. So, I ju

just flow anything that helps motility, anything that helps flow. But I find with hypothyroidism, it's a bit like

going up against um going up a cliff with motility. So I would just adjust the diet, give and I've got a client

that I'm going to talk about in a moment. Um and um definitely focus on the gallbladder. How do you know if

there's sludgy bile? So you know that they're sludgy bile because the person will experience kind of like a a bit of

collic. So they might report a pain. They might have difficulty with digesting fat. So, your client will come

to you with a shiny shiny stall, sticky stool, stall that kind of like grabs onto the side of the toilet, things like

that. And then you will know um that there is a fat issue. And then by asking them, you can narrow down what's leading

to that fat issue. And often it's something to do with the gallbladder. And if they're not having pain yet, then

probably something like sludgy bile. And also a consequence of that will be kind of like hormonal imbalances and things

like that. Okay. Um, how many attacks of bilary colleague per year would you consider

the guide for removal of the gallbladder? Oh, I've got no idea. I would say I

would say I would be totally guessing, Virginia. I don't know. But I would say that if somebody had one attack of a

biliary collic, I would get them investigated and then according to what they see in the scans and subsequent

investigations, they would decide from there. But I would refer relatively quickly. Um, and in the background, I

would do all of the gallbladdery things to help. Um I haven't mentioned gallbladder polyp and I won't mention

gallbladder polyp but if you uh email me I can I can respond directly. So a client who just came off mangaro

difficult to digest food. Yep. Yep. Stubbing pain in gallbladder regions with undigested food as well. Yeah. So,

Mangaro is um activating the satiety receptors that are supposed to be activated only for 30 minutes after a

meal and the jabs are activating them for one entire week and the subsequent what's happening there is that

everything that the body is releasing is not going to where it should go. So, pancreatic enzymes are not going into

the geodenum because there's no motility, right? So how do fluids get through the body? Through motility. So

when you have something like mangaro, you press the brake pedal on motility. So pancreatic enzymes don't get to the

giodinum. They're stuck. There's a traffic jam and they start to digest the pancreas. And gallbladder fluids don't

get to the giodinum. So they stick around and then you get stasis and things like that. So I would um wean

somebody off Mangjaro and give them all the support with motility and definitely in gallbladder as well but I would do it

very very gently. So for for this person I would start with just lavender oil see how they respond and then go into

phosphotidal choline and see how they respond and then and then take it from there. But yeah there's so so many of

it. Um so you can give all of these things to somebody who is pregnant. So the question is how would you support

kolostasis in pregnancy? Everything that you can do for a non-pregant person, so phosphotidal, choline, tudka, lipase,

enzymes, etc., etc., you can give all of those to pregnant people. There are no contraindications or negative

consequences from that. Um, why do people with gallbladder issues get itchy skin? So, that's the buildup of Billy

Rubin. So, it's a buildup of bile that's being leaked into the tissues. Um, they might also get an itchy anus and things

like that. So, um, that's why so the g the bile has nowhere to go. the b bar bile flow is not working properly.

Sometimes the bile goes upwards and the person gets reflux. Sometimes it goes downwards and they get um itchy and

things like that. So that's why people with gallbladder issues get itchy skin because bile is very very coic.

Um I what are your thoughts on GB and liver flushes? I hate them with a passion. Um and I am adamantly against

them particularly gallbladder liver flush. Okay. You know not not too bad. Not not too much danger, not too much

damage. But to do a gallbladder flush, I think you're a little bit playing with fire because you can move stone. So

somebody might have a gallbladder stone and it's just sitting there causing no problems. And then once you really hyper

contract that gallbladder, you can move stone into the wrong place. You can push it into the caniculi. You can get it

into the sphincta. So I would add I'm adamantly against um gallbladder flushes. Don't don't do it. Um what test

would you recommend to assess comprehensive array of digestive enzymes? Um so fecal elastes is a marker

of pancreatic enzyme function. Uh but really you would go on symptoms. So you can't really the only way to measure

what enzymes are working inside a person would be to put some fluid into the giodinum take a sample and then analyze

it which is very very difficult. So I would say the biggest point the biggest red flags for a digestive enzyme issue

is the person is having a digestive symptom first of all and second of all that digestive symptom is linked to

something else. Okay, I will continue with my presentation. Thank you everybody. Great questions. Right, so

gallstones, what do we do? So, if somebody has a gall stone and they have like relatively small gallstones and

they're under the care of a medical professional, they are usually put on a UDCA. I'm not going to attempt to to uh

pronounce that word. And they're typically given a 12 month prescription. And over that time, the small

non-calcified cholesterol stones can be slowly dissolved. Now the issue is is that simp symptom sympto symptom-wise

there is a 50% recurrence. So even though they've gone through this process they will still get gallstones in about

5 years time. Half of them half of all people that have gallstones will be put on this prescription medication which

will do the job for them but then 50% of them will get the stones back and that's because they haven't uh adjusted their

diet and they're not doing the gallbladdery things. So what do we want to do? Uh we when these people come to

us, so if somebody has had gallstones or has a couple of gallstones, but they've said that they're not too bad and they

don't want to interfere too much. What we want to do is we want to improve bile composition, improve bile flow, support

fat digestion, that's the enzyme part, and we want to thin the mucus. So I thin mucus with enzymes, but you might have

already have your go-to things that you use to thin mucus. So, I like to use lipase enzyme for fat digestion and I

like to use enzymes for thinning mucus. But of course, if you have your go-to product or thing that you love to use,

then use it. Now, we want to thin mucus. We always want to thin mucus because when there is a sludess and coagulation

in the gallbladder, we get thickened mucus. and thickened mucus will capture more cholesterol crystals and make

stones worse, more, bigger, all of the terrible things that we want to avoid. So, we want to um always when you're

dealing with gallbladder problems, always think about mucus. And I think a lot of people forget about the mucus

element, but thin the mucus, support with fat digestion, improve bile flow, and improve composition. And this is

pretty much what you're doing for for most problems. So, sludgy bile. Um, so they'll have a cramp-like pain in the

right upper abdomen. So some people say, "My liver hurts." So they'll put they'll put their hand over the liver and they

say, "The liver hurts." And it will feel like they might say, "I feel like something's stabbing me or biting me."

And they might like physically flinch. Um, and it tends to happen when they eat fatty foods because fatty foods trigger

CCK, which triggers gallbladder contractions. Um, they might also the pain might radiate actually

interestingly to the back of their shoulder. So they might say the pain starts here. They might point to two

places or they might just only be feeling it in their shoulder, but it will be it will happen about 30 minutes

after they eat something something fatty. Um and it can last for several hours because that sludge could be doing

anything. So it could just be uh it could be blocking ducks. It could be taking a long time to go through the

caniculi and things like this. Um, so for these people, we want to if if you're clear with your client, if you've

identified that the client possibly has a gallbladder problem and that their gallbladder is protesting,

um, then we can go ahead and improve bile composition, improve bile flow, support fat digestion, and thin the

mucus. So, all the same things, it's just the the differences in the the um order in which you do things and how

strong you go with the things that you're doing. So, if you're very very confident that all they have is a

gallbladder problem, then go go for it. You're not going to hurt your client. But if you think the person might also

have a different problem, they also have SIBO, they also have constipation, they also have heartburn, then you might want

to be a bit more careful about how you do it. But, you know, you know how to navigate your client. So, this was my

client. So, this lady came to me, a stunning lady. She was an aesthetician. Um, 42 years old, very, very healthy,

really good energy. Um but she was constipated and she didn't understand why. So she had sticky fatty stools. So

this was the flags that pointed me to gallbladder. So she had sticky fatty stalls. Her constipation did not improve

with fiber. And I was pretty confident she didn't have SIBO because she didn't have bloating. So she had bloating this

way. You know when your waist you kind of lose your waist and then there's bloating where you acquire a pregnancy

belly. So in the bloating where you lose your waist that's kind of like more large intestine. that's more like a

constipation impaction type of thing. And where the tummy pops out straight in the front, that's more small intestine.

So that's why you see your your SIBO kind of symptoms. So gave her loads and loads of fiber. Gave her loads of all my

favorite fibers and it didn't help her to have a bowel motion. So I was like, okay, that's very very unusual because

often sometimes psyllium husk works, sometimes it doesn't work, but you if you switch the fibers up, you tend to

find one that works with your client. and she was unresponsive to very very high doses of acacia fiber which is kind

of like my never fails fiber. Um she had low energy and when I was doing her case history I noticed that there was a lot

of oil in her life. So she's like she had this like super duper coffee in the morning with some coconut oil and then

she drank this water all day and she put loads of oils in it and things like that. Um but she was constipated and

when she when she did have a bowel motion it was sticky, shiny or floaty. So I was like, "Okay, so um tell me

about hormones." And she was using a progesterone cream. So she had an over-the-counter progesterone cream. It

looked very nice. It was very expensive. It was from Heath. And I asked her uh why are you taking progesterone? And she

told me that she had decided that she was in parmenopause and progesterone would be very very useful for her. So we

talked about kind of messing around with the progesterone. So, okay, let's let's have a look at your hormones and let's

have a look if you need progesterone um or if you're just slowing down your motility to a halt. And when we slow

down motility, we slow down all sorts of flow. So, anything that's supposed to flow will slow down when motility is

slowed down. And for her, I started her off with phosphotidylcholine. So, I said, "Take one phosphotidal choline in

the morning and instead of using laxatives or fibers, I want you to take vitamin C to bow tolerance." So, she

took kind of 2,000 milligrams of very cheap and cheerful vitamin C until she had a bowel motion. Um, and then I

started giving her lipo optimize uh with every meal and enzyme defense one a day. and over a period of 3 weeks. So we we

had a 3-week period where she was having a bowel motion like once every 4 days and then she had a bowel motion kind of

like once every two days and then eventually she was having a bowel motion every day until um she was G1. So the 3

days before her period she became constipated again and then once her period came she was back to normal. So

I'm still working with her but this is a kind of like a typical gallbladdery picture. um the person is doing all of

the right things, but the there's no motility, there's no movement, and it's presenting itself as constipation,

sticky stools, and constipation unresponsive to fiber. And it's definitely not something like um SIBO or

anything like that because there's no there's no popping out of the belly. The waist is disappearing. So, she wakes up

in the morning with a waist like this and by the evening her waist is like that. Um and a lot of your female

clients will will report these kinds of symptoms. Um so Lucille is asking what do I use to

thin mucus? I use an enzyme product called enzyme defense. You can also use a cerapeptase

uh nattokynise. So I use enzymes to thin mucus. That's my that's my go-to. Um Marjorie is asking if you have diarrhea

and gallstones which are in remission for myoma, what would you suggest? Um so I would want to know how recent it is.

Um and if I think the the diarrhea is a result of bile, I would use sequesterance. Um but if the diarrhea is

just diarrhea then I would go in with kind of like you know psyllium husk and things like that. Um and then have a

little look into what what part of the body is protesting here. So is the diarrhea in response to everything? Is

the diarrhea in response to fats? Is the diarrhea in response to proteins? Is there anything that changes the

diarrhea? But I find usually a short period of diarrhea will resolve by itself. But if it's constant and

continuous and I am worried about the gallbladder, I would be thinking about bile acid malabsorption and things like

that. And if there's malabsorption, then you're going with your sequesterance. So malabsorption, sequestrance, sludge,

thinners, flow agents, you know, things like that. So I've got it all on the on the earlier diagram and I think you will

get a copy of the slides. So bile acid reflux. So this is clients who are having reflux. So they and they

might use the word reflux. they might have gone to their GP about reflux. Um, but it's reflux that gets better if they

eat something. So, in acid reflux, the person is incredibly reactive to everything. But in bile acid reflux, the

person has a reflux when they're uh when they're not eating and they usually feel better when they consume something. And

that something that they consume is often high fiber. So, they will say, "I have a bit of banana and I feel better."

or I have a bit of a cracker and I feel better or I have plain white rice and I feel better. And that's because the

fiber is acting as a sequester kind of uh you know taking the bile so absorbing the bile so that the bile cannot reflux.

Um they might also have a lot of weight loss because they're not digesting any of their fats and things like that

because the bile is going in the in the wrong direction. Um and they might report like a metallic taste in their

mouth. And this is actually very very scary because a lot of these clients will go to their GP and they'll be

diagnosed with reflux and they'll be put on proton pump inhibitors and actually for the whole entire time the problem

had nothing to do with with acid and it was all to do with bile. So I've put together like a typical

protocol for what you would do with a bile acid reflux. But the key word here is we want to support flow. So we want

the bile to flow in the right direction and we do that by supporting the sphincters and things like that. So I

think for people with bile acid reflux we definitely want to support motility. We want to support flow. So that's your

phosphatidal choline, your tudka, your lavender oil. Um and for these people you might also want to consider putting

in sequesterance. So things that will kind of sequester the bile and any bile that is available is going in the right

direction and not going in the wrong wrong direction. Now these people will automatically start to avoid fats

because they have noticed that fats and oils and butters and avocados and things like that will make them feel much much

worse. So I do give them uh lipase enzyme lipo optimized with their meals. Once we've got their symptomology under

control and we're confident that it is bile acid reflux then we can move them on to expanding their diet and things

like that. And I always always support with a fat digesting enzyme which is lipo optimize. And then after that

you're you're you're pretty plain sailing. It's that initial period and dealing with the damage. And I have a

client like this actually just started working with me. She's on fire. Her chest is on fire. She's got gastritis as

a result of the bar reflux. She's got injury in her mouth as a result of the bar reflux. She's got, you know, she

can't hear in her ears. her nose is gone cuz she's being washed with bile acid when she goes to bed. And uh these

people just using lots and lots of different over-the-counter stuff and really what they're lacking is an

appropriate system. So if somebody has bile acid reflux, I've written out here kind of like a template of what you can

do. Um and it's basically a combination of all the things that we're talking about, but with a few extra little bits

here and there. Um so I saw this in real time with my with my client. So, this is a 52-year-old male who is possibly one

of the most loveliest men I've ever met in my life. He runs mental health gyms for young men in Morca. So, he uh runs

all of these gyms and he spends all of his life kind of helping young men and boys, particularly those that have grown

grown up without fathers. He gets them into sports. He gets them feeling good. He gets them talking about their

emotions, all sorts of things. And he suffered terribly with reflux for about 10 years. And over that period of time,

he was on increasing amounts of proton pump inhibitors. So if we if somebody's on a proton pump inhibitor, then are we

really getting the CCK release because the stomach doesn't know if there's fat in there or if there's protein in there.

So he had this severe burning kind of to tore up his throat. He could he couldn't get through the day without using

multiple kind of antaces proton pump inhibitors and he ended up on 80 milligrams of a metrosol for about 10

years. And that is shocking because I've only seen those kinds of dosages used for the eradication of H pylori and even

then it's a maximum of two week period. He ended up having surgery. They put him on proton pump inhibits for a short time

after surgery. Um and then he was back to normal and he had uh eight weeks of normality and then he started to get

severe gastrointestinal symptoms. So his gastrointestinal symptoms were very pro profound in response to fats and things

like that. And when he contacted me, I was like, "Okay, so there's lot lots and lots of things that could be going on."

But the fact that he still has reflux even though they've done surgery and all the rest of it means that maybe he had

bile acid reflux all of this time and it had nothing to do with acid. And then I thought maybe because of the loss of the

bacterioatic effect of the stomach, he might have some kind of hydrogen hydrogen sulfide SIBO. So he's now been

they've now discovered lesions on his on his esophagus and the results come back next week and I really hope it's not

anything terrible but in the interim went in with elemental diet to replace the lost calories stop the rapid weight

loss because that will just put further pressure on his gallbladder. Um put him on a vegetarian diet bismouth for

potential hydrogen sulfide tudka and 80 milligram lavender oil with meals. And what happened was all of his symptoms

went away except for the diarrhea which is less than it was before um and the heartburn

um but he still can't swallow and he's got these lesions on his esophagus. So we're waiting for those results. But it

just goes to show um how powerfully and how quickly very little interventions can can help help our clients.

So gallbladder removal, what about clients who have had gallbladder removal? So I'm just going to check the

Q&A before we move forward. Um, so Misha is asking if a client has SIBO or sus suspected SIBO with

constipation, what would be the sequence of treatment and when would you bring in the gallbladder and with what

supplements in and in what order? Okay, so in our members area I have written template protocols for most of the

things and with SIBO um, basically the SIBO is causing the constipation. So I'm imagining it's a methane SIBO and

methane is a is paralytic to the intestines. So it's it's like an anesthetic. So the intestines are not

there's no motility at all. So the first thing I would do is I would confirm whether they have SIBO or not. Then I

would do antimicrobials after the antimicro that's two weeks antimicrobials. then two weeks elemental

um as long as there's no history of an eating disorder and then I would do a mo focus on motility and then I would

expect the constipation to kind of start to move a little bit and then later I would be addressing the gallbladder and

so on and so forth. So in the beginning I would give them the enzymes rather than messing about with their

gallbladder. I do find SIBO people really benefit massively from like phosphotidal choline, MCT, things like

that. uh because they're not digesting properly. There's like stagnancy in the giodinum. Um but I would do first

antimicrobials, then elemental, and then everything else after that because with constipation, with SIBO, you can't give

them fiber, you can't give them slippery elm, you can't give them marshmallow. So all the things we would do for mucus and

con and uh and motility, a lot of the things you can't do while the bacteria is there. So I I would do antimicrobials

first and and see where you get to. Why will slippery elm make things worse in terms of mucus? Slippery elm is amazing

for mucus. Um, slippery elm feeds SIBO bacteria. Sorry. So, slippery elm feeds SIBO bacteria, but in terms of helping

mucous membranes, intestinal lining is absolutely amazing and I love it very much. Um, do you notice lighter color

stores towards yellowish? Yes. So when there is a a blockage then we get a and we're not getting a good bile production

then we lose the brown color. Um so yeah so if somebody has lighter color stool it could mean that they're not

secretreting bile properly. It could mean that they have an obstruction that's preventing bile from going into

the geodenum or in really bad cases if it's very very pale it could indicate a pancreatic issue. So hopefully it's not

a pancreatic issue, but yes, more towards yellow, more towards pale white creamy color. Could reoccurring diarrhea

once every 3 weeks be associated with no gallbladder for many years? Yes, absolutely. So I would put that into

kind of like a bile malabsorption category. Um, and you might find that if you give this person a sequester, so if

you give them something like um, pectin or chitosan, you know, pick pick your favorite um, and experiment with them

and you might find that that will reduce the diarrhea because the bile has nowhere to go. So, it's just going round

and round liver, no gallbladder, back to the liver, back to liver. So, that could create kind of like a bile acid

malabsorption situation, which is classically diarrhea and it's quite costic to the membrane. So, you want to

sequester that nice and quick. Um, what blood test markers indicate a bile issue and how to differentiate whether it's

liver involvement too or just gallbladder? That's a great question. Um, I have that data somewhere but not

off the top of my head. But instinctively, uh, GGGT is like a more gallbladder. Um, ALT, so so ALT and A

ratio shows you more liver, but I think it's ALT is much much higher with gallbladder. But if you email me or

actually I can send it to um Alma, I have all this written down um and I can just send it around because I don't I

don't really identify it from blood work. I more identify it from symptomology.

Clients with HP therefore could also have bile issues. Right. How do we support that pre- or post HP treatment?

What's HP treatment? Um which elemental feed do you use? Most have sugar so problem with cancer patients. Yes. So, I

like the absorb elements which is available on Amriita. Um, and they do sample sizes and they also do different

flavors cuz elemental can be quite nasty. Um, it does contain some glucose but it contains a lot of everything else

as well. So, I use the absorb elements from Amriita. Which lavender oil do you use? Uh, there's so many out there I'm

not bothered um because ultimately it's lavender oil in there. I think New Roots do one. I think Lamberts do one. Um

there's there's quite a lot out there. Uh just ask the client to pick any any one that they're happy with that has 80

milligrams in there. Don't some of them have 500 milligrams. Don't go anywhere near that. 80 milligrams is more than

enough. Um Lynn has a client with one gall stone 2 and a half centimeters. She's getting regular biliary collic

attacks. Bearing in mind the size of the gallstone, would you treat her as a bilary/client?

Yeah, that's a really challenging one. So that's a really challenging one because you don't want to move the

stone. But by my understanding, the larger the stone, the the less risk there is of getting it lodged somewhere.

So would I treat her as a biliary sludge client? Um you can definitely help her on the um biliary tree flow. So

phosphotidal choline should be perfectly fine for her. Um and lavender oil should be perfectly fine for her. Um, and I

would just go very very gently um, and see how you get to with that. But yeah, that's that's a really really

challenging case and I'm happy for you to email me. Um, clients with H pylori could therefore have or H pylori.

Clients with H pylori therefore could also have bile issues. Um, yes, it's possible. So people with H pylori, which

reduces your stomach acid, could also have bile issues. Um, if they have bile reflux, there will be no H pylori. So if

the bile is refluxing into the stomach that will completely eradicate H pylori. Um but it could be that but yes they can

have corresponding things. So it's totally possible to have H pylori and then also to have a gallbladder problem

and also to have an appendix problem and also to have any other type of problem. So yeah um it's very rare to find a

client that has only one thing when they come to see you. And on we go. So um this was another

male that came to me. So he had a gallbladder colleague but he had no gallbladder. So not to forget that when

the uh gallbladder is removed the sphincta is not. So they're just removing the gallbladder with all of the

stones in it but the sphincta remains and that can still have collic and it's called a postcoyectctomy

syndrome. Um and it's basically all of the same symptoms as when they had gallstones but there's no gallbladder

there. Therefore there cannot be no gallstones. Um, and it's because this sphincta is kind of frozen. It's kind of

grip gripped into place and it's not relaxing because it's not having all of the triggers by which to relax. So, for

these kinds of people, um, it's really one thing that's very beneficial is to relax that sphincter um, and to support

fat fat digestion overall and of course always to thin mucus. So, this was my 57 year old male. He had been overweight

all of his life. So, he showed me pictures of himself when he was like five and he he's been a big lad all of

his life. Um, and he's been overweight all of his life and he had a gastric bypass in his 40s and it did not help

him lose weight. Um, he had his gallbladder removed in his 50s. Um, and he had, you know, mad mad blood lipids,

you know, cholesterol is off the charts, triglycerides off the charts. Um, and he was having gallbladder pain and he

didn't understand why because he was like, I had a gallbladder pain. I had had my gallbladder removed seven years

ago and now I've got gallbladder pain and he was considering weight loss medication. So he was thinking about

starting on like a Zeic or Mangjara or something like that. So no. So probably what happened was when he had his

gastric bypass in his 40s he rapidly lost a level of weight. So even though he was still a large gentleman um he did

experience a rapid weight loss. I think he lost like kind of like five six stone in a very short period of time. And of

course, when there is a rapid weight loss, more cholesterol is liberated from the flat fat cells, and that can create

pressure on the gallbladder as the liver is trying to chuck all of that gallbladder, all of that cholesterol

into the into the gallbladder. Um, that would have then created a situation in his gallbladder where it was sludgy and

coagulated, and that would have created stones. And then he had a gallbladder removed, and now he's having gallbladder

pain, and he identified it. So he notices it when he's at family barbecues.

Um and so this is u the the sphincter. So the sphincter is uh is too tight and we need to relax all of the remaining

things that are still there. So the gallbladder is is no longer there, but the hippatic duct from which bile comes

into the gallbladder the and goes back is still is still there and that's that's where the problem probably is.

So, what we're wanting to do is to uh help him support fats first of all. So, help him to support fats because he's

clearly being triggered by highfat foods, things like at family barbecue, they're having olive oils and they're

having hummus and they're having um lots of beautiful oily stuff. Um so, I gave him lipo with meals and 80 milligrams of

lavender oil also with his meals. I gave him phosphatidal coc choline once a day, a high fiber diet and I counseledled him

so as to not do any rapid weight loss but rather to do a nice slow weight loss program and his gallbladder pain um

stopped completely. So he it reduced and reduced but it stopped completely at about the 3 month mark and I attribute

the amount of time it took to his inability to really stick stick to the plan. So being somebody who has kind of

like um issues with eating and hunger and satiety and things like that, he found it very difficult to stick to a

consistent plan um but we eventually got there and he didn't have that colleague anymore.

So bile acid malabsorption is completely different. So bile acid malabsorption is about a problem with the recycling

system of the bile. So um what's happening is bile is not being recycled appropriately. It's not being absorbed

appropriately. So, we just get this continuous uh kind of flow of bile that's going into the small intestine

and making it to the large intestine and usually manifesting itself as kind of like extreme diarrhea and things like

that. Um, and this really has absolutely nothing to do with digestion. So, this is this has nothing to do with enzymes,

nothing to do with digestion, but it's something that um I get asked about a lot. So, we have primary bileasses which

are the bileasses. So the liver secretes bile. Um the conjugates so torine glycine turn it into bile acid and the

bile acid goes into the gallbladder and it's released from the gallbladder into the giodinum and then reabsorbed. Now in

bile acid malabsorption everything is happening except for the reabsorption part. Um and there's very little that we

can do about that other than mop up as much of that bile as possible. And for me that is a sequestering agents. Um,

and my favorite ones are Chetosan, but that's from shellfish. So, if your client has a shellfish allergy, um,

don't give them chitosan. Uh, psyllium husk is very, very good. Uh, anything with high betans, oats, o oats, barley.

Um, and I love I love apple pectin for lots of things, but for bile acid sequestering in particular, it's really

good. And in short, these people will have to consume a relatively high amount of fiber with every single meal that

they have in order to kind of mop up as much of that bile as possible because the bile acid sequestions, they bind to

the bile and then they carry it through the system so it's not not irritating and causing that fast transit time and

things like that. Um, okay. So, uh, histamine intolerance in re in