Speaker 1: It started on a Sunday afternoon. I was sitting on
Speaker 1: the couch working on my laptop when I suddenly got
Speaker 1: an upset stomach. I hid cramps the nausea, but it
Speaker 1: quickly escalated. But in a few minutes, I was crouched
Speaker 1: in my bathroom floor with a sharp pain just below
Speaker 1: my rib cage. It felt like I was being repeatedly
Speaker 1: stabbed on my right side. The pain was so intense
Speaker 1: that my diaphragm wasn't contracting. It felt like it was
Speaker 1: stuck in place. I crawled into the next room, where
Speaker 1: my husband was napping, and I tried to gently call
Speaker 1: to him so as not to alarm him, but I
Speaker 1: was having trouble breathing, so I just managed to stammer,
Speaker 1: I don't feel well. He startled awake and was instantly worried.
Speaker 1: He said my lips were white. He was calling nine
Speaker 1: one one no, I croaked, I just need water, Bring
Speaker 1: me a glass of water. He hesitated, but acquiesced and
Speaker 1: went to the kitchen while I lay on the floor
Speaker 1: trying to reason through what was happening. My symptoms didn't
Speaker 1: match appendicitis or a heart attack, and since I was
Speaker 1: out of ideas, I figured it must not be anything serious.
Speaker 1: Silence from the kitchen.
Speaker 2: Now.
Speaker 1: My husband is not a whimp, but he has been
Speaker 1: to faint while having his blood drawn, and once when
Speaker 1: an acquaintance went into diabetic shock, he stepped outside to
Speaker 1: call nine one one, and then promptly passed out on
Speaker 1: the phone with a dispatcher, such that when the EMTs
Speaker 1: arrived they attended to my husband crumpled on the sidewalk,
Speaker 1: and not the man inside having a seizure. So the
Speaker 1: silence worried me. I called to him, Yes, he said, quietly.
Speaker 1: Are you passing out right now? I asked, trying not to,
Speaker 1: he said meekly. I made a mental note not to
Speaker 1: allow him in the delivery room if I ever went
Speaker 1: into labor, and tried to remind him of the task
Speaker 1: at hand. I could really use that water. I heard
Speaker 1: the faucet turn on, and then a few moments later
Speaker 1: he shuffled over and set a glass down next to me,
Speaker 1: then plopped down on the floor with his head in
Speaker 1: his hands to fight the light headlessness. I was flattered
Speaker 1: on my back. I can't drink this, I told him,
Speaker 1: I need a straw. He looked at me as if
Speaker 1: I'd asked him to climb everest, but he stood up
Speaker 1: and shuffled back into the kitchen. It was at this
Speaker 1: point that I realized I need to snap out of it,
Speaker 1: because I would need my wits about me when he
Speaker 1: inevitably fainted and hit his head on the countertop and
Speaker 1: I had to call nine on one for him. I
Speaker 1: brought myself up to sitting against the wall, and he
Speaker 1: shuffled back with a travel mug of water. I took
Speaker 1: a sip, and in a few minutes I started to
Speaker 1: feel better. I returned my place on the couch. That
Speaker 1: was weird, I said. Now, let it be known that
Speaker 1: my husband wanted me to go to the hospital anyway,
Speaker 1: but I told him I didn't have time to sit
Speaker 1: in the r all night. And sure, that was pretty strange,
Speaker 1: but I felt fine now. My husband flew the South
Speaker 1: Dakota the next day and the rest of the week
Speaker 1: when as usual until Saturday afternoon, when I took her
Speaker 1: dog for a walk. I made it one block to
Speaker 1: her forest trailhead and the stabbing pain returned. I couldn't
Speaker 1: stay upright. I had to lay down on the forest floor.
Speaker 1: It was tick season and I live in a place
Speaker 1: with a very high incidence of lime disease, so this
Speaker 1: didn't seem prudent. You're gonna feel like an idiot if
Speaker 1: you get lime disease because of a stomach ache, I thought,
Speaker 1: and forced myself up. The walk was excruciating, but I
Speaker 1: managed to stumble home without vomiting in my neighbor's yards.
Speaker 1: When I got in my door, I laid down on
Speaker 1: the entryway bench. There I ride and literally moaned in
Speaker 1: agony for over an hour until I eventually made it
Speaker 1: to the couch, where I continued to writhe and moan
Speaker 1: some more. There was no position that was comfortable. After
Speaker 1: several bouts of dry heaving, I started to cough of blood.
Speaker 1: Maybe it's an ulcer, I thought, so I texted my
Speaker 1: close friend who had an ulcer and told her my symptoms. No,
Speaker 1: she said, I've never experienced any of that. You should
Speaker 1: go to the hospital. I can't drive right now, I
Speaker 1: told her, I can't even sit up. Then call a friend.
Speaker 1: She texted back, you know I don't have any of those,
Speaker 1: I replied, I had moved to a new state recently
Speaker 1: and making friends is hard. Well, then call an ambulance.
Speaker 1: She said, that seems like overkill, I told her. Plus,
Speaker 1: the dog would lose his mind and I am in
Speaker 1: no state to control him right now, and so I
Speaker 1: lay there alone, hoping the pain would subside as it
Speaker 1: had before, but it did not. My husband arrived home
Speaker 1: around eleven PM, having had to rent a car from
Speaker 1: the airport since I had texted to say I would
Speaker 1: not be there to pick him up as planned. He
Speaker 1: also wanted to take me to the hospital, but since
Speaker 1: I still couldn't sit up, I dreaded the thirty minute
Speaker 1: car ride and a long wait in the r waiting room.
Speaker 1: I promised him i'd go in the morning, when I
Speaker 1: planned to be feeling better. I spent the night on
Speaker 1: the couch without sleep, though the pain did start to
Speaker 1: lessen in the morning. He reminded me of my promise,
Speaker 1: but I still wasn't feeling up to the trip. I
Speaker 1: renegotiated the terms such that I would go to urgent
Speaker 1: care when I was capable of sitting upright, which happened
Speaker 1: around noon. At this point, I was actually feeling almost normal,
Speaker 1: so I insisted on taking myself and I told the
Speaker 1: check and staff my symptoms. I was told they could
Speaker 1: not see me at urgent care, I'd have to go
Speaker 1: to the er. I called my husband from the parking
Speaker 1: lot and bated whether to wait until Monday morning to
Speaker 1: see a doctor rather than going to the er, where
Speaker 1: I truly waste time. But he was sufficiently worried that
Speaker 1: I relented and drove over to the ar. To my surprise,
Speaker 1: if you tell the check and nurse that you are
Speaker 1: experiencing sharp stabbing pain just under your ribs, there is
Speaker 1: basically no weight. I was called back to a little
Speaker 1: curtained room almost immediately and blood and urintests were taken,
Speaker 1: as well as an X ray. The doctor came to
Speaker 1: tell me my results a couple hours later. My liver
Speaker 1: function tests were off the charts. He suspected my gall
Speaker 1: buttter had to come out. They kept me in the
Speaker 1: hospital overnight. I had an MRI to confirm Coli societis
Speaker 1: the next morning, and then laparoscopic surgery the next and
Speaker 1: I went home that same day. After three days of recovery.
Speaker 1: I felt great, and I promised everyone in my life
Speaker 1: that the next time my gall butter goes, I'll go
Speaker 1: straight to the hospital.
Speaker 2: Oh my gosh, Maria, Maria, Maria, I mean disclosure. I
Speaker 2: have heard this story a couple times now, and every
Speaker 2: time I'm just like I am enthralled and horror spired
Speaker 2: at the right parts and believed at the right parts
Speaker 2: and laugh at the right parts. It's just yeah, it's
Speaker 2: a great story. It's a great story. And I'm glad
Speaker 2: you're okay.
Speaker 3: Set of circumstances.
Speaker 2: Yeah, yeah, thank you, Maria, Yeah.
Speaker 3: Thank you for thank you reliving that yet again for
Speaker 3: us and everyone who's listening.
Speaker 2: Yeah. Hi, I'm Aaron Welsh and I'm erin on an
Speaker 2: Updike and this this podcast will kill you.
Speaker 3: Today we're talking about the gallbladder.
Speaker 2: Just the gallbladder, the gallbladder, the golfbladder.
Speaker 3: I almost texted you multiple times to be like, it's
Speaker 3: just gallbladder, right, We're not doing like a specific part.
Speaker 3: It just it's gallbladder, a specific part of the gallbladder.
Speaker 3: Like we're not just doing like golf gullstos or like.
Speaker 2: Or like gallbladder cancer or like.
Speaker 3: This didus Holy, Yeah, we're doing gallbladder.
Speaker 2: Yeah.
Speaker 3: I can't wait.
Speaker 2: I mean, And and the reason that if you had
Speaker 2: texted me that my answer would have been like, I
Speaker 2: don't know, I don't know what these things are so whatever,
Speaker 2: we could do anything you want to do our podcast.
Speaker 3: We've promised this for a while now we have. I'm
Speaker 3: really excited to finally be doing it.
Speaker 2: I mean, of all of the organs to start with.
Speaker 3: Is this the first like organ episode?
Speaker 2: Yeah?
Speaker 3: Isn't it? Yeah? Yeah? Is that right? I feel like
Speaker 3: we've talked about doing like the heart, We've talked about
Speaker 3: doing other organs.
Speaker 2: I can can you think of other organs?
Speaker 3: I mean, the uterus is the first one I think
Speaker 3: of it. We've done a lot of like uterus right,
Speaker 3: the discussions, but we've not just like done a whole
Speaker 3: episode on the uterus.
Speaker 2: Nope, not yet. Well, gallbladder here we are here. We
Speaker 2: are celebrate the gallbladder and also chastise it for the
Speaker 2: things that it does poorly.
Speaker 3: I can't wait. I'm really really excited. I have no
Speaker 3: idea what you have in store for me, Aaron, but
Speaker 3: I it's gonna be fun.
Speaker 2: I know that we'll see before we get into all
Speaker 2: of that thought quarantine any time, quarantin any time. What
Speaker 2: are we drinking this week?
Speaker 3: We're drinking on the stones, like on the rocks.
Speaker 2: We're going to do gall of stone.
Speaker 3: Oh I thought we said Oh no, you're right.
Speaker 2: We did do on the Stones.
Speaker 3: Okay, we have a lot of ideas.
Speaker 2: We did well, we had two at least so and
Speaker 2: in on the Stones we're actually doing a classic cocktail
Speaker 2: which I've always heard of but never knew what was in.
Speaker 2: It's a Harvey.
Speaker 3: Wallbanger, not to be confused with Wait wait wait, Harvey
Speaker 3: Wahlberg isn't a person, is it.
Speaker 2: There's Mark Wahlberg, right, and then there's Donnie Wahlberg and
Speaker 2: I assume other Wahlberg's.
Speaker 3: I don't know why that was the first thing I
Speaker 3: thought of when you said Harvey Wallbanger, you did?
Speaker 2: You were like, what's in the what's in the the
Speaker 2: Harvey Wahlberg, I'm like, excuse me?
Speaker 1: What?
Speaker 2: Yeah, okay, in the Harvey Wallbanger or on the Stones
Speaker 2: is orange juice vodka a like a yellow kind of
Speaker 2: vanilla e liqueur called galliano or guyano Guyiano I'm not
Speaker 2: sure how you pronounce it, and a marishino cherry delish. Yeah,
Speaker 2: it's delish. The reason we chose this too is because
Speaker 2: I when I was like thinking of the quarantine, I
Speaker 2: was like, Okay, well it's got to be yellow, because
Speaker 2: that's what bile is, and then I told you and
Speaker 2: you were like, yeah, but bile's not yellow. I mean
Speaker 2: what we're going with it anyway.
Speaker 3: It's yellow. It can be yellow. It ranges from like
Speaker 3: yellow to green or black is not a good color
Speaker 3: for bile, but sometimes so it's a spectrum. I think
Speaker 3: we think of it in our minds as more bright
Speaker 3: yet like more on the light yellow spectrum than it.
Speaker 3: It's closer usually to the darker side of the spectrum.
Speaker 2: But you know what, already learning things, already learning things.
Speaker 2: We will post the full recipe for on the Stones
Speaker 2: on our website this podcast will Kill You dot com,
Speaker 2: as well as on all of our social media channels,
Speaker 2: so check it out.
Speaker 3: Check it out. Also check out on our website, our
Speaker 3: merch our bookshop, dot org affiliate account, and our good
Speaker 3: Reads list our music by Bloodmobile, who's also on Instagram,
Speaker 3: Treon page, transcripts, sources from all of our episodes, and
Speaker 3: so much.
Speaker 2: More, so much more. We're on YouTube.
Speaker 3: We're on YouTube, follow you exactly right network, subscribe to
Speaker 3: it all. We're on what do you call It? iHeart podcasts,
Speaker 3: Now and Apple Podcasts and all of the other ones.
Speaker 3: Thanks for listening.
Speaker 2: At the end and now over to the beginning.
Speaker 3: I'm going to talk us through what the heck is
Speaker 3: the gall bladder right after this break Aaron. You know
Speaker 3: those like old timey water skins, like I think they're
Speaker 3: probably made out of like animal organs, but you see
Speaker 3: them in like old movies, like old westerns, like you
Speaker 3: put it on a saddle bag and then you drink
Speaker 3: water out of this. Yeah, okay, So your gallbladder.
Speaker 2: Oh oh af to an unusual start.
Speaker 3: Is kind of like a little water skin kind of okay, okay,
Speaker 3: it's like it shaped a little bit like that, like
Speaker 3: what I what I think of it as those little
Speaker 3: water skins. It's like this seven to ten centimeter so
Speaker 3: it's quite a bit smaller than those water skins. So
Speaker 3: two and a half to four inches long.
Speaker 2: I'm a little so little pouch.
Speaker 3: Yeah, And it sits just on the underside of your liver,
Speaker 3: and your liver hangs out in the right upper quadrant
Speaker 3: of your abdomen. It just like a butts against your diaphragm,
Speaker 3: which is what separates your abdomen from your thorax or
Speaker 3: your chest.
Speaker 2: The liver is always so much higher than I think
Speaker 2: of like for some reason, I just think of the
Speaker 2: chest cavity as empty, and all my organs are somehow crowded.
Speaker 3: At the very bottom, your chest cavity is empty, not
Speaker 3: like your well, my heart.
Speaker 2: That's okay, loves you heart, and then well there's anything
Speaker 2: else until like my until the bottom.
Speaker 3: Yeah, the liveries weigh the heck up there, way up there.
Speaker 3: And this little pouch sits just there's like a little
Speaker 3: a little groove, a little divot that it basically sits in.
Speaker 3: And it is part of what's called our biliary system,
Speaker 3: which is basically a series of tubes like a I
Speaker 3: think of it as like the branching plumbing system that
Speaker 3: the super Mario brothers travel through. Some of these tubes
Speaker 3: come from the liver they're called the hipatic ducts, and
Speaker 3: then they join together with the tube from the gall bladder,
Speaker 3: which is called the cystic duct, and those all joined
Speaker 3: together into what's called the common bile duct. And then
Speaker 3: another branch comes over from the pancreas. I don't know
Speaker 3: why I went this way, because it's coming from your
Speaker 3: left side, and these all together empty out into our duadnum,
Speaker 3: which is the first part of our small intestine. So
Speaker 3: you have this series of duct work that connects our liver,
Speaker 3: our pancreas, and then there's this one branch that ends
Speaker 3: in a blind pouch, and that blind pouch is the
Speaker 3: gall bladder. To better illustrate this.
Speaker 2: Oh, do we have props?
Speaker 3: We have props today. I made a billiary tree, Oh
Speaker 3: my gosh, out of some pipe cleaners and a balloon.
Speaker 3: So if you're just listening, imagine thank you. I tried
Speaker 3: to get my kids to help, and they were like, nah,
Speaker 3: I'm good.
Speaker 2: But minecraft to watch exactly.
Speaker 3: So I made this. Imagine if you're just listening, I'm
Speaker 3: going to talk you through it. Basically, we've got two
Speaker 3: pipe cleaners that come together in like a y shape.
Speaker 3: These are our two hepadict like left and right hepadic ducts.
Speaker 3: These are what are bringing the bile which is made
Speaker 3: in the liver down into the common hepatic duct. This pouch,
Speaker 3: which is a balloon, a squeezy balloon, is the gall bladder.
Speaker 3: It's connected to this whole system by the cystic duct here. Okay,
Speaker 3: then we have the common bial duct. This branch coming
Speaker 3: out towards the left, which is really quite skinny, connects
Speaker 3: really close to the bottom of the common bial duct,
Speaker 3: and that is what connects the pancreas. That's the pancreatic duct.
Speaker 2: Okay, the blues the pancreas, got it.
Speaker 3: And then it lets out in a sphincter. So there's
Speaker 3: a muscular sphincter here called the sphincter of odie, and
Speaker 3: it is what allows flow out into the duadnum or testin.
Speaker 2: Hold on, where's the liver again?
Speaker 3: The liver here is up there, okay, Okay, So the
Speaker 3: liver is what's covering the top part of this, and
Speaker 3: then your gall bladder sits just underneath the liver just
Speaker 3: kind of poking out. Got a day, okay, And so
Speaker 3: the gall bladder it's essentially a storage unit or really
Speaker 3: like a storage and handling unit. Okay. Our liver is
Speaker 3: producing bile, and it produces something like a leader a day,
Speaker 3: which is more than I realized. But it produces this
Speaker 3: bile I know, right. It produces this bio at different
Speaker 3: rates depending on whether we are eating or whether we're fasting, right,
Speaker 3: in response to hormone signals that it gets when we're eating.
Speaker 3: And then this bile is traveling ultimately to the duadnum. Right,
Speaker 3: It has to get into our intestine because it's going
Speaker 3: to help us digest our foods. But because there is
Speaker 3: this muscular sphincter at the bottom, it's regulating the flow
Speaker 3: of bile, So the bio is not just free flowing,
Speaker 3: gushing all the time into our duadnum. So depending on
Speaker 3: the timing pre meal, after a meal, if you're snacking
Speaker 3: and the pressure of this sphincter, bio will either flow
Speaker 3: outwards into the small intestine or it gets diverted into
Speaker 3: the gallbladder.
Speaker 2: Okay, so if you're like, we don't need to digest
Speaker 2: right now, just hold on to this until for a little.
Speaker 3: Bit, then boop the pressure Like that sphincter's closed, so
Speaker 3: the pressure builds up here and then bloop, that fluid
Speaker 3: gets diverted into our gallbladder. Something like ninety percent of
Speaker 3: the bile that's produced during times that we're not actively
Speaker 3: eating or digesting our food ends up going into the
Speaker 3: gallbladder for storage. But while it's there, it's not just
Speaker 3: sitting there. Our gallbladder is doing a job, and that
Speaker 3: job is concentrating this bile. You can think of it
Speaker 3: kind of like a barrel that's aging your fine wine,
Speaker 3: right yeah, some of I'm really going hard on the
Speaker 3: analogies here today.
Speaker 2: I like it.
Speaker 3: So, if you have wine in a barrel, like some
Speaker 3: of that wine soaks into the barrel, right, so the
Speaker 3: wine that comes out after a certain amount of time
Speaker 3: is a little bit different than what went in. It's
Speaker 3: the same thing here. So the bile that exists in
Speaker 3: the gall bladder is more concentrated because there's all these crypts.
Speaker 3: It's not like a smooth wall on the inside of
Speaker 3: the gall bladder. It's got like folds and layers and
Speaker 3: these cryps. So you actually even end up having like
Speaker 3: layers within the gallbladder of this fluid, this bile where
Speaker 3: the most concentrated stuff is deep down in the crypts,
Speaker 3: this inner lining, and then there's less concentrated stuff on top.
Speaker 3: So after a meal, and depending on how big that
Speaker 3: meal was, how much fat was in that meal, like
Speaker 3: a lot of different components, how much hormones are being
Speaker 3: secreted out, how well your gallbladder squeeze is to begin with,
Speaker 3: our gallbladder will get to work squeezing and pushing that
Speaker 3: concentrated bile out the cystic duct, which will mix with
Speaker 3: stuff coming from the liver. That's free flowing still, and
Speaker 3: then we'll eventually travel while mixing also with enzymes from
Speaker 3: the pancreatic duct out through that sphincter into our duodenum
Speaker 3: so that we can digest our fat burger.
Speaker 2: Two questions give it to me? How is it concentrating?
Speaker 3: Like?
Speaker 2: And number two, what is bile?
Speaker 3: I knew you were gonna ask that question, So my
Speaker 3: literal next part is what the heck is bile? So God,
Speaker 3: when we work together, Well, the way that it's concentrating
Speaker 3: is basically there's like, you know, a bunch of transporters,
Speaker 3: like ion transporters and different things in the wall of
Speaker 3: the gall bladder itself, like in that intestinal lumin or
Speaker 3: not intestinal, but in that bile lumine. And so it's
Speaker 3: going to be like soaking up like basically taking back
Speaker 3: some of that water and maybe other parts of what's
Speaker 3: in the bile and leaving a more concentrated bile behind.
Speaker 3: If that makes it. Yeah, So bile, great question. So
Speaker 3: glad you asked. Is this yellowish greenish liquid that's made
Speaker 3: in our liver and it's made up of a bunch
Speaker 3: of different things. It's a combination of bile acids, which
Speaker 3: is the most kind of active part and probably one
Speaker 3: of the more important parts of bile and bile acids
Speaker 3: are We've talked about them in one of our pregn
Speaker 3: the episodes when we talked about cholestasis of pregnancy. But
Speaker 3: these are made from cholesterol. So our liver is making
Speaker 3: cholesterol and then through a process of a whole bunch
Speaker 3: of enzymes converting that cholesterol into bile acids. And then
Speaker 3: what it also does on top of that, there's another
Speaker 3: thing called biol salts, and that's just a fancy name
Speaker 3: for the liver will take these bio acids, combine them
Speaker 3: with other amino acids to make them more hydrophilic so
Speaker 3: that they're more soluble in water, because cholesterol is fat
Speaker 3: and fats don't mix well with water. So our liver
Speaker 3: makes these cholesterol products called bio acids, then makes them
Speaker 3: into something that's more hydrophilic that we call a bio salt,
Speaker 3: and that's a big, huge component of our biole It
Speaker 3: also contains bilirubin, which is a byproduct of like red
Speaker 3: cell breakdown. It also has other phospholipids. There's probably just
Speaker 3: some like plain processed cholesterol in there. There's water, and
Speaker 3: then there's other salts and minerals. What bile does, especially
Speaker 3: these bile acids or bile salts, our help in the
Speaker 3: digestion of lipids or fats in our gi tract. They
Speaker 3: are helping to emulsify and facilitate the absorption of our
Speaker 3: fats and things like fat soluble vitamins. Okay, they also
Speaker 3: are going to grab onto and help eliminate cholesterol from
Speaker 3: our body by grabbing onto it and then essentially like
Speaker 3: we'll poop it out, so they'll like block some absorption
Speaker 3: of cholesterol. And because these are made in the liver
Speaker 3: and then traveling via this biliary system maybe pit stopping
Speaker 3: in the gallbladder, and then being re secreted after they're
Speaker 3: in our digestive tract and they're doing their jobs, they
Speaker 3: actually get reabsorbed through our intestinal wall later on in
Speaker 3: our small intestine, then re enter what's called our entero
Speaker 3: hepatic circulation, go back into our liver where they can
Speaker 3: be reprocessed, re secreted and used again.
Speaker 2: Okay, so we recirculate bile.
Speaker 3: H Yeah, most of our bile is recirculated. Our liver
Speaker 3: is always making more, but we need way more bile
Speaker 3: than it's making in a day, if that makes sense,
Speaker 3: so we recirculate it.
Speaker 2: That's really fascinating. And this is, like you said, a
Speaker 2: leader a day at least. Yeah, that's such a huge
Speaker 2: amount of Okay, yeah, when you're we talked about this
Speaker 2: a little bit, but just again to go over it.
Speaker 2: When you're barfing and you get to the point where
Speaker 2: you're just barfing up like a little kind of gummy, sticky,
Speaker 2: snotty liquid that's bright yellow, Yeah, is that ever bile
Speaker 2: or is it just stomach acid?
Speaker 3: It could or it could not be bile. Okay, really
Speaker 3: billious vomiting is like considered pretty bad. So like that
Speaker 3: would mean like something is pretty wrongs.
Speaker 2: Have to be like from your small intestine backups through
Speaker 2: exact stomach, so like that should not that's a one
Speaker 2: way path.
Speaker 3: It should be a one way path. And so that
Speaker 3: tells us that there's something going on that's causing that
Speaker 3: much of a backup, So we think of that with
Speaker 3: maybe something like a small bowel obstruction or something like that.
Speaker 3: That doesn't mean that it's impossible to barf up bile.
Speaker 3: We definitely like people barf up bile, you know for sure,
Speaker 3: But most of the time when you're doing that, like
Speaker 3: dry heaving, and then you get out just a little bit,
Speaker 3: it's probably mostly just your stomach contents and like the
Speaker 3: stomach acid that's left in there, that's what leaves that
Speaker 3: really terrible taste in your mouth and things.
Speaker 2: Okay, yeah, I feel like I have a lot more questions,
Speaker 2: but they're all related to the things that can go wrong,
Speaker 2: and I agree with feelings. That's what you're going to talk.
Speaker 3: About, that is how can things go wrong? Oh so
Speaker 3: I mentioned already that a big part of what your
Speaker 3: gallbladder is doing is concentrating this bile. Anytime that you
Speaker 3: have a liquid that's not just like say pure H
Speaker 3: two O water, but you have a solution that gets
Speaker 3: more concentrated, the solutes in that solution are at risk
Speaker 3: of precipitating out. And that is essentially what happens when
Speaker 3: you get gallstones there where.
Speaker 2: Now the stuff precipitates out.
Speaker 3: Yeah, it's not like perfectly as simple as that, but
Speaker 3: that's the simplest way to think about it. Because gallstones,
Speaker 3: there's a few different types of gallstones, but something like
Speaker 3: eighty to ninety percent of gallstones are cholesterol stones, so
Speaker 3: they're basically a solid mass of cholesterol from these bile
Speaker 3: acids that essentially crystallizes as well as calcium other proteins.
Speaker 3: And then these things called musins, which are produced by
Speaker 3: our gall bladder and can kind of act as if
Speaker 3: you've ever made like rock candy. Have you ever made
Speaker 3: rock candy?
Speaker 2: I've eaten rock candy.
Speaker 3: If you're gonna make rock candy, you make us supersaturated
Speaker 3: solution of sugar water, and then you have to take
Speaker 3: your stick or your string or whatever and roll it
Speaker 3: in sugar crystals and dunk it in there, and those.
Speaker 2: Sugar crystals kind of exactly domino crystallization exact.
Speaker 3: Actually, yeah, And so these musins are something produced in
Speaker 3: the gall botty that can act as one of those
Speaker 3: crystal formations. They kind of are like that, not a catalyst,
Speaker 3: but they are that first thing where your cholesterol crystals
Speaker 3: can start to precipitate out and then eventually form a gallstone.
Speaker 3: There are other types of gallstones, So pigment stones are
Speaker 3: mostly made up of bilirubin, and so those can happen
Speaker 3: if you have an over abundance of bilirubin in the bile,
Speaker 3: which we might see in something like a hemolytic disease
Speaker 3: or some other kinds of medical disorders, but those are
Speaker 3: much less common. Most gallstones are cholesterol gallstones. You can
Speaker 3: also have mixed gallstones, and.
Speaker 2: That's just where the cholesterol is falling out of solution
Speaker 2: and kind of like.
Speaker 3: Making little chunkies. Okay, so we're big chunkies.
Speaker 2: How common are gallstones and then how common are gallstones
Speaker 2: that cause a major problem?
Speaker 3: Great question. Gallstones are quite common. It's estimated that like
Speaker 3: ten to fifteen percent of adults in the US and
Speaker 3: in Europe where we have the best data, but I
Speaker 3: also saw some studies out of China that were like
Speaker 3: around twelve percent, So like ten to fifteen percent of
Speaker 3: adults have gallstones. Eighty percent of people with gallstones totally asymptomatic,
Speaker 3: never even know that they have them unless they happen
Speaker 3: to get a right up or quadran ultrasound and we
Speaker 3: see them huh, okay, not so bad until they go
Speaker 3: really wrong. And there are a lot of risk factors
Speaker 3: for gallstone formation, and we really, in all honesty, you
Speaker 3: just don't really understand them. Like maybe poor gallbladder motility
Speaker 3: might have a role to play, because we see that
Speaker 3: in conditions like pregnancy, which we talked about, where everything
Speaker 3: slows down, things aren't contracting as much, and so then
Speaker 3: you can get stasis. And if you have stasis, you
Speaker 3: have increased concentration of this solution, and then you have
Speaker 3: more precipitation. We can also see that in diabetes, because
Speaker 3: diabetes can cause a slow down of the GI tract.
Speaker 3: Side note, GLP one medications are friends like ozeen pic
Speaker 3: slow down the GI tract and have been associated with
Speaker 3: an increased risk of gallstone formation.
Speaker 2: Very interesting.
Speaker 3: There's also probably genetic predisposition to things like excess musin
Speaker 3: production or just slow gut transport in general, or differences
Speaker 3: in the way that bile salts are metabolized and reabsorbed
Speaker 3: because you can end up with more or less hydrophobic versions.
Speaker 3: So some that might just be more likely to precipitate
Speaker 3: to begin with, if that makes sense, they're just not
Speaker 3: as good at dissolving in water. There's probably microbiome considerations.
Speaker 3: Estrogen my play role. There's a lot and we don't
Speaker 3: fully understand it. But most of the time gallstones just
Speaker 3: hang out there in your gallbladder and don't really cause
Speaker 3: any problems. But if they're going to cause problems. Most
Speaker 3: of the time. The first presentation if someone is symptomatic
Speaker 3: is what's called billiary colic, and that is this kind
Speaker 3: of I mean good example that Maria gave us an
Speaker 3: herb perstent account. Unfortunately, it's this post pran deal. So
Speaker 3: after eating, about an hour or so after eating, this
Speaker 3: episode of really severe usually right upper quadrant, because that's
Speaker 3: where your liver and gallbwater are. Pain that can be
Speaker 3: very severe, very intense, lasts for maybe an hour, maybe
Speaker 3: a few hours, and then eventually resolves on its own.
Speaker 3: That is the classic description of biliary colic. We think
Speaker 3: that usually this biliary colic is caused by a stone
Speaker 3: or what's sometimes called sludge, because sometimes you don't get
Speaker 3: like a full on stone formation, but you just get
Speaker 3: sludginess where it's like really thick, concentrated stuff that gets
Speaker 3: lodged some where in this biliary system, right, whether it's
Speaker 3: in the cystic duct or somewhere else in this biliary system,
Speaker 3: and then it causes irritation and inflammation and pain because
Speaker 3: it's activating our like visceral sensory nerves. More than ninety
Speaker 3: percent of people who have one attack will have a
Speaker 3: recurrent attack of biliary colic within ten years. A lot
Speaker 3: of them will have a repeat episode within two years. Okay,
Speaker 3: but these type of attacks, this kind of biliary colic
Speaker 3: is usually considered self limiting, right, it's not necessarily causing
Speaker 3: an emergency, it doesn't need intervention necessarily. But these gallstone
Speaker 3: blockages can also cause a number of more severe complications,
Speaker 3: which all have various idis names because they're associated with
Speaker 3: a lot of inflammation. We can get acute colycystitis, we
Speaker 3: can get bacterial cholanngitis, we can get pancreatitis. Gallstone are
Speaker 3: also a very well known risk factor for gallbladder cancer
Speaker 3: down the line. So I want to kind of talk
Speaker 3: through how each of these processes happen, because they're kind
Speaker 3: of all actually the exact same process. It all just
Speaker 3: depends on where in this biliary system a stone is
Speaker 3: getting lodged. Basically anytime that you have a tube in
Speaker 3: your body, but especially when you have a blind tube
Speaker 3: right like this pocket where there's no exit on it.
Speaker 3: When that tube gets blocked, you're going to increase pressure
Speaker 3: behind that blockage. So in your gallbladder especially, this increase
Speaker 3: in pressure is going to cause swelling, which especially along
Speaker 3: with this supersaturated bile that's already present in your gall bladder,
Speaker 3: will cause further inflammation. And inflammation in our body comes
Speaker 3: with edema or swelling, which will further increase this pressure.
Speaker 3: So acute coly sostitis is when you have a gallstone
Speaker 3: that has blocked the cystic duct and then causes this
Speaker 3: increase in pressure and inflammation and swelling in the gall
Speaker 3: bladder itself. Eventually, this can lead to the wall of
Speaker 3: the gall bladder not being able to get enough blood supply.
Speaker 3: So then parts of the tissue because of just there's
Speaker 3: so much like edema and swelling, so then the blood
Speaker 3: can't flow there well, and so then the tissue will
Speaker 3: start to die, so we can see necrosis, and with
Speaker 3: necrosis you can see hemorrhage right because you're going to
Speaker 3: have bleeding from where this tissue is dying. That can
Speaker 3: eventually lead to perforation of the wall and the gall bladder,
Speaker 3: which would cause it to spill out its contents into
Speaker 3: the peritoneal cavity. And that's super concentrated bile acids that
Speaker 3: they're supposed to digest stuff, So that can be really severe. Okay,
Speaker 3: but even if it doesn't perforate, as you continue to
Speaker 3: have all of this edema and sell death and necrosis,
Speaker 3: you eventually can get a purulent phase where you get
Speaker 3: a lot of white blood cells. Inflammation, bacteria can get
Speaker 3: into this system, whether they're coming from the GI tract,
Speaker 3: whether they're kind of they're already but not causing problems
Speaker 3: until they proliferate. They make their way in there one
Speaker 3: way or another and then cause a bacterial infection on
Speaker 3: top of this. So that can happen in any part.
Speaker 3: If it happens near the pancreatic duct and blocks here,
Speaker 3: you can get inflammation in the pancreas, and that's called
Speaker 3: a cube pancreatitis. Fifty percent of cases of that are
Speaker 3: caused by gallstones. Okay, you can get a stone that
Speaker 3: lodges somewhere in the common bile duct itself right so
Speaker 3: below the gallbladder, but before the pancreatic duct, and that
Speaker 3: can cause what's called coolanditis. It's usually bacterial colanditis, and
Speaker 3: that's really severe because this is a relatively small tube,
Speaker 3: so a small increase in pressure you could potentially have
Speaker 3: a perforation that could be a lot more severe. So
Speaker 3: we see people really really sick when that happens.
Speaker 2: And so, but like, no matter where the stone or
Speaker 2: the obstruction is happening, the gallbladder will continue to be
Speaker 2: backed up and swell. Or is it only when that
Speaker 2: stone is at the opening of the gall bladder.
Speaker 3: Yeah, it kind of just depends. So you can definitely
Speaker 3: get pancreatitis without having any gallbladder swelling, like without having
Speaker 3: colicicitis on top of it. Colicystitis. Acute colicstitis is specifically
Speaker 3: when it's blocked at the neck of the gall bladder somewhere,
Speaker 3: so it's the gall bladder that is most affected.
Speaker 2: Like the hotel California of gallbladder issues, you can check,
Speaker 2: you can go in, but you can never come out.
Speaker 2: It's like the worst It's all I can think of
Speaker 2: is like you can you can Yeah, you can't leave.
Speaker 3: Yeah, you can't leave exactly, nothing can leave. Yeah. The
Speaker 3: same is true though, like if you get if you
Speaker 3: get a stone blocking somewhere else, it just depends on
Speaker 3: how long it's there, how severe it gets, whether it's
Speaker 3: ever able to pass. You could certainly get inflammation, like
Speaker 3: you can end up with an infection in the gall
Speaker 3: bladder or inflammation in the gall bladder when you also
Speaker 3: have colandritis in other places, in other places, and at
Speaker 3: the heart of it, the problem ultimately is the gallbladder
Speaker 3: itself in any case, right yep. And so for a
Speaker 3: lot of these cases, though I will say not all
Speaker 3: of them, Like especially not when we're talking about pancreatitis.
Speaker 3: The treatment for that is potentially different. But especially when
Speaker 3: we're talking about acute colis istitis, when it's this inflammation
Speaker 3: of the gallbladder itself, treatment is usually take out that
Speaker 3: gall bladder, cut it the heck out, cola systectomy.
Speaker 2: So what are the consequences of this? What is the
Speaker 2: deciding factor? So obviously if like if it's severe enough, yeah,
Speaker 2: what do we ever just remove the gall stone?
Speaker 3: You absolutely can. Yeah, there's a number of procedures that
Speaker 3: you can do to just remove the gall stone. There's
Speaker 3: also medication that you can use. We use it definitely,
Speaker 3: like in pregnancy when it's the colistasis of pregnancy, which
Speaker 3: is different, that's like it's a different process. See our
Speaker 3: pregnancy episode we talked about it. But so there is
Speaker 3: a medicine that we can use that helps to kind
Speaker 3: of break up these gallstones. Themselves, but it's not necessarily
Speaker 3: like all that effective long term and prevention of complications.
Speaker 3: But that is one option. We used to do a
Speaker 3: lot more of like what we do for kidney stones,
Speaker 3: which is like go in and like ultra sound wave
Speaker 3: them somehow and break them up. That's not really done anymore.
Speaker 3: So another option if someone is really really sick with
Speaker 3: acute coalisistitis, so this infection inflammation in the gall bladder
Speaker 3: and they cannot have a surgery, because ultimately surgery to
Speaker 3: remove that gall bladder is the treatment, especially for acute
Speaker 3: cola sisiitis. Okay, if someone cannot have that surgery because
Speaker 3: they are too sick or they cannot have that surgery,
Speaker 3: then sometimes we'll put a drain in it, so that
Speaker 3: would come from the outside, and that's called a percutaneous
Speaker 3: collisystostomy tube, and so that's just going to drain all
Speaker 3: of the infected fluid, all of the pus, everything, all
Speaker 3: of the bial But it's sort of just a temporizing measure.
Speaker 3: Eventually you're going to have to do something more permanent.
Speaker 3: So yeah, I mean, it really does depend though on
Speaker 3: what the presentation is. So if somebody just has that
Speaker 3: biliary colic that we talked about. They may or may
Speaker 3: not decide to get their gallbladder removed. If they do,
Speaker 3: a surgeon is probably going to want it to be
Speaker 3: at a time when there's not any issues going on,
Speaker 3: because then everything is calm and cool, and it's easier
Speaker 3: to remove because you don't have irritation and inflammation.
Speaker 2: I have a question about diagnosis though, So, like you said,
Speaker 2: this is a These attacks are fairly characteristic. It's like
Speaker 2: right upper quadrant debilitating pain. Like I've heard some people
Speaker 2: that I know I've had it describe it as like
Speaker 2: they're like, yes, I've had children, and this is worse
Speaker 2: than unmedicated child birth. Yeah, which is wild to think about.
Speaker 2: And and but it like you said, it's it's self limiting.
Speaker 2: It's it does go away eventually unless there's doesn't more
Speaker 2: severe unless it doesn't. And so if that goes away,
Speaker 2: and then you go to your doctor a week or
Speaker 2: two later and let's say there's no gallstone, yeah they
Speaker 2: can find, so then what what do you do.
Speaker 3: Yeah, it's a great question. It kind of depends, Okay,
Speaker 3: it depends on if it comes back most of the time,
Speaker 3: Like most of the time you see something whether that's sludge, right,
Speaker 3: so you might not see a stone. If you had
Speaker 3: a small stone and it passed, you know, during that episode,
Speaker 3: then we might only see sludge. But even just sledge
Speaker 3: itself can cause billiary colic, right if that sludge get
Speaker 3: pressed up against and then ends up causing irritation. But yeah,
Speaker 3: I mean, it all just is going to depen and
Speaker 3: on that specific presentation on how often it's happening. There
Speaker 3: are other things, of course that can mimic this, so
Speaker 3: I don't have an easy answer for that.
Speaker 2: All right, So but what if you get your gallbladder out?
Speaker 2: Obviously this happens a lot. Yeah, yeah, what happens.
Speaker 3: It depends some people they don't even miss it and
Speaker 3: they have no issues whatsoever, and then they live their
Speaker 3: life without gallstones, and isn't that great news. But a
Speaker 3: lot of people can have post colo systectomy complications and
Speaker 3: that can really really range estimates. I saw most of
Speaker 3: them were around forty percent on the high end. Some
Speaker 3: were a lot lower, and I'm not sure that I
Speaker 3: believe that just based on all of the other papers
Speaker 3: that said anywhere from like five to forty percent. So
Speaker 3: I think there's a pretty huge range of looking at
Speaker 3: different studies, but the symptoms can also range, and I'm
Speaker 3: not talking about like acutely. There are of course complications
Speaker 3: from surgery that can happen, right have injury to the
Speaker 3: bile duct, you could have leakage things like that. But
Speaker 3: outside of that, like just postop period, some people can
Speaker 3: have acid reflux that they can get after a procedure
Speaker 3: like this. We don't fully understand. Some people get persistent
Speaker 3: right upper quadrant pain, so like they still end up
Speaker 3: having pain in that area where they were having pain
Speaker 3: from their gallbladder. Some people very commonly end up with diarrhea,
Speaker 3: and that has a lot to do probably though we
Speaker 3: don't fully understand it. With the changes in how you
Speaker 3: now are getting bile acids into your GI tract, right
Speaker 3: you're no longer having these concentrated bile acids, but you
Speaker 3: are having more of a constant free flow of less
Speaker 3: concentrated bile acids into your GI tract. And it's thought
Speaker 3: that this likely changes the gut microbiome, which will then
Speaker 3: shift how these bile acids are like conjugated or unconjugated,
Speaker 3: or what they're conjugated with when they go through processing
Speaker 3: and all of that kind of stuff. So there's a
Speaker 3: lot of potential changes that happen after a close etectomy,
Speaker 3: and yet you can function and your GI tract can
Speaker 3: function just fine without your gallbladder.
Speaker 2: You just kind of snip it, snip snip.
Speaker 3: Yeah that's the end. Oh okay, Aaron, Oh wow, tell
Speaker 3: me about this, would you.
Speaker 2: Maybe we'll see, we'll see what what I come up with. Okay,
Speaker 2: have you ever heard someone described as like having the
Speaker 2: goll to do something? Yeah? Like what goal he has
Speaker 2: to suggest that?
Speaker 3: Don't tell me that that has to do with GOLs.
Speaker 2: Tones, of course it does.
Speaker 3: I don't know why I thought it was the gallbladder.
Speaker 3: I know, but I this is so embarrassing, I'm not
Speaker 3: going to say it out loud. I thought it was
Speaker 3: like the glants are like, no, like the birds. Oh goal, Yeah,
Speaker 3: I thought I had something. I mean, I knew it
Speaker 3: was gall but I don't know why I just assumed
Speaker 3: that it had something to do with birds.
Speaker 2: I mean, I would say, goals do have a lot
Speaker 2: of goll.
Speaker 4: I would agree, because it's like usually it's like you
Speaker 4: know someone who's bold hands exactly the goal, the gall
Speaker 4: on that goal, the audacity based on what it is.
Speaker 2: Yeah, I love it. It's it's such a great word.
Speaker 2: It's like a little pearl clutching word. I don't think
Speaker 2: we use it enough. I let's use it for the
Speaker 2: goal and it comes Yeah, it comes from the gallbladder.
Speaker 3: Okay, Like why what does the.
Speaker 2: Gallbladder have to do with personality or temperament or daring?
Speaker 2: So today we may not think that often of our gallbladder,
Speaker 2: except for the subset of us who have been at
Speaker 2: the mercy of our organ because of gallstones or coally
Speaker 2: systectomy or some other reason. Like how many of you
Speaker 2: out there listening knew what the gallbladder did or could
Speaker 2: locate it on a diagram before this episode? I could
Speaker 2: not at all. Yeah, I mean you could do it.
Speaker 3: Yeah. We don't think about it very often. We don't.
Speaker 2: We don't. But this sort of backseat, overlooked role that
Speaker 2: the gallbladder now plays is actually a relatively recent one.
Speaker 2: For centuries, the gallbladder, or maybe more precisely, the substance
Speaker 2: that it stores, was a star. It was famous among
Speaker 2: the organs, or among the substances produced by organs, crucial
Speaker 2: for how it affected not only your health and well being,
Speaker 2: but also your outlook on life? What and that is
Speaker 2: the story that I want to tell today. Okay, I've
Speaker 2: touched on it in other episodes of the podcast, but
Speaker 2: it's not one that I've ever really told or thought
Speaker 2: about in full. And so what better time to discuss
Speaker 2: the humoral theory of disease? Yes? Eight years into this? Yeah,
Speaker 2: so you might be thinking, Okay, well, what do we
Speaker 2: care about an outdated and disproven model for understanding human
Speaker 2: health and disease? Fair enough, I care, I mean yeah,
Speaker 2: but I asked myself, why is this really the right
Speaker 2: thing to do? It doesn't give us a ton of
Speaker 2: accurate info about our bodies inner workings, but it does
Speaker 2: give us insight into how the world was perceived in
Speaker 2: past centuries and how that perception actually lingers today in
Speaker 2: a surprising way, long after the humoral theory of disease
Speaker 2: was supposedly discarded in favor of germ theory and other
Speaker 2: concepts of modern medicine. Okay, but before we get too
Speaker 2: deep into the humors, I figured I should at least
Speaker 2: share some fun gallbladder facts that get collected.
Speaker 3: Give it.
Speaker 2: The largest gallstone removed laparoscopically was twelve point eight centimeters
Speaker 2: long and seven centimeters wide, So that's five point one
Speaker 2: inches two point eight five point one by two point
Speaker 2: eight inches.
Speaker 3: Yeah, that's hefty.
Speaker 2: It's hefty. It's like a smallish avocado, is what I
Speaker 2: would say, like a quite small avocado.
Speaker 3: Just stitting in your gut.
Speaker 2: That was a laparoscopic removal for Yeah, the largest removed
Speaker 2: in a traditional surgery, at least like documented in recent times,
Speaker 2: was sixteen point eight centimeters long and seven point eight
Speaker 2: centimeters wide, so it's like six point six and a
Speaker 2: half by three inches. It's like it's large avocado, good
Speaker 2: sized avocado. Avocado. And also they kind of art were avocado.
Speaker 3: Shaped because the gall bladder is a little alike.
Speaker 2: It's avocado.
Speaker 3: Yeah, pair shaped, avocado shaped.
Speaker 2: That one weighed to one and seventy eight grams or
Speaker 2: zero point six pounds. Wow, it's a large avocado lot.
Speaker 2: I've got citations for those, But this next one comes
Speaker 2: from a more questionable source. So I googled like largest
Speaker 2: gallstone and then found the ones that are like in
Speaker 2: you know, medical journals. But then the Guinness Book of
Speaker 2: World Records of course has an entry stop it quote
Speaker 2: the largest gallstone reported in medical literature was one of
Speaker 2: six point two nine kilograms or thirteen pounds fourteen ounces
Speaker 2: removed from an eighty year old woman by doctor Humphrey
Speaker 2: Arthur at charing Cross Hospital, London. Okay, yeah, okay, no
Speaker 2: citation provided for this, so I hunted it down. I
Speaker 2: read the original paper titled a Large Abdominal Calculus by
Speaker 2: Humphrey Arthur. Couldn't find anything in that paper that was like,
Speaker 2: this is a gallstone. I made you read.
Speaker 3: It, huh?
Speaker 2: And I was like, do you see anywhere that they
Speaker 2: tie this to a gallstone they identify as a gallstone.
Speaker 3: And it doesn't sound like a gallstone either, doesn't sound
Speaker 3: like a bladderstone.
Speaker 2: Yep. In the paper it's not a gallstone. So someone
Speaker 2: has got to notify Guinness to say, you know, sorry,
Speaker 2: that ain't a gallstone.
Speaker 3: Listen, Guinness, wrong, are you hearing this? Can someone at
Speaker 3: them right now, right now, right this minute? You have
Speaker 3: your largest gallstone? Wrong?
Speaker 2: Yeah? Wrong? I mean the largest one I could find
Speaker 2: in the literature was point six pounds. That's not thirteen.
Speaker 3: Pounds fast difference, fast pounds. Yeah.
Speaker 2: So anyway, I.
Speaker 3: Will say, don't you remember at the Sturgical Science museum
Speaker 3: in Chicago. They had some hefty gallstones.
Speaker 2: There had so many gallstones. Yeah, it's highly recommended, such
Speaker 2: a great museum. Yeah, let's go back. Okay, Okay, gallstones
Speaker 2: have been found in ancient Egyptian mummies.
Speaker 3: Of course.
Speaker 2: There is a bronze model of a sheep liver and
Speaker 2: gallbladder from the second century BCE that was found in
Speaker 2: a field in Italy, and the first gallstone removals began
Speaker 2: in the late nineteenth century, led by German surgeon Carl
Speaker 2: Langenbuk who reasoned that some mammals don't have a gallbladder,
Speaker 2: so that probably means that humans can survive with that
Speaker 2: one that but like they were like, eh, that's probably fine.
Speaker 3: That's probably fine.
Speaker 2: Previously, surgeons would treat gallstones or like any gallbladder complaint
Speaker 2: primarily by like creating kind of an opening like you described,
Speaker 2: like a fish Jula's what they described, to excess and remove.
Speaker 3: Stones, remove stones.
Speaker 2: Yeah, okay, what else we can add acute coalesistitis to
Speaker 2: the list of things that allegedly killed Alexander the Great. Oh,
Speaker 2: I think we've covered like poisons on this before, or
Speaker 2: some infection, whether it was typhus or typhoid. Who knows.
Speaker 3: I mean, you can have poisons, so you can get
Speaker 3: colosistitis from not gallstones, like ten percent of cases are
Speaker 3: called a calculus. So maybe in fact it was both
Speaker 3: a poison and a cute could be?
Speaker 2: Could be. The famous American surgeon William Stewart Halsted performed
Speaker 2: surgery on his mom to remove gallstones in eighteen eighty one,
Speaker 2: prolonged her life by a couple of years, And in
Speaker 2: September nineteen sixty five, President Lyndon B. Johnson had his
Speaker 2: gallbladder removed. Okay, you know, laparoscopy helped cut down complications
Speaker 2: and speed up healing time, and the first laparoscopic coali
Speaker 2: systectomy was performed in nineteen eighty five. And now we've
Speaker 2: got robotic assisted coally systectomies. Yeah, pretty pretty cool. Revolutionary
Speaker 2: healing time is yeah, it's it's neat. It's neat stuff.
Speaker 2: That's the end of my gallbladder facts.
Speaker 3: Love it.
Speaker 2: Let me know if you out there have more for me.
Speaker 2: That's really all that I could find for this. Go
Speaker 2: onto humoral theory.
Speaker 3: Okay.
Speaker 2: In the fifth century BCE, our old friend friend of
Speaker 2: the pod Hyppocrates, along with his buds put together the
Speaker 2: revolutionary medical texts that would come to rule Western medicine
Speaker 2: over the next two thousand years. In it, they described
Speaker 2: a person's health, their psychology, character, behavior, preferences, and appearance,
Speaker 2: and how all of this could be traced back to
Speaker 2: the balance or imbalance of four substances in the body.
Speaker 2: The humors. Quoting from Galen, who was a few centuries later,
Speaker 2: quote to begin at the beginning, The elements from which
Speaker 2: the world is made are air, fire, water, and earth.
Speaker 2: The seasons from which the year is composed are spring, summer, winter,
Speaker 2: and autumn. The humors from which animals and humans are
Speaker 2: composed are yellow bile, blood, phlem, and black bile. End quote.
Speaker 3: I love it, He's like listen, it's four four four, okay.
Speaker 2: Four four four. There's a symmetry that is beautiful, undeniable, undeniable.
Speaker 2: The humors were related to the elements of the world,
Speaker 2: like air and blood, water and phlegm, fire and yellow bile,
Speaker 2: earth and black bile interesting, and also to temperature and moisture.
Speaker 2: So blood was hot and moist, phlegm was cold and moist.
Speaker 2: Yellow bial was hot and dry and melancholy or black bile.
Speaker 3: Was cold and dry, okay, interesting, too.
Speaker 2: Much of one humor could be deadly. Your death could
Speaker 2: be caused by excess phlegm, like that would be on
Speaker 2: your death certificate. Let's say you maybe ate too much
Speaker 2: of something or drank too much of something that gave
Speaker 2: you that excess phlem. That was what led to it,
Speaker 2: and treatments were advised based on the precise imbalance. If
Speaker 2: it was an excess of blood, bleeding was your best
Speaker 2: course of action. If it was yellow or black bile
Speaker 2: that you had too much of, you should probably take
Speaker 2: some laxatives or emetics, something to make you throw up.
Speaker 2: And if it was phlegm that was bothering you, like
Speaker 2: it clearly is bothering me. Nothing better, Nothing is better
Speaker 2: than something that caused you to sweat or expectorate.
Speaker 3: Quick question. Sure is phlem back then the same thing
Speaker 3: as phlem today?
Speaker 2: I think so, But it's kind of this is where
Speaker 2: it gets a little bit weird, because what the heck
Speaker 2: is black bile?
Speaker 3: Yeah, that's what that was gonna be my next question.
Speaker 2: Yeah, it's we'll get a little bit more. No, we'll
Speaker 2: get a little bit more into it. But like I
Speaker 2: think that we have to suspend our our perception of
Speaker 2: we have to see what these substances are and where
Speaker 2: they're coming from, because a lot of it was not
Speaker 2: in how they're coming out of your body, but just.
Speaker 3: This like idea of how they exist in your body. Yeah, okay,
Speaker 3: I feel like I always thought of flem as like lymph,
Speaker 3: and I know that they didn't really know that that
Speaker 3: was the thing, but like in my brain act like
Speaker 3: that's what it is.
Speaker 2: Yeah, right, and maybe it is. You know, sometimes these
Speaker 2: did come out like you could see maybe flem is
Speaker 2: you know, snot or whatever. Blood obviously is more visible,
Speaker 2: but like there's blood. Wasn't necessarily blood if that makes sense.
Speaker 3: Oh my god, it doesn't, but I'm going to go
Speaker 3: with it.
Speaker 2: You know, like, well there was like the blood that
Speaker 2: you bleed, and then there was the blood that was
Speaker 2: like a part of your core that beat was different, Yeah,
Speaker 2: which really I mean we got to just try to
Speaker 2: think in their in their minds. Yeah. And so what
Speaker 2: you what you wanted to do with treatment was basically
Speaker 2: treat with opposites, so like allopathy as opposed to homeopathy,
Speaker 2: which is like like with like and so guided by
Speaker 2: these general principles, people suffering from whatever ailment didn't necessarily
Speaker 2: have to seek the help of a physician only in
Speaker 2: extreme cases, but they could concoct their own remedy or
Speaker 2: buy a home remedy. Poultices, aenem syrups, potions, powders, pills, ointments, antidotes, fomentations, inhalations, infusions.
Speaker 3: Lots of options, less possibilities yep.
Speaker 2: And the quality of the treatment was determined not by
Speaker 2: its efficacy necessarily, but generally how rare or expensive the
Speaker 2: ingredients were or how complicated it was to put together.
Speaker 2: But even for the healthy person, there were general guidelines
Speaker 2: for how to live your life under the humoral theory
Speaker 2: of disease. Eat less in the summer and more in
Speaker 2: the winter. Beer nourishes provokes urine has a laxative effect,
Speaker 2: causes gas truth vinegar induces melancholy. I'm not sure about
Speaker 2: that one.
Speaker 3: For me.
Speaker 2: Ye, blood letting is best in springtime and only for
Speaker 2: those older than seventeen. Baths are not recommended during the
Speaker 2: summer months, which is also a time to eat cold
Speaker 2: food and avoid lovemaking, Oh dear, which might be related
Speaker 2: to the baths. Okay, sideline, I'm not sure, but alongside
Speaker 2: temporary imbalances. Rocking the boat people tended to have a
Speaker 2: certain humoral imbalance, which determine their personality. Those with more
Speaker 2: yellow bile or collar colar were choleric, achievement oriented, driven, bold, decisive, independent, argumentative.
Speaker 2: These this yellow bile was associated with or people of
Speaker 2: this temperament was associated with summer and adolescence or youth.
Speaker 2: If you had an excess of black bile, you were
Speaker 2: of the melancholic personality, sensitive, indirect, detail oriented, loyal, associated
Speaker 2: with maturity and audit, and a tendency to delirium or depression.
Speaker 2: A phlegmatic person or phlegmatic person had more. You guessed
Speaker 2: at phlem and they tended to be calm, steady, introverted, agreeable, indirect,
Speaker 2: slow to action, associated with winter and old age.
Speaker 3: Okay.
Speaker 2: And then finally, more blood led to a sanguine personality, optimistic, social, serene,
Speaker 2: fun loving, extroverted, active, associated with springtime and childhood. And
Speaker 2: there's like diagrams that you can see that have like
Speaker 2: these different colors. So like red is sanguine, obviously, black
Speaker 2: biles black. I'm pretty sure yellow bile is yellow, and
Speaker 2: then phlegm, I think is orange or not orange blue. Interesting, Yeah,
Speaker 2: and it has like it's like an idiogram. Yeah, I
Speaker 2: don't know if there are like wings and whatever. And
Speaker 2: I was like thinking in my head, like, oh yeah
Speaker 2: that you know, yellow bile, the choleric personality really sounds
Speaker 2: kind of like an eight or a three, And then
Speaker 2: like yeah, but then I was like, I can't these
Speaker 2: are not one to one.
Speaker 3: Yeah, obviously obviously, but yeah.
Speaker 2: So the humoral theory of disease provided a framework to
Speaker 2: understand not only a person's health or disease, but also
Speaker 2: their emotions and personality, linking the two. And it drew
Speaker 2: connections between the environment, diet, and just inborn temperament to
Speaker 2: not only explain a disease, but also to provide a
Speaker 2: prognosis how the disease was expected to play out, guided
Speaker 2: by adjustments to humoral balance. And more than this, the
Speaker 2: humoral theory of disease represents a revolution in how people
Speaker 2: understood the world to work. Rather than divine intervention or superstition,
Speaker 2: there was a physical basis for every phenomenon of the
Speaker 2: human body and a corresponding explanation. All you had to
Speaker 2: do was closely observe your patient, maybe take a case history,
Speaker 2: which led you to a diagnosis than prognosis than treatment.
Speaker 2: This approach to medicine was really the first to resemble
Speaker 2: the scientific one that we use today to some extent.
Speaker 2: Interesting because instead of there being one answer to every
Speaker 2: question of why, which would be because God decrete it,
Speaker 2: there could be a multitude of answers. This framework of
Speaker 2: humoral theory had its own logic, even if that logic
Speaker 2: is not based on our current understanding of anatomy and physiology,
Speaker 2: and it allowed physicians to, you know, do all of
Speaker 2: these things in order to care for their patient. And
Speaker 2: the humoral theory of disease persisted for centuries despite the
Speaker 2: you know, the lack in our eyes were like you
Speaker 2: kidding me, what even is black bios like, what is that?
Speaker 2: What is it? Based? Not based on fact or on
Speaker 2: what we know? It's still persisted because it gave meaning
Speaker 2: to the world. It answered these unanswerable questions, and I
Speaker 2: think it provided some form of certainty, and we know
Speaker 2: how much people hate uncertainty. Yeah, and so in this way,
Speaker 2: the humoral theory of disease was deterministic, like everything including
Speaker 2: behavior and mood, could be explained as it related to humors. Oh, well,
Speaker 2: of course you have this, you know, like and I
Speaker 2: imagine that would be both satisfying and also like very irritating, right, Like, no,
Speaker 2: I'm not upset because I ate hot soup and my
Speaker 2: bile is up. I'm upset because you borrowed my toga
Speaker 2: and you stained it. But you have a sanguine temperament,
Speaker 2: so of course you wouldn't understand. But at the same time,
Speaker 2: people couldn't use their humoral imbalance as an excuse for
Speaker 2: bad behavior, like if an imbalance represented a diseased, unnatural
Speaker 2: state of being, they should try to act against it,
Speaker 2: to use their rational mind to make decisions and take action, like.
Speaker 3: You're supposed to overcome this kind.
Speaker 2: Of yeah, yeah yeah, and to not overcome it, to
Speaker 2: be beholden to your inborn temperament was kind of like
Speaker 2: viewed as a weakness like you know better, Yeah, fascinating, okay.
Speaker 2: And so the order and explanatory power that the humoral
Speaker 2: system provided is really what helped it survive for so
Speaker 2: many centuries because it could be folded into any religion
Speaker 2: like this is how whatever deity you believed in created humanity.
Speaker 2: It could explain any illness or any state of mind,
Speaker 2: and it was adaptable. Like if you needed to add
Speaker 2: a little bit more color to your diagnosis, you could
Speaker 2: just say, well, you know, it wasn't just an excess
Speaker 2: of blood, but it was the type of blood, how
Speaker 2: viscous it was, where it came from, which organ or
Speaker 2: like part of the body was it concentrated in.
Speaker 3: Could get really really neat gritty with you could your
Speaker 3: various humors yep.
Speaker 2: So like smallpox, for instance, was believed by one ancient
Speaker 2: physician to be the result of retained menstrual blood by
Speaker 2: the fetus. So like you got smallpox as a fifteen
Speaker 2: year old because as a fetus there was retained menstrual
Speaker 2: blood in your mom's womb.
Speaker 3: Oh like not okay, yeah, oh okay, like okay exactly.
Speaker 2: So like there's there's no limit to the mental gymnastics
Speaker 2: that you can do.
Speaker 3: Yeah wow, okay, just come up with an idea and
Speaker 3: then you could say you could you could humor it.
Speaker 2: There you go.
Speaker 3: Uh.
Speaker 2: Infectious inheritable diseases also fit nicely into this, since miasma
Speaker 2: explained how could it could be transmitted from person to person,
Speaker 2: like humors and humoral temperament could be transferred from parent
Speaker 2: to offspring.
Speaker 3: MM naturally.
Speaker 2: Were also less about curing someone than they were about
Speaker 2: guiding someone through their natural course of disease and doing
Speaker 2: their best to get the best outcome, and with things
Speaker 2: like diet and then later on herbal remedies. So this
Speaker 2: left more wiggle room for physicians who weren't expected to
Speaker 2: cure their patients. So it wasn't like you don't know
Speaker 2: what you're talking about because this person's not getting better.
Speaker 2: It was just like, this is the destiny, and I'm
Speaker 2: trying to do my best to fix things, but I'm
Speaker 2: you know, I can only do so much.
Speaker 3: I'm limited.
Speaker 2: I'm limited. Yeah, And the basic principles of humoral theory
Speaker 2: were also fairly easy to grasp, Like if you could
Speaker 2: remember each of the humors and what season or moisture
Speaker 2: they were associated with, and then various foods and their
Speaker 2: you know, moisture or heat levels, yeah, you could make
Speaker 2: a good guess as to what your disease was and
Speaker 2: how to manage it, even if you had no formal
Speaker 2: training or education.
Speaker 3: Okay.
Speaker 2: The other thing that let humoral theory rain was that
Speaker 2: autopsies were not permitted for a good chunk of this time.
Speaker 2: That excess of black bile was based on external observations
Speaker 2: of just like someone's symptoms, and as we'll later see,
Speaker 2: fact checking would undermine the credibility of humoralism.
Speaker 3: Once they tried to find out what the heck is
Speaker 3: black bile, then they were like, there is no such thing. Okay.
Speaker 2: And this isn't to say that humoral theory remained unchanged
Speaker 2: until the seventeenth and eighteenth centuries. You know, there were
Speaker 2: scholars like the famous Persian physician Avicenna who added his
Speaker 2: flare to it, and overall interpretations became more complex, as
Speaker 2: did the mental gymnastics that were required to come up
Speaker 2: with these explanations. So, for instance, a combination of heat
Speaker 2: and the liver weakness of the spleen, external cold and
Speaker 2: a long disease history could lead to a heightened amount
Speaker 2: of black bile in the organism.
Speaker 3: Okay, how do they know what is a liver and
Speaker 3: what is a spleen if they're not yeah, and animals okay,
Speaker 3: animals okay, And then they they really do okay.
Speaker 2: Yeah, they would do autopsy or not autopsies, dissections on
Speaker 2: animals and then like make assumptions like that must be
Speaker 2: what the human coralate is.
Speaker 3: Yeah, so do we even know if yellow bile is
Speaker 3: what we call bile today?
Speaker 2: I think it was because I believe that Hippocrates thought
Speaker 2: it was produced by the liver or not not the liver,
Speaker 2: but a he thought it was produced actually by the
Speaker 2: gallbladder by we're going to attach to the liver, got it.
Speaker 2: So I do think that it was related to the bile.
Speaker 3: That we we have at least those coralates, and phlem
Speaker 3: might be really phlem and then black bio is the
Speaker 3: real question mark here.
Speaker 2: Yeah, I had a little bit about black bile, but
Speaker 2: now I have forgotten what it was. It was just
Speaker 2: sort of like, we don't really know it a certain
Speaker 2: type of blood, is it? I don't know.
Speaker 3: Interesting so interesting arin.
Speaker 2: Yeah, And humoral theory, it's not like it remained super
Speaker 2: popular during this entire time, so it fell out of
Speaker 2: favor occasionally, like in the Middle Ages when Christianity was
Speaker 2: on the rise and treatment was thought to like corrupt
Speaker 2: the soul and go against like God's wishes, or when
Speaker 2: an epidemic exhausted the explanatory power of humoral theory, like
Speaker 2: when the Black Death struck Western Eurasia in the mid
Speaker 2: fourteenth century. You can't explain away a third to a
Speaker 2: half of the population dying because they all took a
Speaker 2: bath in the summer.
Speaker 3: Like that's that's just can't do that.
Speaker 2: Yeah, yeah, So that was a crack in the certainty
Speaker 2: that humoralism had provided, and that crack just widened over
Speaker 2: the next centuries as people tried out alternative frameworks to
Speaker 2: understand the world, you know, magic, religion, alchemy, homeopathy, anatomy.
Speaker 2: By the seventeenth century, humoralism was under threat, with the
Speaker 2: taboo against dissections slowly breaking down. You had anatomous like
Speaker 2: Visalius publishing intricate drawings of the human body, and artists
Speaker 2: like Michelangelo celebrating the naked form. People were gaining a
Speaker 2: clearer insight into structure and function. And then you have
Speaker 2: microscopes allowing a view of the world as it had
Speaker 2: never before been seen. What these new perspectives revealed was
Speaker 2: that humoral theory simply did not hold up under scrutiny.
Speaker 2: The vena cava was not connected to the liver as
Speaker 2: Galen had claimed, nor were the lungs simply there to
Speaker 2: cool the heart. Oh, I mean, there were entire humoral
Speaker 2: structures missing.
Speaker 3: Wow.
Speaker 2: I mean, yeah, we've talked about breath before and how
Speaker 2: it was not understood why.
Speaker 3: Breath was what breath was.
Speaker 2: Yeah, yeah, because we didn't know about oxygen. And yeah.
Speaker 2: Anatomical dissections ironically were permitted because they were supposed to
Speaker 2: support humoral theory and provide more detail, not dethrone it,
Speaker 2: and so Visalius's findings were quite an unwelcome shock to
Speaker 2: the medical establishment of the mid sixteenth century, which had,
Speaker 2: you know, still was adhering to Galen's teachings. But you
Speaker 2: couldn't uncrack that egg, and this marked the beginning of
Speaker 2: the end for humoralism. Observable evidence obtained through experimentation became
Speaker 2: the gold standard for establishing new laws of nature and
Speaker 2: guidelines for practicing medicine, just empiricism basically, but there was
Speaker 2: no concept of health and disease that could immediately replace
Speaker 2: humoral theory, and so it was a slow decline. It
Speaker 2: didn't help that humoralism was literally embedded in language, not
Speaker 2: just for physicians or scientists, but for everyone, Like it
Speaker 2: was how you understood yourself, it was how you understood
Speaker 2: the way you moved about the world. Blood wasn't just
Speaker 2: blood it could be invigorating or excessive, pure or corrupt.
Speaker 2: But that connection grew thin as scientists discovered that blood,
Speaker 2: well was just blood, and the human body actually bore
Speaker 2: a closer resemblance to the machines that engineers were inventing,
Speaker 2: rather than the mystical being imagined by the ancients. The
Speaker 2: feeling was that everything would eventually be figured out in
Speaker 2: short order, and for many things that was true. The
Speaker 2: nineteenth century saw germ theory oust miasma, The circulatory system
Speaker 2: was fully mapped, the beginnings of hormones and vitamins were
Speaker 2: starting to be understood, and there were effective treatments developed
Speaker 2: for a myriad of illnesses. Bit by bit, body part
Speaker 2: by body part, medicine was laying claim to distinct areas
Speaker 2: of human health. The one realm that seemed stubbornly opaque
Speaker 2: was the brain and nervous system. Still true, neurology as
Speaker 2: it was born in the late eighteen hundreds wasn't explicitly
Speaker 2: modeled after humoralism, but it certainly paralleled it. Hysteria was
Speaker 2: associated with excess fluidity okay, and was thought to be
Speaker 2: impacted by diet exercise. Too much of this, too little
Speaker 2: of that some of which might have a trace of
Speaker 2: truth to it, right.
Speaker 3: I think that's what's so interesting about I mean, like,
Speaker 3: you know, not to the extreme of like don't do
Speaker 3: this in summer, don't do this in winter, but like
Speaker 3: so much of it is like still, like we should
Speaker 3: move our bodies makes sense?
Speaker 2: Is common sense? A lot of it is just common
Speaker 2: sense advice. Yeah, but then there were Yeah, things like
Speaker 2: neurasthenia also had associations that were very like humoral in nature.
Speaker 2: Melancholy remained pretty much unchanged in its conception. It was like, oh,
Speaker 2: black bile cooled the brain, it makes you depressed.
Speaker 3: Interesting.
Speaker 2: The psychiatrist of decades past, just like those today, have
Speaker 2: sought to bridge the gap between the brain and the mind,
Speaker 2: and part of that bridge has really been constructed with
Speaker 2: the concept of temperaments, Like why do we respond the
Speaker 2: way we do to certain events? Do certain individuals tend
Speaker 2: to be affected by this disease or that disorder, whether
Speaker 2: these are mental health illnesses, or whether these are like
Speaker 2: physical illnesses, people who are high strung, they are thought
Speaker 2: to have higher blood pressure and all these things.
Speaker 3: Why.
Speaker 2: The reason is because humors have not left the building.
Speaker 2: The traces of humoral theory can be found in the
Speaker 2: language that we use, like sanguine, like melancholy, good, humored,
Speaker 2: bilious gall In Greek, the word coli means bile. Melon
Speaker 2: means black, So melancholy black bile, Like that is directly
Speaker 2: what it comes from. Isn't that fascinating?
Speaker 3: Wow? I didn't know that.
Speaker 2: Yeah huh. But the humoral theory has also lingered beyond linguistics,
Speaker 2: like we still seek balance in our lives, whether it's
Speaker 2: our work life balance, getting the right the balance, diet,
Speaker 2: enough exercise and relaxation. We feel like we should eat
Speaker 2: certain foods in certain times of year, right, like warm
Speaker 2: and hearty soups in the winter. We take ginger for
Speaker 2: nausea and humoralism ginger is warming, and so that was
Speaker 2: supposed to help to combat whatever it is, phlem or something. Yeah, yeah,
Speaker 2: eucalyptus for stuff sinuses like, also straight from humoral theory.
Speaker 2: We're only now recognizing the role that diet might play
Speaker 2: in a myriad of things that we just kind of
Speaker 2: had discarded previously, like mental health, maybe via our microbiome.
Speaker 2: This would not have surprised humorists at all, which I
Speaker 2: find really fun and interesting.
Speaker 3: It's all a circle.
Speaker 2: It's all a circle.
Speaker 3: Yeah.
Speaker 2: Today, scientists and medical practitioners operate under a framework that's
Speaker 2: been refined by decades of observation and experimentation, and we
Speaker 2: rely on these general rules to make sense of the world.
Speaker 2: But when we discarded humoralism in favor of empirical science,
Speaker 2: we also left behind perhaps what I think is like
Speaker 2: the most important lesson of humoral theory, and that is
Speaker 2: that each patient is a unique person, and you have
Speaker 2: to first understand that individual and where they come from
Speaker 2: and who they are in order to help them. So
Speaker 2: like that's I don't know, that was something that I
Speaker 2: was thinking about in terms of like just how the temperaments. Yes,
Speaker 2: it is putting people in boxes, but it is also
Speaker 2: acknowledging them as individual people right at the same time.
Speaker 2: So I just thought that was an interesting little foray.
Speaker 2: That's the lesson that I could draw from humoralism. I mean,
Speaker 2: to be honest, just full disclosure. I wrote most of
Speaker 2: this when I was sick, and so I like reading
Speaker 2: it over. I was like, wow, this feels like a
Speaker 2: fever dream. You can hear it in my voice to me.
Speaker 3: Maybe the humoral theory all is it is a fever dreamer,
Speaker 3: so maybe it.
Speaker 2: Was a fever dream. Yeah. I had no idea what
Speaker 2: I was going to do for gallbladders. I did not
Speaker 2: expect to come down this path of funeral theory of disease,
Speaker 2: but I thought it was fun Then I was like thinking, like,
Speaker 2: what what humoral temperament? Temperament? Am I?
Speaker 1: Yeah?
Speaker 3: What are you?
Speaker 2: I don't know. I asked my sister actually, and she
Speaker 2: said I was choleric, which is like the argumentative one I.
Speaker 3: Would I would agree with that, but I would say
Speaker 3: I was going to guess myself is the same, So I.
Speaker 2: Think we might be. Yeah, we might be a mix
Speaker 2: of of choleric and sanguine as well.
Speaker 3: I think on the border line there yellow and red,
Speaker 3: perfect can optimistic also, right, yeah, sometimes, But that's all.
Speaker 2: I've got for gallbladder, which is really the humoral theory
Speaker 2: of disease.
Speaker 3: I did not expect that journey, and I really quite
Speaker 3: enjoyed it.
Speaker 2: I'm glad. I'm glad. What's what's going on with gallbladder
Speaker 2: stuff today? Let's let's wrap this up by getting back
Speaker 2: to where we started.
Speaker 3: Sure, let me tell you about it. I kind of
Speaker 3: already told you about it, Aaron, Honestly, Okay, ten to
Speaker 3: fifteen of adults in the US and in Europe, and
Speaker 3: we don't have data on like across the whole globe,
Speaker 3: but it's estimated on average ten to fifteen percent of
Speaker 3: adults end up with gallstones. But luckily most people eighty
Speaker 3: percent or so of people with gallstones are asymptomatic. The
Speaker 3: other twenty percent may end up with complications at some point.
Speaker 3: Ten to fifteen percent of those complications will be acute colisciitis,
Speaker 3: so that is by and large the most common complication
Speaker 3: of gallstones. There are pretty big differences in like prevalence
Speaker 3: of gallstones, especially if you're looking at different like racial
Speaker 3: or ethnic groups, like within the US, for example. But
Speaker 3: it is not necessarily thought that this is genetic, Like
Speaker 3: we haven't found genetic markers that clearly explain this, and
Speaker 3: so the thought is maybe it's more related to say,
Speaker 3: dietary factors in different like populations or different areas, which
Speaker 3: my underscore that it's just a social construct after all.
Speaker 2: Of course, Okay, I did think though that like there
Speaker 2: tended to be gallbladder like family history of gallbladder might
Speaker 2: or gallbladder removal makes you more likely to have gallbladder there.
Speaker 3: Yeah, so there are some like familial clustering, but we
Speaker 3: still haven't found any like genetic markers. So is it
Speaker 3: microbiome where you know, you have similar microbiomes when you
Speaker 3: live in the same households and things. I don't know.
Speaker 3: We don't know, Okay, does it could also be genetic
Speaker 3: and we just don't know it yet. Sure, people assigned
Speaker 3: female at birth are more likely to have complications from gallstones,
Speaker 3: although that's also less true in older populations, Like it
Speaker 3: kind of evens out the older that you get. So
Speaker 3: that's why it's maybe thought. Is it the estrogen that
Speaker 3: we have higher levels of, especially you know in our
Speaker 3: younger years prior to menopause. We don't. We don't know,
Speaker 3: but those are some of the risk factors. There's also
Speaker 3: other things. Sometimes higher BMI is associated with the higher
Speaker 3: risk of gallstones, but also so is weight loss associated
Speaker 3: with gallstones and complications. I mentioned diabetes and some of
Speaker 3: our diabetes medications. And we know too that it's not
Speaker 3: just a cute coli cystitis. The incidence of acute pancreatitis
Speaker 3: is about forty per one hundred thousand each year in
Speaker 3: the US. Okay, I should have aired mathat but I didn't.
Speaker 3: But about fifty percent of those are from gallstones, and
Speaker 3: gallstones are kind of the major risk factor for gallbladder cancer,
Speaker 3: of which there are an estimated one hundred and fifteen
Speaker 3: thousand or socases each year across the whole globe. So
Speaker 3: that's my stats. Okay. According to most sources in the US,
Speaker 3: there are about half a million Coli systectomies performed every
Speaker 3: single year, So that means half a million gallbladders. Get
Speaker 3: the bucket kicked? WHOA, I know it's a lot, right. Oh.
Speaker 2: I have a question, okay, if you have a liver transplant,
Speaker 2: uh huh, is the gallbladder ever come with?
Speaker 3: I don't think so.
Speaker 2: No, Okay, I don't know why. I was just curious.
Speaker 3: That's an interesting question, I think so. No, okay, great question.
Speaker 3: Do they take the gallbladder out? I don't. I feel
Speaker 3: like I ought to know more about this, but they're like, yeah,
Speaker 3: they're butts their pals. There's a little pouch for it. Yeah. No,
Speaker 3: I don't know. Great question.
Speaker 2: I love that you abbreviated question. Great question.
Speaker 3: Listen, what are we doing in terms of research with
Speaker 3: the gallbladder. Great question. I don't know, okay, okay, but
Speaker 3: I did find a really interesting paper. It was like
Speaker 3: real long and like deep in detail. So if someone
Speaker 3: wants to get deep into this, I got some sources
Speaker 3: for you. I underestimate just how important bio acids are
Speaker 3: and how much of a role they serve outside of
Speaker 3: just digesting are fats. They're important in like intestinal homeostasis.
Speaker 3: They're important in like absorption. But if there's too much
Speaker 3: of them that makes it to the colon, they can
Speaker 3: end up causing diarrhea. If there's not enough, you can
Speaker 3: end up with chronic constipation. So there's been like bio
Speaker 3: acid dysfunction implicated in ibs. They're affecting our microbiome. That
Speaker 3: might even affect the increases in risk in colon cancer.
Speaker 3: And we've seen a lot about colon cancer lately and
Speaker 3: increased risk especially in young folks. That might have something
Speaker 3: to do with bio acids. We don't know, still up
Speaker 3: for debate, And there's just increasing evidence of bio acid's
Speaker 3: role in a myriad of other disease processes, and so
Speaker 3: there's research ongoing into using drugs that target bio acid receptors.
Speaker 3: Either black looking them or activating them as potential treatments
Speaker 3: for a number of different diseases. We also do use
Speaker 3: bile acid sequestrians, so that's like things that grab onto
Speaker 3: bile acids and help us to just poop them out
Speaker 3: rather than reabsorbing them, mostly to treat elevated cholesterol. But
Speaker 3: we don't use them really often because they have quite
Speaker 3: a lot of side effects, especially diarrhea and like bloating
Speaker 3: and things like that. So yeah, none of that is
Speaker 3: very gall bladder specific, but it's just I mean, but bile,
Speaker 3: bile and bile acids so so interesting. So if you
Speaker 3: want to read more, let us tell you about all
Speaker 3: of our sources.
Speaker 2: Yes, if you want to read more about definitely something
Speaker 2: that is not gallblader specific in any way, shape or form.
Speaker 2: There is a book called Passions and Tempers and it's
Speaker 2: about the humoral theory of disease by Noga Arika. And
Speaker 2: then there's a paper which just has a few funt tedbits.
Speaker 2: It's a book chapter actually called History of Medical and
Speaker 2: Surgical Management of Acute Coalesistitis by Barry and Frank from
Speaker 2: twenty fifteen. And I've got a few more sources, especially
Speaker 2: on those big gallstones and you know, so Guinness Booker
Speaker 2: World Records, get on this.
Speaker 3: Yeah. I also had a number of sources I used,
Speaker 3: primarily also a textbook chapter. It was from the textbook
Speaker 3: Comprehensive Physiology, and the chapter was called Functions of the gallbladder. Surprise, surprise.
Speaker 3: I also used a bunch of other specific papers to
Speaker 3: look at. For example, there was one from the Lancet
Speaker 3: in two thousand and six called Cholesterol gallstone Disease. There
Speaker 3: was a Gamma review from twenty twenty two called acute coalsistitis,
Speaker 3: a review I've got one on gall bladder cancer, one
Speaker 3: on pancreatitis, a few others on bile acids, both the
Speaker 3: synthesis and their use in these other like the other
Speaker 3: functions that they serve. You can find all of that
Speaker 3: on our website, this podcast we Kill You dot Com
Speaker 3: under the episodes tab.
Speaker 2: Certainly, Ken Maria, thank you so much again for sharing
Speaker 2: your story.
Speaker 3: Yes, seriously, thank you so much, so much for telling
Speaker 3: us that story and sharing it with all of our listeners.
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Speaker 2: Thank you to Blood Mobile for providing the music for
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Speaker 3: Thank you to Tom and Leanna and Brent and Pete
Speaker 3: and Jessica and everyone and exactly right for everything that
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Speaker 2: think of the gallbladder. What what temperament are you? What
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Speaker 2: We do well. Until next time, wash your hands
Speaker 3: You feel the animals