Gallbladder/pancreas disorders

• The biliary tract is a system of organs and tubes (ducts) that help transport a digestive fluid, called bile, from the liver to the small intestine. Bile, which is produced in the liver and stored in the gallbladder, is needed to breakdown and absorb fats in foods. Gallbladder disorders, also called biliary tract disorders, occur when there is a disruption in this process.
• For instance, the most common gallbladder disorder is gallstones. This occurs when the bile becomes too concentrated and tiny particles in the fluid form a stone-like mass in the ducts that blocks proper bile flow.
• The pancreas, which is located behind the stomach, is another organ that helps break down foods that are consumed. The pancreas produces enzymes that are released into the small intestine to break down proteins, carbohydrates, and lipids (fats) in food. A section of the pancreas also produces insulin and glucagon; both help regulate the amount of sugar in the blood.
• Pancreatitis is a common pancreatic disorder that occurs when the organ becomes inflamed.
• Most gallbladder and pancreatic disorders can be successfully treated with medications and/or surgery.

B

Good scientific evidence

• Globe artichoke
  : Globe artichoke is a perennial, thistle-like plant originating in southern Europe around the Mediterranean Sea. Globe artichoke leaf extract has been found to increase bile secretion in animal, human, and laboratory studies. Additional human study is needed to make a firm recommendation for artichoke as a choleretic for patients who have cholestasis.
• Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae family (e.g. chrysanthemums, daisies, marigolds, ragweed, and arnica), due to possible cross-reactivity. Use cautiously with cholelithiasis or biliary/bile duct obstruction or kidney disease. Avoid if pregnant or breastfeeding.
• Probiotics
  : Supplementing with Lactobacillus plantarum 299 may help prevent pancreatic infection (sepsis), reduce the number of operations needed, and reduce the length of hospital stay in acute pancreatitis. Additional research is needed to make a conclusion.
• Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.

C

Unclear or conflicting scientific evidence

• Bromelain
  : Bromelain is a digestive enzyme that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is currently little reliable scientific research on whether bromelain is helpful for pancreatic insufficiency. Better study is needed before a firm conclusion can be made.
• Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceae
  family. Use cautiously with history of a bleeding disorder, stomach ulcers, heart disease, or liver or kidney disease. Use cautiously before dental or surgical procedures with bleeding risks. Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.
• Chlorophyll
  : Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants; it is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussels sprouts, cabbage, lettuce, and spinach), algae (Chlorella and Spirulina), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). Based on early study, it has been suggested that chlorophyll-a may reduce the mortality rate in chronic pancreatitis. Additional study is needed in this area.
• Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
• Danshen
  : Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. For many years, danshen has been used as a traditional Chinese medicine (TCM) remedy to treat acute pancreatitis. However, little scientific research is currently available regarding the use of danshen in humans.
• Avoid if allergic or hypersensitive to danshen. Use cautiously with altered immune states, arrhythmia, compromised liver function or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives including ACE inhibitors such as captopril, or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders, low blood pressure, and following cerebal ischemia. Avoid if pregnant or breastfeeding.
• Grape seed
  : Limited available human study suggests that grape seed may reduce abdominal pain in chronic pancreatitis. Further research is needed.
• Reports exist of people with allergy to grapes or other grape compounds, including anaphylaxis. Individuals allergic to grapes should not take grape seed and related products. Use cautiously if taking anticoagulants. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Grape seed may interfere with the way the body processes certain drugs that use the liver's cytochrome P450 enzyme system. Avoid if pregnant or breastfeeding.
• Greater celandine
  : Greater celandine
  (Chelidonium majus)
  and turmeric (Curcuma longa) have traditionally been used to support the liver and gallbladder. However, clinical study is currently lacking. Early human study provides initial data on the efficacy of a Chelidonium and Curcuma combination for pain relief in biliary colic and dyskinesia. The herbs did not appear to be beneficial in resolving associated symptoms, raising questions about the usefulness of this combination in fully restoring biliary function. Additional research is necessary to clarify the optimal dose, length of treatment, and clinical applications for these two herbs individually and in combination.
• Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, dopaminergic drugs, or serotonergic drugs. Use cautiously in patients undergoing radiation therapy. Avoid in patients with liver disease, or in pregnant and lactating women.
• SAMe
  : SAMe (S-adenosyl-L-methionine) is a natural substance found in every cell of the body. SAMe may be beneficial for pruritus (severe itching) and serum bilirubin levels associated with cholestasis. Additional study is needed. Currently, there is insufficient available evidence to determine if SAMe is an effective treatment for cholestasis during pregnancy. Information on the use of SAMe prior to the third trimester is currently lacking.
• Avoid if allergic to SAMe. Use cautiously with diabetes or anxiety disorders. Avoid with bipolar disorder. Avoid in the first and second trimesters of pregnancy or if breastfeeding, due to a lack of safety information.
• Selenium
  : There is currently inconclusive evidence regarding the use of selenium in pancreatitis. Additional study is needed in this area.
• Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
• Soy
  : Due to limited human study, there is not enough evidence to determine if soy is an effective treatment for gallstones (cholelithiasis). Further research is needed before a conclusion can be made.
• Avoid if allergic to soy. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been one case report of vitamin D deficiency rickets in an infant nursed with soybean milk that was not specifically designed for infants. People who experience intestinal irritation from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens (e.g. increased risk of blood clots). The use of soy is often discouraged in patients with hormone-sensitive cancers (e.g. breast cancer or prostate cancer). Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs like warfarin or aspirin should check with their doctors and pharmacists before taking soy supplements. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there are limited scientific data.
• Turmeric
  : Turmeric is a perennial plant native to India and Indonesia that is often used as a spice in cooking. Anecdotally, it has been observed that there is a low incidence of cholelithiasis in Indian populations. Animal research reports that adding the turmeric constituent, curcumin, to the diet reduces the incidence of chemically-induced gallstones in mice, and it has been suggested that turmeric may inhibit the formation of cholesterol gallstones. Preliminary human data suggest that curcumin may function as a cholagogue (gallbladder contracting agent) and may be of benefit for cholelithiasis prevention. However, use of turmeric may be inadvisable in patients with active gallstones.
• Avoid if allergic to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously if taking blood-thinners like warfarin (e.g. Coumadin® or aspirin). Use cautiously if pregnant or breastfeeding.
• White horehound
  : The expert German panel, the Commission E, has approved white horehound as a choleretic for the treatment of dyspepsia (upset stomach) and lack of appetite. The evidence supporting this use is largely anecdotal and based on historical use, and there is currently insufficient scientific research to recommend for or against this use of white horehound.
• Avoid if allergic to white horehound or any member of the Lamiaceae (mint) family. White horehound is generally considered safe when used to flavor foods. Use cautiously with diabetes, high/low/unstable blood pressure, high levels of sodium in the blood, irregular heartbeats, or gastrointestinal disease. Use cautiously if taking diuretics. Avoid if pregnant or breastfeeding.
• zinc
  : In early study, zinc sulfate supplementation was shown to decrease serum unconjugated bilirubin levels in patients with Gilbert's syndrome. Well-designed clinical trials are needed to confirm these results.
• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

D

Fair negative scientific evidence

• Iridology
  : Iridology is the study of the iris for diagnostic purposes. Conventional medicine regards iridology as an unsubstantiated alternative diagnostic technique, although some studies have suggested it may have some potential validity. Preliminary study examined the potential of iridology for gallbladder disease diagnosis using slide photographs of patients with the disease, and found no evidence of agreement or diagnostic accuracy. Therefore, there is currently insufficient evidence supporting the use of iridology as a diagnostic tool in gallbladder disease.
• Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and potentially severe medical problems may thus go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment.

• Avoid or minimize alcohol consumption because it may lead to pancreatitis and may also worsen symptoms of bile reflux by relaxing the lower esophageal sphincter and irritating the esophagus.
• Patients can reduce their risks of developing gallstones by maintaining a healthy body weight, exercising regularly, and consuming a reduced-fat, high-fiber diet that includes a variety of fresh vegetables, fruits, and whole grains.
• Patients are encouraged not to smoke because it increases the risk of developing pancreatitis.
• Patients who have a history of gallstones should take bile salt tablets, called ursodiol (Actigall®), daily to prevent gallstones from recurring.