Since the 1960’s scientists saw a possible correlation between the development of gallstones and heart disease. Most people thought that it was just the risk factors associated with developing gallstones was the cause, not the issues with digestion. Obesity and diabetes are two risk factors for having issues with gallstones that have been linked to developing heart disease. Both, however, have been linked to gut issues as being the cause of developing diabetes or being obese. Later studies, however, cast doubt on the risk factors being the only cause. Instead, upper gut overgrowth and endotoxin up-regulation are now one of the main links between gallstones and heart disease. The health of our microbiome and the state of our gut health can determine whether or not we develop chronic illness.^{1 2}

Most people that have issues with the gallbladder including having an increase in gallstones have severe problems with their digestion. They have fat maldigestion, bile reflux, pain, and gastrointestinal inflammation. Most have an upper gut overgrowth of the duodenum, liver, gallbladder, and/or their pancreas, which further complicates their digestive health. Gram-negative bacteria shed endotoxins that our immune system reacts to negatively if there is overgrowth. An example of Gram-negative bacteria that are linked to upper gut overgrowth include: Citrobacter, Enterobacter, H. pylori, and Proteus mirabilis. Inflammation (Th1 reactions) is upregulated both in the gut and throughout the body. If bile becomes backed up because of overgrowth or digestive issues, altered circulation of bile acids occur and gallstone formation increases which further complicates digestion. Gram-negative bacterial overgrowth interferes with hepatic recirculation and opens tight gut junctions, leading to a leaking of endotoxins into the bloodstream (leaky gut). The digestive system becomes overload and endotoxin load is increased from Gram-negative overgrowth. Endotoxins that would normally be eliminated by the body through proper defecation are reabsorbed by the liver from disruptions in the bile acid cycle (enterohepatic circulation) and can enter portal circulation and distributed throughout the body causing immune reactions and inflammation. These endotoxins and the exaggerated Th1 immune responses caused by them would eventually lead to excessive inflammation of arteries, heart tissue, and veins causing chronic cardiovascular disease.^{3 4 5 6 7 8}

Upper gut dysbiosis also interferes with proper SCFA’s formation and usage which would reduce mitochondrial energy by the body that would reduce your heart’s output. Also, the mitochondria signal an increased need of SCFA’s for greater energy during heart disease or when you have a heart attack. Without these SCFA’s that our gut bacteria produce properly when in balance, our cardiovascular and mitochondrial health suffers.^{9 10}

Gallstones and gallbladder disease is also strongly linked with the development and prevalence of having fatty liver disease. In Hooper’s previous endotoxin post in the series, fatty liver disease has also been associated with Gram-negative overgrowth increased endotoxin production causing liver damage. Upper gut Gram-negative overgrowth causing issues with bile production and hepatic recirculation hinders proper cholesterol usage further complicating heart health. In fatty liver disease, VLDL (very low-density lipoprotein, dangerous cholesterol) is increased and HDL (good cholesterol) is decreased. Furthermore, pro Th1 inflammatory markers are also increased during Gram-negative overgrowth further harming the liver.¹¹

It is my belief that for most people increased gallstone formation, and gallbladder disease stems from upper gut overgrowth and digestive issues. Digestive problems and dysbiosis (especially Gram-negative) in the upper gut can lead to chronic inflammation and heart/liver disease. Read more about improving your Gallbladder function and digestive health in Fix Your Gut.