Can Probiotics Cause Gallbladder Problems

Can Probiotics Cause Gallbladder Problems? (See Which Ones)

Gallstones are a significant health concern among 10% to 15 %of the U.S. population.

With this number projected to rise steadily, you are doing great by examining any suspected trigger for this disease.

Therefore, here are some key points that may help you understand the relationship between probiotics and gallbladder problems.

Key Highlights
  • Probiotics can have both positive and negative effects on gallbladder health.
  • Lactobacillus and Bifidobacterium species are associated with fewer health risks.
  • It is better to exercise caution with the use of Clostridium species.

It might seem so, but the details are not as simple as the summary. 

So, stick to the end to find out more.

Probiotics And Gallbladder Issues – What Does Scientific Research Suggest?

My literature review suggests that balance is the key to harmony because the scientific evidence backs the potential of probiotics to both relieve or worsen gallstones. 

But in order to understand the science talk, you should first understand what bile is, what importance it holds for the gut microbiota, how it is correlated with gallbladder health, and how gallstones form.

Probiotics And Gallbladder Issues - What Does Scientific Research Suggest?

Plus, once you understand the potential of gut microbiota, you can use that knowledge to assume the effect of taking probiotics.

So, keep reading till the end to find out all about it.

The Role Of Gut Microbiota In the Conversion Of Bile

Our liver secretes ‘bile’ to promote digestion and absorption of our food’s fats, lipids, and fat-soluble vitamins. 

However, this greenish fluid does not reach the intestines directly; instead, it is first stored in the gall bladder as mixed micelles in the form of conjugated bile acids (also referred to as bile salts or primary bile acids).

Afterward, when it gets secreted into the intestines, the gut microbiota employs its bile salt hydrolase (BSH) enzyme to convert it into ‘deconjugated or free bile acids.’

The gut friends do this because the deconjugated bile acid alkalizes the gut’s acidic environment and makes it more favorable for their proliferation.

In some cases, another set of gut microbiota that possesses the 7α-dehydroxylation activity will act upon the deconjugated bile acids and convert them into ‘secondary bile acids.’

Now, keep note of these two types of bile acids because I will discuss their significance in detail shortly.

In this regard, research has identified multiple probiotic species that are involved in the signaling of bile release into the intestines and its reuptake from it; these are:

  • Bacteroides, Bifidobacteria, Clostridium, Enterobacter, and Lactobacillus species.

Now that you know how the gut microbiota carries out bile conversion, let me discuss the significance of this process with respect to gallstone formation.

The Role That The Gut Microbiota Plays In The Formation Of Gallstones

Bile is composed of bile salts, bilirubin, inorganic salts, and fats (cholesterol, lecithin, and fatty acids).

Among these components, the formation of gallstones is greatly determined by the amount of cholesterol that solubilizes in the bile. 

You see, the biliary system is responsible for excreting cholesterol from our bodies. 

So, when the cholesterol levels in the bloodstream are elevated, it may get excessively secreted into the bile and saturate it.

Consequently, this cholesterol in bile may precipitate with calcium salts and bile pigments in the gallbladder and form concretions termed gallstones.

However, each type of bile acid correlates differently to gallstone formation.

Correspondingly, studies have found a high level of ‘secondary bile acids’ in gallstone patients.

Remember when I said I am going to discuss this in-depth? I am going to do that next.

Association Of BSH Activity Of Probiotics With Gallstone Incidence

Most of the gut bacteria with BSH activity (such as the Lactobacillus and Bifidobacterium species) can give rise to deconjugated bile acids.

After this, these bile acids need to undergo modifications to get reabsorbed into the enterohepatic circulation, where their cholesterol can be recycled.

Here, enterohepatic circulation refers to the movement of bile molecules from the small intestine (-entero) to the liver (-hepatic) and vice versa.

However, since these bacteria can’t induce such changes, the deconjugated bile acids are excreted as such in the feces.

Consequently, the liver will utilize serum cholesterol for the de novo synthesis of bile acids, thereby reducing its levels.

I hope you can now understand why taking probiotic species with a high BSH activity may lower the risk of gallstones.

And if you want to learn by example, then you may get help from the study by Tsai and his colleagues.

These researchers isolated over 800 probiotic lactic acid bacteria and reported 22 strains that possessed a comparatively high BSH activity.

Some of these strains are Lactobacillus acidophilus NBHK008, Pediococcus acidilactici NBHK002, Bifidobacterium adolescentis NBHK006, and Lactobacillus rhamnosus NBHK007. 

Association Of 7α-Dehydroxylating Probiotic Species With Gallstone Incidence

The 7α-dehydroxylation activity of certain gut bacteria gives rise to secondary bile acids from free bile acids, which can be reabsorbed for recycling. 

These include deoxycholic acid (DCA), lithocholic acid (LCA), and a small amount of ursodeoxycholic acid (UDCA).

Among these, DCA and LCA have a lithogenic activity (promotes the formation of calculi/stones), whereas UDCA has a litholytic activity.

The reason is that the DCA has a strong hydrophobic nature that encourages high cholesterol excretion into bile.

Compared to this, the UDCA can inhibit cholesterol synthesis and prevent its reabsorption from the intestine. This may lower serum cholesterol levels.

There’s more; the UDCA also increases the ratio of bile acids to cholesterol in bile and promotes the excretion of bile acids through our feces.

Consequently, a high amount of bile acids in bile prevents the crystallization of cholesterol and enhances the dissolution of gall stones.

Now again, you might have figured out already how probiotics with 7α-dehydroxylation activity may prevent or cause gallstones.

If you are looking for examples, then bacteria belonging to the genus Clostridium hold such potential.

This is all about it, but before moving on to the next, I’d like to summarize the connection between probiotics and gallstones briefly.  

Probiotics May Counter Gallstones By:

In a nutshell, the potential mechanisms by which probiotics may help prevent gallstones are:

  • By lowering the serum cholesterol levels.
  • By decreasing the ratio of deoxycholic acid (DCA) in bile.
  • By reducing the cholesterol concentration of bile.
  • Or by shortening the intestinal transit time.

Can Probiotics Increase Bile?

Yes, by taking Bifidobacterium and Lactobacillus probiotics, you encourage their colonization in the gut. 

Consequently, this will give rise to a greater degree of BSH activity which will generate high amounts of deconjugated bile acid in the gut.

For instance, in a randomized clinical trial, participants were fed the probiotic strains B. subtilis R0179 and B. animalis subsp. lactis B94 for six weeks.

After the completion of the duration, the researchers noted that probiotics had increased the level of deconjugated plasma bile acids as compared to the placebo.

Do Probiotics Help Bile Acid Malabsorption?

Yes, the Clostridium and Eubacterium species possess the ability to transform deconjugated bile acids to promote their reuptake.

It is important to correct bile acid malabsorption because it may lead to high levels of bile acids in the intestine, which can damage the protective mucosal layer.

As a result, you may become more prone to developing diarrhea or inflammation.

Therefore, 95% of the bile acids (both conjugated and unconjugated) are reabsorbed and transported back to the liver to be recycled for bile production.

These bile acids re-enter the enterohepatic circulation via active transport, or they are reabsorbed via passive diffusion.

On the other hand, only 5% of them are excreted as fecal bile acids.

Additionally, as I mentioned before, probiotics can also promote bile acid reuptake by inducing certain modifications (dehydroxylation) to the deconjugated bile acids.

However, note that the Lactobacillus and Bifidobacterium probiotic species do not have the capability to carry out such transformations. 

Therefore, you should invest in only the products that contain Clostridium and Eubacterium species to manage bile acid malabsorption.

Can Probiotics Dissolve Gallstones?

gallstones

Yes, there are clinical trials that prove that the probiotic strain Clostridium butyricum MIYAIRI has a gallstone dissolution effect.

However, there are also studies with conflicting results, so we have to wait for further research in this respect in order to make a unanimous claim.

Nonetheless, here are a few pieces of evidence that depict the positive outcomes of probiotic supplementation on gallstones.

An Early Evidence Of Probiotic Benefit From Murine Study

In the murine study, researchers fed a lithogenic diet to two groups of mice, but one of them received a probiotic after it.

Surprisingly, although gallstone formation occurred in both groups, they were dissolved in the mice that were administered the good bacteria.

Correspondingly, a lower percentage of the probiotic-fed group developed gallstones as compared to the untreated mice, 40% Vs. 70% respectively.

Additionally, in the probiotic-fed group, the gallstone grade and cholesterol content were lower than in the control group.

Evidence Of Probiotic Benefit From A Human Trial Published In 2022

Researchers performed a clinical trial that showed that the probiotic strain Clostridium butyricum MIYAIRI prevented the formation of gallstones in individuals who underwent bariatric surgery.

In this trial, 156 patients were divided into three groups, one was administered probiotics, the second took UDCA (it is a medical therapy for gallstone disease), and the third was fed digestive enzyme.

After six months, the probiotic group reported the least gallstone incidence (15.2%) and the least side effects.

In comparison, 17.6% of participants in the UDCA group and 29.1% of participants in the digestive enzyme group experienced gallstones.

Nonetheless, this study has many limitations, like insufficient sample size and a short-follow up period, so large-scale experiments are required to corroborate these findings.

Can You Take Probiotics If You Have Gallbladder Problems (Gallstones)?

The potential of probiotics to worsen gallbladder problems cannot be completely denied.

Therefore, to be on the safe side, it is best to avoid them because you should not use something with a controversial reputation as a cure.

Still, in any case, you should take a specialist’s recommendation to make your decision.

Regardless of that, some studies (like the one I mentioned before as well) did obtain positive results.

So, if you are still interested to know about the benefit of probiotics in gallbladder problems, then here is a summary of the information I found in the literature:

  • The eubacterium genus exhibits a cholesterol-lowering effect. Hence, it may decrease the risk of gallstones by reducing cholesterol reabsorption and promoting its excretion in feces.
  • Lactobacillus and Bifidobacterium species present the highest BSH activity and lower cholesterol levels, which may reduce the risk of gallstones.
  • Clostridium is a 7a-dehydroxylation gut bacteria. Therefore, it converts bile acids into secondary metabolites, which are predominately lithogenic. 

Best Probiotics For Gallbladder

1. Culturelle Digestive Daily Probiotic Capsules – Best Probiotic For Gallbladder Removal

culturelle-digestive-daily

It contains the widely characterized Lactobacillus GG strain, which aids digestion that may help prevent side effects of gallbladder removal.

2. Optibac Everyday Probiotics Best For Preventing Gallbladder Issues

Optibac Every Day Probiotics

It contains Lactobacillus and Bifidobacterium strains that may promote optimal gallbladder function.

3. Purica Probiotics – Best for lowering cholesterol levels.

Probiotic-Cardio

It contains L. plantarum, which may keep your serum cholesterol in check, which can prevent gallstones.

FAQs

Can bacteria cause gallbladder problems?

Yes, an imbalance in the gut microbiome or an overconsumption of certain probiotics may cause gallbladder problems like gallstones. The most common reason is the overgrowth of  7α-dehydroxylation which increases the level of DCA in bile which is lithogenic.

Studies have indicated that individuals with gallstone disease (GSD) had 42 times higher levels of 7α-dehydroxylation bacteria compared to those without GSD.

Is Yakult good for gallstones?

It is best to take your doctor’s advice in this regard. Still, the Lactobacillus casei strain Shirota is the main probiotic in Yakult which may not pose much harm to gallstone patients.

Do probiotics lower cholesterol?

Yes, probiotic strains with a high BSH activity, especially the Lactobacillus and Bifidobacterium strains, exhibit cholesterol-lowering properties.

Final Takeaways – Are Probiotics Good For The Gallbladder?

The current findings of research experiments do not provide a satisfactory or conclusive answer to whether probiotics are good for the gallbladder or not.

But one thing is for sure, despite the risks attached to the use of probiotics still, some of them show better effectiveness in promoting gallbladder health. 

Among these, the Lactobacillus and Bifidobacterium species are safer options compared to Clostridium species.

The reason behind this distinction lies in the fact that the Clostridium species have the ability to produce secondary bile acids, including deoxycholic acid (DCA).

Unfortunately, DCA can be reabsorbed into the enterohepatic circulation, which may lead to excessive cholesterol saturation in the bile. 

This, in turn, increases the risk of gallstone formation.

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