The link between Gallbladder Disease and NASH

When my mom passed away at 62 years old six weeks after being diagnosed with a disease I’d never heard of before, it sent me searching for answers. NASH is still widely unknown and the etiology is not well understood. Yes, it is largely linked to obesity, but there are many other risk factors that seem to be playing a role. One such factor that I discovered last year was the link between hypothyroidism and NASH, which my mom had for decades.

Recently I have been working on some projects on how the liver works, and found myself intrigued when writing about the function of the gallbladder. For those that are unaware, its main function is storing bile to be used in the digestion of fats. As I wrote about it, alarm bells began ringing in my head. NASH is the end stage of fatty liver disease, caused by an excess buildup of fat in the liver.

Gallbladder surgery (known as cholecystectomy) is one of the most common surgical procedures in the world, with over 600,000 procedures performed annually in the USA. It is considered completely safe with no long-term negative effects. My mom had her gallbladder removed years ago after suffering gallstones, as is the standard medically recommended procedure. I wondered if there was any studies on possible links between it and NASH, and began searching.

The answer is a resounding yes. Not only is there a strong correlation between gallbladder disease and NASH in several studies, but there is an even stronger independent link between cholecystectomy and NAFLD/NASH.

Gallbladder-Diseases-Fig-1
The gallbladder is a tiny organ long thought to be dispensible, but new research is questioning that

This all makes sense; the gallbladder is closely related to liver functionality and gallbladder disease is also associated with many of the same risk factors as NAFLD/NASH is. But study after study is beginning to raise serious questions about how one of the most common abdominal surgical procedures could by directly related to the massive incidence of NASH worldwide.

This finding suggests that cholecystectomy may itself represent a risk factor for NAFLD, which is in line with the recently undisclosed role of the GB and bile acids in systemic metabolic regulation. Thus, cholecystectomy may not be innocuous and may have a major impact on public health by contributing to NAFLD development. – Nervi F, Arrese M. Am J Gastroenterol.

Reading all of these studies was like another puzzle piece falling into place. It’s far too early to state conclusively that gallbladder removal causes more severe liver damage, but the evidence is mounting. And there have been other recent studies suggesting that gallbladder surgery may be too common outside of any relationship to NASH.

For now, the public should be informed of the possible risks associated with a common procedure that has been previously considered entirely harmless. Gallbladder disease and the surgery commonly used to treat it are yet another risk factor for NAFLD/NASH.

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