Explainer | How the gallbladder helps break down fat, why singer Pink lost hers, and how a healthy diet, coffee and vitamin C can help yours

Anatomists in the 15th century described the gallbladder as “a very long pear compressed from base into neck”. They believed it had an effect on emotion, just as they thought the spleen was the source of melancholy and predisposed a person to irritability. Later “gall” was associated with an “embittered spirit”. Centuries ago in China, having a large gallbladder was associated with strength and courage. Of course, none of the emotional attachment to the gallbladder holds true – although perhaps if you are enduring the pain of gallstones, which can be intense, you may feel “embittered”. Early anatomists were spot on about this little organ’s appearance, though. Some 8cm to 10cm (three to four inches) long, and 2.5cm across, this hollow, pear-shaped organ sits just below the right lobe of the liver. The gallbladder works in tandem with the liver, which produces bile, a potent digestive juice – up to a litre (35 fl oz) a day. This passes through a series of ducts to the gallbladder, which distils it – it can concentrate bile by as much as 10 times – and stores from 30 to 50ml of the liquid. The liver: organ that keeps on giving and how to give it a break Bile’s most important role is breaking down fats, the hardest food group to digest, which requires a complicated chemical process before it is available as energy. Gallstones are the most common cause of hospital admission for digestive problems in the West. They have plagued humankind for centuries. The Museum of the Royal College of Surgeons in London once exhibited an Egyptian mummy (circa 1500 BC) with a gallbladder that contained 30 stones. While up to 12 per cent of the global population may have gallstones – according to statistics from Hong Kong’s Department of Health, 14,463 people were admitted to hospital in the city for gallstones and cholecystitis, inflammation of the gallbladder, in 2017 – 80 per cent never suffer any symptoms. When they do, they may feel pain “over the right upper side of the tummy, especially after eating fatty foods,” according to Professor Anthony Teoh of the Chinese University of Hong Kong. “It is a squeezing type of pain that can come and go. Occasionally, it could be associated with fever and yellowing discolouration of the skin.” The liver will still secrete bile and the digestive functions won’t be seriously affected Professor Anthony Teoh on having your gallbladder removed The pain can be severe, described by some sufferers as 10 on a scale of one to 10. The pain often follows the consumption of a fat-laden meal, as fat triggers the gallbladder to empty. If stones are blocking the ducts, it can’t empty; diagnosis is usually through an ultrasound or CAT scan. Gallstones are created when one of two substances – cholesterol or bilirubin – saturate in the bile and form crystals, or stones. Bilirubin is a brownish-yellow substance found in bile that is formed when old red blood cells in the liver break down. Normally your body gets rid of bilirubin via the bowels – which explains the colour of faeces. But bilirubin-formed stones are rare; 80 per cent of gallstones are the result of cholesterol. How to protect your liver: hepatitis jabs, a good diet and less alcohol It’s not just what you eat, it’s also how you eat that can predispose you to gallstones. Eating one large meal a day increases the chance of stone formation because the bile is inactive for a long stretch, which means there’s more chance for its composite parts – bilirubin and cholesterol – to distil and saturate. These stones can present as a problem when they are large – the largest reported in medical literature, according to the Guinness World Records, weighed 6.29kg (13.8lbs) and was removed from an 80-year-old woman in London. They are also a problem when there are many of them. Two to 20 stones is not uncommon. The record holder, another woman in her 80s, had 23,530 stones removed. It’s not surprising both cases were in women. Teoh says there is a classic mnemonic for remembering risk factors for developing gallstones: fat, fair, female and 40. “This is related to the cause of developing gallstones, which could be too much fat. For ladies who are around the age of 40, it may be related to sex hormones causing supersaturation of bile.” But this isn’t a hard and fast rule: the pop singer Pink, after all, while female and fair, isn’t fat and was only in her early 30s when she had her gallbladder removed, in 2012. Women are three times more prone to gallbladder problems – and gallstones in particular – on account of their hormones: oestrogen increases the amount of cholesterol in the bile and progesterone slows its emptying. Diet drug used by Elon Musk has drawbacks, say doctors – proceed with caution Research suggests this is more prevalent in Caucasian women. And there could be a heritable link, too, according to the latest research. This would add another “F” to the mnemonic: family history. The first removal of gallstones was accidental. In 1687 in Germany, Stalpert van der Wiel operated on a woman who had been complaining of abdominal pain and found gallstones. Some reports suggest they popped out like bullets. Aside from gallstones, says Teoh, the gallbladder can also be affected by polyps or cancer. “Usually, these conditions are treated by cholecystectomy – surgical removal of the gallbladder – and most often by minimally invasive keyhole surgery. Acute inflammation of the gallbladder is sometimes treated via draining with an external tube or internal stent,” he says. The first cholecystectomy was performed in 1882 in Berlin, Germany. This procedure, says Teoh, is one of the most common operations. While removal of the gallbladder will affect bile storage, “the liver will still secrete bile and the digestive functions won’t be seriously affected”. “Some patients who have had this operation may experience diarrhoea after eating fatty foods, but the body usually adapts to this in a few months’ time,” Teoh says. Think of it as a factory still being in production without a warehouse; there may be a slightly elevated risk of hepatic – liver – problems because of the impaired digestion of fats, but a largely healthy life is entirely possible. The many health benefits of a plant-based diet, according to 5 new studies A healthy diet will support a healthy gallbladder. Keep an eye on your weight, avoid the risk of stones by keeping your cholesterol in check – take statins if your doctor recommends them. Some studies suggest drinking coffee may help prevent gallstones and insufficient vitamin C in your diet may prompt them. In short, eat heart-healthy food and you will be well on your way to better gallbladder health, too. Like what you read? Follow SCMP Lifestyle on Facebook, Twitter and Instagram. You can also sign up for our eNewsletter here.

Explainer | How the gallbladder helps break down fat, why singer Pink lost hers, and how a healthy diet, coffee and vitamin C can help yours

The gallbladder concentrates the liver’s potent digestive juice, known as bile, which helps break down fats Gallstones may form in the organ and block the ducts that release the bile, causing pain that sufferers say hits 10 on a scale of one to 10

The gallbladder concentrates the liver’s potent digestive juice, known as bile, which helps break down fats

Gallstones may form in the organ and block the ducts that release the bile, causing pain that sufferers say hits 10 on a scale of one to 10