Return to Post-Cholecystectomy Syndrome (PCS)

My thoughts on dealing with Post-Cholecystectomy Syndrome (PCS)–pain and digestive problems after having your gallbladder removed–have evolved somewhat, so I felt I had to write an update. Several people have commented on the previous posts thanking me for addressing it, which (1) is very flattering–thank you for reading!–and (2) makes me feel the weight of responsibility to not convey wrong information. I promise to share only the best information I can find, but there isn’t a lot of information available, so my understanding of the topic is bound to change somewhat as I learn more.

To recap, in my first post I discussed the symptoms of PCS and what (little) I know about fat metabolism, since that is where the now-absent gallbladder comes into play in digestion. I briefly went over the role of the gallbladder in Traditional Chinese Medicine and herbs they use for gallbladder problems. This is because I’ve never seen it addressed from a Western herbal perspective. Based on that, I made some suggestions for herbal and nutritional support for the upper GI tract and liver.

In my second post on the topic, I opened up a bit about my own experiences with PCS and attempts to remedy it. In particular I suggested that since gallbladder inflammation, gallstones, and the symptoms of PCS seem to correlate with heat and dampness in the upper digestive tract/liver, one might treat them using astringent and bitter herbs–that is, herbs with cooling energetics.

But today I realized that while it might make sense to treat excess heat and damp with herbs that cool and dry, this is not the best long term solution for PCS or gallbladder problems. I do believe they could give short-term relief, and they might be warranted anyway for related conditions (for example if you also have a leaky gut, astringents would be helpful).

What we are talking about here with excess heat and damp is a situation of congestion, which is to say, stagnation. In other words, I was focusing on the heat and damp as the causes of symptoms, which on one level, they are–but the heat and damp have their own cause, and that is stagnation. For long-term improvement, we have to move up the causal chain to find the root tissue state or energetic state, then we find the herbs that address that ultimate cause. (For a detailed explanation of tissue states and energetics, see this article by Kiva Rose.) (EDIT–here’s a great article on stagnation from the TCM point of view.)

Recently I was talking to Rebecca Altman about dampness and the waters of the body, a topic she has written a lot about lately, for example in this excellent post. She made a comment that really struck me–that here in Southern California, nobody needs drying herbs. Obviously she was painting with broad strokes and there are exceptions to every rule, but basically she’s right–it’s so dry here that excess dampness is not a very common condition. And when it is, there are usually better ways to treat it than to dry it out. Dampness is not so much a matter of too much water but of water that isn’t moving–stuck water. And stuck water is not only an issue in the desert–if you are not a mermaid, your body waters can become stagnant. (Maybe even if you are a mermaid.)

So that was in the back of my mind. Then today I was experimenting with an Echinacea tincture I just made, taking note of where I felt it working its magic. Echinacea is a diffusive lymphatic or lymphagogue, which is a fancy way of saying it moves your lymph around. And all of a sudden the pieces came together: stuck fluids need movement. And heat needs not cooling so much as release–a path through which it can escape your body.

Alders, flowing water.

Alders, flowing water.

From the Traditional Chinese Medicine point of view (and I have to reiterate I am not a practitioner of TCM let alone an expert, but what I relate here is based on my research) gallbladder/digestion/upper GI issues are not just a matter of stuck fluid but of stuck qi (“liver qi stagnation”) and stuck emotions. Both Western and Eastern herbalism are agreed that stagnation is involved and that its proper medicine is movement. It just took me a while to fully absorb the lesson.

It’s fitting that it was a lymphatic–Echinacea–that helped me make the connection, because as it turns out, the lymphatic system plays a role in fat metabolism, as does the gallbladder (or lack thereof). I didn’t know about this aspect of the lymphatic system when I wrote about fat digestion previously. While most of the nutrients from your food are transported through the lining of the GI tract to your blood system, there to be circulated around and the wastes processed in the liver, fats are different. Short-chain fatty acids can be directly absorbed into the blood (and then filtered through the liver), but most of the fats we eat are medium- and long-chain fatty acids. These are transported as chyle–“a milky bodily fluid consisting of lymph and emulsified fats” (per Wikipedia)–via lymph vessels from the small intestine to where they need to go for immediate use or storage, and only then enter the bloodstream. The long fatty acid chains are too big to pass directly from the intestine into the veins. By circulating through the lymphatic system, the fat molecules bypass the liver until they have had a chance to be used. The gallbladder’s role is to help digest fats before they get to those lymph vessels, so you can imagine how, if there is no gallbladder or it’s not functioning optimally, the problems will be passed to the next step down the line–the lymphatic system.

So: poor lymphatic drainage, which can (probably*) result from gallbladder/digestive problems, in turn affects the immune system and can ultimately lead to chronic inflammation. And that brings us around to how we might treat PCS using herbs. We need to make sure to:

  • Improve nutrition by eating lots of vegetables, as we know we should, and by supporting the digestion with carminative herbs and bitters. I cannot recommend bitters highly enough. (I have replaced the bile salts I used to take with bitters and the bitters are more effective. Also, I have come to actually crave that bitter flavor, so don’t let that deter you. Very quickly your body will start loving bitter.) Think ginger, turmeric, black pepper (makes nutrients more bio-available), fennel, cloves, dandelion, burdock, leafy greens (the more bitter the better). You may also need astringents (e.g., rose, agrimony) if you are prone to diarrhea.
  • Move around as much as you can. The lymphatic system doesn’t have its own pump but depends on muscular contractions to move the fluid around. Walk, jump up and down, hang from things, climb trees, get massages, do dry-brushing–you get the idea. But also, relax as much as you can. Tightness impedes the free flow of liquids.
  • I now think that it’s likely PCS sufferers may also need some kind of lymphatic support, and possibly also alteratives. There are many lymphatic movers and each works slightly differently. Echinacea, calendula, alder, ocotillo, red root, chilopsis, cleavers (bonus: cleavers are delicious!), burdock again. Remember that as the lymph gets moving, two things are likely to happen: (1) any toxins in the lymph are going to get carried to the liver for filtering and removal, so if your liver is seriously compromised (e.g., jaundice) please be very, very gentle and take it slow. See a clinical herbalist, in fact. And (2) any excess internal heat is going to find a way out, so you may see skin eruptions in the form of acne, rashes, or excema. In this case, these are a good sign. Let the heat go.
  • Be aware that signs of stuck fluid may not be nearly as extreme as edema, even though that is the most commonly referenced example. Puffiness around the eyes, a feeling of sluggishness that gets better with exercise, sore glands, a wan, tired, or blah-looking expression, a little excess phlegm or sinus congestion–all these are signs of stagnation.

And as usual I want to emphasize that this is not a matter of “detoxification,” but of nourishment and movement. Most of the detox routines out there are at best pointless and at worst dangerous. In some ways what I have suggested here boils down to common-sense “eat right and get plenty of exercise,” but with a few more sparkles.

*I don’t know of any research on PCS and the lymphatic system. But according to this article, inflammatory bowel disease (IBD)–which is one kind of poor digestion, caused by the immune system attacking the intestine–leads to compromised lymph drainage and in turn edema, lymph leakage, excess fat deposition, an impaired immune system, and chronic inflammation. Any effects resulting from PCS would presumably be much less severe–but that doesn’t mean there aren’t any.


20 thoughts on “Return to Post-Cholecystectomy Syndrome (PCS)

  1. Pingback: More fun with post-cholecystectomy syndrome (PCS) | Worts & All

  2. Pingback: Suggestions for a Post-Cholecystectomy Syndrome (PCS) remedy | Worts & All

  3. Pingback: Exploring Echinacea tincture | Worts & All

  4. Are you still suffering pcs and if so when did you have your gallbladder removal surgery? I am also having complications . Would appreciate any feedback.

    • I had my gallbladder out in 1998, and yes, I still have PCS symptoms. I think this is because it’s a trial and error process to find what works for you, and also because nothing is going to replace the gallbladder so we’ll always have to manage PCS rather than curing it. Also what we need to do to manage it may change over time. I hope you find something here that helps!

  5. I want to thank you for these posts. I’ve caught up on all of them and have made some notes. I was finally diagnosed with gallbladder disease after two and a half years of being sick. At the end I had pancreatitis and my liver and kidneys were not functioning properly. Surgery was in 2009 and the misery continues. Spending years at 90 pounds afterwards and several bouts of pancreatitis later, I now have more better days than I used to but the “ghost pain” has become unbearable at times. You have given me more options than “let’s just look around in there and see if we see anything going on”. For that I thank you

    • Oh my gosh Laurie, I am sorry you have had to go through all that! It sounds hellish. I really hope you find a therapy that finally gives you relief. Thanks for sharing your story here, and thank you for the kind words. I am happy to say that I am starting to see real improvement in my health after ages of experimenting with herbal therapies. I will be sure to update with any new information I come across!

  6. Thank you Laurie for this 3 part blog. As of last week 3/2016 I have been diagnosed through MRI with PCS. I’m very saddened, frustrated, concerned and tired of the continuous pain. Prescribed a drug I will not take for countless reasons. Grasping at straws, searching the web, I found your blog. I am not alone. Thank you for the insite, research and all the possible helpful holistic approaches. Not sure where to begin but I’m hopeful. I appreciate you!

  7. I’m only 3 months post GBS and have all the symptoms, each time getting worse. I have found also that purchasing liquid bitters (you can get them without alcohol) and taking just a few drops before a meal helps tremendously. A friend just recently pointed me in your direction. So much wonderful information. Thank you!!

    • Candii, sorry to hear you are dealing with PCS. I too have found that bitters are very helpful! I am also lactose intolerant and as long as I take them before eating, they help with that too. It took a while for me to get used to the taste, but now I like it.

  8. I had my gallbladder out 2 years ago. I suffer crippling nausea headaches chills and severe stomach pain. At times it gets better but never goes away. I will pray for all of you. Please pray for me as well. We are suffering without being believed. Like most of you I don’t want medication I just want to feel better

  9. Thank you SO much for sharing your research! You’ve just helped one unhappy person in the Czech Republic, central Europe. I don’t have PCS, but I’d had a dysfunctional bladder and it’s only been several days since the operation and I’ve been having weird problems – right below the ribs where the liver is, my skin is hot, but the rest of my body is cold; I developed a rash and mild nausea. I also have hypothyreosis, asthma and excess of phlegm. The theory about torpor, fluids and lymphatic stagnation makes so much sense! This is the first time I see that all my problems could have a common denominator. Peppermint and sage are two herbs from the ones you mentioned I could get my hands on immediately. Drinking peppermint and sage tea is making the nausea disappear! Will read your posts carefully again and try the things you mention. Thanks so much for giving me explanation and something I can actively do about my problems!

    • Marta, I am so glad you’ve found something useful here, and that peppermint and sage tea is helping! And thank you for letting me know what’s working. I wish you a speedy recovery!

  10. Move and stretch-especially abdomen. Walk, swim, 8 treasure chi gung. Light dumbbell routine and swinging arms while walking moves lymph. Drink plenty of slightly warm water between meals to keep bile thin. Don’t let this become an obsession. Keep mind occupied will hobbies and humor.

    • Thank you, Rick, those are all really great suggestions and I was not aware of the advice about drinking slightly warm water, but that makes sense. And yes, avoiding obsession is HUGE! (And something I need to work on.) I will look into 8 treasure chi gung as well.

  11. Hi there. Just read the second parts of your three piece story. Where would one acquire digestive bitters? I have tried many enzymes except ox bile as I am vegan, but if bitters will help my everyday stomach aches, gas, bloating, and regurgitation, I’m all in. Thanks!

    • Hi! Happily, there is a huge variety of digestive bitters being made by herbalists these days, and they are also easy to make yourself if you want to save money or be a bit of a mad scientist in the kitchen. The ones I’m currently using are these: While expensive compared to what I could make myself, they are delicious. You can also buy bitters at Mountain Rose Herbs (they carry the Urban Moonshine brand), which is a very reputable purveyor of herbs and herbal products.

      If you want to try your hand at making your own, all you need is a bitter herb and some 40 proof (80% ABV) or higher alcohol. There are lots of bitter herbs, which you can get in bulk at most organic co-ops, or online at Frontier Herbs or Mountain Rose Herbs. My go-to is dandelion root. Some other options would be chamomile, gentian, wormwood (VERY bitter), or orange peel. For the alcohol, inexpensive vodka, brandy, or whiskey will do. I don’t get the cheapest stuff available, I usually go sort of low- to mid-price. My personal favorite is blended scotch or pisco, but that’s just because I prefer the tastes of those.

      Get a jar with a tight sealing lid, fill it halfway with your herb, and then the rest of the way with the alcohol, put the lid on and keep it in a cupboard. Every day–preferably a few times a day–give the jar a shake to mix things up. After a month, strain out the solids and put the liquid–your digestive bitters–in a bottle or jar. Alcohol extracts like this will keep for years as long as they’re out of the sun.

      The hardest part of using bitters, I find, is remembering to take them when I’m on the go. Half an eye-dropper-full about 20 minutes before a meal is generally sufficient.

      You can get as creative or stay as simple as you like with them. You can also add some sweetener (I would use raw unfiltered honey)–the blend doesn’t have to be overwhelmingly bitter or foul tasting. And/or, you can add some spices which tend to be helpful with gas and bloating, such as cinnamon, cardamom, fennel, or anise. One note if you use a root, such as dandelion, to make bitters–roots have starches, which will be extracted in the alcohol, so it’s normal to have some cloudiness at the bottom. Just shake the bitters before use.

      • Thanks a bunch! I actually picked up the Urban Moonshine brand at Pharmaca. Fingers crossed I get some relief! I can’t keep alternating between eating and looking 9 months pregnant and not eating somedays at all just so I don’t feel awful. Your writeup makes me feel like I’m not the only one dealing with digestive issues and I appreciate you sharing your story. 🙂

  12. Hello Alexandra, this is Marta from the Czech Republic again 🙂 I am writing because I keep thinking about the “being cold but leaving steam on the car window” thing.

    I know exactly what you’re talking about. I have this, but I don’t have post-cholecystectomy syndrome (my digestion recovered quite well after the operation, partly because, I suspect, thanks to your advice 🙂 I found a good herbalist in my town).

    I, however, have esophagitis.

    I have this feeling of hotness in the upper abdomen, tiredness and weird temperature, like being hot but feeling cold (and almost no other symptoms), whenever I do something to upset my lower esophagus. The cold / warmth problem always disappears when I drink warm water with some milk and calcium bicarbonate.

    I’d suggest visiting your gastroenterologist and asking if you might have esophagitis. Its symptoms vary a lot so I hope s/he is thorough. If you can’t visit a doctor, there’s another way to find out – try sleeping in the sitting position, drinking warm water with some milk and 2 teaspoons of calcium bicarbonate (as often as you want 🙂 ), eating very slowly and only small helpings, not carrying heavier objects, not eating apples or anything sour, spicey or chocolate-y, not drinking soda, black, green tea or coffee or peppermint tea – all this for a week. If it helps a bit – well, there you have it 🙂

    Btw, thanks so much for the advice on rosemary – I’ve fallen in love with it! I’m the sort of person who the European herbalists say it’s for – someone who “grasps life too intensely” 🙂 and it has great effect on me 🙂

    • Hi Marta,

      Thank for for the information about esophagitis! I didn’t know about it; now I will have to investigate it. 🙂 I’m glad to hear you have such a rapport with rosemary–I think it’s wonderful. To me the scent of rosemary is so wonderfully clean. It’s very overlooked as a purifying herb (here in the US, at least, white sage has better PR). Plus, it’s delicious. 🙂

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