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The Link Between Fat Malabsorption, Gallstone Disease and Hashimoto's Thyroid
People with Hashimoto's and hypothyroidism often experience fat malabsorption issues and have an increased risk for gallbladder problems, as the thyroid can affect the composition of bile and its ability to flow.
The lack of thyroxine (free T4), as seen in hypothyroidism, decreases liver cholesterol metabolism. This results in changes to the bile composition itself, which then leads to what is called a state of bile cholesterol supersaturation. This thickens the bile and impairs it by slowing its rate of flow.
Decreased bile flow impacts an important process called peristalsis, which involves wave-like muscle contractions that push food and bile through the intestines. As peristalsis is reduced, many people experience constipation, with up to 15 percent of hypothyroid patients reporting to have fewer than three bowel movements weekly.
As digestion slows down, there can also be increased bacterial growth, which can then result in diarrhea.
Furthermore, the change in bile composition and delayed flow can cause the liver's cholesterol to crystalize, forming gallbladder stones, or gallstones (solid particles that block the common bile duct, pancreatic duct, and cause inflammation of the gallbladder).
The lack of thyroxine associated with hypothyroidism can also affect the sphincter of Oddi (layers of muscle that regulate the flow of bile into the small intestine/duodenum, which close between meals, preventing bile from continuing to flow into the small intestine when it isn't needed). The sphincter may experience increased tension, which can prevent normal bile flow. This has been thought to contribute to the formation of common bile duct stones, as well as gallstones.
Thus, it's not surprising that there is an increased prevalence of hypothyroidism found in patients with common bile duct stones. In fact, patients with common bile duct stones and gallstones have, respectively, 7-fold and 3-fold increases in the frequency of hypothyroidism.
Experiments with hypothyroid rats have confirmed the thyroxine effect on bile composition, decreased bile flow and relaxation of the sphincter of Oddi. Research in rats has also shown that the administration of thyroid hormone improves bile flow – suggesting that there is a strong correlation between developing gallbladder issues and hypothyroidism.
There are also indirect effects relating to bile production in those with thyroid disease.
Remember that when you have issues with bile production, you can have deficiencies in essential fat soluble vitamins such as vitamins A, E, D, and K, as well as fatty acids. Vitamin D deficiency is commonly found in people with Hashimoto's. Some 68 percent of my readers have reported having a diagnosed vitamin D deficiency. In fact, when I know someone has been supplementing with vitamin D, but still tests as deficient, I view that as an important clue that they may have fat malabsorption issues. The lack of key vitamins and fatty acid deficiencies can cause a whole host of additional symptoms, and can further impact thyroid hormone conversion (T4 to the active T3 hormone).
Furthermore, poor bile flow can lead to a recirculation of toxins such as heavy metals and excess hormones.
As you may know, nutrient depletions and impaired detoxification pathways are often the root causes of Hashimoto's symptoms, so it's important to address the gallbladder and bile issues that may be at the root of these issues.
