'Gallstones and Kidney Stones: Differences and Similarities'
sponsored by Rio Health

Please note, this is a transcript of the questions received and have been reproduced verbatim in relation to any grammatical errors.

Would Bilethin be recommended in BAM?

Bile Acid Malabsorption (BAM) is a cause of chronic diarrhoea. My understanding is that it is caused when there is damage to the terminal ileum, the specific part of the small bowel responsible for bile salt absorption (bile salts are generally reabsorbed for using again). When the higher amount of bile salt reaches the colon, these cause fluid to be pumped into the colon, resulting in watery/loose stools. Whilst for these individuals, bile acid absorption is not efficient, for some individuals, there is too high production of bile for the amount which can be reabsorbed and thus results in the watery/loose stools. Bile Acid Malabsorption can also occur in association with Crohn’s disease or after some intestinal surgery.  It seems there can be many reasons for BAM.

Generally speaking, reducing saturated fats, increasing fibre and choosing smaller, more frequent meals, are recommended for BAM.

Constituents in Bilethin include SOD and catalase which may usefully aid re oxidative damage, the enzymes may benefit by aiding the breakdown of macronutrients, particularly of fats.  Bilethin also contains red beet powder which thins bile and promotes its unrestricted flow. Beetroot may also stimulate bile production.

As the consultant doctor diagnosing BAM would have a clearer picture of the specific patient’s health and likely reason for this health condition (as my understanding is that there can be differing reasons), the question could be posed to the consultant whether promoting bile flow, thinning bile, and potentially stimulating bile production (i.e. via the inclusion of beet powder in this product) would be advantageous or disadvantageous for the specific individual. In the absence of such approval by the consultant, I would suggest that Bilethin may not be appropriate.

In BAM, stimulating bile production would likely be counter-productive and I would suggest instead, use of epigenar Enzyme Complex which provides papain, bromelain, amylase, chymotrypsin, lipase and other constituents that can help break down fats, carbohydrates and proteins and may aid the body’s digestion of foods.

My cousin, who was an overweight unhealthy vegan, lost loads of weight and was eating mainly fruit and veg. He ended up in a lot of pain and had to have his gall bladder removed. Could you explain why this might have happened when he lost weight?

As mentioned in the webinar, both fasting and rapid weight loss may associate with gallstone problems.  As the body metabolises fat in adipose tissue, the liver secretes extra cholesterol into bile.  This can result in cholesterol supersaturation of bile, which increases the likelihood of developing gallstones.

When weight loss is a desired health goal, promoting gradual weight loss should always be the aim.  The avoidance of gallstones would be just one reason for this.  I would suggest that Quebra Pedra tea might be a useful addition sometimes to weight loss protocols to help ensure there is no cholesterol supersaturation of bile—for individuals at high risk of gallstone, this could be at the stated recommended amounts; for individuals with no apparent risk, perhaps just one cup of Quebra Pedra daily may provide support to avoid cholesterol supersaturation of bile.

How would you promote oxalate-degrading bacteria if they are deficient in the gut? Are there are any tests that show these markers, i.e. stool test or organic acid test?

This is an interesting question. There is a study Brzica et al 2013 Arh Hig Rada Toksikol 64:609-630 (included in the presentation, slide 44) that provides a list of promoters and inhibitors of oxalate urolithiasis.  Vitamins A, C, E, B6, SOD, hyaluronic acid, citrate, heparin, chondroitin and Oxalobacter formigenes are mentioned. I believe there are products on the market with the Oxalobacter formigenes bacteria included. Other ingredients should be well known. 

Regarding the query about testing, Regenerus Labs suggest the Organic Acids Test which includes markers for glycolic acid, glyceric acid and oxalic acid.  Please contact them for further information.

Does fasting increase risk of gallstones as gallbladder expands and bile remains static?

Whenever fat mobilisation from adipose tissue occurs, the liver secretes extra cholesterol into bile.  This can result in cholesterol supersaturation, which increases the likelihood of developing gallstones.  In fasting, very low-calorie diets and rapid weight loss these changes in fat mobilisation can mean higher risk of gallstone formation.  Additionally, fasting decreases gallbladder movement which also associates with cholesterol supersaturation of bile.

Which botanical would be safe to use for cholestasis in pregnancy?

This is a difficult question.  So often, botanicals are not tested for safety in pregnancy.  I think the entire Rio Health Tincture range, as with most botanical products, have some caution against use in pregnancy and/or breastfeeding.  Quebra Pedra is not suitable for pregnant or lactating women and not advised by those taking fertility medications.  And Sparga, also mentioned in the webinar, has caution against use in pregnancy and breastfeeding.  It may have contraceptive effect.  Sparga may be usable in lactation but that would need discussion with a doctor and dosing may need adjusting.  

However, for cholestasis, Bilethin is the recommended product.  And epigenar Bilethin is allowed in pregnancy and breastfeeding.  Its ingredients are red beet powder, taurine, vitamin C, an enzyme combination, catalase and superoxide dismutase. Bilethin supports bile flow and liver health.

Is there any risk of taking Quebra Pedra and a stone being released and obstructing?

This is an interesting question.  I have found no evidence that there is risk of this, and studies regularly mention how safe Phyllanthus niruri (Quebra Pedra) is and, we regularly receive positive reports of the benefits of using Quebra Pedra.

The mechanism of action is discussed in Boim et al 2010 Int Braz J Urol 36(6):657-64 (included in the presentation, slide 56) where the authors state: ‘Phyllanthus niruri has been shown to interfere with many stages of stone formation, reducing crystals aggregation, modifying their structure and composition as well as altering the interaction of the crystals with tubular cells leading to reduced subsequent endocytosis.  The clinical beneficial effects of Phyllanthus niruri may be related to ureteral relaxation, helping to eliminate calculi or to clear fragments following lithotripsy, or also to a putative reduction of the excretion of urinary crystallization promoters such as calcium. No adverse renal, cardiovascular, neurological or toxic effects have been detected in either of these studies.  Altogether, these studies suggest a preventive effect of Phyllanthus niruri in stone formation or elimination…. These properties of Phyllanthus niruri may constitute an important advantage in the prevention of lithiasis, inhibiting calculus growth and keeping the crystals dispersed in the urine, with their consequent easier elimination.’

Also, as mentioned during the webinar, optimum hydration is needed when using Quebra Pedra.  This would be important to flush any stones/stone fragments.

Is the tea just as effective as the tincture?

Another good question.  My reply below will be both specific to Quebra Pedra/Chanca Piedra, and be applicable more generally to these delivery methods. All formats (capsules, tea and tincture) can be effective and delivery format will, of course, be part of your discussion with the client. 

Generally speaking, tinctures deliver well to body cells and allow for easy titrating of dose (including child dosing).  Tinctures have few or no excipients as the botanical and menstruum (usually water and alcohol) are the only ingredients. Although Quebra Pedra has antimicrobial properties, its primary activities and usage relates to stone breaking, and so the need for dosage adjustment and careful titrating upwards is less of an issue.  The Rio Health Chanca Piedra is recommended at 60 drops twice daily, and the 120 drops contains the equivalent of 2000mg of the herb. Hydration with optimum water consumption must be stressed to the client.

Herbal tea use has the advantage of often replacing caffeinated drinks which otherwise contribute to dehydrating the body. Generally speaking, herbal teas (excluding those with caffeine content) provide this benefit of contributing to the 2 litres of water usually recommended daily.  The water-soluble constituents are extracted during the tea making process by the boiling water.  The amounts of those constituents extracted will depend on the water temperature and length of time the teabag is steeped.  When consuming a tea, one is consuming the water-soluble components that extract into the water. Always choose teabags that are unbleached and plastics-free. Or use loose tea.

Quebra Pedra tea offers many advantages because it is accompanied already by some of the water that is so necessary when using this herb. The Rio Amazon Quebra Pedra teabags are 1500mg each.    For some clients, tea is the preferred method of delivery for a number of reasons, and I would say that, with gallstones and kidney stones, most individuals are ‘on-board’ with continuing prevention once their acute issue is resolved.  The tea is an especially good way to do this. All Rio Amazon teabags are made from unbleached paper, with no plastics.  We also offer Quebra Pedra as a loose tea—available 50g, 100g or 200g packs.

There are also capsules available and Rio Health have 2 strengths of capsule available.  The standard product (which is available only as 60 capsules or 120 capsules) have 500mg Quebra Pedra per capsule.  The recommendation is 3 of these daily (1 capsule, 3 times a day).  The higher strength product (which is only available as 90 capsules) have 500mg each of a 5:1 extract.  This means that each capsule is the equivalent of 2500mg of herb and so these are high strength and what may be a better option for acute situations.  These are also recommended at 1 capsule 3 times daily. And, with the capsules, as for ALL Quebra Pedra products, optimum hydration must be stressed.

Capsules are preferred by some to liquids (teas or tinctures) and practitioners would advise the client based on their personal health condition as well as their delivery preferences.  I suggest considering each client individually, and discussing with them their preference.  Even someone with an acute situation may not want to use capsules/high strength capsules because of an issue swallowing them. And someone on preventive measures might not want to use the tea, so either the tincture or the standard Quebra Pedra product might make a better option for them.