The Turd Nerds

Most people think gallbladder disease is all about gallstones. But what if the real story is hormones?
In Part 2 of our Gallbladder Series, we take a deep dive into the fascinating relationship between estrogen, progesterone, menopause, the microbiome, and gallbladder function. We explore why women are significantly more likely to develop gallbladder disease, why perimenopause may be a perfect storm for biliary dysfunction, and how both high and low estrogen states can increase gallbladder risk.
Along the way, we unpack the surprising idea that the gallbladder behaves like a hormone-responsive organ, discuss how oral contraceptives and hormone replacement therapy may influence gallbladder health, and explain why the microbiome may be one of the most overlooked pieces of the puzzle.
Whether you're navigating perimenopause, supporting patients with digestive issues, or simply curious about the intersection of hormones and gut health, this episode offers a fresh perspective on a commonly overlooked organ.
Why women develop gallbladder disease more often than men

The role of estrogen in bile production and gallbladder function

How both estrogen excess and estrogen deficiency can increase gallbladder risk

Why perimenopause creates a unique challenge for gallbladder health

The relationship between oral contraceptives, hormone therapy, and gallstones

How progesterone influences gallbladder motility

The estrogen–microbiome connection

Changes in the microbiome that occur during menopause

The role of Lactobacillus, Bifidobacterium, Akkermansia, and other key organisms

Why menopause may increase the risk of biliary dysfunction

How hormone fluctuations impact bile flow and gallbladder emptying

Why oral estrogen carries different risks than transdermal estrogen

Clinical considerations for hormone replacement therapy in patients with gallbladder concerns

The importance of antioxidant protection for the biliary system

How this information has changed the way we evaluate and treat patients

✔ The gallbladder is highly responsive to hormonal signaling, particularly estrogen.
✔ Both high and low estrogen states can negatively impact bile acid production and gallbladder function.
✔ Perimenopause may be one of the highest-risk times for gallbladder dysfunction due to fluctuating hormone levels.
✔ The microbiome and estrogen metabolism are deeply interconnected and may influence gallbladder health.
✔ Menopause doesn't just affect reproductive hormones—it also changes the microbiome, bile metabolism, and digestive physiology.
✔ The route of hormone therapy matters, especially for patients with a history of gallbladder disease.
Part 3 of our Gallbladder Series: Practical treatment strategies, supplements, and clinical tools for supporting gallbladder health before and after gallbladder removal.
In This Episode We Discuss:Key TakeawaysListen Next

Music provided by Blue Dot.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

Most people think gallbladder problems start and end with gallstones. The reality is much more complicated.
In this episode of The Turd Nerds, we discuss the hidden connections between the gallbladder, hormones, bile acids, estrogen metabolism, and the gut microbiome—and why these systems become especially important during perimenopause and menopause.

We cover:
✔ Why women develop more gallbladder disease than men
✔ The estrogen–gallbladder connection
✔ How the microbiome influences bile acid metabolism
✔ What changes after gallbladder removal
✔ Gallbladder dysfunction without stones
✔ DIM and calcium-d-glucarate for estrogen metabolism
✔ Taurine, glycine, bitters, phosphatidylcholine, magnesium, and bile support
✔ Bile acid malabsorption and chronic diarrhea
✔ How we approach gallbladder health in clinical practice

If you've ever been told your only option is to remove your gallbladder, this episode explores the physiology behind gallbladder dysfunction and the tools we use to support patients before and after surgery.

Music provided by Blue Dot.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

Could Lyme disease or co-infections be contributing to gut symptoms that aren’t improving?
In this episode, Dr. Crane Holmes and the turd nerds break down Lyme disease and common co-infections - including Bartonella and Babesia - and how they can impact not just the gut, but the entire body.
We explore how these infections can present as chronic digestive issues, brain fog, inflammation, and multi-system symptoms that don’t respond to typical treatments.
In this episode, we discuss:
What Lyme disease actually is (and why it’s often misunderstood)
The role of co-infections like Bartonella and Babesia
How these infections can affect the gut, nervous system, and immune system
Why symptoms often go beyond digestion (brain fog, fatigue, joint pain)
When to consider Lyme or co-infections in complex cases
Challenges with testing and diagnosis
Treatment approaches, including antimicrobials, herbs, and biofilm support
This episode is for anyone dealing with chronic gut symptoms, unexplained inflammation, or complex health issues that haven’t improved with standard approaches.

Music provided by Blue Dot.

👋 Connect with the Dr. Crane Holmes
https://www.drcraneholmes.com/

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

What if your gut symptoms aren’t SIBO—and aren’t improving despite treatment?
In this episode, we explore a common clinical scenario: patients with bloating, gas, and digestive issues that look like SIBO but don’t respond to standard therapies. We take a deeper look at mold exposure, mast cell activation, and histamine as overlooked drivers of chronic gut symptoms.
Dr. Crane Holmes joins us to break down how mold can impact the gastrointestinal system, why symptoms often extend beyond the gut, and how to recognize when something more complex is going on.
In this episode, we discuss:
When to suspect something beyond SIBO
How mold exposure can drive gut inflammation and symptoms
The connection between mold, mast cells, and histamine
Why patients may have multi-system symptoms (brain fog, fatigue, sinus issues)
The role of environmental testing (ERMI) vs lab testing
Practical approaches to treatment, including binders, detox support, and reducing exposure

👋 Connect with the Dr. Crane Holmes
⁠https://www.drcraneholmes.com/

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

What does the vagus nerve actually do—and why does it matter for gut health, IBS, and anxiety?

In this episode, we break down the vagus nerve in a clear, practical way, focusing on how it connects the gut and brain and why low vagal tone is linked to conditions like IBS, IBD, anxiety, depression, and chronic inflammation.
We also explore why common advice like humming, gargling, or cold exposure which often isn’t enough on its own, and what actually makes a meaningful difference clinically.
You’ll learn how the vagus nerve regulates digestion, stress response, inflammation, and gut motility, and how disruptions in this system can create a cycle of persistent symptoms.

In this episode, we discuss:
- What the vagus nerve is and how it connects the gut and brain
- Why low vagal tone is linked to IBS, anxiety, and inflammation
- How stress and the microbiome impact vagus nerve function
- Why gut symptoms and mental health symptoms often overlap
- Evidence-based ways to support vagal tone (breathing, cold exposure, exercise, social connection, and more)
- When vagus nerve stimulators and clinical tools may be helpful

This episode is for anyone dealing with IBS, chronic gut symptoms, anxiety, or feeling “stuck” despite trying multiple approaches to gut health.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com