Having a gallstone or two (or even more) is very common: A third of all women (it’s mainly a female condition) will have them by age 60. Fortunately, most people live peaceably with their gallstones without any symptoms whatsoever. It’s when gallstones act up that you need to do something. A painful “gallbladder attack” may occur when a stone decides to move, or simply may follow bouts of indigestion, especially after a meal rich in fatty foods. A double bacon cheeseburger, fries, and a shake should simply be renamed a “Gallbladder Special.”
Although surgery and drugs are available for troublesome stones, most can safely be left alone. Remember though, it’s a lot easier to prevent gallstones than to treat them. If your case is a mild one, or you don’t know whether you have gallstones but know they run in your family, our suggestions at WholeHealth Chicago just might prevent a painful attack or keep you far from the dazzling lights of a surgical operating room.
What are Gallstones?
Gallstones are hard lumps of cholesterol and other digestive materials that form in the gallbladder–the pear-shaped organ situated just below the liver. The gallbladder helps us digest the fat in the foods we eat. During digestion, it releases bile (a thick greenish-yellow digestive juice produced by the liver) into the section of the small intestine that meets the stomach.
Gallstones may be as small as sesame seeds or as large as marbles. Approximately 20 million Americans have gallstones. In some cases, they are silent and produce no symptoms at all. Other times–especially after a fatty meal–they cause intense abdominal pain.
Occasionally, a gallstone will plug up a bile duct and cause inflammation or infection in the gallbladder. Removal of the gallbladder may be warranted in severe cases of gallstones. But most stones can be managed with the proper diet and the use of certain supplements. In fact, these measures may be enough to prevent gallstones from forming in the first place or to dissolve the ones that have developed and become troublesome.
What Causes Gallstones?
No one knows why gallstones form, but they seem to be related to abnormal bile composition. Gallstones are more likely to appear if the bile contains very high levels of acids, pigments, and other substances such as cholesterol. However, numerous factors are linked to gallstones, among them:
Diet. People who consume foods that are low in fiber and high in calories and fat are more prone to gallstones.
Weight. Obesity as well as a precipitous drop in weight is strongly linked to gallstones.
Age. People over the of age 40 have a much higher incidence of gallstones than their younger cohorts.
Sex. Gallstones are more common in women than in men. Multiple pregnancies and the use of oral contraceptives or hormone replacement therapies (HRT) seem to provoke the disorder.
Heredity. Some ethnic groups, such as the Pima Indians of Arizona, are disproportionately affected by gallstones.
Intestinal disorders. People with inflammatory bowel conditions, such as Crohn’s disease and ulcerative colitis, and those who have undergone intestinal surgery are more likely to have gallstones.
Treatment and Prevention
Although surgical techniques for treating gallstones have vastly improved during the past decade, medical treatment of gallstones has not. So, if your goal is to stay out of all operating rooms throughout your entire life (and I think that’s a sensible health goal), then gallstone prevention is your best bet.
People at high risk: You should probably pay special attention to prevention if the tendency to develop gallstones runs in your family. Every medical student is taught the five “Fs” of gallstone risk: a Fair (complexion) Female, who is Fat, Fertile (previous pregnancies), and over the age of Forty. If you’re in this group, your likelihood of having (or developing) gallstones is high.
To prevent gallstones: To try to stay at an optimum weight, eat a diet that is low in fat and sugar, and high in fiber. Interestingly, vegetarians have a low rate of gallstones, while sunbathers have an unexpectedly high rate. If you need to be on hormone replacement, ask your doctor for the lowest possible estrogen dose. If you are obese, definitely avoid crash dieting as rapid weight loss increases the chance of gallstone appearance.
A number of nutritionally oriented physicians believe that hidden food allergies contribute to gallbladder attacks by causing a swelling of the bile duct and impairment of bile flow. They may suggest trying a Food Allergy Elimination Diet for a month or two to determine if this can reduce your attack rate. Such an approach does not dissolve gallstones, however.
Treatment with drugs: Medication does exist that dissolves gallstones, but is only effective in about 10% of the cases and rarely used by practicing physicians. This is because the dissolving process is very slow, the success rate is low, and when the drug is discontinued, the gallstones start appearing again in half the users.
Treatment with surgery: The main treatment for gallstones is surgery. Over the years, doctors have debated among themselves whether everyone with gallstones should have their gallbladders taken out, or whether they should wait for symptoms to occur. The current thinking is to wait until gallbladder symptoms are frequent enough or severe enough to interfere with a person’s general routine. However, some doctors suggest that patients with no symptoms, but with very large stones, undergo a preventive gallbladder removal.
The current “gold standard” technique is termed laparoscopic cholecystectomy and is termed “minimally invasive” because it requires such small abdominal incisions. Virtually all patients who were initially anxious about undergoing gallbladder surgery remark afterwards how “they never dreamed it would be so easy.” Obviously, once your gallbladder is removed, gallstone formation and gallbladder “attacks” are permanently gone. Some people experience mild difficulty digesting fatty meals afterward, so a post-operative low-fat diet is usually recommended.
Other treatment approaches: A popular “lay” remedy for gallstones is a gallbladder or liver “flush,” usually a combination of olive oil, lemon juice, and perhaps some herbs. The “huge” gallstones reported being passed in this process are actually not stones at all but rather chunks of a soap-like material formed in the intestines by mixing the oil, the lemon juice, and certain minerals. Actually, this “flush” is probably a bad idea. All the oil can cause the gallbladder to start contracting; this may shift a gallstone and induce a severe gallbladder attack as the stone moves down (or even blocks!) the bile duct.
In the Seventies, an approach to dissolving gallstones using natural medicines called terpenes was reported in several journals. (Minnesota Medicine 1971; 54:649-651; British Medical Journal 1979; 278:24). Such an approach has not gained wide acceptance, however, probably because the formula is not readily available. The predominant terpene in this formula is menthol, so essential oil of peppermint in capsule form may have a comparable effect. This use of peppermint is theoretical; no studies using peppermint oil to dissolve gallstones have been performed.
WholeHealth Chicago recommendations: The general goal of using lifestyle changes and supplements in regard to gallstones is one of prevention rather than cure. We know that being a vegetarian, maintaining an ideal body weight, making dietary changes to increase fiber and lessen fat and sugar will all reduce the odds of stone formation or lessen the chance of clinical problems with existing gallstones from occurring. Likewise, increased physical activity, reduced sun exposure, avoiding constipation, and correcting certain nutritional deficiencies may also be of use.
Just a reminder: If you have a serious medical condition, it’s always a good idea to talk to you doctor before beginning a new supplement regimen.
Supplement Recommendations
Take extra vitamin C and vitamin E. Deficiencies of each of these has been linked to gallstone formation in animals. These important vitamins lower the amount of cholesterol in bile, making secretions from the liver less likely to clump together and form stones.
Use a lipotropic factor combination. These are substances that speed up the removal of fat in the liver by interacting with fat metabolism. Lipotropic factors include choline, methionine, folic acid, and vitamin B12.
Add herbs called cholagogues and choleretics, which are known to stimulate bile formation and bile flow. Among the best of these are milk thistle and dandelion. Many good lipotropic combinations contain small amounts of each, but you’ll probably want to take these herbs separately to get the maximum clinical effect. Milk thistle may even alter the composition of bile. In one study, patients treated with milk thistle had much lower levels of cholesterol in their bile.
Take lecithin, too. Inadequate levels of lecithin–a fatty substance rich in choline–has been linked to gallstones.
Psyllium, an excellent source of soluble fiber, binds to the cholesterol in bile and can help prevent gallstone formation. In addition, psyllium will help prevent constipation, a situation associated with increased gallstone formation.
Peppermint oil aids in digestion by stimulating the flow of bile and other digestive juices. In addition, it’s a terpene, one of the natural compounds that may actually have a gallstone-dissolving effect. If you decide to take peppermint oil, be sure to use enteric-coated capsules because they release the oil where it is needed most–in the small and large intestine–instead of in the stomach. Peppermint tea can also be useful for the pain of a gallbladder attack, because it helps relax spasms of the smooth muscle lining, the gallbladder, and bile ducts.
Self-Care Remedies
Watch your weight. Maintaining an ideal body weight can help prevent gallstones. If you are dieting, be careful not to lose too much too fast, however, because rapid weight loss has been regularly associated to increased gallstone production.
Eat a high-fiber, low-fat, low-sugar diet. When snacking, choose fruits and vegetables instead of cookies and crackers. The pectin in bananas, apples, carrots, and peas may be particularly helpful in preventing and dissolving gallstones.
Exercise regularly. Not only will this help keep your weight down, but some evidence is appearing that regular exercisers have less chance of developing gallstones.
Avoid sunbathing, especially if you are predisposed to sunburn. There is a definite–although not completely explained–association with prolonged sun exposure and gallstone development (Lancet 1992; 339:241).
Eat oily fish at least once a week. Animal studies have clearly demonstrated that a diet high in fish oils can have a protective effect when it comes to developing gallstones.
Make sure you have a regular bowel movement. Individuals with chronic constipation are at an increased risk for gallstone formation.
If you are having gallbladder attacks, try a Food Sensitivity Elimination Diet for at least a month and see if you are generally feeling better.
Drink plenty of water and herbal teas. At least six to eight glasses per day to maintain adequate water content of the bile.
When to Call a Doctor
If you experience abdominal pain–particularly in the upper right side–that is accompanied by sweating and shortness of breath. This could indicate a severe blockage of the bile duct or even a heart attack.
If you have intense abdominal pain with or without a fever, nausea, and vomiting. This may be a sign of a gallbladder infection or blocked bile duct.
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Be well,
David Edelberg, MD