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Gallstones | | Description |
Also known as: Cholelithiasis, Gallbladder Attacks.
Gallstones are
formed in the gallbladder, primarily of cholesterol. They are commonly
associated with bile that contains excessive cholesterol, a deficiency of
other substances in bile (bile acids and lecithin), or a combination of
these factors.
What are the symptoms of gallstones? Gallstone
attacks cause extreme pain in the upper-right quarter of the abdomen,
often extending to the back. This pain can be accompanied by nausea and
vomiting.
Conventional treatment options: The most common medical
treatment for gallstones is surgical removal of the gallbladder
(cholecystectomy). Alternatively, bile acids (ursodeoxycholic acid and
chenodeoxycholic acid) may be used to try to dissolve the gallstones.
Mechanical shock waves (lithotripsy) may also be applied to break up the
stones. Unfortunately, gallstones commonly recur following these
non-surgical forms of treatment.
Dietary changes that may be
helpful: Cholesterol is the primary ingredient in most gallstones. Some,1
but not all,2 research links dietary cholesterol to the risk of
gallstones. Some doctors suggest avoiding eggs, either because of their
high cholesterol content or because eggs may be allergenic. (See the
discussion about gallstones and allergies below.) A recent study of
residents of southern Italy found that a diet rich in sugars and animal
fats and poor in vegetable fats and fibers was a significant risk factor
for gallstone formation.3
Most studies report that vegetarians are
at low risk for gallstones.4 In some trials, vegetarians had only half the
gallstone risk compared with meat eaters.5 6 Vegetarians often eat fewer
calories and less cholesterol. They also tend to weigh less than meat
eaters. All of these differences may reduce gallstone incidence. The
specific factors in a vegetarian diet that account for a low risk of
gallstone formation remain somewhat unclear and may only be present in
certain vegetarian diets and not others. For example, some studies have
found that vegetarians eating a high vegetable fat diet had elevated
rather than reduced risks of gallstone formation.7 8
Coffee increases bile flow and therefore might reduce the risk of
gallstones. In a large study of men, those drinking two to three cups of
regular coffee per day had a 40% lower risk of gallstones compared with
men who did not drink coffee.9 In the same report, men drinking at least
four cups per day had a 45% reduced risk. Caffeine appears to be the
protective ingredient, as decaffeinated coffee consumption was not linked
with any protection. People at risk for gallstones who wish to consider
increasing coffee drinking to reduce risks should talk with a doctor
beforehand. Caffeinated beverages can aggravate symptoms of insomnia,
peptic ulcer, panic attacks, and a variety of other
conditions.
Constipation has been linked to the risk of forming
gallstones.10 When constipation is successfully resolved, it has reduced
the risk of gallstone formation.11 Wheat bran, commonly used to relieve
constipation when combined with fluid, has been reported to reduce the
relative amount of cholesterol in bile of a small group of people whose
bile contained excessive cholesterol (a risk factor for gallstone
formation).12 The same effect has been reported in people who already have
gallstones.13 Doctors sometimes recommend two tablespoons per day of
unprocessed Miller's bran; an alternative is to consume commercial cereal
products that contain wheat bran. Bran should always be accompanied by
plenty of fluid. Adding more bran may cause gastrointestinal symptoms in
some people. If this occurs, consult a doctor.
Gallbladder attacks
(though not the stones themselves) have been reported to result from food
allergies. The one study to examine this relationship found that all of
the participants with gallbladder problems showed relief from gallbladder
pain when allergy-provoking foods were identified and eliminated from the
diet.14 Eggs, pork, and onions were reported to be the most common
triggers. Pain returned when the problem foods were reintroduced into the
diet. Doctors can help diagnose food allergies.
Lifestyle changes
that may be helpful: People with gallstones may consume too many
calories15 and are often overweight.16 17 Obese women have seven times the
risk of forming gallstones compared with women who are not overweight.18
Even slightly overweight women have significantly higher risks.19 Losing
weight is likely to help,20 but rapid weight loss might increase the risk
of stone formation.21 Any weight-loss program to prevent or treat
gallstones should be reviewed by a doctor. Weight-loss plans generally
entail reducing dietary fat, a change that itself correlates with
protection against gallstone formation and attacks.22 23
In women,
recreational exercise significantly reduces the risk of requiring
gallbladder surgery due to gallstones. In a study of over 60,000 women, an
average of two to three hours per week of recreational exercise (such as
cycling, jogging, and swimming) reduced the risk of gallbladder surgery by
about 20%.24
Use of birth control pills significantly increases a
woman's risk of developing gallstones.25 26
Nutritional supplements
that may be helpful: Vitamin C is needed to convert cholesterol to bile
acids. In theory, such a conversion should reduce gallstone risks. Women
who have higher blood levels of vitamin C have a reduced risk of
gallstones.27 Although this does not prove that vitamin C supplements can
prevent or treat gallstones, some researchers believe this is plausible.28
One study reported that people who drink alcohol and take vitamin C
supplements have only half the risk of gallstones compared with other
drinkers, though the apparent protective effect of vitamin C did not
appear in non-drinkers.29 In another trial, supplementation with vitamin C
(500 mg taken four times per day for two weeks before gallbladder surgery)
led to improvement in one parameter of gallstone risk ("nucleation time"),
though there was no change in the relative level of cholesterol found in
bile.30 While many doctors recommend vitamin C supplementation to people
with a history of gallstones, supportive evidence remains
preliminary.
According to one older report, people with gallstones
were likely to have insufficient stomach acid.31 Some doctors assess
adequacy of stomach acid in people with gallstones and, if appropriate,
recommend supplementation with betaine HCl. Nonetheless, no research has
yet explored whether such supplementation reduces symptoms of
gallstones.
Phosphatidylcholine (PC)-a purified extract from
lecithin-is one of the components of bile that helps protect against
gallstone formation. Some preliminary studies suggest that 300-2,000 mg
per day of PC may help dissolve gallstones.32 33 Some doctors suggest PC
supplements as part of gallstone treatment, though the supporting research
is weak.34
Are there any side effects or interactions? Refer to the
individual supplement for information about any side effects or
interactions.
Herbs that may be helpful: Milk thistle extracts in
capsules or tablets may be beneficial in preventing gallstones. In one
study, silymarin (the active component of milk thistle) reduced
cholesterol levels in bile,35 which is one important way to reduce
gallstone formation. People in the study took 420 mg of silymarin per
day.
According to preliminary research, a mixture of essential oils
dissolved some gallstones when taken for several months.36 The greatest
benefits occurred when the oils were combined with chenodeoxycholic acid,
which is available by prescription.37 However, only about 10% of people
with gallstones have shown significant dissolution as a result of taking
essential oils. Peppermint oil is the closest available product to that
used in the research described above. Use of peppermint or any other
essential oil to dissolve gallstones should only be attempted with the
close supervision of a doctor.
Are there any side effects or
interactions? Refer to the individual herb for information about any side
effects or interactions.
References:
1. Lee DWT,
Gilmore CJ, Bonorris G, et al. Effect of dietary cholesterol on biliary
lipids in patients with gallstones and normal subjects. Am J Clin Nutr
1985;42:414.
2. Andersen E, Hellstrom K. The effect of cholesterol
feeding on bile acid kinetics and biliary lipids in normolipidemic and
hypertriglyceridemic subjects. J Lipid Res 1979;20:1020-7.
3.
Misciagna G, Centonze S, Leoci C, et al. Diet, physical activity, and
gallstones-a population-based, case-control study in southern Italy. Am J
Clin Nutr 1999;69:120-6.
4. Kratzer W, Kachele V, Mason RA, et al.
Gallstone prevalence in relation to smoking, alcohol, coffee consumption,
and nutrition. The Ulm Gallstone Study. Scand J Gastroenterol
1997;32:953-8.
5. Pixley F, Mann J. Dietary factors in the
aetiology of gall stones: a case control study. Gut
1988;29:1511-5.
6. Pixley F, Wilson D, McPherson K, Mann J. Effect
of vegetarianism on development of gall stones in women. BMJ
1985;291:11-2.
7. Singh A, Bagga SP, Jindal VP, et al. Gall bladder
disease: an analytical report of 250 cases. J Indian Med Assoc
1989;87:253-6.
8. Jayanthi V, Malathi S, Ramathilakam B, et al. Is
vegetarianism a precipitating factor for gallstones in cirrhotics? Trop
Gastroenterol 1998;19:21-3.
9. Leitzmann MF, Willett WC, Rimm EB,
et al. A prospective study of coffee consumption and the risk of
symptomatic gallstone disease in men. JAMA 1999;281:2106-12.
10.
Heaton KW, Emmett PM, Symes CL, Braddon FEM. An explanation for gallstones
in normal-weight women: slow intestinal transit. Lancet
1993;341:8-10.
11. Marcus SN, Heaton KW. Intestinal transit,
deoxycholic acid and the cholesterol saturation of bile-three interrelated
factors. Gut 1986;27:550.
12. Watts JM, Jablonski P, Toouli J. The
effect of added bran to the diet on the saturation of bile in people
without gallstones. Am J Surg 1978;135:321-4.
13. McDougall RM,
Kakymyshyn L, Walker K, Thurston OG. Effect of wheat bran on serum
lipoproteins and biliary lipids. Can J Surg 1978;21:433-5.
14.
Breneman JC. Allergy elimination diet as the most effective gallbladder
diet. Ann Allerg 1968;26:83-7.
15. Sarles H, Gerolami A, Cros RC.
Diet and cholesterol gallstones. Digestion 1978;17:121-7.
16. Kern
F Jr. Epidemiology and natural history of gallstones. Semin Liver Dis
1983;3:87-96.
17. Misciagna G, Centonze S, Leoci C, et al. Diet,
physical activity, and gallstones--a population-based, case-control study
in southern Italy. Am J Clin Nutr 1999;69:120-6.
18. Stampfer MJ,
Maclure KM, Colditz GA, et al. Risk of symptomatic gallstones in women
with severe obesity. Am J Clin Nutr 1992;55:652-8.
19. Maclure KM,
Hayes KC, Colditz GA, et al. Weight, diet, and the risk of symptomatic
gallstones in middle-aged women. N Engl J Med 1989;321:563-9.
20.
Thornton JR. Gallstone disappearance associated with weight loss. Lancet
1979;ii:478 [letter].
21. Everhart JE. Contributions of obesity and
weight loss to gallstone disease. Ann Intern Med
1993;119:1029-35.
22. Scragg RKR. Diet, alcohol, and relative
weight in gall stone disease: a case-control study. BMJ
1984;288:1113-9.
23. Morrison LM. The effects of a low fat diet on
the incidence of gallbladder disease. Am J Gastroenterol
1956;25:158-63.
24. Leitzmann MF, Rimm EB, Willett WC, et al.
Recreational physical activity and the risk of cholecystectomy in women. N
Engl J Med 1999;341:777-84.
25. Thijs C, Leffers P, Knipschild P.
Oral contraceptive use and the occurrence of gallstone disease-a
case-control study. Prev Med 1993;22:122-31.
26. Grodstein F,
Colditz GA, Hunter DJ, et al. A prospective study of symptomatic
gallstones in women: relation with oral contraceptives and other risk
factors. Obstet Gynecol 1994;84:207-14.
27. Simon JA, Hudes ES.
Serum ascorbic acid and gallbladder disease prevalence among US adults.
Arch Intern Med 2000;160:931-6.
28. Simon JA. Ascorbic acid and
cholesterol gallstones. Med Hypotheses 1993;40:81-4.
29. Simon JA,
Grady D, Snabes MC, et al. Ascorbic acid supplement use and the prevalence
of gallbladder disease. J Clin Epidemiol 1998;51:257-65.
30.
Gustafsson U, Wang F-H, Axelson M, et al. The effect of vitamin C in high
doses on plasma and biliary lipid composition in patients with cholesterol
gallstones: prolongation of the nucleation time. Eur J Clin Invest
1997;27:387-91.
31. Capper WM, Butler TJ, Kilby JO, Gibson MJ.
Gallstones, gastric secretion and flatulent dyspepsia. Lancet
1967;i:413-5.
32. Toouli J, Jablonski P, Watts JM. Gallstone
dissolution in man using cholic acid and lecithin. Lancet
1975;ii:1124-6.
33. Tuzhilin SA, Dreiling D, Narodetskaja RV,
Lukahs LK. The treatment of patients with gallstones by lecithin. Am J
Gastroenterol 1976;165:231-5.
34. Holan KR, Holzbach T, Hsieh JYK,
et al. Effect of oral administration of `essential' phospholipid,
8-glycerophosphate, and linoleic acid on biliary lipids in patients with
cholelithiasis. Digestion 1979;19:251-8.
35. Nassuato G, Iemmolo
RM, et al. Effect of silibinin on biliary lipid composition. Experimental
and clinical study. J Hepatol 1991;12:290-5.
36. Somerville KW,
Ellis WR, Whitten BH, et al. Stones in the common bile duct: Experience
with medical dissolution therapy Postgrad Med J 1985;61:313-6.
37.
Werbach MR, Murray MT. Botanical Influences on Illness: A Sourcebook of
Clinical Research. Tarzana, CA: Third Line Press, 1994, 166-8
[review].
Source: NOW Foods
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