Gallstones

You just had a great dinner at your favorite restaurant.  Maybe you’re out with your family, maybe with friends or even on a date 🙂  Then you suddenly feel some pain in your upper abdomen, right under the ribcage.  Quickly it worsens to the point that you can hardly breathe.  You feel sick to your stomach, you’re doubled up in pain wondering if you can make it to the bathroom in time.

The pain spreads through the upper abdomen and aches into the back of the right shoulder.  Somehow you make it home, wondering halfway there whether you should just detour to the nearest emergency room.  Curled up on the couch while your worried family hovers over you, you just wish it would go away.

Then suddenly, it does!  The pain goes from about 254 on the 10-point pain scale to GONE.  You sit up carefully, and everyone jumps and starts asking questions, but you feel completely normal.  Now everybody’s looking at you funny, like you made it up.  Pain can’t go from severe to gone in no time, can it?

Yep, it can.  This was my experience with gallstones.

I thought I was crazy.  When it happened a second time, I went to the doctor who confirmed it with an ultrasound.  I had gallstones.

I had my gallbladder out when I was 19 years old.  Other than having to be careful about fatty, greasy meals, I haven’t had any problems since then.  However not all my patients who have their gallbladders removed have such a good experience.

Gallstones are crystals of cholesterol that form from bile in the gallbladder.  They can grow pretty large (I’ve seen gallstones several centimeters across removed) but generally the little ones cause the most problems.  They get stuck in the neck of the gallbladder and block the duct that drains bile into the intestine.  They can also get stuck in the common bile duct (which drains from the liver into the intestine) and cause pancreatitis, which is on my top-5 list of things I NEVER want to have.

Generally when a person has gallstones with typical pain, doctors will recommend surgery to remove the gallbladder.  The question is, will surgery resolve the pain?

Most of the time, it does.  However, sometimes symptoms continue, and sometimes removing the gallbladder causes other symptoms.

Bile is a soapy substance that acts like Dawn dishwashing liquid.  It breaks up big fat droplets in partially-digested food to little fat droplets that are more readily absorbed.  The gallbladder stores bile, and when you eat a fatty meal the stomach signals the gallbladder to contract and send out extra bile.  After the gallbladder is removed, the digestive system doesn’t have any way to adjust to higher-than-usual fat in the diet.  This can lead to abdominal cramping, bloating and diarrhea if you eat too much fat after gallbladder surgery.

There isn’t any good way to be absolutely sure that the abdominal pain and other symptoms a patient is experiencing are actually caused by the gallstones.  We have plenty of patients that have gallstones found on ultrasound done for another reason, but they have no symptoms at all.

Suppose you have abdominal pain.  As you know, MANY problems cause abdominal pain.  Wouldn’t it be reasonable to try to make sure your pain can’t be relieved by other measures before heading to surgery?

I dove into my nutritional medicine textbook to see if there were any measures that Dr. Gaby can suggest.  He has several recommendations.

1.  Eliminate food allergies

I’m aware that I’m beginning to sound like a broken record.  It seems that EVERYTHING is related to food allergies!  Well, in this case, it makes sense.  Intake of allergenic foods causes inflammation in the GI system.

One study showed that people with untreated celiac disease had VERY delayed gallbladder emptying as compared to celiac disease patients who were well controlled on a gluten-free diet and normal control patients.  Another study showed that 100% of study subjects with gallbladder problems were able to completely resolve their symptoms through use of an elimination diet.  100%.  Every single one.

If you or someone you know is struggling with gallstones or persistent symptoms after gallbladder removal, a food allergy elimination diet is a great next step and may resolve the symptoms.

2. Clean up the diet and use smart supplementation

Formation of gallstones is correlated with a typical Western diet.  Refined sugars, partially-hydrogenated oils, saturated fats and cholesterol in the diet increase the risk of gallstones.

Vegetarians have a much lower risk of gallstones as compared to omnivores.  Vegetable protein and dietary fiber in particular seem to decrease the risk.

Substances that stimulate bile flow and lower the cholesterol content of bile, like caffeine, vitamin C, fish oil and moderate alcohol intake, decrease the risk of gallstones.

It is interesting to note that iron deficiency increases the risk of gallstones.  This may contribute to the increased risk of gallstones during and after pregnancy.

3.  Maintain a healthy weight

Obesity is associated with an increased risk of gallstones.  If you have a family history of gallstones that’s a great reason to get serious about getting to and staying at a healthy weight.

If you have gallstones, are you doomed to have gallbladder surgery?  Not necessarily.  You might very well be able to resolve your symptoms without surgery.  And that, after all, is the goal.

If we can make your gallstones stop bothering you, maybe you shouldn’t bother them!  Over time, if you take care of the risk factors that may have caused them to develop in the first place, they might just resolve themselves.

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5 thoughts on “Gallstones

  1. I had my gallbladder out in 2009 and now I’m having problems with my liver. I wonder if it has something to do with the liver having to do the job of the gallbladder.

    • No, probably not. The liver doesn’t do the job of the gallbladder. After gallbladder removal bile just continually drains into the intestine instead of being stored.

  2. Pingback: Celiac Disease And Pregnancy Complications - Jennifer Wurst, MD

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