GALLSTONES
Gallstones are very common in Americans. Twenty percent of women and 8 percent of men over the age of forty had gallstones at autopsy. About 2/3 of people who develop stones never have any symptoms. As many as 500,000 gallbladders are removed yearly in America, nearly all for stones. The gallbladder is a small sack that collects bile from the liver and stores it. In addition to bile salts needed to digest fats in the diet, the bile contains cholesterol and various toxins processed by the liver. When a meal is eaten, particularly when it has fat in it, the body sends a signal to the gallbladder to contract and send bile through the common bile duct into the first part of the small intestine.
Stones are a mixture of cholesterol, calcium and bile pigments. Stones form when bile salt production is low or cholesterol levels in the bile are high. When a stone gets large enough, it cannot pass through the neck of the gallbladder and out through the common bile duct. This leads to pain, inflammation, nausea and indigestion. The pain is usually in the right upper quadrant of the abdomen, just below the rib margin. The pain may be referred by the nerves to the right shoulder blade area. Diagnosis is easily made by an ultrasound exam. In rare cases, the gallbladder becomes infected or may rupture. This is a surgical emergency and has a significant complication rate, including death.
Risk factors for stone formation include female sex, Native American ethnicity, older age, alcoholic cirrhosis, liver flukes (rare in America), high fat diet, obesity, high sugar intake, low calcium intake, rapid weight loss and certain drugs. Drugs known to be involved in higher risk include oral contraceptives, female hormone replacement and the cholesterol lowering drugs clofibrate and gemfibrozil.
The three main management choices are surgery, watchful waiting or dissolving stones by medication. Surgery is now usually done by small laprascopic incisions. Besides the usual potential complications of any major surgery, this surgery may leave stones behind in the common bile duct, which can cause symptoms later on.
In addition, since the underlying cause of the stone formation has not been addressed, reoccurrence of stones in the common duct may occur up to 25% of the time within five years. Dissolving the stones with the drug Actigall only has a 30% success rate, requires months of therapy, is expensive and still does not alter the underlying stone formation process. Watchful waiting includes a low fat diet, losing weight, stopping drugs that contribute to stone formation.
Prevention of gallstones is by eating a high fiber, low fat diet with plenty of vegetables and fruit. Decreasing sugar, drinking lots of water to maintain hydration and eating adequate calcium is helpful as is regular physical exercise. A study in the 1960’s showed that people with gallstones were often able to avoid symptoms by eliminating certain foods from their diet. The biggest offenders were eggs, pork, onion, fowl, milk, coffee and oranges.
Supplements that are helpful include lethicin, choline, folic acid, Vitamin B-12, Vitamin E and C, magnesium, methionine and taurine. Herbs that increase bile salt production include dandelion, Silymarin, artichoke, tumeric and boldo. Castor oil packs over the gallbladder area may be helpful. A natural flushing procedure involving apple cider vinegar for several days followed by a large dose of lemon juice and olive oil can be used to flush the stones out into the intestines. This does have a risk of causing a stone to obstruct the neck of the gallbladder or the common bile duct. This should only be done under the supervision of a physician.
Daniel Blodgett MD