Gallstones- An overall picture

How & Why Do Gallstones Form?

Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube--called the common bile duct--that carries it to the small intestine, where it helps with digestion.

Right now you are probably feeling terrible. Sharp pains may be shooting through your body, most likely in your upper abdomen. There's an unexplainable tenderness, and you may have pain between your shoulder blades, or in your right shoulder. You may feel like vomiting, or you may have nausea.

Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stool a yellowish color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, under certain conditions it can harden into stones.

The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas.

 If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called gallstone pancreatitis.

If any of these ducts remain blocked for a significant period of time, severe--possibly fatal--damage or infections can occur, affecting the gallbladder, liver, or pancreas. Warning signs of a serious problem are fever, jaundice, and persistent pain.

Your gallbladder is a “pouch” below the liver that stores a fat emulsifying liquid (bile) produced by the liver. While a small amount of cholesterol in the bile is normal, bile acids and lecithin are necessary to keep the cholesterol soluble. When there is more cholesterol than the bile salts and lecithin can dissolve, gallstones begin to form.

This type of gallstone, made primarily of cholesterol, occurs most frequently. There are also many types known as “mixed” because they contain varying amounts of calcium and bilirubin along with cholesterol.

Gallstones (cholelithiasis) and inflammation of the gallbladder (cholecystitis) are the two most common forms of gallbladder disease. Gallstones are usually present when there is an inflammatory process going on within the gallbladder, and there is a controversy as to which of these disorders occurs first.

What follows are dietary guidelines to decrease both the cholesterol saturation of the bile and the irritation and inflammation of the gallbladder. Since the two conditions are so closely related, the same dietary guidelines apply. If you feel any of them need to be modified for your unique situation, please ask your doctor.

§  If applicable, reduce your total caloric intake. Being overweight is associated with an increased incidence/risk of gallstones.

§  Avoid fats, particularly if you are experiencing any symptoms, as fats stimulate contractions of the gallbladder. This means avoiding all dairy products, fried foods, meats, chocolate, nuts, olives, avocados, gravy, creamy sauces, etc. Even if you are not currently symptomatic, these foods are to be avoided and high quality fats are encouraged in moderation for overall health and to help keep the bile flowing. These “good fats” are available in foods such as fish (baked, broiled, poached, or grilled, not deep fried), soy beans and soy-derived products, olive oil, cold-pressed vegetable oils and flaxseed oil.

§  Avoid all refined and processed foods. They are generally high in fat and sugar, and low in fiber. All three of these factors, together or independently, tend to increase gallstone formation.

§  A high fiber diet is also recommended for overall health benefits, but specifically in this case as fiber prevents constipation and binds fats to encourage their excretion. High fiber foods include grains, vegetables, fruits and legumes (beans).

§  Eat primarily a vegetarian diet. Vegetarianism is associated with reduced risk/incidence of gallbladder disease. This may be due to the fact that vegetarian diets generally consist of fewer calories, less fat and more fiber than non-vegetarian.

§  Avoid all foods that you have a known sensitivity to (wheat, dairy, etc.). They do not cause gallstones, but can trigger attacks.

§  Eliminate eggs, onions and pork from your diet and make note of any changes in your symptoms. These foods are particularly irritating to the gallbladder in many individuals.

§  The following foods may also cause gastric distress, and should be omitted from your diet if they are not tolerated well: broccoli, cauliflower, corn, cucumbers, green peppers, radishes, turnips, dried peas, and various beans.

§  Certain spices can cause distention of the intestinal tract and increased intestinal movement (peristalsis), which may be irritating to the gallbladder. Avoid any spices that cause you discomfort.

§  Drink at least 8-10 eight ounce glasses of water a day to keep your system properly hydrated. Additionally, drink juices and teas freely, but avoid coffee and alcohol as they put extra stress on your liver. When drinking juices, dilute them with water (mix half water, half juice), as they have a high natural sugar content.

§  Incorporate beets and artichokes into your diet liberally. These foods help to nourish and strengthen your liver, the primary organ responsible for processing cholesterol.

§  Read food container labels to avoid “hidden” fats, sugars, and chemicals.

GALLSTONES
Gallstones are masses made mainly of cholesterol that form in the gallbladder. The gallbladder is responsible for storing bile, which is created in the liver and used to digest fats. If the proportion of cholesterol, bile acids, lecithin, and water in the bile changes, a gallstone can form. Gallstones are caused by improper metabolism in the liver, particularly by excess cholesterol and/or a deficiency in bile acids and lecithin. Such an imbalance is often due to a high-fat, high-sugar, low-fiber diet. Constipation and excess weight (both also linked to such a diet) also predispose a person for gallstones. Food allergies may also contribute to the formation of gallstones in some cases. Many people who have gallstones are not even aware of them, although gallstones may produce pain in the upper right abdomen, as well as nausea and vomiting.

Gallstone formation, according to Traditional Chinese Medicine (TCM), is dependent on the function of the Liver. Excess cholesterol is produced by the liver in relation to the quantity of bile acids due to a Liver Qi stagnation. Liver Qi stagnation refers to an impaired circulation of energy within the Liver, leading to congestion. When Liver Qi stagnates and insufficient amounts of bile are secreted, this leads to Damp-Heat in the gallbladder. This triggers the formation of stones, usually from excess cholesterol in the bile.

Liver Qi is stagnated by diet, repressed emotions, overwork, or excessive sexual activities. Anger, resentment, frustration, and hatred can all cause Liver Qi stagnation, especially when they are repressed and not acknowledged or expressed. Refer to Dr. Sarno’s book Mindbody Prescription for how to resolve repressed emotions.

Doctors of Natural Medicine recommend herbs and supplements such as milk thistle and phosphatidylcholine (a lecithin extract), which improve liver function and protect against the development of gallstones. A high-fiber, low-fat diet is also recommended.

HERBS

Milk Thistle (Silybum marianum)
Action: Supports liver functions. Milk thistle contains liver-protective flavonoids known as silymarin. Clinical trials show that they protect the liver and counteract the toxic effects of a wide variety of poisons. Silymarin also has antioxidant activity and helps to protect against depletion of antioxidant glutathione in liver cells. Supports liver functions of clearing metabolic toxins, inhibits leukotriene formation, and stimulates protein synthesis. 1,2 Milk thistle may also be helpful in keeping stones from getting larger and in keeping new gallstones from forming. One study showed that milk thistle reduced cholesterol levels within bile, which is partly how gallstones are believed to be formed. 

3 Dosage: 400 to 500 milligrams of standardized extract in divided doses daily. The extract should be standardized to 70 to 80% silymarin content. Continue for 8 weeks and reduce the dosage to 280 to 300 milligrams of silymarin.

PROFESSIONAL CHINESE HERB FORMULA

There are many Chinese herb formulas that address gallstones; however the various signs and symptoms of the patient must be carefully considered before recommending a formula.

NUTRITIONAL SUPPLEMENTS

Phosphatidylcholine
Action: An essential nutrient that is required for proper liver function. In the so-called lipotropic effect, it is used to move fat from the liver. Used extensively by German doctors to treat liver disorders. 4

Dosage: 1,500 milligrams daily in divided doses.

Flaxseed Oil
Action: Provides essential fatty acids, which are needed for many bodily functions including cellular repair and the formation and viscosity of bodily fluids.

Dosage: 1 to 2 tablespoons daily.

Multiple Vitamin and Mineral Formula
Action: Many vitamins and minerals contribute to the proper function of the liver and protect against the formation of gallstones. A multiple vitamin and mineral formula will also help prevent nutrient imbalances that can result from taking high doses of any one vitamin or mineral that is needed for a health condition.

Dosage: As directed by manufacturers. Select a formula according to age and gender. See information on this topic at multiple vitamin and mineral formulas.

Dietary Considerations
Eat a high-fiber, low-fat, low-sugar diet with many fresh fruits and vegetables. When gallstones are present, eat olive oil, apple juice, beet juice, grapefruit juice, and carrot juice. To prevent or treat gallstones, avoid meat, eggs, dairy products, hydrogenated fats, nuts and nut butters, sugar, alcohol, and refined foods.

Lifestyle Considerations

For severe attacks of pain, try a castor oil compress over the liver/gallbladder region. A coffee enema may also be used for severe attacks. Brew a cup of strong, caffeinated coffee and dilute to a pint or more, retaining for 20 to 30 minutes. Notify your doctor if you perform this enema. 

Precautions and Adverse Effects

Planetary Formulas: No reported side effects.

Milk Thistle: Very safe. May cause mild, temporary diarrhea.

Phosphatidylcholine: High doses may cause abdominal bloating, gastrointestinal upset, diarrhea, nausea, and reduced appetite. Should not be taken by people with unipolar or clinical depression since phosphatidylcholine may increase depression in some cases.

Flaxseed Oil: Safe if taken as recommended. Only use a high-quality, organic oil that has not been exposed to light, heat, or oxygen, which alter and damage the oil. Regularly using a damaged oil can result in cellular damage and serious health conditions.