Essential facts to know about your gallbladder and gallstones

The pain of a gallbladder attack, it’s probably something you’ll never forget.  Sometimes mistaken for having a heart attack, the pain is described as beginning suddenly in the center of the right upper abdomen spreading to the right upper back or shoulder blade area making it hard to get comfortable and can prevent you from taking a normal or deep breath. Moving around does not help and the pain may be continuous lasting from 15 minutes up to several hours. 

The most commonly reported symptom for emergency room visits is stomach or abdominal pain and a good portion of those visits are due to gallbladder issues of gallstones.  More than 25 million Americans have gallstones but only about 1-3% of the population will have symptoms over the course of a year. 

What does the gallbladder do?

The gallbladder is a 4-inch pear-shaped sac on the right side of the abdomen underneath the liver.  It quietly does its job of storing a substance called bile necessary to help digest fat in the small intestine.  Bile is made in the liver using cholesterol but is stored in the gallbladder. It is a fluid composed mostly of water, bile salts, lecithin and cholesterol.  Whenever we eat food containing fat, a hormone called cholecystokinin, signals the gallbladder to contract releasing bile into the small intestine.  Bile helps to emulsify or break down fat from our food along with aiding in the absorption of the fat-soluble vitamins A, D, E, and K.

What are gallstones and why do they form?

Gallstones are small, hard crystal deposits ranging in size from a grain of sand to a golf ball, forming in either the gallbladder or the bile ducts leading to the small intestine. 

There are two types of gallstones – cholesterol and pigment stones. More than 80% of gallstones are cholesterol stones that are usually yellowish-green in color.  They form when there is too much cholesterol in the bile secreted by the liver.  Bile will usually dissolve the cholesterol but if the liver is making more than what the bile can break down, gallstones can form.

Pigment stones are dark in color and form when there is too much bilirubin or not enough bile salts.

What increases the risk of developing gallstones?

·      Being a woman - Women are probably at a greater risk due to higher levels of estrogen which stimulates the liver to remove more cholesterol from the blood and redirects it to the gallbladder.

·      Pregnancy - Again, a pregnant woman will have higher levels of estrogen causing cholesterol levels in bile to increase.

·      Hormone Replacement Therapy and birth control pills - These medications contain estrogen and can increase the risk of developing gallstones.

·      Diabetes and Metabolic Syndrome – Both of these conditions place a person at an increased risk of gallstone formation and can progress more rapidly leading to a worse infection.

·      Obesity – Being obese causes the liver to overproduce cholesterol which gets stored in bile in the gallbladder causing gallstone formation.

·      Rapid weight loss – When a person loses weight rapidly, the body breaks down fat causing the liver to secrete extra cholesterol into bile.  Rapid weight loss can also prevent the gallbladder from emptying properly.  Bariatric surgery such as laparoscopic banding also increase the risk of gallstones when the weight is lost quickly. 

·      Crohn’s Disease – This inflammatory bowel disease leads to poor absorption of bile salts from the digestive tract increasing the risk of gallstones.

·      Heme Iron – Consuming a high amount of heme iron, the type of iron found in animal sources such as red meat, poultry and fish, has been found to lead to an increased risk of gallstone formation in men.

·      Over the age of 40 – Older people are more likely to develop gallstones than younger people.

·      American Indians – Due to genetic factors increasing the amount of cholesterol in their bile, American Indians have the highest rate of gallstones in the United States.  About 30% of men and 65% of women will develop gallstones.

·      Mexican Americans – This ethnic group has a higher risk of developing gallstones.

Preventing gallstone formation by changing what you eat 

You can possibly reduce your risk of developing gallstones by making some dietary changes.  Here is what you can do: 

·      Choose healthy fats – Monounsaturated fats found in olive and canola oils and omega-3 fatty acids found in flaxseed and fish oil, are good choices for fats.  Fish oil may help in improving the emptying actions of the gallbladder.

·      Increase fiber – The risk of developing gallstones is reduced when a high fiber diet is consumed. 

·      Eat more almonds and walnuts – Some studies have found gallstone risk is decreased by eating more nuts.

·      Increase fruit and vegetable intake – By eating more produce, this not only increases fiber intake but can also help control weight gain leading to reduced risk of gallstone formation. Aim for at least 5 servings of fruits and vegetables a day. 

·      Decrease sugar – Too much sugar is not good along with eating too much other simple carbohydrate foods as they rapidly are converted into sugar when digested, possibly increasing the risk of gallstones. No more than 50 grams of sugar should be consumed when following a 2,000 calorie diet.   

·      Maintain a normal weight and avoid rapid weight loss.  Maintaining a healthy weight by eating a nutritious diet can help prevent gallstone formation.  If a person needs to lose weight quickly due to extreme obesity, the medication ursodiol can be taken to reduce a gallbladder attack by dissolving existing gallstones. Orlistat (Xenical) which is used for obesity, may reduce gallstones by reducing bile acids leading to gallstone formation.  

·      Increase coffee intake – A cup or more of coffee each day appears to decrease the risk of gallstones.  The caffeine in coffee is believed to stimulate gallbladder contractions, lowering the amount of cholesterol in bile. 

Take away message on preventing gallstones

There are no guarantees that you’ll never develop gallstones during your lifetime but adding in some dietary changes can possibly help.  Focus on maintaining a healthy body weight, increasing consumption of foods high in fiber such as fruits, vegetables, and nuts and avoid losing weight too rapidly.