Gallstone disease, the lifestyle related condition once associated with the western world, has markedly increased here due to the growing popularity of western diets. Although the exact causes of gallstones are not known, they are believed to have multi-factorial origin, with interaction of both genetic and environmental factors. Common risk factors include obesity, food allergies, sensitivities, ageing, hormone (estrogen) treatment, pregnancy, diabetes, Crohn’s disease, cystic fibrosis, liver disease and even crash dieting.
The gallbladder is a little pear shaped sac which sits close to the liver and helps in efficient digestion. It is the organ that stores and concentrates the bile produced by the liver. It also releases the bile into the small intestines during meals to aid fat digestion and absorption. The gallbladder helps to break up fat globules and in the absorption of cholesterol and hence its health is critical to digestive and overall health.
Gravel-like deposits or solid masses that form in the gallbladder are referred to as gallstones. They are largely made up of cholesterol or are a mix of bile salts, calcium and bile pigment. A stone is formed as cholesterol precipitates when there is a lower concentration of bile acids, water and emulsifying agents (lecithin) in bile. These may be as fine as beach sand or as coarse as river gravel or stones ranging from 5 mm to 25mm. They accumulate over years at an estimated growth rate of approximately 2 mm a year. Gallbladder stones are the most common form of gallbladder disease. Inflammation of the gallbladder is also seen sometimes in the absence of gallstones (Cholecystitis).
Since gallstones are asymptomatic, formed over years, many people may never know they have them. Common symptoms include bloating, belching, heartburn, fullness, abdominal discomfort, pain, indigestion and nausea especially after food. For some, however, the presence of gallstones can cause pain in the upper right abdomen when the gallbladder contracts to release bile after a meal. Inflammation of the gallbladder can bring on sudden, severe pain extending to the back and under the right shoulder blade, with fever, chills, and vomiting. If stones obstruct the flow of bile, the skin and the whites of the eyes become jaundiced. Left untreated, stones can lodge in the bile duct and cause inflammation of liver or pancreas and may even result in gallbladder cancer.
Food allergies that are common contributing factor especially allergies to eggs, pork, onions, milk, dairy and corn. Recent studies show that 60 per cent of celiac disease ( gluten sensitivity) sufferers are known to have gall bladder, liver or pancreatic disease. When one eats, the cells that line the duodenum (the first segment of the small intestine) detect the presence of fat and protein and react by releasing a hormone called cholecystokinin. This hormone stimulates both the release of digestive enzymes from the pancreas and bile from the gallbladder. It also signals to the stomach to slow down the speed of digestion so the small intestine can effectively digest the fats. When the gut is damaged because of gluten sensitivity or otherwise, the cells that line the small intestine secrete less cholecystokinin.
This results in a situation where there isn’t enough stimulus to the gallbladder to release bile salts into the duodenum. Reduced cholecystokinin release is reported in celiac disease and may be one of the key causes of gallbladder malfunction that is seen in celiac or gluten sensitivity. It is now recommended that those with unexplained liver and/ or gallbladder symptoms be evaluated for celiac disease or gluten sensitivity.
Crash weight loss diets are believed to be an important risk factor for developing gallstones. Many people appear to develop gallstones after a period of yo-yo dieting, with repeated cycles of weight loss and gain, or after a single dramatic weight loss.
Taking cholesterol-lowering drugs has been linked with cholesterol stones. Lowering blood cholesterol increases bile cholesterol and this, in turn, can promote stone formation. Also, women taking oral contraceptives or hormonal medication (progesterone and estrogen) are at an increased risk of gallstone formation.
The nature of fat appears to play a significant role. Mono unsaturated fats like those present in mustard, canola, olive and most nuts have been found to decrease the risk of stone formation.
High carbohydrates particularly from refined sugars and sugar sweetened beverages is strongly correlated with gallbladder disease. On the other hand, high fibre intake and moderate consumption of alcohol have been found to reduce the risk. Vitamin C,magnesium and calcium have been found to be beneficial in preliminary studies.
A protective effect of modest coffee drinking has also been associated with risk reduction.