Gallstones and gallbladder disease
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of gallstones.
Alternative Names
Cholecystitis; Choledocholithiasis; Bile duct stones
Prevention
Diet plays a role in gallstones. The following discussions are some observations on specific dietary factors.
Role of Fats.
Although fats have been associated with gallstone attacks -- particularly saturated fats (found in meats, butter, and other animal products), evidence suggests that fat intake may have benefits under specific conditions.
Some studies, for example, have found a lower risk for gallstones in people who consume foods containing monounsaturated fats (found in olive and canola oils) or omega-3 fatty acids (found in canola, flaxseed, and, particularly, fish oil). Fish oil may be of particular benefit in patients who have high triglyceride levels by improving the emptying actions of the gallbladder.
Fiber.
High intake of fiber has been associated with a
lower
risk for gallstones.
Nuts
. Studies suggest that people may be able to reduce their risk of gallstones by eating more nuts (peanuts, walnuts, almonds).
Vegetable Protein
. A 2004 epidemiologic study found evidence that consumption of vegetable protein (such as soybean products) can help to prevent symptomatic gallstones.
Lecithin.
Lecithin is a key component of bile. It contains choline and inositol--two compounds that are important for the breakdown of fat and cholesterol. Low levels of lecithin may precipitate the formation of cholesterol gallstones. Animal studies have suggested that lecithin-rich soy and buckwheat protein may protect against gallstones. (Buckwheat may be more protective than soy.) Dietary lecithin is available in health food stores and is found in eggs, soybeans, liver, wheat germ, and peanuts. There is no evidence, however, that lecithin supplements or foods containing it can prevent gallstones in humans.
Sugar.
High-intake of sugar has been associated with an increased risk for gallstones. Diets that are high in carbohydrates (pasta, bread) can also increase risk. Carbohydrates are converted to sugar in the body.
Alcohol.
A few studies, including one in 2003, reported a lower risk for gallstones with alcohol consumption. Even small amounts (one ounce per day) have been found to reduce the risk of gallstones in women by 20%. Moderate intake (defined as one or two drinks a day) also appears to have heart protective benefits. It should be noted, however, that even moderate intake increases the risk for breast cancer in women. Pregnant women, people who can't drink moderately, and people with liver disease should not drink at all.
Vitamin C.
Ascorbic acid (vitamin C) appears to help break cholesterol down in bile. Vitamin C deficiencies have been associated with a higher risk for gallstones. One 2000 study, which confirmed some previous ones, reported that women with high blood levels of ascorbic acid had a lower risk for gallbladder disease than women with low levels.
Coffee.
In one study, men who drank two or more cups of regular coffee daily (either instant, filtered, or espresso) had a 40% lower risk of developing gallbladder disease over ten years than men who did not drink coffee regularly. Those who drank more than four cups had the lowest risk. A more recent study in 2000 did not find any general protective effect, although women with gallstones who drank coffee reported fewer symptoms than those who didn't.
Preventing Gallstones During Weight Loss
Maintaining a normal weight and avoiding rapid weight loss are the keys to reducing the risk of gallstones. Taking the medication ursodiol (also called ursodeoxycholic acid, or Actigall) during weight loss may reduce the risk for people who are very overweight and need to lose weight quickly. This medication is ordinarily used to dissolve existing gallstones. It should be noted, however, that it is very expensive. A promising 2001 study suggested that orlistat (Xenical), a drug for treating obesity, may protect against gallstone formation during weight loss. The drug appears to reduce bile acids and other components involved in gallstone production.
Exercise
Exercising regularly and vigorously may reduce the risk of gallstones and gallbladder disease, even in people who are overweight. Studies are reporting a lower risk for gallstones in both men and women who exercise. Active sports exercise appears to be most protective for both men and women. A 1999 study of women reported that exercise reduced gallstone risk regardless of whether women lost weight or not. Some evidence suggests that that, in addition to controlling weight, exercise helps reduce cholesterol levels in the biliary tract, which could help prevent gallstones.
Nonsteroidal Anti-Inflammatory Drugs
Some data had indicated that taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, protects against the development of gallstones. Recent studies have been mixed, although a 2001 study reported significant protection against gallstone recurrence in people who took NSAIDs after being treated with lithotripsy.
NOTE: Long-term use of NSAIDS can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events and gastrointestinal bleeding. Talk to your doctor before taking these drugs.
The Effects of Cholesterol-Lowering Drugs
Although it would be reasonable to believe that agents used to lower cholesterol would protect against gallstones, they either have little effect or, in the case of fibrates, actually increase the risk. One study reported a weak association between statins and a lower risk for gallstones. These are the most effective drugs for treating high cholesterol and include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). Most evidence, however, has found no protection even from these agents. Reducing cholesterol itself, then, does not have any effect on cholesterol gallstones.
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Review Date: 6/12/2006
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Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
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