Gallstones

Also indexed as: Cholelithiasis, Gallbladder Attacks

Gallstones are formed in the gallbladder, primarily of cholesterol. They are commonly associated with bile that contains excessive cholesterol, a deficiency of other substances in bile (bile acids and lecithin), or a combination of these factors.

Checklist for Gallstones

Rating Nutritional Supplements Herbs
2Stars Wheat bran  
1Star Betaine HCl
Phosphatidylcholine
Vitamin C		 Milk thistle
Peppermint oil
See also:  Homeopathic Remedies for Gallstones
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of gallstones? Gallstone attacks cause extreme pain in the upper-right quarter of the abdomen, often extending to the back. This pain can be accompanied by nausea and vomiting.

How is it treated? The most common medical treatment for gallstones is surgical removal of the gallbladder (cholecystectomy). Alternatively, bile acids (ursodeoxycholic acid and chenodeoxycholic acid) may be used to try to dissolve the gallstones. Mechanical shock waves (lithotripsy) may also be applied to break up the stones. Unfortunately, gallstones commonly recur following these non-surgical forms of treatment.

Dietary changes that may be helpful: Cholesterol is the primary ingredient in most gallstones. Some,1 but not all,2 research links dietary cholesterol to the risk of gallstones. Some doctors suggest avoiding eggs, either because of their high cholesterol content or because eggs may be allergenic. (See the discussion about gallstones and allergies below.) A recent study of residents of southern Italy found that a diet rich in sugars and animal fats and poor in vegetable fats and fibers was a significant risk factor for gallstone formation.3

Most studies report that vegetarians are at low risk for gallstones.4 In some trials, vegetarians had only half the gallstone risk compared with meat eaters.5 6 Vegetarians often eat fewer calories and less cholesterol. They also tend to weigh less than meat eaters. All of these differences may reduce gallstone incidence. The specific factors in a vegetarian diet that account for a low risk of gallstone formation remain somewhat unclear and may only be present in certain vegetarian diets and not others. For example, some studies have found that vegetarians eating a high vegetable fat diet had elevated rather than reduced risks of gallstone formation.7 8

Coffee increases bile flow and therefore might reduce the risk of gallstones. In a large study of men, those drinking two to three cups of regular coffee per day had a 40% lower risk of gallstones compared with men who did not drink coffee.9 In the same report, men drinking at least four cups per day had a 45% reduced risk. Caffeine appears to be the protective ingredient, as decaffeinated coffee consumption was not linked with any protection. People at risk for gallstones who wish to consider increasing coffee drinking to reduce risks should talk with a doctor beforehand. Caffeinated beverages can aggravate symptoms of insomnia, peptic ulcer, panic attacks, and a variety of other conditions.

Constipation has been linked to the risk of forming gallstones.10 When constipation is successfully resolved, it has reduced the risk of gallstone formation.11 Wheat bran, commonly used to relieve constipation when combined with fluid, has been reported to reduce the relative amount of cholesterol in bile of a small group of people whose bile contained excessive cholesterol (a risk factor for gallstone formation).12 The same effect has been reported in people who already have gallstones.13 Doctors sometimes recommend two tablespoons per day of unprocessed Miller’s bran; an alternative is to consume commercial cereal products that contain wheat bran. Bran should always be accompanied by plenty of fluid. Adding more bran may cause gastrointestinal symptoms in some people. If this occurs, consult a doctor.

Gallbladder attacks (though not the stones themselves) have been reported to result from food allergies. The one study to examine this relationship found that all of the participants with gallbladder problems showed relief from gallbladder pain when allergy-provoking foods were identified and eliminated from the diet.14 Eggs, pork, and onions were reported to be the most common triggers. Pain returned when the problem foods were reintroduced into the diet. Doctors can help diagnose food allergies.

Lifestyle changes that may be helpful: People with gallstones may consume too many calories15 and are often overweight.16 17 Obese women have seven times the risk of forming gallstones compared with women who are not overweight.18 Even slightly overweight women have significantly higher risks.19 Losing weight is likely to help,20 but rapid weight loss might increase the risk of stone formation.21 Any weight-loss program to prevent or treat gallstones should be reviewed by a doctor. Weight-loss plans generally entail reducing dietary fat, a change that itself correlates with protection against gallstone formation and attacks.22 23

In women, recreational exercise significantly reduces the risk of requiring gallbladder surgery due to gallstones. In a study of over 60,000 women, an average of two to three hours per week of recreational exercise (such as cycling, jogging, and swimming) reduced the risk of gallbladder surgery by about 20%.24

Use of birth control pills significantly increases a woman’s risk of developing gallstones.25 26

Nutritional supplements that may be helpful: Vitamin C is needed to convert cholesterol to bile acids. In theory, such a conversion should reduce gallstone risks. Women who have higher blood levels of vitamin C have a reduced risk of gallstones.27 Although this does not prove that vitamin C supplements can prevent or treat gallstones, some researchers believe this is plausible.28 One study reported that people who drink alcohol and take vitamin C supplements have only half the risk of gallstones compared with other drinkers, though the apparent protective effect of vitamin C did not appear in non-drinkers.29 In another trial, supplementation with vitamin C (500 mg taken four times per day for two weeks before gallbladder surgery) led to improvement in one parameter of gallstone risk (“nucleation time”), though there was no change in the relative level of cholesterol found in bile.30 While many doctors recommend vitamin C supplementation to people with a history of gallstones, supportive evidence remains preliminary.

According to one older report, people with gallstones were likely to have insufficient stomach acid.31 Some doctors assess adequacy of stomach acid in people with gallstones and, if appropriate, recommend supplementation with betaine HCl. Nonetheless, no research has yet explored whether such supplementation reduces symptoms of gallstones.

Phosphatidylcholine (PC)—a purified extract from lecithin—is one of the components of bile that helps protect against gallstone formation. Some preliminary studies suggest that 300–2,000 mg per day of PC may help dissolve gallstones.32 33 Some doctors suggest PC supplements as part of gallstone treatment, though the supporting research is weak.34

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Milk thistle extracts in capsules or tablets may be beneficial in preventing gallstones. In one study, silymarin (the active component of milk thistle) reduced cholesterol levels in bile,35 which is one important way to reduce gallstone formation. People in the study took 420 mg of silymarin per day.

According to preliminary research, a mixture of essential oils dissolved some gallstones when taken for several months.36 The greatest benefits occurred when the oils were combined with chenodeoxycholic acid, which is available by prescription.37 However, only about 10% of people with gallstones have shown significant dissolution as a result of taking essential oils. Peppermint oil is the closest available product to that used in the research described above. Use of peppermint or any other essential oil to dissolve gallstones should only be attempted with the close supervision of a doctor.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Lee DWT, Gilmore CJ, Bonorris G, et al. Effect of dietary cholesterol on biliary lipids in patients with gallstones and normal subjects. Am J Clin Nutr 1985;42:414.

2. Andersen E, Hellstrom K. The effect of cholesterol feeding on bile acid kinetics and biliary lipids in normolipidemic and hypertriglyceridemic subjects. J Lipid Res 1979;20:1020–7.

3. Misciagna G, Centonze S, Leoci C, et al. Diet, physical activity, and gallstones—a population-based, case-control study in southern Italy. Am J Clin Nutr 1999;69:120–6.

4. Kratzer W, Kachele V, Mason RA, et al. Gallstone prevalence in relation to smoking, alcohol, coffee consumption, and nutrition. The Ulm Gallstone Study. Scand J Gastroenterol 1997;32:953–8.

5. Pixley F, Mann J. Dietary factors in the aetiology of gall stones: a case control study. Gut 1988;29:1511–5.

6. Pixley F, Wilson D, McPherson K, Mann J. Effect of vegetarianism on development of gall stones in women. BMJ 1985;291:11–2.

7. Singh A, Bagga SP, Jindal VP, et al. Gall bladder disease: an analytical report of 250 cases. J Indian Med Assoc 1989;87:253–6.

8. Jayanthi V, Malathi S, Ramathilakam B, et al. Is vegetarianism a precipitating factor for gallstones in cirrhotics? Trop Gastroenterol 1998;19:21–3.

9. Leitzmann MF, Willett WC, Rimm EB, et al. A prospective study of coffee consumption and the risk of symptomatic gallstone disease in men. JAMA 1999;281:2106–12.

10. Heaton KW, Emmett PM, Symes CL, Braddon FEM. An explanation for gallstones in normal-weight women: slow intestinal transit. Lancet 1993;341:8–10.

11. Marcus SN, Heaton KW. Intestinal transit, deoxycholic acid and the cholesterol saturation of bile—three interrelated factors. Gut 1986;27:550.

12. Watts JM, Jablonski P, Toouli J. The effect of added bran to the diet on the saturation of bile in people without gallstones. Am J Surg 1978;135:321–4.

13. McDougall RM, Kakymyshyn L, Walker K, Thurston OG. Effect of wheat bran on serum lipoproteins and biliary lipids. Can J Surg 1978;21:433–5.

14. Breneman JC. Allergy elimination diet as the most effective gallbladder diet. Ann Allerg 1968;26:83–7.

15. Sarles H, Gerolami A, Cros RC. Diet and cholesterol gallstones. Digestion 1978;17:121–7.

16. Kern F Jr. Epidemiology and natural history of gallstones. Semin Liver Dis 1983;3:87–96.

17. Misciagna G, Centonze S, Leoci C, et al. Diet, physical activity, and gallstones--a population-based, case-control study in southern Italy. Am J Clin Nutr 1999;69:120–6.

18. Stampfer MJ, Maclure KM, Colditz GA, et al. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr 1992;55:652–8.

19. Maclure KM, Hayes KC, Colditz GA, et al. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N Engl J Med 1989;321:563–9.

20. Thornton JR. Gallstone disappearance associated with weight loss. Lancet 1979;ii:478 [letter].

21. Everhart JE. Contributions of obesity and weight loss to gallstone disease. Ann Intern Med 1993;119:1029–35.

22. Scragg RKR. Diet, alcohol, and relative weight in gall stone disease: a case-control study. BMJ 1984;288:1113–9.

23. Morrison LM. The effects of a low fat diet on the incidence of gallbladder disease. Am J Gastroenterol 1956;25:158–63.

24. Leitzmann MF, Rimm EB, Willett WC, et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med 1999;341:777–84.

25. Thijs C, Leffers P, Knipschild P. Oral contraceptive use and the occurrence of gallstone disease—a case-control study. Prev Med 1993;22:122–31.

26. Grodstein F, Colditz GA, Hunter DJ, et al. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstet Gynecol 1994;84:207–14.

27. Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults. Arch Intern Med 2000;160:931–6.

28. Simon JA. Ascorbic acid and cholesterol gallstones. Med Hypotheses 1993;40:81–4.

29. Simon JA, Grady D, Snabes MC, et al. Ascorbic acid supplement use and the prevalence of gallbladder disease. J Clin Epidemiol 1998;51:257–65.

30. Gustafsson U, Wang F-H, Axelson M, et al. The effect of vitamin C in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones: prolongation of the nucleation time. Eur J Clin Invest 1997;27:387–91.

31. Capper WM, Butler TJ, Kilby JO, Gibson MJ. Gallstones, gastric secretion and flatulent dyspepsia. Lancet 1967;i:413–5.

32. Toouli J, Jablonski P, Watts JM. Gallstone dissolution in man using cholic acid and lecithin. Lancet 1975;ii:1124–6.

33. Tuzhilin SA, Dreiling D, Narodetskaja RV, Lukahs LK. The treatment of patients with gallstones by lecithin. Am J Gastroenterol 1976;165:231–5.

34. Holan KR, Holzbach T, Hsieh JYK, et al. Effect of oral administration of ‘essential’ phospholipid, 8-glycerophosphate, and linoleic acid on biliary lipids in patients with cholelithiasis. Digestion 1979;19:251–8.

35. Nassuato G, Iemmolo RM, et al. Effect of silibinin on biliary lipid composition. Experimental and clinical study. J Hepatol 1991;12:290–5.

36. Somerville KW, Ellis WR, Whitten BH, et al. Stones in the common bile duct: Experience with medical dissolution therapy Postgrad Med J 1985;61:313–6.

37. Werbach MR, Murray MT. Botanical Influences on Illness: A Sourcebook of Clinical Research. Tarzana, CA: Third Line Press, 1994, 166–8 [review].