Gallstones

Gallstones is one of the most prevalent gastrointestinal disorders in the Western population. There are two types of stones: cholesterol and pigment stones. Cholesterol stones are more common. Stones can range in size and numbers. Most are asymptomatic and are unnoticed. Some start out as biliary sludge, especially during pregnancy, which can cause some of the same symptoms as gallstones.

Let us first look at the anatomy of the gallbladder:

The Gallbladder is a pear-like muscular structure on the right side of the abdomen under the liver. It is 1 inch wide and 3 inches long. It holds the digestive fluid, Bile, which is a strong enzyme that breaks down fats and certain vitamins and turns them into energy. Bile is formed in the liver and stored in the gallbladder. Bile also carries cholesterol and Bilirubin, a byproduct of red blood cell breakdown. The Gallbladder is stimulated to contract from signals for the stomach and duodenum (small intestine) when fat is present.

The gallbladder is part of the biliary tree. This tree consists of ducts or vessels that bring secretions from the liver, gallbladder and pancreas into the small intestine, the duodenum. The common bile duct receives secretions from the common hepatic duct (liver secretions), cystic duct (gallbladder secretions) and the pancreatic duct (pancreatic secretions). Gallstones can get stuck/lodged in any of these ducts and cause a blockage. Gallstones can be asymptomatic until they cause a blockage and thus inflammation in the joining organ (liver, gallbladder and/or pancreas).

The most common causes of stones are:

For Cholesterol Stones:

Impaired Gallbladder emptying and/or not emptying fully
Too much cholesterol for Bile to breakdown
Many cases have unknown causes

For Pigment Stones:

Bile contains too much bilirubin due to liver cirrhosis, Biliary tract infections and blood disorders (Sickle Cell Anemia, Leukemia).

Risk factors include:

Women
Age over 40
Native and Mexican descent
Overweight or obese
Sedentary lifestyles
Pregnancy
High Fat and/or cholesterol diet
Low fiber diet
Family History
Diabetes
Certain blood disorders (Sickle Cell Anemia, Leukemia)
Losing weight quickly
Oral contraceptives and/or Hormone Therapy Drugs
Liver Disease
Certain Medications that lower cholesterol, Fibrates
Bacterial infection of the gallbladder

The most common symptoms are:

Sudden and extreme pain in the upper right area of the abdomen
Sudden extreme pain in the center of the abdomen below the breast bone
Pain in the back of the shoulder blades
Nausea, vomiting, gas

These symptoms can last from minutes to hours.

Complications include:

Inflammation of gallbladder due to a stone being lodged in the neck of the gallbladder. Symptoms would be pain and fever
Inflamed gallbladder in severe causes can lead to perforation of the gallbladder thus contents of the gallbladder would be emptied in the abdomen.
Blockage of the Common Bile Duct due to blockage at the Gallbladder and/or liver causing severe pain, jaundice and bile duct infection
Blockage of the Pancreatic duct causing pancreatitis. Symptoms would be intense constant abdominal pain.
Gallbladder Cancer but this is very rare
Perforation of the Gallbladder
Infection of Gallbladder, Pancreas and lining of the abdomen

Diagnosis of Gallstones consists of:

Physical and medical history with your doctor
Blood work to rule out other causes, look for infections and/or blockage
Ultrasound for imaging of Gallbladder and liver and look at blood flow
CT Scan for more detailed imaging of organs, muscles and bones
Magnetic resonance cholangiopancreatography (MRCP) for imaging
Cholescintigraphy (HIDA scan) specialized test to see the contraction of the gallbladder
Endoscopic retrograde cholangiopancreatography to view the ducts
Endoscopic ultrasound combines ultrasound and endoscopy to look for gallstones

Conventional Treatments consist of pain management, medication for infection if needed and medications to break up the gallstones. These medications can cause gastrointestinal symptoms and the gallstones can return after stopping the medication. Surgical removal of the gallbladder is the most common treatment. Some people experience ongoing gallbladder symptoms or the development of new gastrointestinal symptoms after surgery (Postcholecystectomy syndrome). Asymptomatic gallstones do not need treatment.

Prevention of gallstones are:

Slow gradual weight loss
No fast weight loss or yo yo diets
Assessing food allergies
Decreasing fried foods, saturated and trans fat and foods high in cholesterol
Increasing more healthy fats like olive oil, fish oils and nuts
Increasing dietary fiber
Increasing vegetables and leaning towards vegetarian diets
Decreasing refined sugars
Eating more foods high in Vit C (Guavas, Blackcurrents, Sweet yellow peppers, parsley, Mustard spinach, kale, kiwis, broccoli, brussell sprouts, lemons, papayas, strawberries, oranges, Kakadu plums, acerola cherries)
Drinking more water
Getting regular exercise

There are several Naturopathic treatments for Gallstones that consist of allergy testing, supplements and diet recommendations. Please contact your Naturopathic Doctor to discuss what is right for you!

References:

Gaby, Alan R. “Gallstones.” Nutritional Medicine, by Alan R. Gaby, 2nd ed., Fritz Perlberg Publishing , 2017, pp. 438–443.

https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214

https://www.webmd.com/digestive-disorders/ss/slideshow-gallbladder-overview

https://www.webmd.com/digestive-disorders/gallstones#1

http://ddc.musc.edu/public/organs/gallbladder.html

https://www.healthline.com/health/gallbladder-sludge

https://www.webmd.com/digestive-disorders/what-is-chloecystitis#3

https://www.healthline.com/nutrition/vitamin-c-foods#section1

https://www.medicalnewstoday.com/articles/325067#meals-and-recipes

Picture reference- http://ddc.musc.edu/public/organs/gallbladder.html