Nutritional Influences on Illness: Gallstones - Part 2 - Nutrient Influences

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Nutritional Influences on Illness: Gallstones - Part 2 - Nutrient Influences

A deficiency in any of a number of nutrients may promote cholesterol gallstone formation. Animal studies have shown that vitamin C is the rate-limiting step in the breakdown of cholesterol,( 1) and that a vitamin C-deficient diet results in gallstone formation.( 2) As human studies have found that many groups that are at increased risk for cholesterol gallstones also have reduced ascorbic acid levels, a marginal vitamin C deficiency may well promote gallstone formation.( 1)

Other animal studies suggest that vitamin E deficiency is a risk factor. Animals given a vitamin E-deficient diet developed cholesterol gallstones -- even if they were on a fat-free, cholesterol-free diet,( 3) while animals given large amounts of cholesterol, saturated fat, or unsaturated fat failed to develop cholesterol stones so long as vitamin E intake was adequate.( 4) Animal studies have also found a deficiency of essential fatty acids in the diet will cause gallstones to form.( 5)

An adequate calcium intake is also protective. Calcium binds secondary bile acids (chenodeoxycholic and deoxycholic acid) in the colon, causing them to be excreted in the feces. This reduces the cholesterol saturation of the bile which, in turn, reduces the risk of cholesterol gallstone formation.( 6) When a group of 860 middle-aged men was followed for 25 years, their risk of developing symptomatic gallstones was found to be inversely related to their calcium intake.( 6)

In addition, preliminary data suggests that nutrient supplementation can inhibit gallstone formation even if there is no evidence of deficiency. Supplementation with vitamin E (d-alpha-tocopherol 200 mg 3 times daily), for example, may reduce the bile's tendency to form cholesterol stones.( 7) Fish oils, presumably because of their high concentration of omega-3 fatty acids, have been shown to reduce the formation of gallstones in animals,( 8) perhaps due to their ability to enhance bile flow?( 9)

In the one published human study,( 7) patients with cholesterol stones were studied before and after 5 weeks of fish oil supplementation (11.3 g daily = 3.75 g omega-3 fatty acids daily). While the cholesterol saturation index was reduced by 25%, this decrease was insufficient to prevent gallstone formation,( 10) suggesting that fish oil should be adjunctive to other treatments.

The amino acid taurine, which conjugates (binds) bile acids, also shows promise. Both animal( 11) and human( 12) studies have found that taurine inhibits cholesterol gallstones by increasing bile flow and excretion, thus decreasing the opportunity for gallstones to develop. Moreover, when mice were given a lithogenic (gallstone-forming) diet along with taurine, gallstones failed to form.( 13)

Finally, supplementation with S-adenosyl methionine (SAMe) may prevent gallstone formation by normalizing impaired bile flow. It has been shown to have this effect under controlled conditions in women whose bile flow impairment was due to raised estrogen levels, either because of pregnancy( 14) or the use of oral contraceptives.( 15) (A dosage of 800 mg daily was most effective.) The same normalizing effect was found when SAMe was given prophylactically to rats whose bile flow would otherwise have been reduced due to exhaustive exercise,( 16) suggesting that SAMe may be effective in normalizing impaired bile flow due to a variety of causes.

References
(1.) Simon JA. Ascorbic acid and cholesterol gallstones. Med Hypotheses 40(2):81-4 1993.

(2.) Jenkins SA. Biliary lipids, bile acids and gallstone formation in hypovitaminotic C guineapigs. Br J Nutr 40:317-22, 1978.

(3.) Dam H et al. Acta Physiol Scand 36:329, 1956.

(4.) Christensen F et al. Acta Physiol Scand 27:315, 1952.

(5.) Robins SJ, Fasulo J. Mechanism of lithogenic bile production: studies in the hamster fed an essential fatty acid-deficient diet. Gastroenterology 65: 104-14, 1973.

(6.) Moerman C J. Smeets FWM, Kromhout D. Dietary risk factors for clinically diagnosed gallstones in middle-aged men. A 25-year follow-up study (The Zutphen Study). Ann Epidemiol 4(3):248-54, 1994.

(7.) Saito T, Tanimura H. The preventive effect of vitamin E on gallstone formation. (3). A study of the biliary lipids in patients with gallstones. Arch Jpn Chir 56(3):276-88, 1987.

(8.) Magnuson TH et al. Dietary fish oil inhibits cholesterol monohydrate crystal nucleation and gallstone formation in the prairie dog. Surgery 118(3):517-23, 1995.

(9.) Levy R, Herzberg GR. Effects of dietary fish oil and corn oil on bile flow and composition in rats. Nutr Res 15:85-98, 1995.

(10.) Berr F, Holl J. Jungst D, et al. Dietary N-3 polyunsaturated fatty acids decrease biliary cholesterol saturation in gallstone disease. Hepatology 16(4):960-7, 1992.

(11.) Bellentani S et al. Taurine increases bile acid pool size and reduces bile saturation index in the hamster. J Lipid Res 28(9):1021-7, 1987.

(12.) Wang WY, Liaw KY. Effect of a taurine-supplemented diet on conjugated bile acids in biliary surgical patients. JPEN J Parenter Enteral Nutr 15(3):294-7, 1991.

(13.) Yamanaka Y et al. Effect of dietary taurine on cholesterol gallstone formation and tissue cholesterol contents in mice J Nutr Sci Vitaminol (Tokyo) 31(2):225-32, 1985.

(14.) Frezza M, Pozzato G, Chiesa L, et al. Reversal of intrahepatic cholestasis of pregnancy in women after high dose S-adenosyl-l-methionine administration. Hepatology 4(2): 274-8, 1984.

(15.) Di Padova C, Tritapepe R, Di Padova F, et al. S-adenosyl-L-methionine antagonizes oral contraceptive-induced bile cholesterol supersaturation in healthy women: preliminary report of a controlled randomized trial. Am J Gastroenterol 79(12):941-4, 1984.

(16.) Villa JG, Almar MM, Collado PS, et al. Impairment of bile secretion induced by exhaustive exercise in the rat. Protective effects of S-adenosyl-L-methionine. Int J Sports Med 14(4):179-84, 1993.

Reprinted with permission from the International Journal of Alternative and Complementary Medicine, Green Library, 9 Rickett St., Fulham, London SW6 1RU, United Kingdom.

Townsend Letter for Doctors & Patients.

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By Melvyn R. Werbach

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