I have a family history of gallstones...

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Dear Dr. Klaper,

I was advised by my health practitioner to do a 'gallbladder flush', consisting of drinking 16 ounces of olive oil followed by a 1/2 pint of lemon juice. I have a family history of gallstones - do yon feel this 'gallbladder flush' would be a good idea? S .G.

Dear S.G.,

At the risk of offending some practitioners in the alternative healing community who believe in "gallbladder flushes," I feel that such a technique is probably useless - and in some cases, hazardous.

The oil/lemon juice combination has been used for over 200 years to convince people that they have cleansed their gallbladder of gallstones. If you were to ingest such a mixture, the following morning you would probably observe thick chips of whitish mat erials in your feces. Your health practitioner would likely believe that their therapy was effective and tell you that the whitish chips were "broken up gallstones." In reality, both you and the practitioner would have witnessed a physiological parlor tr ick...

As all first-year chemistry students learn, when you combine a fat with an acid, the fat turns into soap - a classic saponification reaction. The "broken up gallstones" in the feces are actually chips of olive oil soap, created in the intestine by the ac tion of acid (the citric acid in the lemon juice) upon fat (the olive oil). To those unaware of the underlying chemistry, the appearance can look like a spectacular "cure," when it is merely an illusion of a "gallbladder cleanse." (Incidentally, this is probably where the term "snake oil" got its reputation, as this stunt has been employed by patent medicine purveyors since days of old. The "snake oil" that "broke up the gallstones" was really olive or similar oil - and those who perpetrated this "soapy " ruse were justifiably labeled "snake oil salesmen.")

From the preceding, you can see why I believe that the "gallbladder flush" is without benefit to health. The element of risk - and even danger - enters when there are actual gallstones in the gallbladder. The gallbladder is a small sac on the undersurfac e of the liver, just below the lower front margin of the right rib cage. The gallbladder stores bile between meals and contracts in response to the presence of fat in our food as it leaves the stomach on its journey of digestion down the small intestine.

Swallowing several ounces of pure olive oil at one sitting makes for a very large, fatty meal - and such a great load of fat could potentially trigger a sustained, severe contraction of the gallbladder. If there are actual stones contained inside the gal lbladder, such a forceful contraction could result in an excruciating bout of right upper quadrant abdominal pain for the owner of the gallbladder - and a possible unplanned trip to the operating room for an emergency cholecystectomy (removal of the gall bladder).

If you strongly believe that you suffer from gallstones, I would advise you to ask your physician about having an ultrasound scan of your gallbladder performed.

This non-invasive scan, using sound waves to make a picture of the gallbladder and its contents, can verify whether your gallbladder really does contain stones. (Incidentally, the proper name for stones is "calculi.") If calculi are found, you should tal k to your physician about possible causes and treatments. (Sometimes formation of gallstones is a sign of serious medical conditions that require therapy, such as obesity, diabetes, intestinal disease, excessively high levels of cholesterol in the blood, etc. These conditions need to be diagnosed and properly treated.) Whatever the cause, in this physician's opinion, swallowing several large gulps of olive oil in the presence of gallstones is not a smart idea - and may well be asking for trouble.

One plan of action - or non-action - is to realise that you can live to a ripe old age with stones in your gallbladder. If they are not causing you any distress ("silent stones"), a low-fat, low-refined sugar diet might be all that you require to avoid p ainful gallstone attacks. Up to 30% of people with a painful gallstone episode never suffer another recurrence. Watchful waiting is an appropriate choice - especially after the diagnosis is first made - and if the only distress you feel from your gallsto nes is a small twinge of discomfort every year or two, that might be an acceptable price to pay to avoid surgery.

There are oral medications capable of dissolving small gallstones. However, such a stone-dissolving regimen can be a prolonged process, requiring pills several times daily for months - and which has a 50% rate of the stones re-forming once the medicine h as been discontinued. A faster method, requiring but 24 hours, involves placing a small into the gallbladder, and irrigating with stone-dissolving medications. Your physician can refer you to a specialist skilled in this technique.

Finally, if your gallbladder has become a chronically inflamed, stone-filled, fibrotic little bag, causing frequent episodes of severe abdominal pain, you probably would be better off having it out. Fortunately, the "bad old days" of gallbladder surgery - with its lengthy, painful incision across the right upper quadrant of the abdomen - are essentially over.

Surgically removing a gallbladder through a "keyhole" incision via a laparoscope has made this operation much less risk-filled and uncomfortable. In most cases, it requires only an overnight stay in the hospital.

In some surgical centers, it has become a "daycare procedure," allowing the person to sleep in their own bed at home the same evening of the surgery. Return to work in three to seven days following laparoscopic cholecystectomy is not unusual.

(In case you are wondering, the digestive system functions quite well without a gallbladder. The bile, normally stored in the gallbladder between meals, is instead excreted steadily from the liver, through the common bile duct and into the intestine. In the gut, the bile does its work facilitating digestion of fats, and then is absorbed through the intestinal wall and returned, via the bloodstream, to the liver. There it is filtered from the blood and then excreted once again into the intestine - an "en dless loop" system.)

In summary, if you think that you have gallstones, find out for sure. If you do, pay attention to which foods seem to set off the painful episodes, avoid them as best you can, and you and your gallbladder - stones and all - may yet achieve peaceful coexistence. If that is not possible, seek a definitive medical or surgical treatment - but I strongly advise you to stay clear of "snake oil cures."

~~~~~~~~

By Michael Klaper

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Soap is typically made with fat and lye (a base), so I don't think the oil and lemon combination is making soap. Even if there was a base in your system mixing with the oil it would take temperatures well above 98.6°F to make soap. Isn't it reasonable to assume though, that gallstones passing through the duodenum and small intestine (both of which absorb calcium) would be softer or broken up compared to gallstones removed through surgery?