Nutritional Influences on Illness: Gallstones - Part 1

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Nutritional Influences on Illness: Gallstones -- Part 1

Dietary Influences

Gallstones are quite common in most Western countries. In the United States, Australia, and Europe, they are found in 10% or more of all adults.( 1) Formed in the gallbladder by concretion or accretion of both normal and abnormal constituents of the bile, 80% are predominantly composed of cholesterol, while 20% (pigment stones) are principally calcium bilirubinate.

Diet, by affecting the dynamics of gallstone formation, modifies the genetic influences. We know, for example, that obesity is a risk factor( 2); thus a weight loss diet may reduce risk. While rarely documented, it is even possible that major weight reduction in an obese person will cause their gallstones to regress.( 3) However, since dietary fat stimulates gallbladder contractions, the low fat content of rapid-weight-loss diets may encourage further gallstone formation and therefore they need to be closely monitored.( 4)

Vegetable fat may be preferable to animal fat. In a large survey, women with the highest levels of vegetable fat intake had only 60% of the risk of gallstones of women consuming the lowest levels. Even though animal fat consumption does not appear to encourage gallstone formation, neither does it appear to be protective. The situation is similar in regard to vegetable versus animal protein.( 5)

While specific fatty acids may have different effects, the ideal fatty acid composition of an anti-gallstone diet has not been well delineated, in part because individual responses vary greatly. One report has suggested that the composition of a fat may be less important than its melting point; specifically, a fat which is liquid at room temperature may reduce gallstone risk by causing greater gallbladder contractions than a fat which is solid at that temperature.( 6) Some polyunsaturates may be lithogenic (gallstone-promoting) for a small minority of people( 7); however, their presence is irrelevant unless they account for more than 10% of total energy intake.( 8)

In relation to the risk of cholesterol gallstones dietary cholesterol only needs to be restricted in predisposed people -such as people who already have developed gallstones. Because of their preexisting abnormal cholesterol and bile acid homeostasis, dietary cholesterol will increase their biliary cholesterol secretion, and decrease both the synthesis and pool of their bile acids, changes associated with cholesterol gallstone formation.( 9)

Several reports have suggested that a high fiber diet is protective; however, a recent double-blind study found it ineffective in reducing the risk of gallstone recurrence.( 10) While also inconsistent, there is evidence that refined sugars promote gallstones, probably through their effect on lipoprotein metabolism. ( 11)

Despite the lack of consistency in the research data on specific dietary factors, vegetarians are known to have a lower risk of gallstones.( 12) This correlation is consistent with much of the literature we have just reviewed and thus, the vegetarian diet, devoid of animal fat and cholesterol and high in fiber, should be recommended to anyone concerned about gallstones. Legumes, however, should be avoided, as they have been shown to significantly increase the cholesterol saturation of bile.( 13)

A moderate intake of coffee and alcohol may actually be a good idea. Coffee, whether or not it is decaffeinated, is a potent promoter of gallbladder contractions and has been shown to inhibit the formation of gallstones in animals.( 14) Alcohol's protective effect may be due to a reduction in the secretion of biliary cholesterol.( 15)

Finally, evaluate for food sensitivities. While not well studied, they appear to be a common cause for gallbladder attacks. When 69 patients with gallstones or a post-cholecystectomy syndrome were placed on a common food elimination diet, all were relieved of their symptoms! Improvement usually started in 3 to 5 days.( 16)

Next Month: Gallstones -- Part 2: Nutrient Influences

References
(1.) Brett M, Barker DJ. The world distribution of gallstones. Int J Epidemiol 5:335-41, 1976.

(2.) Stampfer MJ et al. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr 55:652-8, 1992.

(3.) Thornton JR. Gallstone disappearance associated with weight loss. Letter. Lancet ii:478, 1979.

(4.) Klawansky S, Chalmers TC. Fat content of very-low-calorie diets and gallstone formation. Letter. JAMA 268(7):873, 1992.

(5.) Maclure KM et al. Dietary predictors of symptom-associated gallstones in middle-aged women. Am J Clin Nutr 52:916-22, 1990.

(6.) Sarles H et al. Etude de l'action des corps gras sur la contraction vésiculaire. 1: Compariaison de l'action de divers corps gras. Nutritio Dieta 2:219-22, 1960.

(7.) Kolhmeier M, Stricker G, Schlierf G. Influences of "normal" and "prudent" diets on biliary and serum lipids in healthy women. Am J Clin Nutr 42:1201-5, 1985

(8.) Committee on Diet and Health, Food and Nutrition Board, National Research Council. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC, National Academy Press, 1989.

(9.) Kern F Jr. Effects of dietary cholesterol on cholesterol and bile arid homeostasis in patients with cholesterol gallstones. J Clin Invest 93(3): 1186-94, 1994.

(10.) Hood KA, Gleeson D, Ruppin DC, Dowling RH. Gallstone recurrence and its prevention: The British/Belgian Gall Stone Study Group's post-dissolution trial. Gut 34(9): 1277-88, 1993.

(11.) Moerman CJ, 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.

(12.) Nair P, Mayberry JF. Vegetarianism, dietary fibre and gastro-intestinal disease. Dig Dis 12(3):177-85, 1994.

(13.) Nervi F et al. Influence of legume intake on biliary lipids and cholesterol saturation in young Chilean men. Gastroenterology 96:825-30, 1989.

(14.) Lillemoe KD et al. Caffeine prevents cholesterol gallstone formation. Surgery 106(2):4007, 1989.

(15.) LaVacchia C, Decarli A, Ferraroni M, Negri E. Alcohol drinking and prevalence of self-reported gallstone disease in 1983 Italian National Health Survey. Epidemiology 5:5336, 1994,

(16.) Breneman JC. Allergy elimination diet as the most effective gallbladder diet. Ann Allergy 26:83-7, 1968.

Townsend Letter for Doctors & Patients.

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By Melvyn R. Werbach

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