Gallstone Prevention

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Gallstones take 5 to 20 years before becoming large enough to cause problems, usually growing at about 1 to 2 mm/year. 80 percent of people with gallstones are asymptomatic. As these gallstones are forming they can seriously cause biliary problems that may impact your health in ways that you would never imagine. Most patients wait until the gallstones create alarming symptoms to correct this health problem, but by then it is too late for many patients, and the removal of the gallbladder surgically is performed (laparoscopic cholecystectomy). Removal of a gallbladder results in chronic dysfunction and poor assimilation of many fat-based nutrients, including Vitamins E, A, D, and K, and many beneficial fatty acids, as well as calcium. Gastrointestinal health is affected, and recycling of the bile, providing increased antioxidant and toxin clearing potential for the liver, is diminished. Long-term consequences are rarely discussed with the patient, but patient awareness of this problem is growing, and increased attention to early correction of liver and gallbladder ill health is a growing concern among intelligent proactive patients.

Gallstones are a slowly developing problem, and while they develop bile flow may be negatively impacted. Poor bile flow may contribute to unhealthy conditions in the small intestine that also leads to acid regurgitation, heartburn, slow stomach emptying and damage to the mucosal linings. This last problem may lead to problems affecting the protective integrity of the intestinal tract letting irritating toxins, allergens, protein antigens, and acidic levels of hydrogen ions into the blood. This 'Leaky Gut Syndrome' contibutes to muscle tissue and joint inflammation, allergic hyperreactivity, blood and body acidity affecting your metabolism and hormonal health, problems with blood proteins, increased stress on the detoxification system in the liver, etc. It can also lead to increased feedback stimulation of bile production in the liver, which cannot excrete bile salts properly due to the formation of stones. Hence bile may back up into the blood (jaundice), and supersaturation of bile creates a vicious cycle that accelerates bile stone growth. There are a number of presentations of stone formation seen in the patient population, presenting different consequences. Many naturopathic experts on cancer believe that decreased bile flow can even contribute to cancer and inhibit the body from fighting the cancer as well. Pancreatitis, irritable bowel syndromes, and celiac disease may also be at least partially caused by poor bile flow and problems with the liver and gallbladder. There is a relationship between gallstone accumulation and gallbladder inflammation and osteoporosis and subclincial hypothyroid conditions as well.

The time to deal with this problem is now, when subclinical underlying health problems indicate an increased risk for gallstone formation, not when the symptoms occur. Correcting the underlying dysfunctions and preventing stone formation is very important. Even after gallstones are broken and passed with lithotripsy and endoscopic procedures, stone recurrence is expected. Utilizing Complementary and Integrative Medicine will help you to correct the underlying causes of gallstone formation.

Gallstones occur more frequently in women, during pregnancy and menopause, with a history of inflammation or infections, with aging, with liver disease, with obesity, with metabolic syndrome, with poor diet, perhaps with improper chronic supplementation with calcium, with other GI problems, with excessive alcohol consumption, and with a history of family inheritance. The incidence of symptomatic gallbladder disease is more than doubled when women take hormone replacement therapy with synthetic estrogens and progestins. Gallstones occur in both sexes, but different underlying causes tell the physician and patient what aspects of the individual's health need to be assessed to design a simple protocol to prevent gallstone formation or recurrence. Patients with the above health problems, or those taking synthetic hormone therapies, should be aware of the increased risk of gallbladder disease and utilize Complementary Medicine to help decrease the risk of developing an array of other health problems related to, or caused by, gallbladder disease and gallstones.

A 2013 study by the Albert Einstein College of Medicine, Bronx, New York, U.S.A. found that there is a strong correlation between rising obesity rates in children and hospitalization for symptomatic gallstone disease in patients age 4-20 (PMID: 23969538). Since gallstones normally take many years to develop, this is an alarming finding. Such study indicates that the modern diet for children, as well as environmental toxins and xenohormones in products that exert hormonal effects, are having a significant effect on the health of the liver and gallbladder. Such alarming statistics does not bode well for the future of these patients. Xenohormones, or synthetic chemicals with hormone-like effects, are finally becoming a concern, with government regulation and public pressure on industry causing changes in products such as soft plastics, flame retardants, etc., but the prevalence of these endocrine disruptors in the food industry, with pesticides, herbicides, growth hormones, and even newer types of antibiotics routinely given to animals grown for our meat, affecting our food and our human endocrine system, are a significant concern. Chemicals such as polyvinyl chloride (PVC), polychlorinated biphenyls (PCBs), phthalates, sodium laurel sulfate in toiletries and cosmetics, and dioxins react with other chemicals to disrupt the hormonal system, as well as the immune function in clearing these effects. Some of these xenohormones do not break down easily and are passed to the infant through breast milk. They are now ubiquitous in our industrialized world, requiring greater effort to clear them from our body and restore endocrine balance. Healthy changes in the public diet, as well as avoidance of these chemicals, and clearing and detoxifying strategies, are now an important issue in public health. The U.S. Centers for Disease Control and Prevention (CDC) states that the main source of exposure of PCBs and dioxins for the general population is our food, with these chemicals accumulated in our water supply, and continuously released from our solid waste sites, entering the food chain by a variety of routes, and contaminating animal feeds, accumulating in the fatty tissues of meats that we eat. The CDC state that higher concentrations are found in fatty meats, and the prevalence of consumption of these meats in fast foods by our children is a concern. The CDC also states that injury from these chemicals nearly always occurs as mixtures, or interactions, between chemicals, making the study of toxic effects more difficult. Measurable health effects reported by the CDC include liver and gallbladder disease, cancers, neurotoxicity, immune suppression, and altered thyroid and reproductive function. Strategies in gallstone prevention must be holistic, both to prevent initial symptoms or to prevent recurrence.

Besides utilizing Complementary Medicine to prevent gallstone disease or its recurrence, or to better manage the health once the gallbladder is surgically removed, direct treatment for gallstones and gallstone disease has been a part of Traditional Chinese Medicine for many centuries. Gallstones can be successfully treated directly with Complementary Medicine, although often the patient seeks treatment too late and surgical removal of the gallbladder must be performed when the gallstones are too large and numerous. The standard guidelines for surgery, or cholecystectomy, are alarming symptoms of biliary colic and cholecystitis (inflamed gallbladder), or in the asymptomatic patient, gallstones larger than 3 centimeters, gallstones smaller than 3 millimeters in a position to block the bile duct, a calcified gallbladder, and gallbladder polyps larger than 10 millimeters. If the obstruction of bile flow or pathological changes to the gallbladder are not seen in testing, the surgical removal of the gallbladder is usually delayed, as symptoms of biliary dysfunction will occur even after the removal of the gallbladder. As with all surgeries, the benefits of specific surgeries are specific, and not a panacea. The underlying health problems continue after surgical removal of the gallbladder and should be addressed, as well as a post-cholecystectomy syndrome (PCS), with conservative estimates of 15 percent of patients experiencing significant PCS, either acutely, or with chronic onset. Post-cholecystectomy syndrome may involve irritating effects of constant bile flow, even with gastritis and esophagitis when stomach dysfunction and reflux occurs, as well as episodic diarrhea, loose stools, and lower abdominal pain. If underlying health problems are not addressed, bile stones may continue to develop and block the bile ducts even after the removal of the gallbladder. If immediate surgery to remove the gallbladder is not necessary, the patient can choose to try a safe and conservative approach with herbs, diet changes and acupuncture to accomplish the task of dissolving or passing the gallstones, or at least preventing future growth of gallstones, and resolving calcification and inflammation of the gallbladder. This has to be decided by integrating your medical care and advice with both the M.D. specialist and the licensed acupuncturist. These strategies have been very successful throughout history in China as long as the patient starts the therapy at an early enough stage, and is persistent with the protocol. Gallstones present a wide variety of presentations, thus the therapeutic protocol is individualized to each patient, and the time frame of the protocols may vary considerably.

Treatment that is more sensible than waiting until alarming symptoms occur, and surgical removal of the gallbladder may be necessary, involves preventive medicine when you feel that you are at increased risk of gallstone formation, or when vague symptoms lead to a suspicion of gallbladder sludge. This approach can solve the problem and restore biliary health before painful episodes and serious health problem develop. In the U.S. 10 percent of the population or more develop gallstones, and more than 20 percent of people over 65 develop them. This is a very high percentage, and growing. Considering the health studies linking childhood obesity and symptomatic gallstones at an early age, the percentage of the public with gallstones in the future may be very high. We have no figures on the percentage of people developing health problems secondary to gallstone formation, but it is potentially a very high number as well. Short courses of preventive therapy could solve this problem and prevent all these consequences.

Recognizing the signs of a potentially developing gallstone formation pathology

Over 80 percent of patients with gallstones do not experience symptoms that they may attribute to the stones. Our organs have very few pain receptors, and a large mechanical or inflammatory response is needed to initiate actual organ pain. Patients thus have a tendency to ignore gallbladder disease. Understanding the pathology of gallstone formation helps the patient to see the subtle signs of gallstone formation, and take early steps to correct this dysfunction and maintain better health. The following section may be somewhat technical, but hopefully will elucidate the health problem for many patients at increased risk of gallbladder disease.

Gallstone formation occurs in three stages: 1) supersaturation of cholesterols formed in the liver; 2) nucleation of cholesterol and bile salts; and 3) growth of the gallstones from the crystalline sludge in the gallbladder. A number of dysfunctions must occur to form gallstones, including excess secretions of biliary cholesterols, poor regulation of crystallization of bile salts, hypomotility of the gallbladder, excess arachidonyl lecithin formation, imbalance of prostaglandins, and problems with mucin and calcium salts in the liver. A Complementary Medicine physician will guide the patient to a better understanding of these factors and improved dietary, lifestyle and treatment regimens to address these physiological concerns and improve overall health while preventing gallstone formation. A number of health concerns raise red flags for the patient and physician.

A 2010 assessment of gallstone formation by Leiden University Medical Center, Leiden, The Netherlands (see study link below in additional information), noted that "bile composition (supersaturation with cholesterol), gallbladder dysmotility, inflammation, hypersecretion of mucin gel in the gallbladder, and slow large intestinal motility and increased cholesterol absorption may contribute to the pathogenesis of cholesterol gallstones." This research also noted that decreased sensitivity to the hormone cholecystokinin (CCK) is also associated with decreased gallbladder motility and emptying. CCK is one of a cascade of hormones that are involved in Metabolic Syndrome, along with insulin, leptin, glucagon, and gastrin, and decreased sensitivity to CCK may develop with excess CCK released into circulation. High triglycerides were also associated with poor gallbladder emptying, or dysmotility, albeit indirectly, and these researchers noted that treatment with omega-3 essential fatty acid supplement (krill oil) both decreased biliary cholesterol saturation and increased bile acid synthesis via 7alpha-hydroxylase activation. Standard treatment for lowering triglycerides, with fibrates, was found to increase biliary cholesterol saturation and reduce bile acid synthesis, thus contributing to formation of gallstones. Fibrate drugs, increasingly prescribed, often with statin drugs for cholesterol inhibition, include Lopid, TriCor, Triglide, TriLipix, and Fibricor. These fibrate drugs have been heavily marketed since 2008, doubling the prescription rate in the U.S., despite major studies finding that they failed to reduce cardiovascular risks in diabetes, and a large clinical trial, the Action to Control Cardiovascular Risk in Diabetes(ACCORD) trial, with 10,000 patients followed, found that the combination of statin drugs and fibrates did not lower incidence of heart attacks, strokes or cardiovascular mortality. Dr. Steven E. Nissan, chairman of cardiovascular medicine at the esteemed Cleveland Clinic Foundation, was quoted as saying: "The use of fibrates in America is very troubling." Numerous experts around the world are noting the increased risk of gallstone formation with Metabolic Syndrome and the prescription of fibrate drugs, while the utilization of Complementary Medicine, such as EPA/DHA in krill oil, and other nutrient and herbal medicines, may safely and effectively decrease biliary supersaturation, aid healthy bile synthesis, and modulate inflammation.

Biliary sludge is a precursor of gallstones and consists of calcium bilirubinate and cholesterol microcrystals. This sludge develops during gallbladder stasis, or slow emptying of bile coupled with decreased circulation or nerve stimulation. This stasis occurs frequently during pregnancy, with mechanical pressure during later stages and with morning sickness, and slow GI function during early stages of pregnancy, as well as with hormonal imbalances causing changes in biliary stimulation and liver function. This is why many gallbladder diseases and stone formations start during pregnancy. This is also why a high percentage of women during menopause, or with hormone replacement therapy after menopause, acquire gallstones. Studies in recent years have also demonstrated the relationship between polycystic ovarian syndrome (PCOS) and impaired gallbladder motility and emptying, a well-documented contributor to gallstone formation. Besides hormonal pathologies, a wide array of underlying health problems are also associated with formation of biliary sludge.

Biliary sludge can be formed during periods of rapid weight loss. This rapid weight loss may occur with dieting regimens, as a side effect of medication, during severe illness or debility, during chemo or radiation therapy, etc. The mechanism seems to be related to gallbladder stasis, or slowing of gallbladder function. Liver and gallbladder stasis is perhaps the most commonly seen imbalance traditionally in TCM, and TCM physicians have long examined the signs and symptoms of patients for subtle indicators of subclinical liver and gallbladder stasis, called Liver Qi Stagnation, noting that increase in this diagnosis has accompanied changes in diet and lifestyle in developing countries. This holistic medicine has concentrated on the big picture and sought to prevent this problem, and the resulting secondary health problems, for centuries.

Biliary sludge formation is also frequently seen when a patient receives Total Parenteral Nutrition (TPN), which is a type of intravenous nutritional therapy increasing promoted in Obstetrics and Pediatric medicine, primarily for expectant mothers, but has traditionally been utilized during hospitalization when oral consumption of food is not possible, with bowel resection, radiation enteritis, high-dose chemotherapy, small bowel diseases, pancreatitis, AIDS, inflammatory bowel diseases, celiac disease, after major surgery or with a nalmourished patient. If you have gone through any of these processes and received TPN, your risk of gallstone formation is increased.

How does this biliary sludge form during these periods of ill health or after surgery? Studies of patients pre and post-operatively found that changes in liver function may be responsible. Significantly higher values of glutamic oxaloacetic transaminase (SGOT/AST), glutamic pyruvic transaminase (SGPT) and alkaline phosphatase were noted in patients 1 and 3 months post-operatively that formed gallstones. This indicates a problem with both liver enzyme formation and acid conditions that may not show up on normal blood tests for liver enzyme dysfunction. The healthy ratio of these liver enzymes may be the most important indicator of disease and poor liver function, with the SGOT/SGPT ratio associated with gallstone disease. The Glutamic acid metabolism has been well studied and seems linked to many health problems. Some herbs, like milk thistle and schizandra berry, have shown dramatic results in normalizing glutamic acid metabolism in the liver. The bottom line for patients is the fact that gallstone formation occurs over years and is related primarily to poor liver function, chronic acidity, and poor health of the small intestine, as well as hormonal imbalances. A comprehensive and holistic treatment strategy is needed to correct these underlying problems, and Complementary and Integrative Medicine is being realized as the most professional and studied medical specialty to deliver this holistic therapy. Standard allopathic medicine ignores poor liver function until blood and urine tests reveal a serious pathology. Medical doctors tell their patients that nothing is wrong with their liver function until the liver enzyme tests reveal a serious malfunction. The study of gallstone formation shows that this is not a careful analysis.

Gallstones primarily form when cholesterol, suspended in carrier fluid, and transported in bile salt clusters called micelles, becomes imbalanced in proportion to the bile salts, or calcium bilirubinate. Supersaturated cholesterol forms crystals that are difficult to move through the bile ducts and gallbladder, and we call this sludge. Scientists are still unsure exactly how this supersaturation of cholesterol occurs, but it is generally agreed that a number of cofactors contribute, including excess dumping of cholesterols into the bile, inhibition of the emptying of the gallbladder, ill health of the gallbladder lining, and episodic high levels of bilirubin, formed in the liver from the breakdown of hemoglobin in red blood cells. About 20% of gallstones are pigment stones, composed of calcium bilirubinate, or calcified bilirubin, and these are sometimes occurring with excess destruction of red blood cells, as in hemolytic anemia, or when infection and inflammation causes excess destruction of red blood cells, although these causes of excess unconjugated bilirubin in the liver do not explain all of the cases of pigmented gallstones. Most cases of gallstones involve a mixture of the type of stones.

Diagnosis of biliary sludge may be accomplished by ultrasound, but endoscopy with ultrasonography and microscopic analysis of aspirated bile are far more sensitive. Discuss these tests with your M.D.

Certain drugs can increase the risk of developing biliary sludge and gallstones dramatically, especially ceftriaxone/Medtrax/Rocephin, a cephalosporin antibiotic, and octreotide/Sandostatin, used in the treatment of diarrhea. But more than 21 medications are listed as possible causes of gallstones, including cholesterol lowering statins and Clofibrate (fibrate drugs), as well as a number of synthetic hormone replacement drugs, including Oestriol, a synthetic estrogen metabolite used in oral hormone replacement therapies and creams such as Ovestin and Ortho-Gynest, and Oestrone, the most common current hormone replacement therapy that is part synthetic and part naturally derived from horse urine, etc. If you are at risk for gallstones, you might want to consider options to these in Complementary Medicine.

When gallstones finally become apparent

In the end, we finally experience alarming symptoms only when the gallbladder starts filling up with stones, and even then, this pain may be avoided by avoiding fatty foods and excess alcohol consumption. Pictures of gallbladders filled with stones are alarming, though, and explain much of the discomfort that we feel as a fullness under the ribcage on the right, spreading across the abdomen and chest in a disconcerting manner, and usually hard to localize. The sparsity of pain receptors in deep tissues and organs in our bodies makes these uncomfortable sensations hard to perceive for our brains. Alarming pain from the gallbladder, or the transporting bile and pancreatic ducts, only occurs when enough pain receptors are triggered by this mechanical pressure, or when inflammation of tissues becomes more severe, with swelling and blood stasis. In many patients, the gallbladder is filled with hard stones, and yet the patient is unaware that this is occurring, and is surprised when the surgeon shows how many, and how large, the stones have become. Often, the actual acute pain episodes are caused by the tiniest stones, which may enter the bile ducts and cause an obstructive swelling and inflammatory response.

The real problem with gallstones, though, and with the eventual removal of the gallbladder, is the lack of function of the gallbladder, which serves some useful purposes in the body. Modern allopathic medicine will tell us that we can function without a gallbladder, and this is true, since bile will still be produced by the liver and flow into the small intestine. But, the dysfunction or removal of the gallbladder will impact the digestion and the health of the patient negatively. The functions of the gallbladder allow us to eat and digest a larger amount of fat in a single meal. The liver is not able to produce enough bile to digest a large amount of fat. Without enough bile, the fat goes through the body partially undigested. Since fatty molecules are important to our health, in the form of essential fatty acids, membrane phospholipids, cholesterols (the building blocks of most of our hormones), essential vitamins, etc. this eventually will cause chronic health problems. A lack of utilization of calcium will also occur, with ill health of the small intestine, and signs of bile deficiency, such as dry skin and peeling on the soles of the feet, are common. Fullness and nausea, more frequent bowel movements, occasional constipation, and other gastrointestinal problems will occur, partially related to the great amount of bile constantly dumping directly into the small intestine. The liver produces up to a quart and a half of bile per day. Recycling of the bile may no longer be efficient without the gallbladder control. Bile is also a potent antioxidant as it recycles through the liver, and the ability of the liver to clear toxins and protect itself from chronic inflammatory problems, and hepatitis, may be diminished. Allopathic medical doctors are loathe to relate these chronic health problems to the lack of gallbladder function, instead prescribing more pills to counter the symptoms of these problems. Today, more informed patients are starting to realize that this is not a desirable situation for them, suffering from more chronic health problems as the medical industry makes more money off of them to just relieve symptoms, not to make them healthy.

Understanding the physiology of the bile metabolism and how gallstones and biliary sludge forms

85 percent of gallstones in the U.S. are cholesterol stones, made of hardened cholesterol and calcium bilirubinate. The other types, Black Pigment stones and Brown Pigment stones, are caused primarily because of liver disease, chronic hemolysis, excess supplementation with calcium carbonate or phosphate, infections, chronic inflammatory states, parasitic infestations, or excess consumption of unhealthy fats. The use of EDTA chelation has been shown to be effective in clearing these brown pigment stones. Cholesterol stones are thought to occur when the liver excretes too much cholesterol, bilirubin, or not enough bile salts, or when the gallbladder does not empty completely or not often enough. Correcting liver function, lipid imbalance, and fatty accumulation in the liver, as well as hormonal imbalances, and chronic liver inflammation, will prevent these underlying problems from causing gallstones.

Bile is a bitter dark fluid produced by the liver that aids the digestion of fatty molecules in the small intestine. Water makes up to 85% of bile, and bile salts make up 10%, while cholesterin should make up just 0.3% of the bile. Excess cholesterol metabolites in the bile contribute to supersaturation of cholesterin, or the extreme concentration of this cholesterol metabolite, the first stage of gallstone formation. Bile is normally desaturated in the gallbladder, and problems with chronic inflammation of the gallbladder lining also leads to problems with this desaturation. An inflamed gallbladder lining impedes the normal absorption of cholesterol and calcium, which are recycled to the liver. Supersaturation and the inability to desaturate leads to biliary sludge in the gallbladder and reduced ability to excrete bile as needed. Both bilirubin and cholesterol are relatively insoluble, and much of the bile salt is recycled back to the liver, rather than broken down.

Cholesterol crystal nucleation in the gallbladder, associated with surpersaturation of bile with cholesterol metabolites, is the first step of actual stone formation. Pronucleating factors include N-Aminopeptidase, fibronectin, excess mucin, immunoglobulins and haptoglobin. Mucins are concentrated glycosylated proteins, or advanced glycation endproducts (AGEs), and excess AGE formation is a problem for our bodies, and associated with Metabolic Syndrome, diabetes, and obesity. Increased mucin production in the epithelial lining of the small intestine is associated with cancers of the pancreas, lung, breast, ovary, colon and other tissues, and mucins are overexpressed in asthma, bronchitis, and cystic fibrosis. Abnormal mucin deposits are seen in hypothyroid disease, and are seen in severity as facial edema, or as edema in the lower leg, or pretibial area. Fibronectin is a matrix glycoprotein that plays an important role in tissue healing, cell differentiation and growth, and cell adhesion in inflammatory conditions. Altered fibronectin and expression has been associated with cancer, fibrosis, and other pathologies. Immunoglobulins are commonly referred to as antibodies. Increased antibodies are seen in celiac disease and allergic conditions in the small intestine. Haptoglobin is a protein that binds free hemoglobin released from red blood cells (e.g. when they degrade or are destroyed), inhibiting harmful oxidative activity. These haptoglobin-hemoglobin complexes will generally circulate and be removed by the spleen. Haptoglobins are mostly produced in the liver, but other tissues, such as fat cells, may also produce excess haptoglobins. Acute haptoglobin deficiency is seen in hemolytic anemias, but chronic haptoglobin excess is still puzzling to scientists, and may be a response to chronic hemolytic anemias or acute toxins. Cancers and cardiovascular lesions are also known to increase haptoglobin levels. Aminopeptidse-N is an enzyme produced in the small intestine lining, and plays a part in the final digestion of protein fragments. Problems with protein breakdown, such as gluten intolerance and celiac disease could play a part in the formation of excess N-aminopeptidase. These various pronucleating factors point to an array of health problems that may need to be considered in the overall assessment of developing gallstone disease.

Bile is secreted at about 500-1000 ml per day and plays a number of vital functions in the body. Bile is essential for the breakdown of fat molecules in digestion, serves as a route of excretion of bilirubin, a byproduct of red blood cell breakdown, induces phospholipid and cholesterol secretion, binds calcium to help prevent stone formation and tissue irritation, and serves as a route for excretion of lipid soluble toxins, drugs and heavy metal toxins. Bile acids need to be synthesized in proportion to cholesterols to prevent the cholesterol supersaturation that leads to biliary sludge. Two pathways of bile acid synthesis occur, the neutral and acidic pathways. The acidic pathway is problematic, and leads to types of bile acids that create dysfunction. The acidic pathway is seen in chronic disease states, while the neutral pathway is more utilized in healthy individuals. Bile acids recycle in the portal blood from the small intestine mucosal lining back to the liver. Symbiotic bacteria in the small intestine transform primary bile acids to lithocholic and dexycholic acids, rendering negatively charged bile acids neutral. Increased conversion to deoxycholate contributes to the cycle of gallstone formation.

The main bile acids, cholic and chenodeoxycholic acids, are synthesized in the liver from cholesterol. Problems with liver metabolism may present problems with a metabolic balance of these bile acids with the cholesterol metabolites in the bile. Blocking of cholesterol production with statin drugs has been associated with increased risk of gallbladder disease as well. Improving liver function and health is the most direct way of preventing gallbladder disease and gallstones.

The basic reasons for gallstone formation must not be overlooked in the holistic treatment regimen. Studies confirm that patients with cholesterol gallstones have delayed small intestine transit, defective gallbladder function, and increased biliary deoxycholic acid, a pathological bile salt (hydrophobic and encouraging of excess arachidonic acid and inflammatory prostaglandin E2). This means that you must consider problems with slowed stomach and small intestine function that occur when symptoms of bloating, acidity, heartburn and indigestion occur. It also means that you must consider healthy liver function and bile excretion. And lastly, you must change your diet to decrease arachidonic acid excess from excess red meat in the diet.

Hormonal imbalances relating to Gallstone Formation

Synthetic hormones in hormone replacement therapies and contraceptives are one of the main causes of gallstone formation. The U.S. Congress Office of Technology Assessment, citing the large Nurses Health Study, and numerous other patient studies, concluded conservatively that the risk of symptomatic gallstone disease more than doubled when a postmenopausal woman was placed on hormone replacement therapy with synthetic hormones, and that the addition of progestins did not reduce this risk, as synthetic progestins, commonly found in birth control hormone therapies, also increased the risk of symptomatic gallbladder disease. Studies on animals reveal alarming data. A study on hamsters at Beth Israel Medical Center in New York revealed that female hamsters given synthetic androgen increased gallstone formation from 0% to 40% of subjects in just 3 weeks, and in up to 86% of the hamsters in 6 weeks. Males were not affected. Cholesterol saturation of the bile increased from 34% to 109% in 6 weeks in subjects given synthetic androgens, such as corticosteroids. Taurine levels in the bile were dramatically reduced in relation to glycine, also contributing to stone formation. Introduction of synthetic thyroid hormone increased the secretion of cholesterol saturated vesicles in the bile in a manner similar to the synthetic androgen. Prior study by Gilloteaux showed that after a 10-day synthetic estradiol treatment in male hamsters, stone-like deposits developed in the gallbladders. Ethinylestradiol, or synthetic estrogen, also increased bile cholesterol saturation. The study concluded that synthetic hormones in general seemed to increase the cholesterol-phospholipid output and shifted cholesterol into vesicles, which were a precursor to cholesterol gallstones.

Studies have shown for decades that women taking birth control pills show considerably more supersaturation of bile with cholesterol (NEJM, Jan. 1976, Bennion et al), putting them at much higher risk of developing gallstones. Since progestins, as well as synthetic estogens, create a higher risk of developing gallstones, even the newer forms of birth control, such as progestins delivered from an IUD, or from a topical patch, increase risk of gallstone disease.

Why does this occur? Cholesterol is a steroid hormone that is very similar in structure to other steroid hormones, and in fact, is the building block of steroid hormones. Cholesterol need in women is thus metabolically greater at times than in the male, because female hormone levels may change dramatically depending on the menstrual cycle, pregnancy etc. Synthetic hormones are now well known to cause many types of health problems in the human body. Since they are not the same as actual human hormones they trigger certain key responses yet cause confusion in many of the actions that the analogous human hormone triggers. Taking of a synthetic steroid hormone will also cause a negative feedback related to hormone production, affecting the entire sequence of events neeeded to create hormones, including the cholesterol metabolism. Cholesterol is the precursor for steroid hormones. Hormonal function in the human body relies upon a complicated feedback system, called the neuroendocrine system. When one aspect of hormonal health is dysfunctional it may affect other hormonal mechanisms. One of the key hormones that regulate the emptying of the bile from the gallbladder is cholecystokinin, which is released via a feedback mechanism as partially digested foods leave the stomach and enter the small intestine. Gastrointestinal problems may contribute heavily to a dysfunction of the cholecystokinin response, inhibiting bile release, and eventually contributing to gallbladdder dysfunction and ill health.

Symptoms and Conditions Secondary to Gallstones

Of course, most people realize that acute pain to the right subcostal area, back or shoulder, especially after eating fatty foods, is the classic symptom of gallstones. Gallstones are also found to be a significant cause of acute pancreatitis, and deficiencies of bile flow may contribute heavily to gastric and small intestine dysfunction. More subtle gastrointestinal symptoms may be caused by, or made worse by gallstone blockage or other health problems affecting bile synthesis and flow. To further research this subject, go to acid reflux on this website. The symptoms attributed to gallstones may be coming from other health problems, though, and a careful workup and testing is advised to clarify that the symptoms experienced are caused by actual gallstones.

Early symptoms of gallbladder disease include bloating and increased gas. Light colored and floating stools indicate a lack of breakdown of fat in the intestine associated with poor bile flow or other bowel disease, and constipation may also occur with poor regulation of bile, as well as more frequent or loose stool. These symptoms are often overlooked or attributed to irritable bowel syndrome or other health problems. The symptoms may be episodic, depending on the diet and dietary changes, liver function and stress.

Symptoms of gallstones usually relate to inflammatory problems, or cholecystitis. An acute attack of gallstone pain usually occurs when a gallstone blocks a passageway of bile from the gallbladder, initiating an inflammatory response. The gallstones in these cases are often very small, though, while the gallstones accumulating in the gallbladder are large. Gallbladder inflammation without stones is also fairly common, and is called cholecystitis.

Dietary Considerations in Prevention of Gallstones:

Since bile is a substance created to break down digestive fats for easy transport and utilization, fatty foods and essential fatty acids in the diet are perhaps the primary consideration. Also, since the balance of essential fatty acids (e.g. omega 3 & 6) are very important for your immune regulation of inflammatory processes, and since inflammation is a key component of gallstone pathology, this may be an important area of focus in your diet. A simple low fat diet has long been suggested in standard medicine, but this is not effective in preventing gallstones or gallbladder disease, and focus should be on healthy fats and improving liver health. Post-surgical recommendations after cholecystectomy has long suggested a low fat diet, but a study in 2013 at the Federal University of Alagoas, in Maceio, Brazil (PMID: 23912367) showed that there was no significant benefit of such a diet in prevention of gastrointestinal symptoms in either pre-operative or post-operative patients with gallstone disease.

Studies of the composition of bile in relation to gallstone formation are very revealing. The study of fatty acid patterns of the major component of bile, phospholipids (95% lecithin and phsophatidylcholine), shows that excess arachidonic acid could be a major factor in cholesterol gallstone formation. Excess arachidonic acid can induce the gallbladder mucosa to produce excess prostaglandins and mucus. More hydrophobic bile acids promote the excretion of bile with a higher concentration of arachidonic and stearic acids. Since arachidonic acid is a precursor of prostaglandins, this leads to excess inflammatory mechanisms in the mucosa. Other fatty acids, such as linoleic acid is correlated with a lower concentration of the hydrophobic biliary deoxycholate, and would lead to a lowered risk of gallstone formation and more desaturation of cholesterol in bile. (van Berge Henegouwen, Dept of Int Med and Gatroenterology, Malberg-GZ, Arnhem, The Netherlands, 1986, Clinica Chimica Acta, Vol 165, 29 May 1987, pg 27-27)

What does this mean in simple terms? We'll get to that. A typical American diet, with large portions of meat, dairy, eggs and simple carbohydrates produces an excess of arachidonic acid (AA), which transforms into prostaglandin E2 (PGE2). This fatty acid, PGE2, is responsible for much of our inflammatory pain, and can encourage excess clotting of blood, as well as gallstones. Excess of PGE2/AA also releases excess leukotrienes that are shown to promote arthritic and autoimmune conditions, and breast lumps and tumors. The main action of anti-inflammatory medications such as aspirin and ibuprofen, as well as steroids, is to block production of PGE2. PGE1 and PGE3 (omega 3) are synthesized from linoleic acids, which create the beneficial essential fatty acids EPA and DHA found in fish oil or krill oil supplements. These prostaglandins counter the harmful effects of excess arachidonic acid, and may prevent the formation of gallstones. Linoleic acid transforms into linolenic acid. Many Chinese herbs are rich in linoleic and linolenic acids, and supplements of gamma linolenic acid (GLA), derived from black currant seed oil, are available as a nutritional supplement.

Translated in simple terms: start eating a diet with greater percentages of fresh vegetables and whole grains, and start eating oils and fats with a high content of linoleic acid. Oils rich in essential fatty acids include krill (a wonderful supplement), ocean fish, walnut, pumpkin seed and hazelnut. Olive oil and avocado oil are healthy but contain only 6% essential fatty acid. Many whole grains are high in essential fatty acid, such as steel cut oats, soy, rice, garbanzo, quinoa and millet. Foods rich in linoleic acid include fresh nuts, seeds, whole grains, legumes, most vegetables, fruit and animal products. Dairy products from grass fed cows, goats and sheep are much higher in PGE3 than commercial products. One should avoid rancid nuts and seeds, though, as the fatty acids oxidize and are bad for you. You may also supplement with conjugated linoleic acid derived from safflower.

Transfats found in commercial foods, shortenings and margarine block the transformation of linoleic and linolenic acid into healthy PGE1. Excess saturated fats, such as fatty meat and butter, also do this, as well as tobacco, alcohol, low level radiation, aspirin, most synthetic drugs, excess free radicals, and deficiencies of Vitamins B6, B3, C, E, zinc and magnesium. Attention to these factors in important in maintaining healthy liver and gallbladder function and preventing stone formation.

Scientific study has also confirmed that a diet high in simple carbohydrates (sugar, pastries, refined flours, starchy foods like potatoes etc.), coupled with obesity, also is a significant factor in gallstone formation. (Mathur, Al-Azzawi et al, Indiana Univ School of Med, 2007, Steatocholecystitis: The Influence of Obesity and Dietary Carbohydrates). Increasing true whole grains in the diet, and eating a more plant-based diet with healthy fresh organic vegetables and fruits, is recognized now by every health authority in countering obesity and encouraging better overall health. Avoiding fast food, sugary drinks, carbohydrate snacks, and cereals also help with chronic acid conditions that contribute to stone formation.

The bottom line is that direct scientific study shows that our typical diet of lots of fatty red meat, simple starchy carbohydrates (which create acidity), excess commercial dairy products, fast food, commercial foods, low fat foods, alcohol, and avoidance of fresh green vegetables, whole grains and healthy fats and oils creates gallstones. A change in diet can both benefit the health and create a great appreciation for delicious healthy foods and the joys of cooking.

Encouraging Increased Bile Excretion:

If the gallbladder function is insufficient, there are means of encouraging increased excretion of bile. Beets increase bile flow and thin the bile, and raw beet juice is an excellent food to encourage improved bile flow. Lecithin, choline (phosphatidylcholine is a form of lecithin ideal for this effect), taurine (a nutrient supplement that is a major constituent of bile), turmeric, curcumin, yarrow, Oregon grape, milk thistle, artichoke leaf extract, and dandelion root extract have similar effects. The Chinese herbs Mu xiang and Bing lang have been found to relax the gallbladder sphincter and increase bile flow in scientific studies. Naturopathic cancer cures often use coffee enemas to increase bile flow, although this is probably not popular in the general population. An individually designed treatment protocol, utilizing both diet and herbal prescription, and enhanced with acupuncture stimulation, could be part of an effective health maintenance or treatment protocol from a knowledgeable Licensed Acupuncturist and herbalist.

Healthy bile flow from the liver and healthy production of bile by the liver are important to maintain healthy gallbladder function. Herbal cholagogues stimulate the release of bile from the liver to the gallbladder, and the use of bitters has long been used to promote a chologogic flow of liver bile. Herbal choleretics stimulate liver bile production, and common herbs that promote this bile production include Goldenseal, Barberry, Turmeric, Gentian, Milk Thistle, Artemesia absinthia, dandelion root, artichoke leaf extract, peppermint and ginger. A number of Chinese herbs found in formulas promoting liver health are bitters and choleretics. Such formulas, combined with acupuncture, will maintain a healthy liver function to prevent the formation of gallstones.

Basic Chinese Herbal strategies for decreasing gallstone size and encouraging the passing of gallstones:

If the size of the gallstones, or the inflamed gallbladder, is causing symptoms to occur, Chinese medicine has effective strategies for resolving these health problems. Diagnostic tests and analysis are important, though, and the Medical Doctor should order ultrasound studies and blood labs to evaluate the severity of the problem, and suggest the array of treatment options. Classic Chinese herbal formulas focus on decreasing inflammation and helping to dissolve stones, as well as to promote healthier liver function and to promote passing of stones. These formulas have been used successfully for centuries, and short courses are safe and without ill effects, so that they can be used as preventative measures by taking short courses periodically.

Modern medicine is now utilizing a few naturally derived products as well to aid in the dissolution of gallstones. Natural bile acids are now packaged and prescribed, although these medicines, such as ursordeoxycholic acid (Actigall and other brand names), also known as ursodiol, require months of therapy, and complete dissolution of stones does not occur in all patients. Studies of ursodeoxycholic acid treatment also show that over 50% of patients experience recurrence of stones within 5 years. Utilizing Integrative and Complementary Medicine will increase the chances of more quickly dissolving the gallstones with this therapy, and better chances of clearing the underlying causes of gallstone formation and preventing recurrence. Ursodeoxycholic acid is considered safe and perhaps protective against some forms of colon cancer. This chemical has long been used in Traditional Chinese Medicine, both as an animal and plant derived product (herbs promoting the production of this bile acid in the liver). Deoxycholic acid, or DCA, is the main component of a Chinese herb called Niu huang, which is derived from actual bilestones of oxen. Niu huang has been used for centuries in Traditional Chinese Medicine to treat inflammation and enhance the immune system. Less commonly used is the bile acids from other animals. The continued use of harvesting the bile acid from domesticated bears is being discouraged, though, and the plant derived acids now make up the bulk of the supply. Plant derived bile acids are actually precursor acids, and pharmaceutical DCA is assimilated from these natural acids in most products. Ursolic acid, a precursor chemical, is found in mint, sage, rosemary, thyme, savory, oregano, basil, marjoram, lingonberry, apples, prunes and lavender, and taking of these garden herbs and foods couldn't hurt.

Foods and nutrient medicines useful in clearing and preventing the formation of gallstones

Research is revealing a number of effective foods and nutrient supplements to help prevent or clear gallstone formation. Fenugreek seed has long been utilized in Traditional Chinese and Indian Ayurvedic Medicine for resolution of digestive problems and in many cultures has long been utilized to stimulate breast milk flow when problems arising in nursing infants. In Chinese herbal medicine, this seed is called Hu lu ba, to warm and circulate flow in the gallbladder and kidney, preventing stone formations. Fennel seed is also used in this regard, a proven choleretic, stimulating bile production. The combination of fennel, fenugreek and flax seed has long been used as a dietary supplement to restore gastrointenstinal function and health. Fenugreek seed is used in the preparation of curry powders, pickled foods, and powdered as a spice, or cut and mixed in yoghurt. In Egypt, fenugreek seed is boiled and sweetened to make a popular tea. The maple syrup taste of fenugreek has prompted some American food companies to use fenugreek in substitute maple syrups.

Increased dietary garlic and onion has been proven to be a potent inhibitor of gallstone formation as well. Cholsterol desaturation is aided by the eating of garlic and onion, which contain a number of beneficial chemicals that serve as antioxidants and cholagogues, choleretics, and anti-inflammatories, such as ferulic acid, kaempferol, chlorogenic acid, caffeic acid, and coumaric acid. Common herbs may help the health of the liver and gallbladder as well, and the use of garlic, onions, shallots, leeks, and garden herbs may be a delight to the taste senses as well as a healthy protocol. Juicing, and the utilization of raw beet juice, combined with celery and some bitter greens, may also be a good dietary habit.

An array of nutrient medicines are now routinely prescribed to enhance gallbladder health, including phosphtidylcholine (a lecithin metabolite), taurine (a constituent of bile as well), alpha-lipoic acid (an antioxidant), Essential Mineral formulas (including selenium, magnesiums, zincs), and high dose Vitamin C. Common herbal supplements include Milk Thistle and Turmeric. Chinese Medicinal herbs present a more potent benefit to clearing or aiding function of the liver and gallbladder, though, and formulas taken periodically are both effective and healthy, with no side effects. Working with the professional herbalist and Complementary Medicine physician, namely the Licensed Acupuncturist or Naturopathic doctor, is highly recommended.

Information Resources

  1. To see an illustration of the close physical relationship between the gallbladder, liver, esophagus, stomach, pancreas, and small intestine, click on this University of Maryland website illustration: http://www.umm.edu/patiented/articles/gallbladder_000353.htm
  2. The University of Maryland website succinctly outlines the basic treatments commonly used in Complementary Medicine to treat gallbladder disease, and notes that the patient should always work with a professional Complementary Medicine physician with this therapeutic protocol: http://www.umm.edu/altmed/articles/gallbladder-disease-000066.htm
  3. While the study of common Chinese herbal formulas for the treatment of gallstone disease is sparse in modern medical journals, there are a few promising studies in recent years. A 2008 study at Shanghai University, Shanghai, China, found that the most common formulas used in China, Qingdan Capsule and Yanggan Lidan Granule, significantly decreased rates of stone formation in animal studies, and components of problematic gallstone components, such as unconjugated bilirubin and calcium density in bile were also significantly reduced. These formulas contain the common array of herbs seen in most professional Chinese herbal formulas used in the United States by TCM physicians: http://www.ncbi.nlm.nih.gov/pubmed/18664357
  4. Research in 2011 in Mysore, India, at the Central Food Technological Research Institute, found that fenugreek seed increased bile flow, decreased early formation of bile stone, and reduced cholesterol content in bile, to effectively reduce bile stone formation in animal studies: http://www.ncbi.nlm.nih.gov/pubmed/21215764
  5. Research in 2010 in Mysore, India, at the Central Food Technological Research Institute, found that increased eating of garlic and onion may prevent gallstone formation by promoting cholesterol desaturation, and stimulating bile flow: http://www.ncbi.nlm.nih.gov/pubmed/20153000
  6. An excellent website explaining diagnosis, symptomology, and treatment for gallbladder disease and gallstones is found here: http://www.liverdoctor.com/
  7. As far back as 1992, researchers had found that biliary sludge, the early form of gallstones, composed of cholesterol and calcium bilirubinate crystals, was a cause of, or at least highly associated with, about a third of the cases of acute pancreatitis seen in the hospital and clinic: http://www.nejm.org/doi/full/10.1056/NEJM199202273260902
  8. Research in recent decades has led to an increased scientific understanding of gallstone formation, and this article from the University of Washington summarized these findings: http://www.ncbi.nlm.nih.gov/pubmed/2199058
  9. A host of dysfunctional health factors are needed to form gallstones during the three stages of formation 1) cholesterol supersaturation, 2) nucleation, and 3) actual stone growth. This article summary from the Humboldt University in Berlin, Germany, lists the health factors involved to help guide the holistic therapy: http://www.ncbi.nlm.nih.gov/pubmed/8211853
  10. An article in the January, 1976 issue of the New England Journal of Medicine, by Donald M. Small M.D. of the Boston University School of Medicine, shows that women taking synthetic hormones in the form of birth control showed a consistent supersaturation of cholesterol in bile compared to women not taking synthetic hormones, and Dr. Small asks whether the use of synthetic hormone therapy is worth the physiological risks. Dr. Small founded the biophysics department at Boston University School of Medicine, and later chaired the Physiology and Biophysics Department until July of 2006: http://www.nejm.org/doi/full/10.1056/NEJM197601222940409
  11. A study in 2010, at Leiden University Medical Center, Leiden, The Netherlands, noted that changes in bile acid formation as well as gallbladder emptying, or motility, are equally implicated in gallstone formation, and Metabolic Syndrome is implicated in a number of ways, with hormonal changes in excess CCK excretion and decreased CCK sensitivity, insulin resistance with excess insulin in circulation and high triglycerides. These researchers noted that treatment for Metabolic Syndrome that increasingly utilizes fibrate drugs actually increases bile supersaturation and decreased bile acid production, thus contributing to gallstone formation, while the use of omega-3 essential fatty acids, as fish or krill oil, actually reduces triglycerides and bile supersaturation, while increasing normal bile acid production: http://www.ncbi.nlm.nih.gov/pubmed/20699090
  12. Research in 1999 at the VA Medical Center in Boston, Massachusetts, revealed that problems with intestinal bacterial degradation of bile salts played a significant role in the formation of gallstones. Attention to balance of the symbiotic microbial health of the small intestine is thus very important in preventing gallstone formation. Bile salts are broken down and recycled in the small intestine, and problems with this metabolism lead to unhealthy cholesterol and bilirubin micelles and crystal formations, as well as mechanical obstruction of the emptying of bile into the small intestine: http://www.ncbi.nlm.nih.gov/pubmed/10198779
  13. Another complete explanation of gallstones and gallbladder disease is presented on this excellent website: http://gallbladder-symptoms.blogspot.com/
  14. Problems after gallbladder removal, or post-cholecystectomy syndrome (PCS) are fairly common, conservatively affecting 10-15 percent of patients, either acutely or chronically. This study in 2003, at Fudan University, Shanghai, China, investigated the efficacy of endoscopic diagnosis and treatment in PCS, and reveals that even after surgery, stones that block the bile ducts do occur: http://www.ncbi.nlm.nih.gov/pubmed/14607662
  15. While most standard medical sources continue to describe post-cholecystectomy syndrome (PCS) as rare (acute presentation is still relatively rare), this 2004 study at the Third Medical Clinic in Cluj-Napoca, Romania, found that PCS occurs in 20-30 percent of patients, sometimes relieved wtih a combination of magnesium glucomate and magnesium methionine, Vitamine B6 (P5P), and calcium lactate: http://www.ncbi.nlm.nih.gov/pubmed/15637226