Gallstones

Think of your gallbladder as a kind of storage tank for your liver. It collects bile, a cholesterol-rich fluid secreted by the liver. When you eat something fatty, your small intestine sends out a biochemical message to the gallbladder--"Hey, squirt out some bile!" The bile interacts with the food, helping to break it down into digestible bits.

Think of gallstones as sand or pebbles in the storage tank. Gallstones form when there is too much cholesterol or pigment in the bile. They start out as tiny globules but can snowball to the size of an egg.

Lots of times, gallstones don't cause any problems at all. People may not even realize they have them until they show up on an x-ray or during an ultrasound examination. When gallstones do cause pain, it's usually because one has gotten stuck in a duct, blocking the flow of bile. If that happens, you'll have steady, severe pain in the upper abdomen that lasts at least 20 minutes but may continue up to four miserable hours. You may also feel pain between the shoulder blades or in the right shoulder. Nausea and vomiting are common, too. Pain-producing gallstones sometimes pass through the duct or drop back into the gallbladder. The pain and the problem are temporarily on hold. When they get stuck in a duct for long, though, they can cause serious problems.

Once you have pain-producing gallstones, you may be able to tame your symptoms by losing weight and going on a moderately low-fat diet, says Henry Pitt, M.D., director of the Gallstone and Biliary Disease Center at Johns Hopkins Hospital in Baltimore.

"Usually the symptoms don't go away, and you may run into complications," he adds. "So your doctor will probably recommend that your gallbladder be removed."

But if you still have a gallbladder and it's giving you gallstone problems, here's what doctors suggest to minimize symptoms.

When to See the Doctor

Don't assume the pain you're experiencing is your gallbladder acting up. Get a doctor's diagnosis. A variety of tests are available to detect gallstones, including ultrasound and x-rays.

For occasional mild attacks, your doctor may suggest you wait and see if your symptoms become worse before getting treatment. "These days, though, there has been a slight shift toward recommending that something be done earlier than it used to be," says Henry Pitt, M.D., director of the Gallstone and Biliary Disease Center at Johns Hopkins Hospital in Baltimore.

That's because most gallbladders can now be removed with laparoscopic surgery--sometimes called Band-Aid surgery--because the incisions are so small. To perform the operation, the doctor makes four hairline slits or incisions, each about an inch long. Through one slit the doctor inserts a kind of periscope into the abdomen. The other slits are just big enough to allow the doctor to work with specially designed surgical instruments and remove the entire gallbladder. The surgery usually involves an overnight stay in the hospital.

Alternatively, a prescription drug, Actigall, can be used to dissolve gallstones, but it isn't for everybody, Dr. Pitt says. "The pills are likely to work in only about 20 percent of patients with gallstones--thinner, younger patients with small- to medium-size cholesterol stones," he explains. The pills take months or years to dissolve the stones, and the stones frequently return when the drug is stopped, Dr. Pitt says.

Two other treatments to remove gallstones, lithotripsy (shock waves that break up stones) and drugs injected into the gallbladder to dissolve stones, are used infrequently.

Shed those few extra pounds. When it comes to developing gallstones, even slightly overweight people have twice the risk of people at their ideal weight. And seriously overweight people run a sixfold risk. Your doctor can check a weight/height chart to determine your ideal weight. If you're overweight, plan a change of diet and exercise to bring down your weight.

But do it gradually. Dropping weight too fast (more than one pound a week) actually increases your chances of developing gallstones, which can form within four to six months of beginning a weight-loss program. So stick with a weight-loss program that will let you reduce slowly and steadily, Dr. Pitt recommends.

Avoid no-fat diets. Virtually fat-free weight-loss diets seem to pose a particularly high risk for gallstone formation, according to several studies.

Why? An extremely low-fat diet (less than 20 percent of calories from fat) allows bile to sit and concentrate in the gallbladder, explains Stanley Heshka, Ph.D., a research associate at the Obesity Research Center at St. Luke's-Roosevelt Hospital Center in New York City. Dietary fat stimulates the gallbladder to expel its contents, which reduces the concentration of cholesterol and pigments. "Research suggests that a weight-loss diet of at least 1,200 calories, with 20 percent of calories from fat, may offer protection from gallstones," he says.

But don't go overboard on the fat. Although data are conflicting, many doctors suspect a diet high in saturated fat can contribute to gallstone problems as well as to weight gain, a risk in itself So stay away from foods that are very high in saturated fat, such as butter, highly processed foods, marbled meats and products containing palm or coconut oils.

Better not count on old-time "cures." Old-time remedies, which involve a three-day fast followed by a whopping dose of olive oil and fruit juice, are said to stimulate your gallbladder so vigorously that it spews out any stones. Some people say they actually see the stones pass in the form of greenish blobs when they try this remedy.

I am not convinced this works," says Andrew Weil, M.D., associate director of the Division of Social Perspectives in Medicine of the College of Medicine at the University of Arizona in Tucson. "It's possible that the greenish blobs are actually residues of the olive oil, not stones."

Trying this remedy may increase your risk of a major gallbladder attack, with the possibility of stones lodging in the bile ducts, says Johnson Thistle, M.D., professor of medicine at the Mayo Clinic in Rochester, Minnesota.

Have you or a family member had an experience with this? Help others by sharing your story now.

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