The gallbladder is a small, grape sized, organ attached to the digestive tract. It secretes a fluid called bile into it in response to a meal. Bile emulsifies dietary fats by increasing their exposure to digestive enzymes. However, sometimes gallstones form and cause problems. Gallstones affect up to 15% of the US population and are the predominant form of intestinal issues.

Bile

Bile is originally produced in the liver. The main emulsifying agents are bile salts and phospholipids. Bile also contains waste products such as excess cholesterol and bilirubin. Bilirubin results from the breakdown of red blood cells.

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Bile salts are made from liver cholesterol and form amphipathic molecules/salts, which means they have both water- and fat-soluble components. This makes them good emulsifiers.

Similarly, phospholipids are both water- and fat-soluble. Like triglycerides, they have a glycerol backbone. But instead of three fatty acids attached to the glycerol, they have two attached with a water-soluble phosphate.

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Gallstone Formation

When excessive amounts of cholesterol and bilirubin exist in bile, they can precipitate out and form gallstones.

When gallstones block the cystic duct from the gallbladder, bile cannot flow readily into the digestive tract. When the gallbladder becomes inflamed, a painful condition called cholecystitis can result.

Dietary Causes of Gallstones

Foods high in refined carbohydrates contribute to high blood glucose, high insulin, and higher triglycerides. The higher triglyceride levels indirectly contribute to excess liver cholesterol production.

Foods high in saturated fats include fried foods, butter, creams, and fatty meats. These more directly contribute to higher cholesterol levels resulting in high bile cholesterol concentrations.

Sudden calorie restriction decreases the release of cholecystokinin (CCK), an intestinal hormone responsible for gallbladder contraction resulting in bile flowing into the small intestine. Low CCK then facilitates bile stagnation allowing cholesterol to accumulate in the gallbladder and crystallize into gallstones.

Additionally, sudden weight loss from restrictive diets can result in rapid breakdown of adipose tissue triglycerides. This increases the concentration of fatty acids in the blood causing even more liver cholesterol production. This excess cholesterol is incorporated into bile.

A low fiber diet also contributes. Insoluble dietary fiber normally binds with bile salts, bile acids, and the excess cholesterol sent to the small intestine for excretion. A low fiber intake permits more reabsorption, ultimately increasing cholesterol in the bile.

Dehydration can also increase bile concentration facilitating gallstone formation.

Signs and Symptoms

Symptoms of gallstones blockages and resulting cholecystitis can include sharp pain radiating from the upper right abdominal region. Blockages can also cause the gallbladder to leak bilirubin into the blood, causing the whites of eyes and skin to turn yellow, a form of jaundice. Symptoms also include nausea, vomiting, fever, and chills. Ultrasound is a common way to detect gallstones.

Treatment

Although sometimes no treatment is warranted, oftentimes, the blockage is so severe, surgical removal of the gallbladder, cholecystectomy, is performed. Less invasive procedures using shockwaves, lithotripsy, can break up gallstones. Existing openings can also be used to remove them using a procedure called endoscopic retrograde cholangio-pancreatography (ERCP).

Prevention and Conclusion

However, a preventative diet is indisputably preferred. This includes 1) consuming a diet low in saturated fats and refined carbohydrates, 2) avoiding rapid weight loss, particularly from very low-calorie diets, and 3) staying hydrated.

A registered dietitian (RD), can help create such a diet as well as help with safe weight loss, if that is a goal. They can also help with post cholecystectomy diets.

Health promoting diets can be most delicious, rewarding, and satiating. Some RDs accept insurance and so can provide medical nutrition therapy at little to no cost.

Patrick Traynor, PHD, MPH, RD, CPT is a registered dietitian with an insurance-based practice, MNT Scientific in South Lake Tahoe & Sacramento, CA, Minden, NV, and Ashland, OR. He does telehealth as well. Inquiries can be directed to Dr. Traynor at (530)429-7363 or info@MNTScientific.com. Instagram: @dr.patricktraynor