Thursday, December 18, 2008

Gallstones and the Diets That Heal Them

Gallstones are crystalline precipitates of fats and minerals normally flushed out from the liver with the flow of the yellow-green fluid known as bile. This fluid passes through the gallbladder. Since bile has an important role in regulating the absorption of cholesterol from food, the gallbladder regulates just how much bile is released into the colon. Sometimes while bile is waiting to be discharged, the cholesterol it contains can crystallize into stones.

Every year over 1 million people just in the United States are newly diagnosed with gallstones, and over 800,000 cholecystectomies (surgical removals of the gallbladder) are performed. Some studies estimate that 8 percent of men and 20 percent of women in the United States, over twenty million people, have gallstones.

A gallstone forms when the bile becomes supersaturated with cholesterol, calcium, the pigment bilirubin, or a combination of all three. Since cholesterol is a fat, it cannot be carried through the watery fluid of the bile unless it is joined to a carrier, lecithin. If cholesterol is overabundant, or if lecithin is in shortage, or if the liver fails to produce enough bile to flush it downwards to the gut, cholesterol tends to accumulate and form stones in the gallbladder.
Stones grow very slowly, usually about 1/10 of an inch (2 mm) in diameter a year, and cannot be felt until they have been forming in the gallbladder for 8 to 10 years. Calcium and bilirubin almost always collect with the cholesterol during the formation of the stone.

Since cholesterol is the principle component of gallstones, lowering cholesterol is the key to preventing the formation of gallstones. Bloodstream cholesterol levels, however, are not related to the risk of gallstones. In fact, some studies have found that lower levels of cholesterol in the blood. and taking cholesterol-lowering medications. are associated with increased risk of gallstones. The important cholesterol level for gallstones is not the amount of cholesterol in the blood but the amount of cholesterol in the bile. Cholesterol concentrations in the bile are not related to the amount of either LDL or HDL in the blood, but rather to the concentration of triglycerides.

When the diet is rich in refined sugars or the kind of fructose found in corn syrup, the liver is forced to store energy in the form of triglycerides. Long-chain triglycerides are absorbed by fat cells and contribute to weight gain. Medium-chain triglycerides (MCTs), sometimes referred to as “the lean fats,” can be used by the liver itself for energy. When so many MCTs are created that they spill over into the bile, however, they compete with cholesterol for carriers and leave some cholesterol behind. This increases the rate at which gallstones are formed.

Crash diets, especially those that are very low in fat and very high in carbohydrates, increase the formation of MCTs and sometimes trigger gallbladder attacks (although this usually does not happen until the dieter begins to add back previously forbidden foods). The solution, however, is not to eat more fat. The solution is to consume beneficial fats.

Essential fatty acids from fish oil counteract the negative effects of dieting. Fish oils reduce the cholesterol content of the bile and, based on the results of the single clinical study of their use, prevent gallstones in women dieters. Physicians at the Médica Sur Clinic in Mexico City gave women fish oil, ursodeoxycholic acid, or a placebo while they strictly observed a 1200-calorie a day reducing diet. At the end of 6 weeks, cholesterol nucleation time, a measure of how easily stones can form from cholesterol, had been lowered significantly in the women who had been taking fish oil but not in the women who had received ursodeoxycholic acid or a placebo.

The other always-useful food for treating gallstones is fiber. Wheat bran has been reported to reduce the relative amount of cholesterol in bile of a small group of people whose bile contained excessive cholesterol (a risk factor for gallstone formation). The same effect has been reported in people who already have gallstones. Any kind of fiber should taken with plenty of fluid.

For people who have gallstones, drinking the often-recommended eight glasses of water a day has an additional benefit. Keeping the colon hydrated reduces the cholesterol concentration of the bile (regardless of any other changes in your diet) and reduces the likelihood that enough cholesterol can accumulate to form a stone. You can take some of your fluid in the form of peppermint tea, which can help prevent gallbladder attacks. Peppermint helps relax spasms of the smooth muscle lining, the gallbladder, and bile ducts. Other helpful foods are those that contain folic acid (folate), and vitamins B12, C, and E.

What are the whole foods that heal gallstones? With every meal, drink at least one glass of water or peppermint tea. Interestingly, the one food that contains all of the recommended vitamins for treating gallstones is chicken or goose liver—but be careful with paté. More helpful are meals that are low in fat, based on fish.

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