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Gallstones
Gallstones can form in the gallbladder over time, a condition called cholelithiasis. This condition is often without symptoms and individuals can live with gallstones for many years without being aware of the fact.
If the gallstones move out of the gallbladder into the bile duct, they can cause serious symptoms, such as obstruction, pain and severe cramps. Because gallstones block the bile duct, bile (which is essential for the digestion of fats) is not delivered to the digestive tract and fats are not digested properly.
By blocking the bile duct, gallstones also cause a build-up of bile in the gallbladder, which can result in jaundice and liver damage.
Risk factors
The following factors are associated with an increased tendency to develop gallstones:
- Female gender – women are more prone to developing gallstones than men
- Pregnancy and especially multiple pregnancies
- Age – older people are more inclined to develop gallstone problems than young people
- Family history – if gallstones run in the family, your chance of developing gallstones is higher
- Obesity – the incidence of gallstones is much higher in obese individuals
- Fat deposits in the upper body or trunk
- Diabetes – patients with diabetes mellitus are more prone to gallstones
- Inflammatory bowel disease (e.g. Crohn's disease and ulcerative colitis)
- Lipid-lowering medication – patients using statins to lower blood cholesterol levels may be exposed to greater risk of gallstones
- Female hormone treatment – oral contraceptives and hormone replacement therapy with oestrogen can increase the risk of gallstones
- Rapid and pronounced weight loss by means of gastric or jejunal bypasses, fasting or severe kilojoule restriction
- Habitual high fat intake or use of a high-protein, high-fat, very-low-carbohydrate diet such as the Atkins diet
Treatment
Gallstones are usually removed surgically either by means of a laparotomy or the less invasive keyhole surgery. In some cases, using ultrasound can shatter the stones.
Dietary treatment consists of a low-fat diet. The following foods need to be avoided:
- Full cream milk and any products made from full cream milk, such as full cream yoghurt and/or cream cheese
- Cheeses, except fat-free cottage cheese
- Biscuits, high-fat rolls or bread, pancakes, doughnuts, waffles, fritters, buttered popcorn, muffins, cakes, pies (sweet and savoury)
- Ice cream, fatty desserts
- More than one egg a day, and not more than four eggs per week (boil or poach to reduce fat intake)
- No more than 25 g of fat or oil a day (five teaspoons or 2,5 tablespoons a day of polyunsaturated or monounsaturated margarine or oil or mayonnaise/salad dressing)
- Fried or fatty meat or fish, sausages, poultry with skin (remove skin), smoked pork and ham, visible fat on meat, duck, goose, meat drippings and gravies made with drippings, fish canned in oil (rather use tuna canned in water or pilchards canned in tomato sauce), cold meats (except thinly sliced cooked beef or pork or poultry with all visible fat and skin removed)
- No more than five nuts a day, or one teaspoon of peanut butter
- Fatty or creamed soups
- Chocolate and all chocolate-containing foods and desserts
- Deep-fried potato chips, crisps, baked potatoes with sour cream, butter added to vegetables and potatoes, rich sauces added to vegetables, more than five small olives a day, more than 1/4 avocado a day
Most patients can return to their normal diet once the gallstones have been removed and they have recovered from the operation.
However, prevention is better than cure. If you have one or more risk factors for gallstones as described above, it may be a good idea to reduce your fat intake as a preventive measure.
Individuals who are seriously obese need to lose weight to prevent gallstones and gallbladder disease as well as other conditions associated with obesity.
On the other hand, those of you who are starving yourself to lose weight, should keep in mind that this increases your risk of developing gallstones. Rather use a more balanced slimming diet with a low-fat content.
This also applies to people who are using a high-fat, very-low-carbohydrate diet like the Atkins diet for slimming purposes. Keep in mind that all the fat you eat can make you susceptible to gallstones and that it is much better to use a low-fat, high-fibre diet if you are trying to lose weight. – (Dr Ingrid van Heerden, DietDoc)
