Gallstone surgery is one of the most commonly performed surgeries there is today. Estimates show that more than 750,000 surgeries to remove gallstones are performed every year and, in North America, around 10 percent to 15 percent of the adult population has gallstones (more woman than men).
Surprisingly, many people suffering from gallstones who choose to have surgery don’t fully understand how gallstones are formed in the first place, why surgery alone can’t fix the underlying problem or what they can do to best prevent gallstones from returning once again, such as following a “gallbladder diet.”
What Are Gallstones?
Gallstones are tiny “stones” (solid pieces of matter) found in the gallbladder, which is a small organ in the shape of a “sac” that has the primary role of storing bile made by the liver. Gallstones (sometimes called cholelithiasis by doctors) are made up of cholesterol particles, calcium deposits and other substances that are found in bile. They can vary in terms of size, shape, composition, density and severity of symptoms — but for the most part, they are all caused by the same things and treated very similarly.
They are formed when cholesterol, calcium and other particles bind to each other and become lodged in the gallbladder, causing pain and other problems, such as indigestion and back pain. Normally, the gallbladder only stores liquid material, so when solid stones accumulate it can become serious and noticeable in terms of symptoms.
A gallbladder attack or gallstone attack is also called biliary colic and refers to when pain strikes in the abdomen area (often upper right part). Biliary colic happens due to a gallstone temporarily blocking the bile duct. Pain may be radiate to the shoulder and may last for an hour or longer. (1a)
Gallstones can vary in terms of size, some small and softer (almost like sand or sludge) to very big and denser gallstones that expand to almost the whole size of the gallbladder. Compared to kidney stones, gallstones are usually softer since they are made of primarily cholesterol, which isn’t solid.
Who’s Most at Risk for Developing Gallstones?
Several factors can make people more susceptible to developing gallstones, including their diet, age, gender, body composition and genetics. (1b)
Gallstones are most common in:
- people over the age of 40
- people who are overweight or obese (especially if they hold excess fat around their waist)
Other risk factors for gallstones include:
- eating a poor diet
- losing weight too quickly (for example, fasting and going long periods without eating)
- family history of gallstones
- high triglycerides (a type of fat in the blood)
- lack of physical activity
- low HDL (good) cholesterol
Why is this the case? Gallstones seem to be influenced by hormonal imbalances, for starters. This is the reason that women who are pregnant or on birth control pills tend to deal with gallstones more often than the general population.
Currently, it’s believed that women of “reproductive age,” especially those between the ages of 20 and 60, are the group most affected by gallstones. According to the National Foundation of Diabetes, Digestive and Kidney Diseases, the female sex hormone estrogen might be the reason why gallstones are more common among women than men.
Estrogen can increase the amount of cholesterol in the bile and possibly also decrease gallbladder movement, both of which set the scene for gallstone formation. This is one reason why following a diet for a healthy gallbladder can be beneficial — it lowers the occurrence of “estrogen dominance” or excess estrogen.
High levels of estrogen are more common today due to to the growing presence of endocrine disruptors. These are found in chemical beauty or cleaning products, certain water supplies and chemicals added to processed foods. These chemicals “mimic” the effects of true estrogen, linking to receptor sites and contributing to excess estrogen, which can cause fat cells to become resistant to normal breakdown.
Taking medications and the health of someone’s liver, including liver disease, also impact gallbladder health and can determine whether or not someone develops gallstones. Some drugs contain estrogen, such as birth control pills and hormone replacement therapy, so these can increase the odds for gallstones. Taking drugs that lower cholesterol levels in the blood can also cause gallstones since these make the liver release more cholesterol into the bile. This can affect everything from mood and metabolism to sleep and sexual functioning.
What Causes Gallstones?
The gallbladder itself is usually described as a soft, flimsy, bag-like organ. It has the ability to expand when bile accumulates, which can happen when someone hasn’t eaten in a long time, such as if they are fasting, sick or severely dieting. Bile is the digestive liquid we produce within the liver, which has bile salts and other substances that help break down fats from our diet.
The size of the gallbladder is different from person to person depending on eating schedule and diet, but usually it’s a size somewhere between that of a small plum and a large apple. The gallbladder is attached to the liver and rests on top of the small bowel, which is important for allowing the gallbladder to do its job correctly. The gallbladder has the ability to drain and accumulate bile through transporting it via a pipe called the cystic duct.
To picture how gallstones develop, some experts recommend picturing the digestive organs as a “biliary tree.” (2) The biliary tree features four organs connected by a series of tubes. This means that if you were to draw a diagram of how they all work together, you would see two “pipes” criss-crossed, with your liver connected at the top, a gallbladder connected at the left, a pancreas connected at the right and a small bowel at the bottom.
The purpose of the biliary tree is to move secretions from one organ to another, which helps with digestion, nutrient absorption and removing waste from the body. Secretions move from the liver, gallbladder and pancreas to the small bowel. Their job is to get rid of the body’s waste products in the form of bile, which the liver creates to capture waste particles and take them to the small bowel before they are eliminated by going to the bathroom.
The body normally stores secretions like bile until they’re needed, instead of emptying extra secretions into the small bowel constantly and wasting them. We hold on to these important fluids so we can use them efficiently once we eat food and need to perform digestion. We have an important valve-like muscle that is our “bile duct,” the controller of where bile goes in response to eating.
When we haven’t really eaten anything and there is no food present in the small bowel, the bile duct valve is closed. Then when we eat, the valve opens up so enzymes, secretions and bile can do their job.
The catch is that the liver and pancreas don’t stop producing bile or other digestive secretions. They have no way of knowing when we will eat next and no feedback system in place to turn off production, so they basically always pump out extra bile whether it’s needed at the time or not. The liver continues to make bile that reaches the bile duct valve, but the valve stays shut until we eat something, so the bile has no choice but to pour back into the gallbladder.
This is why the gallbladder is so important — it acts like a digestive backup system and catches the “extras,” then moves them to a safe storage area where they don’t normally interfere with the whole digestive process. When you do eat something, the gallbladder contracts and squeezes out enough bile to keep the system running smoothly.
So what disrupts this process and leads to gallstones?
When cholesterol and other matter within bile bind together and become more solid, they can become lodged in the inner lining of the gallbladder, growing into gallstones over time. The exact reason that gallstones form isn’t agreed upon by most doctors or researchers. One of the leading theories is that they can form when your bile contains too much cholesterol, which can be caused from a poor diet or hormone imbalances.
Usually, bile has the enzymes necessary to properly dissolve cholesterol released by your liver, but in some cases the liver might excrete more cholesterol than can be dissolved, so it builds up into solid pieces. Other reasons gallstones might form are because the bile duct valve stops working properly or because the liver starts making too much bilirubin (forming “pigment gallstones”), which is a chemical used to break down red blood cells. (3a)
Gallstone Symptoms & Diagnosis
It’s believed that most people with gallstones aren’t even aware they have them. Gallstone symptoms are different for every person and can vary in terms of intensity or duration. Some people with gallstones don’t have any pain or noticeable symptoms at all, while others have sharp pains and ongoing trouble functioning normally.
When someone does have “gallstone attacks,” they are more likely to happen at night. Some people only find out about their gallstones for the first time when they have a CT scan for another problem and gallstones are detected by their doctors.
Gallstone symptoms can also vary depending on where the stone is located. Gallstones always originate inside the gallbladder, but sometimes they can become dislodged and move to different places, such as in the bile duct (the main pipe that attaches all digestive organs), at the junction of the pipe and small bowel, or even inside the small bowel.
When a stone forms in the region of the drainage pipe that connects the gallbladder to the bile duct, bile can be blocked and pain can occur when the gallbladder squeezes but has nowhere to release the bile. Pressure forms, and the normally soft gallbladder can become tense and taut. Gallstones forming a blockage can also cause the liver or pancreas to become inflamed. This is another reason for pain and swelling around the abdomen and even up to the back or shoulders.
When someone does have symptoms related to gallstones, these can include:
- pain and nausea in the abdomen
- tension around the stomach, intestines and other organs, especially after meals (including those high in fat and protein)
- severe pain in the upper-right side of the abdomen, usually which comes on suddenly and lasts from 30 minutes to many hours (this is clinically labeled biliary colic)
- pain under the right shoulder or within the back by the right shoulder blade (also often related to biliary colic )
While most gallstones don’t cause serious problems, in some cases they require surgery, or they can cause such pain and issues that the entire gallbladder needs to be removed. If you suspect you have gallstones, you can talk to your doctor, who will likely perform an ultrasound or X-rays. Ultrasounds, or ultrasonography, are believed to be the best method for detecting them, since they are not fully solid or made of bone and thus won’t always show up on a CT scan.
In addition, cholescintigraphy (HIDA Scan) is another common procedure used to diagnose gallstones as well as tumors in the gallbladder. (4a)
Conventional treatment may include endoscopic retrograde cholangiopancreatography (ERCP), which is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat common bile and pancreatic ducts problems. (4b)
For people with ongoing symptomatic gallstones where pain is high, surgery such as cholecystectomy to remove the stones might be performed. Gallstone removal doesn’t ensure that they won’t return — however, it’s mostly used to avoid pain. Doctors usually wait several months on average to warrant noninvasive surgery or medical therapy. (4c)
My recommendation is taking measures into your own hands and doing your best to naturally treat and prevent gallstones (see below).
Meanwhile, in some severe cases, cholecystitis or inflammation of the gallbladder is diagnosed. Cholecystitis is usually caused by gallstones blocking the gallbladder tube. Other causes are bile duct issues, tumors, along with serious infections or illnesses.
If left untreated, cholecystitis may progress to life-threatening complications, even a rupture of the gallbladder. Therefore, cholecystitis treatment often leads to gallbladder removal. (4d)
If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture. Diagnosis of and treatment for cholecystitis often involves gallbladder removal.
Natural Treatments for Gallstones
1. Maintain a Healthy Body Weight
Being overweight or obese might increase your chances of having gallstones (especially females who are overweight) since studies suggest that obese people might produce high levels of cholesterol in their livers. (5) Research shows that people who don’t maintain a healthy weight might experience more inflammation and swelling within the gallbladder, especially if they have large amounts of fat around their waist that signifies underlying visceral fat stores around the organs.
The healthiest thing for your body overall is to maintain your weight and stay within a healthy range of your natural “set point.” Yo-yo dieting (gaining and losing over and over again) has negative impacts on your hormones, digestion, immune system and metabolism. Weight cycling is believed to increase the chances for gallstones, so if you think you need to lose weight for health reasons, do so in a moderate way by taking it slow and avoiding crash diets or fad-diet programs that restrict calories too much.
2. Avoid Rapid Weight Loss and Fad Diets
Obesity seems to be a bigger risk factor for gallstones than weight loss, however rapid weight loss can trigger deficiencies, electrolyte imbalances and other issues that increase the odds for gallstone formation. Research shows that people who lose more than three pounds per week might have a greater chance of getting gallstones than those who lose weight more slowly and without drastic measures. (6a)
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), very low-calorie diets and weight-loss surgery may lead to a higher risk of gallstones. (6b)
This is also true in people who have weight-loss surgery and rapidly slim down by following a very low-calorie diet. Most experts recommend losing between a half pound to two pounds every week, which is a slow and steady improvement that won’t cause the body to rebound in terms of digestion too dramatically.
3. Follow an Anti-Inflammatory Diet that Supports Liver and Gallbladder Health
Your diet can dramatically impact liver and gallbladder health and determine whether or not you properly produce and release cholesterol particles into bile. To regulate your body’s use of cholesterol, consume more anti-inflammatory foods − which have numerous benefits in addition to lowering risk for gallstones. An anti-inflammatory diet also lowers high-estrogen foods that can contribute estrogen excess.
Try to eat more high-fiber foods, like all types of vegetables, fruit, nuts/seeds, beans/legumes and in moderation gluten-free grains. Processed foods are more refined and usually contain less fiber, but are higher in sugar, artificial ingredients and inflammatory compounds like vegetable oils. Beets, artichokes and dandelion greens are great choices for supporting digestive health since these vegetables help improve bile flow, which breaks down fat.
When it comes to fats, focus on easily digestible healthy fats like fish oil, coconut oil and olive oil that are supportive of your liver and help your gallbladder contract and empty on a regular basis. Coconut oil contains the easiest form of fat for the body to digest, which are medium-chained fatty acids (MCFAs). Sprouted seeds such as flax, chia, hemp and pumpkin seeds are also beneficial since they are easy to digest and can reduce inflammation.
To support gallbladder health best, I recommend consuming healthy fats in small amounts over the course of the day, only about one tablespoon of oils at one time, or about 2 tablespoons of sprouted nuts and seeds. This is because you don’t want to overconsume fat and put stress on the organs.
Remember that many people come into contact with all types of “toxins” every day, from chemicals in household products to water and air pollution. One of the main ways the body rids itself of toxins is through the liver, which works very hard to clean the blood, produce the bile needed to digest fat, break down hormones and store essential nutrients.
Dietary factors that can increase gallbladder risk include eating high levels of cholesterol, saturated fat, trans fatty acids, refined sugar and possibly legumes. Consuming a vegetarian diet is also associated with decreased risk, as is avoiding allergenic foods. (7) To help cleanse the liver, remove the following foods from your diet as much as possible:
- hydrogenated oils (canola, corn, sunflower, safflower)
- refined sugar
- convenience foods
- lunch/deli meats
- excess alcohol
- conventional, farm-raised animal products or dairy products (which are difficult to digest and often pro-inflammatory)
Focus on adding more fresh produce and vegetable juices, organic and grass-fed animal products, and potassium-rich foods — like avocado, leafy greens, tomato, sweet potato and bananas.
4. Be More Active
People who are more active tend to have better protection against gallstones. (8) You’re probably already aware of the many benefits of exercise — regular physical activity not only improves your general health, but it can also be beneficial for maintaining a healthy weight without needing to dramatically cut calories, plus it can boost digestive functions.
The general recommendation for most adults who are capable of being active is to aim for 30–60 minutes of moderately intense exercise each day or a bit less if you also practice high intensity workouts, like HIIT or burst training, that accomplish the same benefits in less time.
5. Reconsider Taking Birth Control Pills or Unnecessary Medications
Birth control pills and some hormonal medications increase the body’s estrogen stores, which has an influence on cholesterol production and storage (in addition to body weight in some cases). In a study published in the Canadian Medical Association Journal, researchers found a “statistically significant increase in the risk of gallbladder” in women who took oral contraceptives, though the compounds in the birth control pills may play a role in these results. (9)
If you’ve been experiencing gallstones or they run in your family, talk to your doctor about other treatment options, such as non-hormonal birth control.
Beneficial Supplements for Gallstones
Several supplements and natural herbs can help improve liver health and reduce inflammation, which are both important for regulating the production and use of cholesterol. These include:
- Turmeric (aids in digestion, fights inflammation and supports liver metabolism)
- Milk thistle (eliminates buildup of medications, heavy metals, etc., within the liver)
- Dandelion root (helps the liver eliminate toxins by acting as a natural diuretic)
- Activated charcoal (binds to toxins and helps remove them)
- Lipase enzymes (2 caps with meals helps improve fat digestion and the use of bile)
- Bile salts or ox bile (500–1,000 milligrams with meals can improve gallbladder function and the breakdown of fats)