Gallstones

See Wikipedia Gallstone. Most people with gallstones (about 80%) never have symptoms. When a gallstone blocks the bile duct, a cramp-like pain in the right upper part of the abdomen, known as biliary colic (gallbladder attack) can result. This happens in 1–4% of those with gallstones each year. Complications of gallstones may include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), jaundice, and infection of a bile duct (cholangitis). Symptoms of these complications may include pain of more than five hours duration, fever, yellowish skin, vomiting, dark urine, and pale stools.

Gallstones may be suspected based on symptoms. Diagnosis is then typically confirmed by ultrasound (i.e. sonogram). In those who are having gallbladder attacks, surgery to remove the gallbladder is typically recommended. (Surgeons will show you a sonogram of a gallbladder laden with stones as a selling point to get you on board for the surgery.) This can be carried out either through several small incisions or through a single larger incision, usually under general anesthesia. In rare cases when surgery is not possible medication may be used to try to dissolve the stones or lithotripsy to break down the stones.

Consequences of gallbladder removal. Long-term consequences of removal of your gallbladder are related to the lack of a storage sack for bile acids. Bile is continuously synthesized by the liver. The purpose of the gallbladder is to store this greenish fluid between meals. When you eat, the gallbladder contracts, empting its contents into the small intestine, where the bile mixes with the food. If there is no storage sack (gallbladder), then the bile constantly drips into the intestine, even when no food is present. In this concentrated form, the bile acids are very irritating to the linings of the intestine. In the short term, irritation of the large intestine by bile acids often causes diarrhea - and long-term the irritation can cause colon cancer. This is the reason why cancer of the right side of the colon is more common in people who have had their gallbladders removed.

Medical. Cholesterol gallstones can sometimes be dissolved with ursodeoxycholic acid (abbrev. UDCA, aka Ursodiol [USAN]) taken by mouth, but it may be necessary for the person to take this medication for years. Gallstones may recur, however, once the drug is stopped. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). Gallstones can be broken up using lithotripsy procedures, including laser lithotripsy and shock wave therapy. These involve the breaking down of stones into tiny pieces that are then passed safely in the urine or feces.

Why gallstones form

• Your liver may secrete more bile than it can dissolve.
• Your body may have excess pigment called bilirubin, which cannot be dissolved.
• The gallbladder might not empty completely or as frequently as it needs to.

Major causes of gallstones (Reference)

• Blood sugar imbalances. When we have poor blood sugar regulation, it causes stress and inflammation in the liver increases the production of cholesterol which concentrates in the bile. This causes a thicker, slower moving bile. Poor blood sugar regulation will lead too higher LDL cholesterol, higher triglyceride levels and lower HDL cholesterol. This triad is not only a risk for heart disease, but also gallstones.
• Estrogen dominance. When we have an overabundance of natural estrogen production or a buildup of artificial estrogen substances within our body it leads to increases in cholesterol that create thicker, sluggish bile.
• Food allergies and sensitivities.
• Chronic stress.
• Low fiber diet. Fiber is critical for the elimination of cholesterol and estrogenic molecules in the body. A low fiber diet has been shown to cause that same thick sluggish bile production.
• Low stomach acid production. Stomach acid is necessary to sterilize the gut environment, metabolize proteins and stimulating all the digestive juices – including bile production in the liver and its release from the gall bladder.
• Obesity.
• Rapid weight loss.
• Low fat diets. A low-fat diet for a long-period of time reduces the overall secretions of bile, which can cause the bile to become stagnant. The stagnancy of the bile increases the risk of bile stone production.
• Cholesterol lowering medications. Certain types of cholesterol lowering medications increase the amount of cholesterol being bound into the bile. This will cause more concentrated bile that is sluggish and at greater risk for forming stones.
• Leaky gut syndrome. When we have damage to the intestinal lining, it reduces CCK and secretin levels. This inhibits the ability of the gall bladder to contract effectively and can lead to biliary stasis.

How physicians detect gallstones

• Ultrasound.
• Computerized tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Cholescintigraphy.
• Endoscopic retrograde cholangiopancreatography (ERCP).
• Gallbladder Radionuclide Scan--also called hepatobiliary imaging, or hepatobiliary iminodiacetic acid scan (HIDA). A gallbladder radionuclide scan is an imaging test that uses radiation to detect infection, disease, bile fluid leakage, or blockage in your gallbladder. The procedure uses radioactive “tracers” injected into your bloodstream that are viewed under specialized imaging equipment. A gallbladder radionuclide scan is done to help detect potential problems with your gallbladder or ducts near the gallbladder. Problems may include: bile duct blockage, cholecystitis (gallbladder inflammation), gallstones, bile leakage. Also to test your gallbladder ejection fraction (the percentage of total bile that gets produced during a certain period of time) and the rate at which your gallbladder releases bile.

Gallbladder pain

• The most common symptom from gallbladder disease is pain from inflammation. The pain typically occurs in the upper-right section of your abdomen. Other symptoms you may experience include: nausea, vomiting, fever, diarrhea, dark urine.
• If a stone gets lodged in a duct and prompts a blockage, a patient can experience extreme pain and discomfort that may last for several minutes up to a few hours. Common gallstone symptoms include: Sudden and rapid pain that intensifies in the upper right part of the abdomen, and/or in the center of your abdomen just below the breastbone, back pain between the shoulder blades, pain in the right shoulder, nausea or vomiting.
• If gallstones block the bile duct, the risk of infection go up. If the individual has the pain but is also experiencing fever, chills, nausea and vomiting than an infection has most likely begun. If nothing is done, it can spread to the liver where it can cause jaundice, or a yellowing of the skin and the eyes.
• Another condition, called gallbladder ileus happens when a gallstone slips into the small intestine and blocks the entry of bile to the small intestine. This can only be corrected by surgery, but nutritional support should still be used.

Gallbladder pain treatments

• Pills. Doctors often treat gallbladder pain with anti-inflammatory medication or painkillers.
• Heated compress. Applying heat can be soothing and relieve pain. For gallbladder health, a heated compress can calm spasms and relieve pressure from bile build up. To relieve gallbladder pain, wet a towel with warm water and apply it to the affected area for 10 to 15 minutes. You can also use a heating pad or hot water bottle for the same effect. Repeat this process until the pain goes away.
• Peppermint tea. Peppermint contains menthol, a soothing compound that promotes pain relief. It can be used to ease stomach pain, improve digestion, and relieve nausea. To ease gallbladder pain and improve gallbladder health, drink peppermint tea until your pain goes away.
• Apple cider vinegar. Raw apple cider vinegar contains anti-inflammatory properties that can be useful in relieving gallbladder pain. To treat gallbladder pain, dissolve two tablespoons of apple cider vinegar with warm water. Sip this tonic until the pain subsides. It’s important not to drink apple cider vinegar straight, as the acid can damage your teeth.
• Turmeric. Turmeric is a spice used to treat many health conditions. Turmeric contains curcumin, which is known for its anti-inflammatory and healing benefits. For gallbladder health, turmeric can stimulate bile formation to ease gallbladder emptying. Incorporating turmeric into your diet can also reduce inflammation and gallbladder pain. Turmeric can be made into a tea to drink daily for pain relief. Curcumin is also available as an oral supplement.
• Magnesium. Magnesium is a helpful component for gallbladder emptying. It can also ease gallbladder spasms and pain. Magnesium deficiency can increase the risk of gallstone formation. To ease pain symptoms, mix a teaspoon of magnesium powder in warm water to drink every few hours.

Severe indicators requiring immediate medical attention

• A high fever with chills
• Yellowing of the skin and the whites of the eyes
• Intense abdominal pain that prevents the patient from sitting still or finding a comfortable position

Common Treatment Protocols (excluding gallbladder removal)

• Oral bile acids. About 30 percent of gallbladder patients are candidates for this treatment.. Certain chemicals or substances like ursodiol (i.e. ursodeoxycholic acid, brand names Actigall or Urso) or chenodiol (i.e. chenodeoxycholic acid) are available as oral bile acid pills that may have the ability to dissolve stones. These oral bile acids initiate stone dissolving by thinning the bile. You need to take this medication for six months to a year before the stones are fully dissolved. If you have large gallstones or gallstones that don’t appear to be made from cholesterol, the medication likely won’t work. As a result, your doctor may recommend surgery if your gallstones are causing symptoms.
• Risk of side effects in taking oral bile acids include: diarrhea or constipation, upset stomach, indigestion or vomiting, dizziness, cough or sore throat, runny nose, muscle or joint pain, hair loss, dry skin or skin rash, headache, metallic taste in mouth, tiredness, cough with fever, pain or frequent urination, allergic reactions such as hives, rash, itching, chest tightness or swelling, etc.
• Extracorporeal shock wave lithotripsy (ESWL). (This treatment is somewhat rare, as it is only available in a few locations.) An ESWL involves sending shock waves through the body's soft tissues to shatter gallstones into smaller fragments. Unfortunately, only less than 15 percent of gallstone patients may find ESWL effective, since it only works on solitary gallstones that are less than 2 centimeters in diameter. Fewer than 15 percent of patients are eligible for ECSWL.
• Contact dissolution therapy. In order to dissolve gallstones, methyl tertiary-butyl ether (MTBE), a type of solvent, is injected into the gallbladder. While initial studies have highlighted MTBE's potential in rapidly dissolving stones, this procedure can also trigger severe side effects like a burning pain sensation. If you're thinking about undergoing contact dissolution therapy, inquire about your doctor's level of experience in performing this procedure. Better yet, look for safer alternatives for gallstone treatment.

Alternative therapies (1): Plant terpenes (product brand name, Rowachol, on Amazon)

• Description: Treat your gallstones with plant terpenes. Scientific testing of a proprietary blend of plant-based compounds called Rowachol has produced encouraging results. A six-month course of treatment produced complete or partial dissolution of gallstones in 29 percent of a 27-patient research population.
• These plant terpenes appear to stimulate bile production by your liver and inhibit the formation of cholesterol crystals.
• Rowachol also enhanced the effectiveness of other solvent drugs.
• On Amazon: Rowachol Capsules 100 capsules by Rowa. Price is approximately $21.00. Amazon testimonials seem very positive.
• Anecdotal comment from an Amazon user of Rowachol: Rowachol for gallbladder stones really works. I have found that peppermint oil supplements work also and are easier to purchase. Too bad there are not more studies to discover what the compound are in peppermint oils that allieviate gallstone symptoms. I think it actually may dissolve gallstones over time.

Alternative therapies (2): Gallbladder flush (or cleanse)

• Description: To cause the gallbladder to release the gallstones, assuming they are small enough to pass through the bile duct. The danger, of course, is that they are too large and could block the duct during the cleanse.
• Lemon juice and olive oil. This method involves not eating for 12 hours during the day and then, at 7 p.m., drinking four tablespoons of olive oil and one tablespoon of lemon juice — eight times every 15 minutes.
• Apple juice and vegetable juice. This method involves drinking only apple juice and vegetable juice until 5 p.m. After 5 p.m., drink 18 milliliters (ml) of olive oil and 9 ml of lemon juice every 15 minutes until you’ve consumed eight ounces of olive oil.
• Gallbladder flushes often produce pain and diarrhea.
• By the next morning, you’ll typically pass soft green or brown spheres. Again, these are not usually gallstones, but rather the byproducts of the treatment.

Notes

• Some foods that aggravate the gallbladder include: eggs, refined sugar, foods with saturated fat, food allergens.
• Gallstones: What Are Its Causes and Symptoms. A comprehensive article from Dr. Mercola's website.
• Women are more likely to develop gallstones than men because estrogen increases cholesterol levels in bile. Obesity is another risk factor.
• Twenty percent of gallstones are “pigment stones” made of calcium salts and bilirubin, a product made from the breakdown of red blood cells. This type of gallstone is usually caused by liver disease, anemia, or an infection of your bile ducts.
• Die With Your Gallstones. The McDougall Newsletter, published May, 2002. Encourages a high-fiber, no-cholesterol diet and exercise to prevent future attacks. If symptoms continue, recommends considering Actigall therapy (oral bile acids) with possibly "statin" drugs. If unsucceful then consider lithoripsy. If that fails then consider dissolving with MTBE. Finally, if all else fails then surgery.