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MagazineApril 2009 (Vol. 20 Issue 1)Gallstones

Q) A friend of mine recently discovered she has gallstones, although she has no obvious symptoms

Q) A friend of mine recently discovered she has gallstones, although she has no obvious symptoms. Her doctor told her not to worry and said that treatment is currently not necessary. However, he warned that surgery might be required in the future if symptoms develop. Is there anything she can do to prevent the condition from worsening and avoid the need for surgery?-O.E., via e-mail

A) Around 10-20 per cent of people living in most Western countries have gallstones (Dig Dis Sci, 2007; 52: 1313-25), which arise when bile-the fat-digesting juice made by the liver and stored in the gallbladder-hardens into stone-like lumps.

There are various types of gallstones, but most are 'mixed' stones, made from cholesterol plus calcium salts and other bile ingredients. These are thought to form when the bile contains too much cholesterol, or when the gallbladder doesn't empty as it should.

Gallstones can go unnoticed for years but, when they lodge in the bile ducts, which carry bile from the liver to the small intestine, they can cause a painful obstruction. Bile is then prevented from entering the bowel to assist with digestion, leading to biliary colic (pain in the upper right abdomen) and symptoms such as bloating, burping, flatulence, nausea, vomiting and sometimes jaundice. Complete or partial blockage can also cause the irritation and inflammation of the gallbladder known as 'cholecystitis'. The result may be fever and prolonged pain.

Most people with gallstones, however, have no symptoms whatsoever and, luckily, your friend is one of those. As only 10-25 per cent of asymptomatic patients ever develop symptoms, the usual recommendation is observation alone (Dig Dis Sci, 2007; 52: 1313-25). For symptomatic patients, however, cholecystectomy-surgery to remove the gallbladder-is the gold standard (Am J Gastroenterol, 1993; 88: 633-9).

Happily, your friend may be able to avoid future surgery by taking steps now to prevent the development of new stones or the further growth of existing ones.

- Change your diet. Switch from animal to vegetable proteins and from refined to unrefined carbohydrates (Am J Epidemiol, 2004; 160: 11-8; Med Hypotheses, 2003; 60: 143-7). Consuming calcium-rich foods and more fibre, particularly the insoluble kind (found in whole-grain foods, and certain fruit and vegetables), may also be beneficial (Am J Surg, 1993; 165: 541-8; Am J Gastroenterol, 2004; 99: 1364-70). Foods to avoid include saturated fats and refined sugars (Am J Clin Nutr, 1999; 69: 120-6).

- Have your cholesterol checked and, if necessary, switch to a low-cholesterol diet.

- Take small meals at regular intervals to reduce bile gallbladder storage time (Am J Surg, 1993; 165: 541-8).

- Stay slim, as people with gallstones are often over-weight (Obes Res, 1993; 1: 51-6). However, too-rapid weight loss could increase the risk of stone formation so, if necessary, aim to lose no more than 1.5 kg/ week (Ned Tijdschr Geneeskd, 2004; 148: 174-7).

- Drink plenty of water to prevent overconcentration of bile.

- Eat more nuts as this is associated with a reduced risk of cholecystectomy (Am J Clin Nutr, 2004; 80: 76-81).

- Get active. In a study of more than 60,000 women, regular recreational exercise (such as cycling, jogging and swimming) dramatically reduced the risk of cholecystectomy (N Engl J Med, 1999; 341: 777-84). Another study found that 34 per cent of cases of symptomatic gallstone disease in men could be prevented by increasing exercise to 30 minutes of endurance-type training five times a week (Ann Intern Med, 1998; 128: 417-25).

- Avoid the Pill, as it may increase the risk of gallstones in some women (Br Med J [Clin Res Ed], 1984; 288: 1795-9).

- Take supplements-in particular, vitamins C and E, beta-carotene and magnesium can help to prevent gallstones (Clin Chim Acta, 2004; 349: 157-65; Am J Gastroenterol, 2008; 103: 383-5).

- Try herbs. Silymarin, the active component of milk thistle, can prevent gallstones by reducing the

cholesterol in bile (J Hepatol, 1991; 12: 290-5). Turmeric, Oregon grape (Mahonia aquifolium), Bu-pleurum and gold coin grass

(Jin Qian Cao) can reduce gall-bladder inflammation and relieve liver congestion (Med Hypotheses, 2003; 60: 143-7). However, be sure to consult a qualified alternative health practitioner before trying any of these remedies.

- Consider acupuncture/electro-acupuncture if symptoms devel-op, as either, along with a Chi-nese herbal decoction, can be effective for treating gallstones

(Zhongguo Zhen Jiu, 2006; 26: 772-4; J Tradit Chin Med, 2006; 26: 167-9).

Dissolving gallstones naturally

WDDTY columnist Dr Harald Gaier recommends the following remedy for dissolving gallstones:

- Menthol 30 mg

- Menthone 5 mg

- Pinene 15 mg

- Borneol 5 mg

- Camphene 5 mg

- Cineol 2 mg

- Citral 5 mg

- Phosphatidylcholine 50 mg

- Medium-chain triglycerides 125 mg

- Chenodeoxycholic acid 750 mg.

Once it's been made up, take one-third with each of your three meals for one day only.

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