Gallstones: Formation, Prevention, and Treatment

What are gallstones?

Gallstones are a common gastrointestinal disease. They are hard deposits in the gallbladder resulting from over-concentrated bile precipitation. The precipitate can be of cholesterol monohydrate minerals or black pigment caused by calcium bilirubin polymerization (Abraham et al., 2014). Based on the precipitate composition, are three types of gallstones: cholesterol, pigment, and mixed stones. According to Bouchier (1983), cholesterol stones are light brown, smooth or sided, and trans-sectionally appear coated and/or crystal-like. Pigment stones are numerous small black or brown unevenly shaped solids that are shapeless or trans-sectionally crystalline. Mixed stones are brown and contain cholesterol and traces of calcium and bilirubin salts (Grattagliano, 2015).

According to the National Institute for Health and Care Excellence (2014), gallstones can infuriate the gallbladder and block the biliary tract leading to pain, inflammation, and infection. Additionally, gallstone-related diseases such as pancreatitis, cholecystitis, jaundice, and cholangitis are fatal. Although gallstones are often asymptomatic, they may progress into symptomatic (Gaby, 2009). The asymptomatic nature many gallstones makes it challenging to determine the actual prevalence rate. According to Hopkins Medicine Organization (2013), however, the prevalence rate of gallstones is high in the United States, Chile, Sweden, Germany, and Austria, and low among Asian and African populations. In the United States, around 13% of the adult population has gallstone disease. Over 80% of these gallstones cases mainly constitute cholesterol (Abraham et al., 2014). The epidemiology of gallstones shows that the various types of gallstones vary in terms of the constitution, cause, formation, prevention, diagnosis, and treatment (Abraham et al., 2014; Gurusamy & Davidson, 2014). It is therefore imperative to consider each case without over-generalization. 

How are gallstones formed?

The composition of gallstones mainly includes cholesterol, calcium salts, bilirubin, and traces of proteins among other materials (Njeze, 2013). Cholesterol gallstones are the most common. According to Njeze (2013), cholesterol gallstones are formed due to over-concentration of cholesterol in the bile, flawed cholesterol conversion into bile acids, and disruption of the enterohepatic flow of bile acids which results in cholesterol-saturated bile. Estrogen therapy in women also restrains bile acid synthesis leading to increased cholesterol levels. Subsequently, crystallization of cholesterol may gradually occur to produce stones. Practically, cholesterol does not dissolve. Accumulation of these stones results in cholesterol gallstones and other related diseases. 

symptoms of gallstones

Pigment stones are formed during the destruction of red blood cells which leads to extreme levels of bilirubin in the bile (Njeze, 2013). The most common is the black pigment stones. According to Njeze, black pigment stones occur frequently in people with liver cirrhosis, thalassemia, genetic spherocytosis, sickle cell disorder, and conditions that affect red blood cells level and elevate the excretion of bilirubin (2013). Pigment stones that form in the bile duct referred to as bile-duct stones, are usually brown and are linked to bacterial infections in the biliary system. These infections break glucuronic acid from the fixed bilirubin to produce calcium salts precipitates which gradually form brown pigment gallstones. 

Mixed stones are a result of a high concentration of lipids, biliary proteins, cholesterol, and calcium salts which form gallbladder sludge (Grattagliano, 2015; Njeze, 2013). According to Njeze (2013), gallbladder sludge can resolve on its own without treatment or develop into gallstones that cause pancreatitis, biliary pain, and cholecystitis. Pregnancy, lengthy intravenous feeding, malnourishment, and/or rapid emaciation are the stimulating factors for the formation of gallbladder sludge. The use of certain antibiotics such as ceftriaxone can also lead to gallbladder precipitations that later transform into gallstones. Most patients with mixed gallstones tend to have high levels of calcium salts.

Risk Factors for Gallstones 

Various factors influence the formation of gallstones. These factors include age, drugs, gender, geographical location and ethnicity, obesity, rapid weight loss, diabetes, cardiovascular disease, poor sugar metabolism, and altered microbiome (Hopkins Medicine Organization, 2013; Thamer, 2022; Sun et al., 2022). Gutt et al. (2020) add that poor diet is also an important predisposing factor. The occurrence rate of gallstones increases with age. Studies also show that gallstones are more prevalent among young women than men. The difference, however, decreases with the increase in age. Disturbance of gut and bile duct microbiomes influences the formation of cholesterol and pigment gallstones. Certain drugs such as ceftriaxone, clofibrate, oral birth control, estrogen medications, progestins, and octreotide stimulate excessive secretion of cholesterol into bile and precipitate to form gallstones (Hopkins Medicine Organization, 2013). In addition, health conditions such as obesity, diabetes, and cardiovascular diseases affect body fat distribution and hypersecretion of cholesterol. 

Prevention of gallstones 

There are several preventive measures that people can use to avoid gallstones. According to Gurusamy and Davidson (2014), life modifications such as maintaining a healthy diet, exercising regularly, and observing body weight can potentially prevent the formation of gallstones. For instance, high-calorie diets, rapid weight loss, obesity, diabetes, and sugar dysmetabolism are implicated in most gallstone cases. Predisposing factors such as hemolysis and other health conditions and infections such as cardiovascular and sickle cell disease can also be prevented through early diagnosis and adopting appropriate measures. There are two pharmacological interventions for gallstones. First is the use of prophylactic antibiotics for people who have undergone spleen surgery or had splenic infarction. The use of ursodeoxycholic acid to prevent the crystallization of cholesterol in bile stops the formation of cholesterol crystals in patients undergoing rapid weight (Gurusamy & Davidson, 2014; Gutt et al., 2020). Removal of the gallbladder has also been recommended for people undertaking weight-loss surgeries as a preventive measure.  

Prevention of gallstones 

Additionally, nutritional supplements rich in Vitamin C, Lecithin, and Iron can also be used to prevent the formation of gallstones. According to Gaby (2009), Vitamin C limits the formation of cholesterol gallstones by accelerating the conversion of cholesterol into bile salts, thus preventing bile lithogenesis. Lecithin supplements have high concentrations of phospholipids which intensify the dissolution of biliary cholesterol decreasing the chance of crystallization in the bile. The deficiency of iron contributes to the formation of gallstones in humans. Iron supplementation therefore could help prevent the formation of gallstones. 

Gallstone diagnosis

Asymptomatic gallstones are parenthetically diagnosed through abdominal ultrasounds (Thamer, 2022). With time, asymptomatic gallstones advance into symptomatic. The typical symptoms of gallstones are biliary pain experienced in the right upper quadrant of the abdomen, nausea, and vomiting. Symptomatic gallstones are diagnosed through physiological examinations, blood tests, urinalysis, liver function tests, stool tests, and more advanced imaging examinations such as ultrasonography, cholescintigraphy, and oral cholecystography (Njeze, 2013; Thamer, 2022).

Gallstone diagnosis

Imaging examination, especially ultrasonography, is the standard method of diagnosing gallstones due to its accuracy, specificity, radiation absence, and low cost. In vague cases, however, Febyan (2020) recommends the use of computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. Iqbal et al. (2019), emphasize keenness in differentiating the symptoms of gallstones from those of other abdominal and duodenal diseases to avoid unnecessary treatments. 

Managing and Treating Gallstones 

The recommended approach for managing gallstones depends on the severity of symptoms and the individual’s overall health. Treatment options may include medication, dietary modifications, or in some cases, cholecystectomy–surgical removal of the gallbladder Extracorporeal shock wave lithotripsy and endoscopic gallbladder stenting have also been used in gallstones’ dissolution. Indication for treatment of asymptomatic patients with gallstones less than three centimeters is currently absent. 

Medication therapy includes the use of ursodeoxycholic acid for patients with small cholesterol gallstones, prophylactic medication such as laparoscopic cholecystectomy for patients with more severe symptoms of gallstones, and administration of non-steroidal anti-inflammatory drugs or narcotic painkillers for biliary pain control (Abraham et al., 2014; Gutt et al., 2020). According to Abraham et al. (2014), lipolysis with oral dissolution agents such as chenodeoxycholic acid can also be used to treat cholesterol gallstones. Medication therapy is not effective for asymptomatic pigment or mixed gallstones; pain management using painkillers is, however, recommended..  

Laparoscopic cholecystectomy is the most conclusive treatment for symptomatic gallstones. Laparoscopic cholecystectomy involves minimal incisions in the abdomen to find, detach, and remove the gallbladder from the liver and bile ducts (Hopkins Medicine Organization, 2013). Extracorporeal Shock Wave Lithotrips (ESWL) can be used in the treatment of gallstones to avoid surgery. According to Abraham et al. (2014) and Hopkins Medicine Organization (2013), ESWL is a noninvasive treatment technique that uses compressive and ductile shock waves to disintegrate and rapture the gallstones. Endoscopic Gallbladder Stenting (EGS) can be used in high-risk gallstone patients. It is a non-surgical method that involves the use of endoscopic retrograde cholangiopancreatography to place a naso-biliary pigtail catheter or double-pigtail stent in the gallbladder (Hopkins Medicine Organization, 2013).

Do herbal and plant-based remedies have a place in gallstone preventative/dissolution diet?

The key to the dissolution of cholesterol-based gallstones is achieving and maintaining the flow of unsaturated bile in the gallbladder (Potincasa et al., 1996). Consequently, substances that reduce the amount of cholesterol in bile, increase bile secretion, and increase gallbladder motility are great candidates for the dissolution of gallstones.

Olive oil may stimulate the production of bile, which could potentially help dissolve gallstones. The most commonly recommended method involves mixing olive oil with lemon juice or grapefruit juice and consuming it in larger quantities, typically on an empty stomach. The idea is that olive oil stimulates the gallbladder to contract and release bile, which may help in flushing out the gallstones.

Considering the complex mechanics involved in cholesterol metabolism, bile production, and gallstone formation, a personal opinion is that incorporating small amounts of this mixture into daily diet plans might yield results in breaking down small gallstones and preventing the formation of new ones. Crash diets or extreme diet plans tend to throw the body off balance and create metabolic chaos that is mostly counter-intuitive in the long term. It is important to note that the effectiveness of olive oil in dissolving gallstones is not scientifically proven. While there are anecdotal reports of people claiming success with this method, there is a lack of robust clinical evidence to support its use.

Peppermint oil is sometimes suggested as a natural remedy for gallstones, but its effectiveness is not well supported by scientific evidence. While peppermint oil is known for its potential digestive benefits, including easing symptoms of irritable bowel syndrome (IBS), there is limited research on its direct effects on gallstones. Some studies suggest that peppermint oil may help relax the muscles in the bile ducts, which could potentially improve the flow of bile and reduce the risk of gallstone formation.

Castor oil is known for its potential laxative and anti-inflammatory properties. It is believed to stimulate bowel movements and promote the flow of bile, which could potentially help in passing gallstones. However, gallstones are hardened deposits that may not be easily dissolved solely through the use of castor oil.

In addition to the above oils, dandelion, and milk thistle teas have been cited as useful in gallstone dissolution. Dandelion root tea is often mentioned as a natural remedy for gallstones. It is believed to have diuretic properties and may help stimulate bile production, potentially assisting in gallstone dissolution. Milk thistle (Silybum marianum) is an herb commonly used for liver health support and is believed to have antioxidant and anti-inflammatory properties. Extracts and milk thistle supplements are also available and have been cited to support gallbladder function.

Chanca piedra, boldo, turmeric curcumin, apple cider vinegar, and artichoke leaf extracts have also been used in alternative medicine to promote the dissolution and prevention of gallstones. Besides the herbal and oil remedies, hydration, physical activity, and a diet low in fats, cholesterol, and sugar are key in preventing gallstones and aiding in the dissolution of existing stones.

It is important to note that herbal remedies and lifestyle modification are not a substitute for medical treatment or professional advice. If you suspect you have gallstones or are experiencing symptoms related to gallbladder issues, it is crucial to consult a healthcare professional. Proper diagnosis will offer guidance on the best treatment options.

Takeaway Message

Cholesterol gallstones are the most common in the general population. calcium salts, bilirubin (pigment stones), and/or traces of proteins among other materials in the bile. Gallstones are classified into cholesterol, pigment, and mixed stones.  In most patients, gallstones are asymptomatic. The symptomatic cases are characterized by biliary pain. It is important to treat the symptoms early to avoid gallstone-related complications such as pancreatitis, cholecystitis, jaundice, and cholangitis. Patients also have various treatment options for gallstones ranging from medical, and surgical, to non-surgical therapeutic measures. diet, physical exercise, and observing body weight can prevent the formation of gallstones. Herbal remedies and oils including olive, peppermint, artichokes, chanca piedra, lemon, grapefruit, milk thistle, and dandelion root, among others, have been used to aid in the dissolution and prevention of gallstones. 


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