Overview 

Gallstones are crystalline deposits composed of cholesterol or calcium salts that form in the gallbladder. Technically known as choleliths, gallstones can form singularly or as many stones, and can range in size from of a grain of sand to a golf ball. Usually, gallstones resolve themselves and no special treatment is needed. However, sometimes gallstones can cause a blockage in a bile duct, a condition that can lead to further complications and which warrants medical intervention. 

The materials that make up gallstones are provided by a normal byproduct of liver metabolism called bile. This fluid is used to help breakdown fats in the duodenum, or the upper small intestine, the delivery of which occurs when the gallbladder contracts and pushes the bile through ducts. Normally, bile contains a balanced concentration of salts, fatty compounds and cholesterol. However, if this balance is compromised and too much cholesterol, protein, or salts buildup in the bile, these substances may become trapped and form deposits. 

Types of Gallstones 

Generally, there are two types of gallstones—cholesterol or pigment. The cholesterol type account for up to 80% of gallstone formation and are characterized by the presence of excess of undigested cholesterol and can be yellow, green or white in color. Pigment gallstones are dark brown or black in color and are formed when there is too high a concentration of bilirubin, the byproduct of red blood cell breakdown. 

Complications 

As previously stated, the formation of gallstones usually does not require treatment. IN fact, it has been estimated that as much as 20% of the adult American population may have gallstones, but only 1-3% will experience any symptoms. However, unpleasant symptoms may appear if stones form in an excessive size or number. The presence of these stones may become particularly apparent after indulging in a fatty meal, which stimulates the gallbladder to contract to eliminate bile. The migration of gallstones out of the gallbladder can also present problems, since one or more ducts of the biliary system can become partially or completely blocked, which can lead to inflammation, severe pain and, possibly, infection. Blockage can also trap digestive enzymes in the pancreas. Left untreated, these conditions can lead to organ damage, even death. 

Risk Factors 

Obesity  Being overweight increases the risk of developing gallstones.

Gender and Age  Gallstones are more common in middle-aged women. However, men and senior citizens of either sex are more likely to experience symptoms.

Ethnicity  African Americans are at the lowest risk for gallstones. The highest rate of incidence occurs in Native Americans, Hispanics and those of northern European descent. 

Symptoms and Diagnosis 

Generally, symptoms occur as the result of developing a complication, which can trigger a gallbladder attack that is characterized by severe pain on the right side (just under the rib cage) that radiates to the back and/or right shoulder. Typically, an attack will occur about 30 minutes after eating a fatty or greasy meal and last anywhere from an hour to several hours. 

Additional symptoms may also appear, such as: 

Sleep Disturbances (gallbladder attacks often occur at night during sleep).

Bloating

Nausea

Mild Fever

Jaundice

Chills

Excessive Sweating 

While there is no one specific test to confirm the presence of gallstones, a clinician will likely be able to make a diagnosis based on symptoms alone. However, additional tests may be needed to make a firm diagnosis or to rule out other medical conditions. These tests may include: 

Urinalysis to rule out kidney disease.

Blood tests to help detect infection or a problem with the liver or pancreas.

Ultrasound

X-rays

Oral Cholecystogram (OCG), which is a series of x-rays following swallowing a dye-filled capsule.

Endoscopic Retrograde Cholangiopancreatography (ERCP), which involves an exploration of the biliary system with an endoscope. 

Conventional Treatment 

In severe or chronic cases of gallstones, and providing your state of health permits it, your physician may recommend removing the gallbladder, a procedure known as a cholecystectomy. Once the gallbladder is removed, bile is then redirected from the liver to the small intestine. For some people, this surgery is the best course of action to avoid future occurrences of gallstone formation. However, there is a drawback to having the gallbladder removed. Since bile acids will flow directly to the small intestine, irritation can develop. The consequences associated with this include frequent diarrhea and, possibly, an increased risk for colon cancer. In fact, researchers have noted that developing cancer of the right side of the colon occurs more frequently in patients that have had their gallbladder removed. 

Other medical treatments currently available include: 

Extracorporeal Shockwave Lithotripsy (ESWL) uses shockwaves to break up gallstones into tiny pieces that can then pass through the biliary system without causing any damage.

Medications that are composed of bile acids to help dissolve gallstones. 

Natural Prevention and Treatment of Gallstones 

The natural approach to treating—more importantly, preventing—the formation of gallstones involves an integrated course of therapies that includes a balanced diet, nutritional support, and the use of botanical cholagogues and choleretics, which stimulate gallbladder contractions and bile secretion from the liver, respectively. 

The diet should be high in fiber and low in fats and refined carbohydrates. Obtaining adequate fiber is of particular importance since fiber inhibits the activity of a compound manufactured as a byproduct from bile acids called deoxycholic acid, which contributes to insolubility of cholesterol in bile. Fiber also improves intestinal transit time, thereby minimizing bile acid absorption. 

In addition to increasing fiber intake, the following dietary guidelines are recommended: 

Fatty and greasy foods should be restricted or eliminated from the diet.

Increase your intake of vegetables, particularly raw vegetables.

Limit refined sugars, since studies have shown a correlation between sugar intake, blood lipids and gallstone formation.

Avoid coffee if you currently have gallstones, even the decaffeinated form. Coffee stimulates gallbladder contractions. 

In addition, there are some specific foods that may help to prevent gallstone formation, as well as help dissolve existing gallstones, such as: 

Fruits and vegetables high in pectin (apples, bananas, cabbage, carrots, oranges, peas, and okra).

Oat bran. 

Recommended Supplements in the Treatment of Gallstones 

Soy 

Researchers have found that soy protein inhibits cholesterol crystallization. In addition, soy significantly increases the production of ursodeoxycholic acid, a bile acid often used in conventional medications intended to dissolve gallstones. 

Vitamin C 

This vitamin is considered to be a lipotropic agent, which means a substance that stimulates the elimination of fat from the liver. In fact, studies have shown that a deficiency in vitamin C promotes cholesterol super-saturation of bile, leading to cholesterol gallstones. However, increasing vitamin C intake increases production of certain bile acids that help to dissolve gallstones, specifically ursodeoxycholic acid. 

Additional beneficial lipotropic agents include: 

Inositol (also known as vitamin B-8)

Choline

Methionine

Lecithin 

Antioxidants 

Researchers have found that people who have low antioxidant intake are more prone to develop gallstones. The reason behind this may be that oxidative stress in the liver may promote bile super-saturation of both cholesterol and bilirubin. In addition to methionine and vitamin C, recommended antioxidants include vitamin E and manganese. 

Herbs Used in the Treatment of Gallstones 

Flaxseed 

Flaxseed oil is rich in essential fatty acids, a deficiency of which contributes to cholesterol super-saturation of bile. 

Milk Thistle 

The active component of milk thistle is silymarin, a flavonoid compound composed of silibinin, silidianin, and silicristin. Aside from offering the therapeutic benefit of protecting the liver from the buildup of toxins, milk thistle alters bile composition to improve bile solubility. In fact, studies have shown that supplementation with milk thistle extract can reduce bile cholesterol concentration. In addition, silymarin appears to deter the action of HMG-CoA reductase, the enzyme responsible for cholesterol metabolism in the liver. 

Peppermint 

Peppermint oil contains menthol, a member of a class of compounds referred to as terpenes that stimulate bile flow from the liver and are believed to help prevent the formation of cholesterol gallstones, as well as possibly contributing to the dissolution of existing ones.

Safety Precautions 

Soy 

Do not supplement with soy protein if you are currently taking tamoxifen for estrogen-receptor positive breast cancer. 

Vitamin C 

Do not take if you are undergoing chemotherapy or have a history of kidney disease. 

Flaxseed 

Be aware that flaxseed can interfere with the results of certain radiological tests and procedures. 

Milk Thistle 

Consult with your physician if you are taking any medications metabolized by cytochrome P450 3A4, which can be affected by milk thistle. 

Peppermint