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Gallstones
by John Morley, MBAcC, MSocBiolMed, HD, MMAA |
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Gallstone disease, also known as cholelithiasis, is a very common digestive problem. In Western countries gallstones are are found at autopsy in 20% of women and 10% of men over forty. Most individuals with gallstones do not have symptoms, but gallstones can produce serious medical problems, such as recurrent abdominal pain (symptomatic cholelithiasis), gallbladder inflammation (cholecystitis), and obstruction of bile ducts (choledocholithiasis).
Gallstones are collections of solid matter that generally form in the gallbladder. The gallbladder is a small sac-like organ located underneath the liver on the upper right side of the abdomen. Its primary purposes are to store and concentrate the bile that is secreted by the liver (up to three cups each day) and to deliver bile to the intestine so that adequate fat metabolism is possible. During a meal, the gallbladder will contract and empty bile into the intestines through a series of small tubes, or bile ducts. Bile is a fluid comprised mainly of water, cholesterol, fat, bilirubin (the pigment that gives bile its yellow-brown color),and bile salts (detergent-like substances that help with fat digestion).
 Gallstones form when bile becomes over-saturated with cholesterol or bile pigments. Small amounts of calcium are also usually present. The size and number of gallstones may vary greatly in different people. Some people may have only one stone; others can have several hundred! While most gallstones are about the size of a small marble, they can be as small as a grain of sand or as large as a golf ball. Sometimes, only a sludge-like material will form.
Composition of gallstones varies and is divided into 3 main types. The most common types of gallstones contain 70% cholesterol plus a mixture of calcium salts and bile ingredients. The less common pigment stones, which comprise 20% of all gallstones, consist mainly of calcium bilirubinate.
The gall-bladder itself can become irritated and diseased from the presence of stones. Using natural remedies it is possible to gradually dissolve the stones but this can be a long procedure. Generally speaking, unless a stone is actually blocking the bile ducts, natural therapies can improve the health of the gall-bladder and prevent further crystallisation so that surgery is not necessary. In addition, the stones may gradually be dissolved if natural treatment is continued over a long period.
Who Gets Gallstones?
Although no one knows for certain why some people will form gallstones and others won't, we do know of several potential risk factors for gallstones.
Ethnicity: In general, Western Caucasians, Hispanics, and Native Americans have a higher rate of gallstone formation than do Eastern European, African-American, and Japanese individuals.
Women: Women are much more inclined to develop gallstones than men. In fact, women between the ages of 30 and 39 have a threefold greater incidence of gallstones than men in the same age group. This disparity decreases with advancing age. Sex hormones, especially estrogen, appear to be largely responsible for this, having been shown to promote gallstone formation. Along these lines, women who are on estrogen replacement therapy or oral contraceptives also seem to be at a higher risk for developing gallstones. Pregnancy, or a history of childbirth, are also risk factors for forming gallstones. One study reported that only 1.3 percent of women who have never given birth had gallstones, compared to a 12.2-percent prevalence of gallstones among women with a history of childbirth. With regard to pregnant women, gallbladder problems commonly return to normal within one to two months after delivery. Gallbladder sludge will resolve in two-thirds of women, and more than a third of small stones will disappear altogether.
Age: Age is also a major risk factor for both men and women. As we age, our chances of developing gallstones increase substantially, particularly after we hit age 60.
Obesity: Obesity (weight greater than 120 percent of ideal body weight) is certainly a major risk factor as well. Even being moderately overweight increases your chance for forming gallstones.
Lack of physical activity: A recently published study of more than 60,000 women showed that the risk of having symptomatic gallstone disease is inversely proportional to levels of physical activity. Women who were the most sedentary were at a 2.3 times greater risk for needing gallbladder surgery than were the women who had the highest levels of recreational physical activity. Interestingly, this increased risk was independent of obesity. Similar findings have also been observed with men.
Other risk factors:
Other risk factors for gallstone formation include rapid weight loss, family history of gallstones in a first degree relative, and certain medical conditions such as diabetes, cirrhosis of the liver, sickle cell anemia, and Crohn's disease.
Gallstone Symptoms
Most people with gallstones have no symptoms. One study found that more than 80 percent of patients who were found to have gallstones had no symptoms.
Unfortunately, many people will develop symptoms over the course of their lives. Typically, patients report attacks of pain in their upper-right or mid-abdomen. It is thought that the pain stems from a gallstone causing a transient blockage of the gallbladder duct (cystic duct). The pain is usually steady, starting gradually and building in intensity over a 15 to 30 minute period, and remaining constant for up to several hours before gradually disappearing. Pain may also be experienced in the back near the right shoulder blade, Nausea and vomiting may also occur. Your symptoms may even be fairly vague. Rather than having attacks of pain, you may experience a sensation of bloating after meals, indigestion, or intolerance to particular foods (often fatty foods). We do know that once you experience gallbladder pain, you are likely to get it again. Unfortunately, the timing and frequency of subsequent attacks are unpredictable.
Other causes of upper abdominal pain
It is important to remember that pain in the upper abdomen can be caused by conditions other than gallstone disease. Such conditions may range from simple indigestion to more serious problems such as ulcer disease, disorders of the liver or pancreas, or even heart disease. That is why a complete history and examination by a health professional is important.
Gallstone Complications
Cholecystitis
If a gallstone becomes impacted in the cystic duct, it may lead to inflammation of the gallbladder, known as cholecystitis, which can cause fever and prolonged pain. Severe cases can result in serious, even life-threatening infection.
Cholangitis
Sometimes gallstones escape from the gallbladder but become lodged in the segment of the bile duct that connects with the small intestine. The obstruction can be temporary or prolonged. A prolonged obstruction (usually more than several hours) can result in jaundice (yellowing of the skin) and pain. A prolonged obstruction of the bile ducts can also lead to a severe,life-threatening infection, called cholangitis. If you were to develop fever in addition to jaundice and abdominal pain, you may be developing cholangitis and it is important to see a doctor immediately.
Pancreatitis
Another complication of gallstone disease is pancreatitis, or inflammation of the pancreas. The pancreas is an organ that secretes digestive juices through the pancreatic duct, which empties into the same opening as the bile duct. If a gallstone becomes lodged in this opening and obstructs the flow of the pancreatic juices, pancreatitis occurs. This can also be a severe, even life-threatening condition that often requires hospitalization for treatment.
Diagnosing Gallstones
There are a number of tests that can determine a diagnosis of gallstones.
Ultrasound
If you have symptoms that might suggest the presence of gallstones, most often your doctor will order a test called an abdominal ultrasound or sonogram. This is a non-invasive test that utilizes sound waves, rather than x-rays, to create images. It is excellent for detecting gallstones and sludge.It is also useful in establishing whether the gallbladder appears inflamed.
Cholecystogram
Another test that is good for finding gallstones is an oral cholecystogram. This test involves ingesting radiographic dye in pill form and taking an x-ray of your gallbladder. Ultrasound is much more commonly used because it is simpler to perform and does not involve exposure to radiation.
CT scan and x-ray
Occasionally, gallstones may be identified on a plain x-ray or by computerized tomography (CT scan), but these are much less sensitive for finding gallstones.
Endoscopic retrograde pancreatogram
If there is suspicion that a gallstone may be lodged in the bile duct, a test called an endoscopic retrograde pancreatogram (or ERCP) may be suggested. This is a test that is performed by a gastrointestinal specialist and involves swallowing a flexible tube that is moved through to the area of the small intestine where the bile duct opens. X-ray dye is then injected into the bile duct, which enables the doctor to determine if gallstones are present. If so, they can often be removed during this procedure.
Bioenergetic Testing
A Health Professional who can test with a Vegatest Expert, or similar equipment, can determine the presence of gallstones and often their particular composition, and the environmental stresses that may be contributing to the formation of gallstones. This can be very useful in fine-tuning a long-term strategy.
Causes
The Liver, which produces the bile that the gall-bladder stores and concentrates, is a fundamental organ for attention by a wholistic practitioner who takes a naturopathic approach. The Liver is the seat of all metabolic processes and its sluggishness is found to underlie the many disorders related to poor digestive function. This is why so many treatments include Liver herbs, remedies and nutritionals. Since using Bioenergetic testing with the Vega equipment, the liver has been found to be the most stressed organ or the origin of the pathogenic causal chain in the majority of cases.
Natural therapists consider that a sluggish flow of bile encourages the formation of gallstones.
This can be due to :
(i) toxic overload and/or damage of the liver caused by daily intake and lifestyle choices and leading to reduced liver function,
(ii)toxic residues (from our history)that the liver can not detoxify or eliminate and which are stored in the intra-hepatic bile ducts within the liver where the bile is actually produced
(iii)old viral fragments and remnants of previous infections, including toxic metabolites and vaccination toxins, also often stored in the intrahepatic biles ducts
At the more subtle level, the Liver is considered to closely reflect the emotional state of the person and it has strong energetic links to the Gall-bladder in addition to the obvious physiological link. The Chinese Medical model attributes the functions of planning and decision-making to the Liver and Gallbladder, and links inappropriate Anger and Irritability to Liver and Gall-bladder malfunction. In may cases the emotional imbalance is the origin, developing long before the organ malfunction and the disease process. Liver's close link to all the emotions accounts for why irritability has often been associated with an upset Liver and, by association, gallbladder.
Treatment Options
In general, if you have had more than one attack of gallbladder pain, you should be treated for gallstones. Their removal will save you from further pain and potential complications. It is controversial as to whether you should be treated after only one episode of pain, so discuss this with your Health Professional. If you do this, and especially if you do not consult your doctor, I would recommend that you initially pay great attention to your diet, removing all fats so as not to stimulate the gall-bladder.
Immediately after an attack of gallstones a diet of vegetables and fruit juices is best. This has the effect of reducing inflammation in the gallbladder and of resting all the digestive organs.
Specific remedies for the gall-bladder and liver are as follows:
1) Magnesium Phosphate, as tissue salt or low-dose Celloid Mineral, to reduce spasm
2) Iron Phosphate, as tissue salt or Celloid Mineral, for inflammation of the gallbladder
3) Homeopathic doses of herbs for Liver and Gall-bladder. (Herbs are too strong for the liver near the time of an attack and may provoke further discomfort). Chelidonium, Chionathus, Carduus, Hepatica and Berberis in low potency are a good selection of homeopathic herbs which have worked well.
4) If the actual composition of stones is known, then the exact antidote in homeopathic doses can be used.
5) Bach Flower remedies : useful for the pain assocaited with gallstone colic, and for emotionally linked causal factors.
6) Sodium Sulphate, as tissue salt but preferably as a Celloid Mineral, helps to tone the Liver and to reduce the possibility of further stone formation.
Long-Term Strategies and Individual Fine Tuning
A good Wholistic Health Professional will be able to fine-tune all of the above suggestions and many others that may be specific for you and your history.
There is currently no hard scientific evidence that treating someone who has no symptom is of any benefit. In a scientific paradigm, nothing is necessary if there is no symptom, and this hypothesis is therefore impossible to genuinely investigate. To someone who is concerned about Prevention and Health Maintenance, having no symptoms is only a small and not very useful piece of information.
Whereas a "School" doctor would not recommend treating patients with "incidentally" discovered gallstones but no symptoms, it is possible to unmask the factors contributing to your gallstone(s), whether they be dispositional, environmental, dietary, toxic residual, electromagnetic, psychological, allergic or metabolic. You need a Health Professional who is also an experienced tester in BioEnergetic methods, and who uses the Vegatest Expert or similar equipment to its fullest capability. Such a practitioner will be able to do any and all necessary tests to determine the relevant stress factors, their priorities in the treatment strategy, and the possibilities for overcoming them.
It is difficult to convince clients to continue treatment once symptoms have gone completely. With gallstones, when the symptoms go this is because the gallstone(s) have stopped interefering with bile flow and more-or-less normal digestion is possible again. The gallstones are still there though, and if you slide back into the same habits that created them, they will soon become a painful problem again.
Medium-term treatment with Mitosan Therapy, homotoxicology, acupuncture, good nutrition, occasional liver flushes and common-sense eating, will continue the process of reducing the gallstone(s) and any related inflammation.
I now cover medical/surgical options. In acute situations these may be the only options, as the recommendations above would take too long when there is complete or partially complete blockage in the digestive tract.
Surgical options
In general, surgical removal of the gallbladder (cholecystectomy) is the treatment of choice for most patients.
Until about ten years ago, the open cholecystectomy was the standard operation. The surgery involves removing the gallbladder through a relatively large incision made in the right upper abdomen. While this is a safe procedure, it usually requires a four-to-five-day stay in the hospital followed by two to three weeks of recuperation.
Laparoscopic cholecystectomy:
Over the past decade, a less invasive approach to removing the gallbladder, called laparoscopic cholecystectomy, has become widely available. Typically, three, one-inch incisions are made in the upper abdomen, through which a thin fiberoptic video camera and surgical instruments are passed. This enables the surgeon to remove the gallbladder by watching a video monitor while manipulating the instruments. This results in much less damage to the abdominal muscles and surrounding tissue. As a result, you can expect less pain, a shorter hospital stay, and a quicker recovery. It is important to mention that not all patients can have the laparoscopic procedure. If the gallbladder is very inflamed at the time of surgery, it may not be possible to remove it laparoscopically. Additionally, if a gallstone has become trapped in the bile duct and your surgeon wishes to remove it at the time of surgery, it may be difficult to do so laparoscopically. Alternatively, your surgeon may wish to remove the gallbladder laparoscopically and have the bile duct stone removed non-operatively at a later time using the ERCP procedure. Finally, there is a five percent chance that your laparoscopic procedure would need to be converted to an open procedure due to technical difficulties that your surgeon may encounter during surgery.
Risks: Injury to the bile duct is the only complication that appears to be significantly more common with the laparoscopic approach. This occurs in two percent of patients, as compared to 0.1 percent of patients who have the open procedure. However, the overall complication rates for both open and laparoscopic surgeries are similar, as you would have a five percent chance of having a complication from either procedure.
Nonsurgical options
Sometimes an ERCP can be performed to remove gallstones that have been trapped in the bile duct. Most patients will also have the gallbladder removed to reduce the chance of having any future problems from gallstones; however, in special circumstances your doctor may advise against removing your gallbladder.
Lithotripsy
If you have severe medical problems that preclude surgery, and you have mild to moderate symptoms from gallstones, your doctor may wish to try to dissolve the gallstones using medications or lithotripsy. Lithotripsy is a technique that uses sound waves to fragment the gallstones. If you have relatively few gallstones and they are not too large or comprised of a lot of calcium, you may be a candidate for this therapy. Unfortunately, gallstones tend to reappear in about half of patients within three years, unless you are able to change the daily choices and lifestyle habits that contribute to the creation of gallstones.
Gallstone disease is a very common condition, afflicting millions people all over the world. Fortunately, most people with gallstones will remain free from symptoms or other problems associated with gallstones. If you do have symptoms that are suggestive of gallstone disease, see your health professional. Safe and effective treatment options are only a stone's throw away. There is also much that you can do, and be taught to do, to prevent the development of new stones or the further growth of already-existing ones.
© Copyright Wholistic Research Company 2001
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