Gallstone

Description

Gallstones are small stones made of cholesterol, calcium bilirubinate, or a mixture of cholesterol and bilirubin pigment. It is common and often painful, usually requiring surgery and can also be life threatening. Gallstones are related to many gallbladder and duct diseases.

Ten percent of the general population and 20% of the population over 40 years of age have gallstones. Before age 50, women are diagnosed more often than men; over the age of 50, occurrence is equally common.

Choledocholithiasis is a condition of gallstones in the common bile duct.

Cholecystitis is an acute or chronic inflammation of the gallbladder and is usually associated with gallstones in the cystic duct.

Gallstone ileus results from a gallstone lodging in the terminal ileum of the gut lumen.

Cholelithiasis, the fifth leading cause of hospitalization among adults and accounting for 90% of all gallbladder and duct diseases, is the condition of calculi in the gallbladder. These result from changes in bile composition.

Treatments may involve a Low Fat Diet: vitamin K therapy to counter the loss of vitamin K due to itching, jaundice, and bleeding tendencies; administration of antibiotics and drugs to dissolve the calculi; or surgery.

Causes

Primary Factors
The primary cause of gallstones is a change in bile composition. Cholesterol is not water soluble and requires a sensitive chemical balance to remain in solution. The molar ratio of cholesterol to bile acids and phospholipids appears to partially determine whether cholesterol will remain in solution or precipitate and form stones. Saturation with cholesterol and other factors may also be required for calculi formation.

Predisposing Factors
High dietary cholesterol, pregnancy, obesity, oral contraceptives, diabetes mellitus, celiac disease, cirrhosis, pancreatitis, biliary tract infection, genetic predisposition and aging.

Signs & Symptoms

Symptoms of gallstones are generally the same regardless of the type of calculi. In up to half of those affected there are no symptoms.

Abdominal distention
Absence of bowel sounds
Belching which leaves a sour taste in the mouth
Biliary colic
Chills
Clay-colored stools        
Diaphoresis
Flatulence
Functional dyspepsia
Indigestion
Intermittent recurrence of colicky pain, indicating gallstone ileus
Jaundice, if gallstones block the common bile duct
Low grade fever
Nausea
Recurring fat intolerance
Vomiting
Acute and sometimes severe pain, which may radiate to the back between the shoulder blades or to the front of the chest in the upper right quadrant of the abdomen; this symptom commonly follows fatty meals but may occur spontaneously, even while sleeping

Nutritional Supplements

Structure & Function:
        Single Nutrients &
        Multi Vitamin/Multi Mineral Formulas

---------------------------------
General Supplements
---------------------------------

	Adult
Copper	2 - 5 mg
Fiber	3 - 5 tbsp
Lecithin	1 - 3 g
Magnesium*
Phosphatidyl choline*
Taurine	500 - 1,000 mg
Vitamin C	1,000 - 3,000 mg

* Please refer to the respective topic for specific nutrient amounts.

Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Dietary Considerations

Gallstones are more prevalent in societies which consume diets high in calories and fat.

With an acute attack, the diet is restricted to a Full Liquid Diet without fat.

Individuals who are poor surgical risks are placed on Low Fat Diets to accommodate transient episodes of impaired fat digestion and absorption. Supplements of fat-soluble vitamins must be provided.

The following foods are not tolerated and should be omitted from the diet:

Greasy or fried foods	Eggs
Mayonnaise	Salad dressing
Cheese products	Pork products
High fat pastries

The following foods may or may not be tolerated:

Onion	Sauerkraut
Cabbage	Radish
Turnip	Cucumber
Spicy foods

The following may be permitted in small amounts:

Whole milk
Butter
Margarine

Homeopathic Remedy

1.* Cholesterinum         - 3X to 15C

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.


References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Tissue Salts

Biliousness

Ferr. Phos.	early stage, with inflammation, fever;
Kali Mur.	white-grey coated tongue, jaundice;
Kali Phos.	bilious disorder (high or low) from nervousness;
Nat. Mur.	drowsiness, jaundice;
Nat. Sulf.	excess bile, greenish-brown coated tongue;

Herbal Approaches

----------
Herbs
-----------

Artichoke leaves (Cynara scolymus)
Boldo (Paemus boldo)
Chamomile
Dandelion
Greater Celandine
Milk Thistle
Olive oil
Peppermint oil
Turmeric

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Artichoke leaves are choleretic (stimulates bile secretion by the liver).

Boldo is useful for gallstones.

Chamomile is anti-inflammatory and relaxes the smooth muscles.

Dandelion may be useful in limiting the episodes of cholecystitis, it is choleretic and a cholagogue agent. (1,000 mg t.i.d.)

Greater Celandine is a major phytomedicine on the German market as a gastrointestinal agent, with sales in excess of $6 million in 1996. It is also approved by the German Commission E for spastic discomfort of the bile ducts and GI tract.

Milk Thistle is choleretic (stimulates bile secretion by the liver).

Olive oil is a popular cholagogue (stimulates gallbladder contraction).

Peppermint oil (2 enteric capsules, b.i.d.) is used as a carminative but together with chamomile, may relax the lower esophageal sphincter and also cause rectal irritation.

Terpene A commercial product (Rowachol), available on prescription, combines a number of plant terpenes e.g. menthol, camphene.

Turmeric is choleretic (stimulates bile secretion by the liver).

References:

Bell, GD & Doran, Gallstone dissolution in man using essential oil preparation. BMJ, 1979, 278:24.

Briggs, C: Peppermint: medicinal herb and flavoring agent. Can. Pharm. J. 1993, 129:89-92.

Ellis, WR & Bell, GD: Treatment of biliary duct stones with terpene preparation. BMJ, 1981, 282:611.

Giachetti, D et al., Pharmacological activity of essential oils on Oddi's sphincter. Planta Med. 1988, 54:389-392.

Hordinsky, BZ: Terpenes in the treatment of gallstones. Minnesota Med. 1971, 54:649-651.

Aromatherapy - Essential Oils

Chamomile Essence,

Peppermint Essence.

Related Health Conditions

Aging	Celiac disease
Cirrhosis	Diabetes mellitus
Fever	Icterus
Indigestion	Infection
Obesity	Oral contraceptives
Pain	Pancreatitis
Pregnancy	Vomiting

Abstracts

References

Alpers, D.H., R.E. Clouse & W.F. Stenson. 1983. Manual of Nutritional Therapeutics. Little, Brown, and Company, Boston. 457 pp.

Baggio, G. et al: Olive-oil-enriched diet: effect on serum lipoprotein levels and biliary cholesterol saturation. Am. J. Clin. Nutr. 1988, 47: 960-964.

Ballentine, R. 1978. Diet And Nutrition. The Himalayan International Institute Pub., Honesdale, Pennsylvania. 634 pp

Bell, G.D. & Doran, J.: Gall stone dissolution in man using an essential oil preparation. BMJ. 1979, 1: 24.

Bergman, F. et al: Gallstone formation in guinea pigs under different dietary conditions. Effect of vitamin C on bile acid pattern. Med. Biol. 1981: 92-98.

Berkow, R. 1977. The Merck Manual. Merck Sharp and Dohme Research Laboratories Pub., Rahway, New Jersey. 2165 pp.

Bland, Jeffrey. Nutraerobics. San Francisco: Harper & Row, 1983.

Bland, Jeffrey. Medical Applications of Clinical Nutrition. New Canaan, Conn.: Keats, 1983.

Breneman, J.C.: Allergy elimination diet as the most effective gallbladder diet. Ann. Allergy, 1968, 26: 83.

Burkitt, D.P. 1971. Etiology of Cancer of the Colon and Rectum. Cancer. Vol. 28.

Capper, W.M. et al: Gallstones, gastric secretion and flatulent dyspepsia. Lancet, 1967, 1: 413-415.

Capron, J.P. et al: Meal frequency and duration of overnight fast: a role in gall stone formation? BMJ. 1981, 283: 1435.

Chicago Dietetic Association and the South Suburban Dietetic Association of Cook and Will Counties. 1981. Manual of Clinical Dietetics. W.B. Saunders Co., Philadephia.

Conter, R.L. et al: Carbohydrate diet-induced calcium bilirubinate sludge and pigment gallstones in the prairie dog. J. Surg. Res. 1986, 40(6): 580-587.

Davidson, C.S. 1978. Nutrition in Diseases of the Gastrointestinal tract: Diseases of the liver. Modern Nutrition in Health & Disease. 6th ed. R.S. Goodhart and M.E. Shils, eds. Lea and Febiger, Philadelphia.

Dorvil, N.P. & C.C. Roy. Taurine Prevents Cholestasis Induced by Lithocholic Acid Sulfate. Am J Of Clinical Nutrition, 37 (1983).

Douglas, B. R. et al: Coffee Stimulation of Cholecystokinin Release and Gallbladder Contraction in Humans, American Journal of Clinical Nutrition, 1990;52:553-6.

Eagles, J.A. & M.N. Randall. 1980. Handbook of Normal and Therapeutic Nutrition. Raven Press, New York. 323 pp.

Eschleman, M.M. 1984. Introductory Nutrition and Diet Therapy. J. B. Lipincott Co., Philadelphia. 464 pp.

Ginter, E. : Reduction of gallstone formation by ascorbic acid in hamsters. Science, 1973, (February 16).

Graham, E.A. et al: Diseases of the Gall Bladder and Bile Ducts. Lea & Febiger, Philadelphia, 1928.

Grundy SM & Barnett JP: Metabolic and health complications of obesity. Dis Mon, 1990 Dec, 36:12, 641-731.

Hamilton, H. K. ed. 1982. Professional Guide To Diseases Intermed Communications Inc. pub, Springfield, Massachusetts. 1323 pp.

Heinerman, John. 1982. Herbal Dynamics. Root of Life, Inc.: Publ.

Holon, K.R. et al: Effect of oral administration of "essential" phospholipid, beta-glycerophosphate and linoleic acid on biliary lipids in patients with cholelithiasis. Digestion, 1979, 19(4): 251-258.

Hordinsky, B.Z.: Terpenes in the treatment of gallstones. Minnesota Med. 1971, 54: 649-651.

Hui, Y.H. 1983. Human nutrition and diet therapy. WadsWorth, Inc; Belmont, California. 1039 pp.

Jenkins, S.A.: Vitamin C and gallstone formation: a preliminary report. Experientia, 1977, 33(6): 716-717.

Jenkins, S.A.: Vitamin C status, serum cholesterol levels and bile composition in the pregnant guinea pig. Br. J. Nutr. 1980, 43(1): 95-100.

Kamrath, R. O. et al: Cholelithiasis in Patients Treated With a Very Low Calorie Diet. American Journal of Clinical Nutrition, 1992;56:255S-7S.

Kirschmann, J.D. 1990. Nutrition Almanac: Nutrition Search. McGrew-Hill: New York.

Koch, M. & F. Orlandi. Effect of Chenodeoxycholic Acid on Liver Function in Man. Digestion, 20. 1980.

Koliado, V.B. [Effects of unbalanced diet on the etiology and course of cholecystitis.] Vopr. Pitan. 1983,6: 23-27.

Kritchevsky, D. & Klurfeld, D.M.: Influence of vegetable protein on gallstone formation in hamsters. Am. J. Clin. Nutr. 1979, 32: 2174.

Kunz, J.R.M. 1982. The American Medical Association Family Medical Guide. Random House Pub, New York. 832 pp.

Leo MA et al., Carotenoids and tocopherols in various hepatobiliary conditions. J Hepatol, 1995 Nov, 23:5, 550-6.

Lillemoe, K.D. et al: Caffeine prevents cholesterol gallstone formation. Surgery, 1989, 106(2): 400-407.

Luke, B. 1984. Principles of Nutrition and Diet Therapy. Little, Brown, and Co., Boston. 816 pp.

Maclure, K.M. et al: Weight, diet and the risk of symptomatic gallstones in middle-aged women. NEJM. 1989, 321(9): 563-569.

Maclure, K.M. et al: Dietary predictors of symptom-associated gallstones in middle-aged women. Am. J. Clin. Nutr. 1990, 52: 916-922.

Magnati, G. et al: [The dietary problem in cholelithiasis and patients at risk.] Acta Biomed. Ateneo Parmense, 1986, 57(5-6): 168-177.

Mamianetti, A. et al: [Biliary lipids and cholesterol saturation rate in relation to lecithin administration by oral route.] Acta Gastroenterol. Latinum, 1979, 9(2): 89-94. (Spanish)

Maurer KR et al., Risk factors for gallstone disease in the Hispanic populations of the United States. Am J Epidemiol, 1990 May, 131:5, 836-44.

Moerman CJ et al., Dietary risk factors for clinically diagnosed gallstones in middle-aged men. A 25-year follow-up study (the Zutphen Study). Ann Epidemiol, 1994 May, 4:3, 248-54.

Murray, M.T., & J.E. Pizzorno. 1991. Encyclopedia of Natural Medicine. Rocklin, Ca; Prima Publishing.

Nakamura-Yamanaka, Y. et al: Effect of dietary taurine on cholesterol 7 alpha-hydroxylase activity in the liver of mice fed a lithogenic diet. J. Nutr. Sci. Vitaminol (Tokyo). 1987, 33(3): 239-243.

Necheles, H. et al: Allergy of the gallbladder: a study using the Graham-Cole test and the leukopenic index. Am. J. Dig. Dis. 1940, 7: 238.

Nervi, F. et al: Influence of legume intake on biliary lipids and cholesterol saturation in young Chilean men. Gastroenterology, 1989, 96(3): 825-830.

Pedersen, L. : Biliary lipids during vitamin C feeding in healthy persons. Scand. J. Gastroenterol. 1975, 10(3): 311-314.

Pixley, F. et al: Effect of vegetarianism on development of gall stones in women. BMJ. 1985, 291: 11-12.

Reif S et al., Gallstones in children. Characterization by age, etiology, and outcome [see comments]. Am J Dis Child, 1991 Jan, 145:1, 105-8.

Report: How sugar can get you stoned. New Scientist, 1985, 14 (March 21).

Rescorla FJ: Cholelithiasis, cholecystitis, and common bile duct stones. Curr Opin Pediatr, 1997 Jun, 9:3, 276-82.

Saito, T. The preventive effect of vitamin E on gallstone formation. I. A study of biliary cholesterol and bile acids in vitamin E-deficient hamsters. Arch. Jpn. Chir. 1987, 56(3): 247-261.

Saito, T. The preventive effect of vitamin E on gallstone formation. 2. A study of the prevention of gallstone formation and protection from liver disorders in hamsters. Arch. Jpn. Chir. 1987, 56(3): 262-275.

Sarles, H. et al: Diet and cholesterol gallstones: a multicenter study. Digestion, 1978, 17(2): 121-127.

Sarles, H. et al: Gallbladder contraction and type of fat. Lancet, 1989, 2: 1399. (Letter)

Scragg, R.K. et al: Diet, alcohol and relative weight in gall stone disease: a case-controlled study. BMJ. 1984, 288: 1113-1119.

Sichieri R et al., A prospective study of hospitalization with gallstone disease among women: role of dietary factors, fasting period, and dieting. Am J Public Health, 1991 Jul, 81:7, 880-4.

Sjovall, J. Dietary Glycine and Taurine on Bile Acid Conjugation in Man. Proc Of Society For Experimental Biology & Med, 100. 1959.

Somerville, K.W. et al: Stones in the common bile duct: experience with medical dissolution therapy. Postgrad. Med. J. 1985, 61: 313-316.

Sturdevant, R.A. et al: Increased prevalence of cholelithiasis in men ingesting a serum-cholesterol-lowering diet. NEJM. 1973, 288(1): 24-27.

Tanno, N. et al.: Effect of taurine administration on serum lipid and biliary composition in man. Tohoku J. Exp. Med. 1989, 159(2): 91-100.

Taylor, K.B. 1983. Gastroenterology - Nutritional Support of Medical Practic. 2nd ed. H.A. Schneider, C.E. Anderson, & D.B. Coursin, eds. Harper and Row, Philadelphia.

Thornton, J.R. et al: Gallstone disappearance associated with weight loss. Lancet, 1979, 2:478. (Letter)

Thornton, J.R. et al: Diet and gallstones: effects of refined carbohydrates on bile cholesterol saturation and bile acid metabolism. Gut, 1983, 24: 2-6.

Tompkins, R.K. et al: Relationship of biliary phospholipid and cholesterol concentrations to the occurrence and dissolution of human gallstones. Ann. Surg. 1970, 172(6): 936-945.

Toouli, J. et al: Gallstone dissolution in man using cholic acid and lecithin. Lancet, ii: 1,124-1,126.

Trotman BW: Pigment gallstone disease. Gastroenterol Clin North Am, 1991 Mar, 20:1, 111-26.

Tuzhilin, S.A. et al: The treatment of patients with gallstones by lecithin. Am. J. Gastroenterol. 1976, 65(3): 231-235.

Vessey, D.A.: The biochemical basis for the conjugation of bile acids with either glycine or taurine. Biochem. 1978, 174: 621-626.

Wang, W.Y. & Liaw, K.Y.: Effect of taurine-supplemented diet on conjugated bile acids in biliary surgical patients. JPEN. 1991, 15(3): 294-297.

Watkins, J.B. Taurine Supplementation: Influence on Bile Acid Kinetics. Pediatric Research, 14. 1980.

Watts, J.M. et al: The effect of added bran to the diet on the saturation of bile in people without gallstones. Am. J. Surg. 1978, 135: 321.

Wood OB & Popovich NG: Nonpharmacologic treatment of obesity. J Am Pharm Assoc (Wash), 1996 Nov, NS36:11, 636-50.

Worthington HV et al., A pilot study of antioxidant intake in patients with cholesterol gallstones. Nutrition, 1997 Feb, 13:2, 118-27.

Wyngaarden, J.B. & L.H. Smith. 1985. Cecil's Textbook of Medicine. Saunders Pub Co., Philadelphia. 2341 pp.

Zoli G et al., Promotion of gallbladder emptying by intravenous amino acids. Lancet, 1993 May 15, 341:8855, 1240-1.