In Western countries, gallbladder sludge and gallstones are common phenomena. In fact, 10% of the population may have gallbladder sludge or gallstones. We don’t know for sure, as these conditions often don’t cause any significant symptoms. This means many people are unaware they have a potential problem with a build-up of sludge in the gallbladder.
So what are gallbladder sludge and gallstones?
The liver makes bile to aid in the digestion of fats. Bile flows from the liver into the small intestine. A portion of this bile is stored in the gallbladder. When food enters the small intestine it stimulates the gallbladder to contract. This squeezes the stored gallbladder bile into the small intestine so that it can help to break down fats for absorption.
Bile stored in the gall bladder is more concentrated than the bile that the liver secretes. The gallbladder concentrates bile by removing water and electrolytes. In fact, if bile is in the gallbladder for too long it can become thick and stagnant. As the bile thickens it becomes supersaturated with cholesterol. The waxy cholesterol begins to form particles or crystals of cholesterol. The cholesterol crystals mix with mucous from bile, forming bile sludge. Gallbladder sludge makes gallstone formation much more likely. The biliary sludge particles can grow in size and become gallstones. There are also other types of gallstones but these are the most common.
Symptoms of gallbladder disease
Pain in the upper right part of the abdomen is the most common symptom. This abdominal pain is felt around or behind the lowest rib on the right-hand side. The pain, called biliary colic can be quite intense and usually occurs straight after eating. Pain may also occur towards the right shoulder or right shoulder blade tip. Still more symptoms may occur after eating, such as nausea, bloating or fullness after eating. Though these symptoms are not always suggestive of gallstones.
If a gallstone is trapped in a bile duct it can cause intense pain and inflammation. Cholecystitis is the medical term for gallbladder inflammation. The obstruction of the bile duct prevents bile flow and pressure builds up. Increasing pressure leads to pain that can be extreme. Acute cholecystitis is a medical emergency, requiring a trip to hospital and perhaps gallbladder removal.
Risk factors for developing gallstones
Women are much more likely to develop gallstones than men. This has to do with the effect of female hormones. The oral contraceptive pill, hormone replacement therapy and pregnancy all increase the risk. This is because oestrogen increases the amount of cholesterol in bile.
Genetics also play a role. Certain populations of people are much more likely to develop gallstones. For instance, Western Europeans, Hispanic and Native American people are at higher risk. Whilst people from Eastern Europe, Japan or African Americans are less likely to develop gallstones.
Dietary and lifestyle are also important factors. Diets rich in processed carbohydrates and sedentary lifestyles are known risk factors. Fasting and rapid weight loss also increase risk. People that are overweight and/or have insulin resistance are far more likely to develop gallstones. On the other hand, people wishing to lose weight should do so gradually. Losing no more than 1.5kg per week to avoid bile stagnation.
Providing there are no gallstones causing obstruction, in general the aim should be to keep the bile dilute and moving. Bile can flush the ducts of the liver and gallbladder. So that it does not become stagnant or concentrated with cholesterol. I encourage fluidity and hydration by drinking plenty of water or herbal teas.
In people with symptoms, avoiding fat in the diet can reduce symptoms but causes bile to stagnate. Eat healthy fats with each meal, little and often. This can ensure that the gallbladder squeezes out bile regularly.
Studies show that people with gallstones tend to eat less fibre, fish and fruit. And, they tend to eat more sugar, cereals and calories. A Mediterranean type diet is likely to provide many of the preferred qualities. As this type of diet is rich with colourful vegetables, fruits and healthy fats.
Any food that provokes acute symptoms should be avoided.
Keep blood sugar levels stable by minimising refined sugars and carbohydrates. A low-glycemic index diet can help to keep cholesterol levels lower.
Enjoy regular exercise. This helps to lower cholesterol levels and has a beneficial effect on glucose metabolism.
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