Gallstones & Weight Loss FAQs

Like many others, my mother has had issues with her gut most of her life. Several years ago, she experienced an episode of excruciating pain in her chest. Fearing a heart attack, she called an ambulance, but by the time they arrived, the pain had subsided. After some investigation, it was discovered she had sludge in her bile ducts and gallstones in the gallbladder. She tried a low-fat diet for some time, but several attacks later, she opted to have her gallbladder removed. 

While it may seem a little scary to have an organ taken out, the human body is capable of functioning without a gallbladder. There just may be some things that don’t digest as well afterwards, like high fat foods, but this can be managed with some dietary adjustments. 

Let’s take a look at the gallbladder and the causes, symptoms, and treatment options for gallstones

What is the function of the gallbladder?

The gallbladder is a small organ that stores bile, a fluid made by the liver to help digest fats. It removes water from the bile, making it more concentrated. When a person eats foods high in fats or oils, the gallbladder releases the concentrated bile into the small intestine to help break down the fats.

What are gallstones?

Gallstones are small, hard stones that form in the gallbladder. They are made from a mix of cholesterol, bile pigment, and calcium. Gallstones can form for a few reasons, such as when too much cholesterol in the bile crystallizes or when the gallbladder doesn’t empty properly. Most of the time, gallstones don’t cause any issues. However, if they block the bile ducts, they can lead to serious problems like infections or inflammation of the pancreas, which may require quick medical treatment. Gallstones are a common problem with the digestive system, especially in people over 50, and affect about 15% of the population of the USA.

What are the symptoms of gallstones?

Gallstones often don’t cause any symptoms. When symptoms do appear, they can include pain in the abdomen or back, which is usually severe but happens only once in a while. The pain may get worse after eating a meal high in fat. Other possible symptoms are yellowing of the skin and eyes (jaundice) or a fever with pain if the gallbladder or bile duct gets infected.

What are the types of gallstones?

Gallstones come in three main types. Mixed stones are the most common. They are made of cholesterol and salts and usually form in groups. Cholesterol stones are mostly made of cholesterol, a fatty substance the body needs for certain processes. These stones can grow big enough to block bile ducts. Pigment stones are formed from bile, which is greenish-brown because of certain pigments. These stones are usually small but appear in large numbers. 

What are the risk factors for gallstones?

Gallstones are more likely to affect women than men, especially those who are overweight or have a family history of the condition. There isn’t one specific cause of gallstones. In some cases, the liver makes too much cholesterol, which can lead to tiny crystals forming in bile that eventually turn into stones. In other cases, gallstones may form due to changes in the makeup of bile or because the gallbladder doesn’t empty properly.

How are gallstones diagnosed?

Doctors can use several tests to check for gallstones. These include:

• A physical exam and x-rays to look for signs of gallstones.
• An ultrasound, which uses soundwaves to create an image that can show gallstones.
• An endoscope test (ERCP), where a thin tube is passed through the throat into the digestive system. Dye is then injected to make x-ray images clearer.
• An HIDA scan, where a special nuclear scan checks how well the gallbladder is working.
• A MRCP scan, which is a type of scan that creates detailed images of the liver, pancreas, and bile ducts, similar to what the ERCP test shows. 

What are the treatments for gallstones?

When gallstones don’t cause symptoms, treatment is usually not needed. However, certain complications may require medical attention:

• Biliary colic: A gallstone may move into the neck of the gallbladder (cystic duct) and block it, causing severe pain and fever.
• Gallbladder inflammation (cholecystitis): A blocked gallbladder duct can lead to infection and swelling of the gallbladder, resulting in intense abdominal pain, nausea, and vomiting.
• Jaundice: If a gallstone blocks the bile duct to the bowel, bile can enter the bloodstream instead of the digestive system. This can turn the skin and eyes yellow, and urine may appear orange or brown.
• Pancreatitis: A blocked bile duct near the pancreas can cause the pancreas to become inflamed. This results in irritation and leakage of enzymes into the abdomen.
• Cholangitis: When a bile duct is blocked and becomes infected, it can lead to pain, fever, jaundice, and shaking chills (rigors).
• Liver infection: A blockage can also lead to infections in the liver.
• Gallbladder cancer: Though rare, long-term issues with gallstones can increase the risk of cancer in the gallbladder.

The treatment for gallstones depends on their size and where they are located. Options may include the following:

• Adjusting the diet to cut back on or avoid fatty foods and dairy products.
• A lithotripsy. This is a procedure that uses soundwaves to break gallstones into smaller pieces. It’s not common and is mostly used for stones stuck in the bile duct, not the gallbladder.
• Some medicines can dissolve gallstones, but these are rarely used because of side effects and mixed results.
• Surgery, the most common treatment for gallstone symptoms. About 80% of people will need surgery, which could involve removing the entire gallbladder (cholecystectomy) or just removing stones from bile ducts. 

When is surgery required for gallstones?

Doctors might take out a person’s gallbladder if gallstones or other gallbladder problems are causing issues. This surgery is called a cholecystectomy and can be done as keyhole surgery (laparoscopic) or through open surgery. Since the gallbladder isn’t essential for survival, the body can function without it.

There are two main ways doctors can remove the gallbladder:

• Laparoscopic/keyhole surgery. This involves making small cuts in the skin. Through these cuts, the surgeon can remove the gallbladder.
• Open surgery. In this method, the surgeon makes a larger cut in the abdomen to reach and remove the gallbladder. Open surgery is usually done if the patient has scar tissue from earlier surgeries or a condition like a bleeding disorder.

Right after gallbladder surgery, patients may experience mild shoulder pain caused by the carbon dioxide gas used during the procedure. They will likely be given pain medication to help manage discomfort. If the surgery was done laparoscopically, most patients stay in the hospital overnight. However, if it was open surgery, the hospital stay can last longer.

How does weight affect gallstones?

People who are overweight or obese are more likely to get gallstones, especially women. This could be because obesity can lead to higher cholesterol levels in bile, which might cause gallstones to form. Obesity can also affect how well the gallbladder works, as larger gallbladders are less efficient. People who store most of their body fat around their waist have a higher chance of developing gallstones compared to those who store fat around their hips and thighs.

Losing weight too fast can increase the risk of gallstones. It’s important to talk to a doctor to learn safe ways to lose weight.

How does fast weight loss affect gallstones?

If someone goes a long time without eating or loses weight too quickly, their liver might release more cholesterol into the bile. Rapid weight loss can also make it harder for the gallbladder to empty as it should. Weight-loss surgery, also known as bariatric surgery, can cause rapid weight loss, which increases the chances of developing gallstones. Weight loss medications such as Wegovy have gallstones listed as a potential side effect for this reason.

People who are starting a very low-calorie diet or having weight-loss surgery should talk to their doctor about ways to avoid gallstones. A medication called Actigall can help prevent gallstones, especially in those who lose weight quickly through strict diets or surgery.

Is weight cycling a problem?

Repeatedly losing and gaining weight, known as weight cycling, can increase the risk of gallstones. The more often someone goes through this cycle, the higher their chances of getting gallstones. Crash diets that claim to help people lose weight fast should be avoided. Instead, it’s better to focus on losing weight slowly and keeping it off in the long run.

How can I safely lose weight to lower my chances of getting gallstones?

Losing weight slowly can help reduce the risk of gallstones. Experts suggest that people who are overweight or obese aim to lose five to ten percent of their starting weight over six months.

Making healthy food choices can help with weight loss and may also reduce the risk of gallstones. Staying active is another way to lower the chances of getting gallstones while also improving overall health. Experts recommend at least 150 minutes of moderate exercise each week, such as brisk walking or dancing. To stay fit, adults should also include strength training, like lifting weights, twice a week.

It’s important to check with a doctor before beginning a new diet or exercise plan to improve health or keep off lost weight.

FAQs

What is the fastest way to relieve gallstones?

Gallstones are often treated most effectively with surgery, which usually involves removing the gallbladder to prevent stones from recurring. For individuals who cannot have surgery, medications like Actigall can be used to dissolve existing gallstones. To ease gallbladder pain, applying a warm compress to the area may provide relief.

Can gallstones go away on their own?

Small stones or sludge may pass naturally through the bile duct and bowel or be treated with medication. However, larger stones can cause inflammation and infection, often requiring an urgent cholecystectomy to address the issue.

Can you still get gallstones without a gallbladder?

Some individuals with gallstones will experience stones forming in the common bile duct, a narrow tube that transports bile from the gallbladder to the intestines. Having a history of gallstones increases the risk, but choledocholithiasis can still develop in those who have undergone gallbladder removal.