Gallbladder disorders, particularly gallstones, are an extremely common problem in Western societies, affecting around 10% of the population. Gallstones often cause no symptoms, but when they do, these can be extremely unpleasant, ranging from recurrent pain to life-threatening complications. After being diagnosed with gallstones, many people feel uncertain about what they can eat, how they should change their lifestyle, and what treatment options are available to them. In this article, we provide a detailed overview of the background to gallstones, the symptoms, the principles of a healthy diet and lifestyle, as well as the latest diagnostic and therapeutic procedures available for the Endomedix Gastroenterology Centre are also available to experts.
What is gallstones and how do they form?
Bile is a digestive fluid produced by the liver that helps break down fats. The gallbladder is a small, pear-shaped organ situated beneath the liver, which stores and concentrates this bile. When you eat, the gallbladder contracts and releases bile into the small intestine.
Gallstones form when the balance between the components of bile – cholesterol, bilirubin (bile pigment) and calcium salts – is disrupted. As a result, the bile becomes supersaturated, and the dissolved substances coalesce into solid crystals and then into stones.
Types of gallstones:
- Cholesterol stones: These are the most common in Western countries, accounting for approximately 75% of cases. They are usually yellowish-green in colour and form when the bile contains too much cholesterol, which it is no longer able to keep in solution.
- Pigment stones (bilirubinate stones): They are smaller and darker, and consist mainly of bile pigment, i.e. bilirubin. Their formation is often linked to conditions involving increased breakdown of red blood cells (e.g. sickle cell anaemia) or to infections of the bile ducts.
Who is most at risk of developing gallstones?
Anyone can develop gallstones, but certain factors increase the risk. These are known as risk factors:
- Age: The risk increases with age.
- Female: Gallstones are approximately twice as common in women, a fact which can be explained by the effects of female sex hormones, particularly oestrogen.
- Family accumulation: Genetic predisposition also plays a role.
- Pregnancy and childbirth: Hormonal changes during pregnancy and elevated cholesterol levels contribute to the formation of kidney stones.
- Medicines: Certain medicines, such as oestrogen-containing preparations (contraceptives, hormone replacement therapy), cholesterol-lowering fibrates or octreotide, may also increase the risk.
- Obesity: Being overweight, particularly abdominal obesity, is a significant risk factor when combined with insulin resistance. Obesity increases the excretion of cholesterol by the liver.
- Rapid weight loss: Rapid weight loss following drastic diets or weight-loss surgery alters the composition of bile and reduces the motility of the gallbladder, which can also lead to the formation of gallstones.
- Western-style diet: A diet high in fat and refined carbohydrates but low in fibre promotes the formation of gallstones.
- Other diseases: Diabetes, cirrhosis, Crohn’s disease and diseases affecting the final section of the small intestine (the ileum) or the removal of this section also increase the risk.
Symptoms of gallstones: From ‘silent stones’ to biliary colic
Between 70 and 75% of people with gallstones are completely asymptomatic. In such cases, the stones are often discovered by chance during an abdominal ultrasound scan carried out for another reason. These are known as „silent stones” and generally do not require treatment.
However, if a stone blocks the cystic duct or the common bile duct, characteristic and painful symptoms may occur.
The most common symptoms:
- Biliary colic: This is the most characteristic symptom. It is a sudden-onset, intense, cramping or gnawing pain in the upper right side of the abdomen or just below the breastbone. The pain often radiates towards the right shoulder blade or down the back. It usually occurs after a fatty meal, or occasionally at night, and can last from a few minutes to several hours.
- Nausea, vomiting: The pain is often accompanied by nausea and vomiting.
- Bloating, indigestion: Some patients report vague abdominal discomfort, a feeling of fullness and bloating, particularly after eating fatty foods.
When should we seek medical advice immediately?
If any of the following symptoms occur alongside abdominal cramps, this may indicate a serious complication and requires immediate medical attention:
- High fever, chills (may be a sign of gallbladder inflammation)
- A yellowish discolouration of the skin and the whites of the eyes (jaundice), dark urine, pale stools (signs of a bile duct obstruction)
- Severe, persistent abdominal pain
Lifestyle and diet for gallstones
A diagnosis of gallstones does not mean that you can never eat delicious food again. However, making conscious changes to your diet and lifestyle is essential for preventing symptoms and avoiding spasms. The aim is to avoid fatty, hard-to-digest foods, which can trigger the contraction of the gallbladder.
Foods and ingredients to avoid
- Fatty meats and cold cuts: pork fat, bacon, crackling, sausage, salami, fatty poultry skin.
- Full-fat dairy products: high-fat milk, cream, sour cream, full-fat cheeses (e.g. Camembert, Trappist).
- Baking fats: foods fried in oil (breaded meat, chips), mayonnaise, fatty sauces.
- Egg yolk: on its own or in larger quantities (e.g. scrambled eggs).
- Vegetables that cause flatulence: cabbage, kale, cauliflower, broccoli, dried beans, lentils, green peppers. These may be consumed depending on individual tolerance.
- Sweets: chocolate, oily seeds (walnuts, hazelnuts), cakes made with rich creams.
- Spices: strong, hot spices such as chilli, hot paprika and black pepper.
- Alcohol and fizzy drinks.
Recommended foods and dietary advice
A gallbladder-friendly diet is based on a low-fat, high-fibre and easily digestible diet.
- Lean meats: chicken breast, turkey breast (skinless), fish, lean pork loin. These should be prepared by steaming, boiling, grilling or baking in a roasting bag.
- Low-fat dairy products: 1.5% milk, yoghurt, kefir, low-fat quark, low-fat cheeses.
- Cereals: white bread (easier to digest than wholemeal), rolls, croissants, rice, potatoes, porridge.
- Vegetables and fruit: Most fruit and vegetables can be eaten (apart from those that cause flatulence), preferably peeled and steamed. Soups and vegetable stews (thickened with a low-fat roux) are good choices.
- Fats and oils: only in minimal quantities, in the form of vegetable oils (e.g. olive oil), used primarily in food preparation, not added afterwards.
- Fluid intake: It is particularly important to drink plenty of fluids – 2–2.5 litres a day – primarily in the form of water and herbal teas (e.g. camomile, peppermint).
Practical advice on eating:
- Eat frequently, but in small portions! Eating 5–6 small meals a day puts less strain on the digestive system and the gallbladder than 2–3 large, hearty meals.
- Avoid overeating! Never eat until you’re completely full.
- Please bear in mind individual tolerance levels! Keep a food diary to find out which foods cause you problems. What causes problems for one person may not necessarily cause problems for someone else.
- Eat slowly and chew thoroughly! Eating slowly and chewing thoroughly aids digestion.
Weight management and exercise
Losing excess weight can reduce the risk of developing gallstones and alleviate symptoms, but it is crucial that weight loss is gradual (0.5–1 kg per week). Drastic, rapid weight loss can make the situation worse. Regular, moderate-intensity exercise, such as walking, swimming or cycling, also helps to maintain a healthy weight and improves general well-being.
Complications and treatment of gallstones
Although gallstones may remain asymptomatic for a long time, they can cause serious complications that require medical intervention.
Possible complications:
- Acute cholecystitis: A persistent blockage of the bile duct leads to inflammation of the gallbladder. This is characterised by severe abdominal pain, fever and chills. It requires hospital treatment.
- Bile duct obstruction (choledocholithiasis): If a stone from the gallbladder enters the common bile duct and becomes lodged there, it blocks the flow of bile into the small intestine. This can cause jaundice, severe pain and inflammation of the bile ducts (cholangitis).
- Acute pancreatitis (acute biliary pancreatitis): If a gallstone becomes lodged at the junction of the bile duct and the pancreatic duct, this can lead to a build-up of pancreatic juices and „self-digestion” of the pancreas – that is, a severe, life-threatening inflammation.
- Gallbladder cancer: A rare but serious complication, the risk of which is increased by chronic gallstones and inflammation.
Diagnostic procedures
A suspicion of gallstones arising from the symptoms can be confirmed by imaging tests. The Endomedix Gastroenterology Centre It has a range of modern diagnostic tools to enable an accurate diagnosis to be made.
- Abdominal ultrasound: The primary and most important test. It is painless, quick and extremely reliable in detecting stones in the gallbladder and signs of cholecystitis.
- Endoscopic retrograde cholangiopancreatography (ERCP): A specialised endoscopic procedure used when a gallstone is suspected. During the procedure, a thin, flexible instrument (endoscope) is passed through the mouth and stomach into the small intestine, where the bile duct opens. By injecting a contrast medium and using an X-ray screen, the bile ducts can be visualised. ERCP is not only a diagnostic but also a therapeutic procedure: stones in the bile duct can be removed during the examination.
- Magnetic resonance cholangiopancreatography (MRCP): A non-invasive imaging technique that does not involve radiation exposure and provides detailed images of the bile ducts and pancreatic ducts.
Treatment options
Treatment depends on whether the gallstones are causing symptoms and, if so, what those symptoms are.
- Asymptomatic gallstones: It does not usually require treatment, only regular medical check-ups and following lifestyle advice.
- Symptomatic gallstones (biliary colic): The definitive treatment for gallstones causing symptoms is the surgical removal of the gallbladder (cholecystectomy). Nowadays, this is usually carried out using the laparoscopic (keyhole surgery) method, which involves smaller incisions, a quicker recovery and less pain. After the operation, the liver continues to produce bile, but it is no longer stored in the gallbladder; instead, it flows continuously into the small intestine. Most patients lead a normal life after the operation, but it is recommended that they follow a low-fat diet for a while.
- Gallstone: As mentioned, these are removed endoscopically during an ERCP procedure, often prior to or in conjunction with gallbladder surgery.
Medical treatment for kidney stones is now only considered in very rare, specific cases, as it is a lengthy process, less effective, and stones often recur after treatment.
The road to recovery
Gallstones are a manageable condition that can be well controlled through a suitable lifestyle and, where necessary, modern medical interventions. If you have been diagnosed with gallstones or are experiencing the symptoms described above, do not hesitate to consult a specialist. A timely diagnosis and personalised treatment can prevent painful spasms and serious complications.
From Endomedix Gastroenterology Centre Its team of experienced gastroenterologists and state-of-the-art diagnostic facilities provide support in the accurate diagnosis of gallstones and other digestive system disorders, and in devising the most appropriate treatment plan. Take a step towards better health and a symptom-free everyday life!
