Introduction
The gallbladder stones , as well as those of the bile ducts (of the cystic duct, of the common bile duct but also of the pancreatic duct ), represent the most frequent disturbances and/or complications of the biliary tract; moreover, it seems that (in addition to an individual predisposition) both the onset and the prevention of recurrences strongly depend on the subject’s diet .
Characteristics of Gallstones
In medicine, gallstones are better known as biliary lithiasis . It is estimated that they affect 6-10% of the general adult population with almost double frequency in women compared to men, for a total (in Italy) of about 3,000,000 people. In this regard, see the article relating to the epidemiology and risk factors for the appearance of gallstones .
Not all gallstones are created equal; regardless of subjective differences in size and number, it is possible to distinguish TWO main types of gallstones:
- Based on cholesterol : 75-80% of cases;
- Mixed or pigmented base: about 20% ( calcium bilirubinates , calcium carbonates and phosphates ); of these, some are black and typical of haemolytic or cirrhotic patients , while others are brown and typical of infectious diseases of the gallbladder tree or parasitosis .
NB : Cholesterol-based gallstones prevail in Western patients. These depend significantly on the diet and are formed in three stages:
- Saturation of bile ;
- Nucleation;
- Training.
Food as a Cause
Diet and formation of cholesterol gallstones
Cholesterol-based gallstones form when the balance between:
- Biliary cholesterol (fundamental to the formation of BILE, a chemical digestive juice physically definable as a suspension);
- Bile salts
- Phospholipids .
” If the diet is particularly RICH in cholesterol *, it is possible that the excess of this lipid – steroid in the bile disrupts the balance of the suspension” . In short, the alteration of the balance of bile suspension favors the “precipitation” (the deposit) of cholesterol which subsequently crystallizes and then aggregates and form gallstones.
*See: ” Foods with cholesterol ”
Another extremely important risk factor – and, like the previous one, closely related to the subject’s diet – is the reduced motility/contractility of the gallbladder. This (which in itself could be pathologically sluggish) by contracting mixes and empties the bile preventing the precipitation of cholesterol. Considering that the gallbladder is stimulated by meals and in particular by those containing dietary fat , it can be deduced that: ” a diet characterized by long periods of fasting … or even simply by long dietary periods in lipid deficiency… determines the reduction of the motility of the gallbladder which prevents both the mixing and the emptying of the bile ( biliary stasis ), favoring the precipitation of cholesterol with the subsequent formation of gallstones” .
It is appropriate to also recall other risk factors for the formation of food-dependent gallstones: dyslipidemia , diabetes , obesity , estrogenic therapies and excessively rapid weight loss .
Consequences
Consequences of the Formation of Gallstones
In most cases, people with gallstones remain symptom-free for a long time. In a minority of cases, on the other hand, the following may occur: post-prandial biliary colic and food vomiting for a duration of 30-180′, in which it is often necessary to intervene with a pharmacological therapy based on antispasmodics and painkillers . In the most serious situations it may be necessary to break-remove the stones or even to remove the entire gallbladder ( cholecystectomy ). NB : The routine examination for the diagnosis of gallstones is abdominal ultrasound .
Nutrition for Gallstones
Nutrition in the presence of gallstones and to prevent its formation
The first tip to limit the onset of gallstones is to return to normal weight ; therefore, in conditions of overweight or obesity, low-calorie slimming therapy is necessary NORMO divided: 25-30% of calories supplied by lipids , 13% by proteins (or 0.75-1.2g of proteins per kg of body weight ), and the remainder from carbohydrates .
Secondly, the diet of the subject MUST be aimed at reducing the dysmetabolic conditions mentioned above, therefore useful for returning to normal parameters referring above all to cholesterolemia , triglyceridemia and blood sugar .
As already specified, the diet of the subject potentially at risk must NOT be characterized by long periods of fasting, on the contrary, it is better if (from an organizational point of view) it is divided into at least 5 meals a day.
It is also advisable that the water balance supplied with the diet is sufficient to maintain hydration ; bile is a suspension and as such is also characterized by an aqueous portion. A state of constant dehydration could favor the precipitation of cholesterol, therefore it is advisable to treat:
- The choice of foods with a greater quantity of water ( soupy first courses , vegetables and fruit );
- The habit of drinking about 1ml of water for each kcal introduced; for example, a 1800 kcal diet requires at least 1.8 liters of water.
Some statistical studies have also demonstrated a correlation between a diet rich in refined sugars , low in dietary fiber , and a high incidence of gallbladder stones . This is probably an indirect relationship but, in confirmation of this, it emerged that diets with a predominantly vegetarian diet (which, contrary to what one might think, are NOT HYPOlipidic) are more protective than those with a greater component of foods of animal origin .
It should also be taken into account that, in long-term patients (worse if fed parenterally), the contractility of the gallbladder is strongly limited by the scarcity of stimuli induced by feeding,posture and lack of physical movement.
Finally, regular physical activity is recommended which, probably due to mechanical and/or chemical stress, favors the mixing of bile juices.
