Normally bile holds cholesterol in solution. Cholesterol gallstones form when the cholesterol concentration in bile exceeds the ability of the bile to hold it in solution, and it forms crystals and then stones.
The medical term is cholelithiasis. Chole is from the Greek meaning "bile"; lithos is "stone" and iasis is "condition of" – so it is the condition of having bile stones.
Gallstones are usually formed in the gallbladder. They are made from the bile and consist of mainly two things, cholesterol or bilirubin. The usual center of gallstones is a mixture of cholesterol, bilirubin and calcium, in differing amounts of each.
These stones can be black, red, white, green, or tan-colored. The most common found during a flush is the pea-green color which contains the highest concentration of cholesterol and are generally soft and easy to crumble.
As the stones grow and become more numerous, they clog the tubing, creating back pressure on the liver, causing it to make less bile. The back-up of bile can cause jaundice which gives a yellow coloring to the skin and the whites of the eyes.
Pigment Or Bilirubin Stones
Pigment gallstones are generally black and brown and contain more calcium than cholesterol. They are also called bilirubin stones. Bilirubin is the result of normal breakdown of old red blood cells, or heme catabolism.
Bilirubin is excreted in bile and urine, and too much bilirubin in the bile may end up forming bilirubin stones. This may be indicative of certain diseases including liver disease and bacterial infection.
Research shows that bacteria play a central role in the formation of pigment gallstones. Stones found in the bile ducts, regardless of consistency, nearly always have a bacterial component.
Symptoms Of Gallstones
Gallbladder symptoms can look and feel the same with or without stones. And gallbladder attacks can happen with or without gallstones.
However, when gallstones get stuck, symptoms of an acute gallbladder attack are classic:
- Severe right-sided abdominal pain
- Pain may refer to the right shoulder blade in the back
- Symptoms generally come on at night, especially after eating fatty foods
- Pain may be sharp like a knife, cramp-like when acute
- Pain may be dull and colicky when chronic
- Pain may be worse on a deep inhale
- Pain that makes you double over
- Possible nausea and vomiting
- Possible chills and fever
- Gallbladder chest pain extends to chest from the gallbladder
- Chest pain after eating
- Possible yellowing of the skin and whites of eyes (jaundice)
- Gas and bloating is frequently present
- Possibly belching or burping
Symptoms of a gallbladder attack are often caused by gallbladder stones. A stone may block the neck of the gallbladder or get stuck in a bile duct inhibiting the flow of bile or possibly causing a backing up of bile. However, short of causing an actual attack, stones may be present for years and never cause any symptoms at all.
"Biliary pain can occur in about a third of the gallstone patients" (which leaves two thirds NOT experiencing pain) and "sometimes the gallstone symptoms are difficult to differentiate from that of dyspepsia." (indigestion)
The gallstones can impair the functioning of the gallbladder, however, which can result in any of the common gallbladder symptoms listed above.
If you have been in the ER with a gallbladder attack, chances are your bilirubin levels were elevated. This is usually due to an obstruction of the bile duct most commonly from a gallstone that is trying to pass. Choledocholithiasis is the term given to a stone in the bile duct, usually the common bile duct. Because the bile is not able to flow due to this obstruction, it backs up causing a yellowing or jaundice. It is the conjugated bilirubin that is high in this case and liver enzymes will also be somewhat elevated, especially the GGT. Both levels will level out once the bile is moving again.
What Is A Bile Stone Versus A Gallbladder Stone?
A bile stone is the same thing as a gallstone and a gallbladder stone. Since all gallstones are formed from bile, they are sometimes referred to as bile stones. However, a bile stone or a gallbladder stone can be found in the gallbladder organ, the cystic duct leading out of the gallbladder, the common bile duct, other smaller bile ducts coming from the liver to the common bile duct, and even in the very tiny biliary caniculi within the liver organ itself. Just because it is called a gallstone doesn't mean it is necessarily in the gallbladder itself. However, gallstones in the gallbladder is the most common. Another word for stone is concretion or calculus. Sometimes gallstones will be called biliary calculi or gallbladder calculi.
Cholelithiasis - Managing Gallstones
Gallbladder symptoms can look and feel the same with or without stones. That is why medical testing is so necessary for an accurate diagnosis. Someone will go into the emergency room with a gallbladder attack and be told it's because he has gallstones. The person in the bed next to him also has a gallbladder attack and has an inflamed gallbladder but no stones. A third person has an attack but they can find nothing. This is not an uncommon question I get: "The diagnostic tests are all negative. What do I do now?" People are upset because they want a diagnosis. "But what am I supposed to do with my discomfort if it comes back when the medical people don't know what to do with it?" Hey, lucky you! At least they won't want to cut your gallbladder out! This person is the best candidate for turning around a gallbladder problem with natural products, protocols, and diet.
Apart from life-threatening complications which must be considered carefully and with your doctor, my answer is that you address almost any gallbladder problem the same way, stones or no stones, gallbladder or no gallbladder: with diet, with bile thinning substances, with fat emulsifiers and metabolizers. You support the bile. And you work on improving your overall digestion in general. Gallstones are considered a gallbladder disease, and for any gallbladder problem or disease the above-mentioned principals are the same.
70-80% of people with gallstones never know they have them. These are called "silent gallstones". However, the remaining 20-30% still results in over 800,000 gallbladder removals every year (statistic as of 2009). And since the diet of the general American population is not improving, those numbers are rising.
The risk of silent gallstones causing a gallbladder attack is about 1% per year.
A study in the New England Journal of Medicine compared the mortality rate from emergency surgery performed for obstructing gallstones with the mortality rate from routine, scheduled gallbladder surgery and concluded that the latter gallbladder surgery is actually more dangerous. They advised that "silent" gallstones should not be subjected to surgery but left alone.
And another study reports:
"We conclude that innocent gallstones are not a myth, and that in some populations the majority of silent gallstones are inconsequential. We believe that routine prophylactic operation for silent gallstone disease, at least in white American men, is neither necessary nor advisable."2.
How Do You Get Gallstones?
There are common as well as some less known causes of gallstones. Some people understand immediately why they developed gallstones. They've been living on fast foods, sugars or greasy, fried foods etc.
The ones who eat a healthy, organic and maybe vegetarian diet are more surprised and are looking for answers to how they got gallstones. If you study the list below, you will find many places you may fit.
For example, some people get gallbladder attacks eating wheat or other gluten with no fat on it at all. This is more likely an intolerance to gluten.
A person who is thin, and who has a foggy brain, fatigue, insomnia, anxiety and gallstones could be someone with Hashimoto's. Not all these symptoms need to be present and there are many others that could be. Read the page on hypothyroidism if any of that sounds familiar.
It's important that you identify the causes that are contributing to your gallstone problem, because even if you choose to remove your gallbladder, the root of the problem has not been addressed and could be contributing to more than just gallstones. Use this time and this condition as a motivation to look into your overall health.
One can't do too much about these first four causes of gallstones:
- Over 40
There are many studies backing up that list. I am including here an abstract from the journal "Medical Hypothesis" entitled "Alternative Treatment of Gallbladder Disease" because it enumerates several causes of gallbladder disease and gallstones. Note that gallstones is disease of the gallbladder.
"Major risk factors for gallbladder disease include a sedentary lifestyle and a diet rich in refined sugars. In genetically prone individuals, these two factors lead to an abnormal bile composition, altered gut microflora, and hyperinsulinemia, with resulting gallstone formation. As a large percentage of gallbladder patients have continued digestive complaints following cholecystectomy, the author examines complementary and alternative medicine (CAM) treatments to counteract gallstone formation. Herbal medicine such as turmeric, oregon grape, bupleurum, and coin grass may reduce gallbladder inflammation and relieve liver congestion. Elimination of offending foods, not necessarily 'fatty' foods, is often successful and recommended by many holistic physicians. Regular aerobic exercise has a beneficial effect on hyperinsulinemia, which is often associated with gallbladder disease. Dietary changes that lower plasma insulin levels, such as a change in dietary fats and substitution of unrefined carbohydrates for refined carbohydrates, may also be helpful."8
How Do Gallstones Form?
Stasis or stagnation of bile or incomplete emptying of the gallbladder causes the bile to coagulate or precipitate and clump together into stones. Sometimes it will form one large stone the size of a large marble or even a golf ball.
The precursor to stones will be what is termed "sludge". A more scientific explanation would be that cholesterol stones are caused by the imbalance of cholesterol to bile salts, too much of one or not enough of the other. There can also be too much bilirubin. So what good is that information? How can we control the "too much" of any of the above?
The following research makes much more practical sense as far as we are concerned:
"Formation of pure cholesterol stones is initiated by an excessive intake of highly purified carbohydrates, a large intake of animal fats and a restricted intake of vegetable fibers. When the protein content of the lithogenic diet was reduced, mixed or combined, stones were formed in golden hamsters. These experimentally, dietarily produced gallstones had compositions and fine structures similar to those of human gallstones. Some mentions were made of black stones which were found in the aged golden hamsters fed with lithogenic diets."
Translation: Cholesterol stones are formed by eating a diet high in refined foods, especially white foods – sugar, white bread, pasta, pastries, sodas, – and by eating too much meat and not enough vegetables.
When the protein content of your diet is low and just the sugars (refined carbohydrates) are eaten, the calicified stones began to form along with the softer cholesterol ones. The black stones that are sometimes passed during a flush or found in a surgically-removed gallbladder, seem to be older stones that have been there for a long time. Lithogenic means contributing to the formation of stones.
There is also the medical opinion that some pharmaceutical drugs may contribute to the formation of gallstones.
An underlying hypothyroid condition could also contribute to the formation of gallstones according to research. A low-functioning thyroid means that the metabolism in general is slow. The gallbladder may not empty as efficiently as it should, contributing to a condition of stasis as well.
Food allergies also play a big part in gallstones. For information on which foods are most likely to contribute to gallbladder stones and to gallbladder attacks, read the gallbladder diet page. And to discover what food intolerances you may have, check out our allergy diet page.
Gallstones And Pregnancy
Pregnancy is a risk factor for gallstones because of the high hormone levels. The excess hormones result in excess cholesterol in the bile which can form stones. Also, studies show that progesterone, which is the hormone of the highest levels during pregnancy, has a relaxing or inhibitory effect on the gallbladder. This results in lower functioning than normal.
Catching the stones early when they are small and less in number makes it easier to manage with diet and natural supplements. Don't try to eat a non-fat diet, unless you absolutely cannot tolerate fat at all. Usually good fats such as Omega 3's like flax oil are quite digestible and needed by the body and the brain. Olive oil in small doses is also recommended. The oil contained in fish is easier to digest than that in meats as well.
Avoid eggs, onions, and pork and follow the gallbladder diet as well as you can, taking care to get all the calories and protein that you need. There are specific foods to avoid with gallstones specifically as well as good foods to include. Download our Gallstones Diet here.
Surgery is not usually recommended in the first or third trimesters of pregnancy anyway, so finding a way to control the symptoms naturally is usually necessary.
Diagnosis Of Gallstones
Frequently, gallstones are discovered during tests for other health conditions. When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam—the most sensitive and specific test for gallstones. A handheld device, which a technician glides over the abdomen, sends sound waves toward the gallbladder. The sound waves bounce off the gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture of the gallbladder on a video monitor. If gallstones are present, the sound waves will bounce off them, too, showing their location.
CT Scan Or Computerized Tomography
The CT scan is a non-invasive x ray that produces cross-section images of the body. The test may show the gallstones or complications, such as infection and rupture of the gallbladder or bile ducts.
ERCP Or Endoscopic Retrograde Cholangiopancreatography
ERCP is used to locate and remove stones in the bile ducts. After lightly sedating you, the doctor inserts an endoscope—a long, flexible, lighted tube with a camera—down the throat and through the stomach and into the small intestine. The endoscope is connected to a computer and video monitor. The doctor guides the endoscope and injects a special dye that helps the bile ducts appear better on the monitor. The endoscope helps the doctor locate the affected bile duct and the gallstone. The stone is captured in a tiny basket and removed with the endoscope.
Blood tests may be performed to look for signs of infection, obstruction, pancreatitis, or jaundice.
Importance Of Diagnosis
Because gallstone symptoms may be similar to those of a heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis, an accurate diagnosis is important.
The standard removal of gallstones in the gallbladder is gallbladder surgery to remove the whole organ. Removal of gallstones from the common bile duct is usually done manually. The following methods are not always effective and therefore are not commonly prescribed over the option of gallbladder removal. They will most commonly be used for stones in the ducts.
Bile Salt Therapy
Ursodiol is a natural occuring bile salt or bile acid. Actigall is one brand name for ursodiol. Although ursodiol has been FDA approved for dissolving cholesterol gallstones and for the prevention of gallstones, since the introduction of the laparoscopy, gallbladder removal is the medical treatment of choice for gallstones. Surgery is quick; dissolving gallstones with ursodiol or other bile salts takes a long time. And whether done via lithotripsy or bile acids, research shows that 50% of the time the stones will come back.5 The same will be true for liver and gallbladder flushes, too, unless dietary changes are made and fat digestion is improved.
Gallbladder And Liver Flush
Gallstones may sometimes be removed from the gallbladder by means of a gallbladder and liver flush. However, this is generally safer with small stones and very difficult with large ones. It is advisable to take time to prepare for a flush. While flushes seem to work well for some peope, I am not a big fan since sometimes a stone will get stuck.
(1)Torsoli A, Corazziari E, Habib FI, Cicala M. Scand J Gastroenterol Suppl. 1990;175:52-7.
(2) The physicochemical basis of cholesterol gallstone formation in man William H. Admirand and Donald M. Small 1Boston University Medical School, Department of Medicine, Section of Gastroenterology, Boston, Massachusetts 02118
(3) Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg 1993; 165: 399-404.
(4) Nagase M, Hikasa Y, Tanimura H, Setoyama M, Kamata T, Mukaihara S, Maruyama K., Etiology of cholesterol gallstones., Gastroenterol Jpn. 1979;14(1):40-7
(5) Ruppin DC, Dowling RH.Is recurrence inevitable after gallstone dissolution by bile-acid treatment? Lancet. 1982 Jan 23;1(8265):181-5.
(6) Weinstein S, Lipsitz EC, Addoniziol L, et al. Cholelithiasis in paediatric cardiac transplant patients on cyclosporin. J Pediatr Surg 1995;30:61-4.
(7) Carey MC.,Pathogenesis of gallstones.Recenti Prog Med. 1992 Jul-Aug;83(7-8):379-91
(8) M.M. Moga, Alternative treatment of gallbladder disease, Medical Hypothesis Volume 60, Issue 1, Pages 143-147 (January 2003)
(9)Igimi H, Tamura R, Toraishi K, Yamamoto F, Kataoka A, Ikejiri Y, Hisatsugu T, Shimura H. Dig Dis Sci. 1991 Feb;36(2):200-8 Medical dissolution of gallstones. Clinical experience of d-limonene as a simple, safe, and effective solvent. Shionogi Research Laboratories, Shionogi & Co., Ltd., Osaka, Japan
(10,12) Hiroshi Tanimura and Yorninori Hikasa, The Etiology and Pathophysiology of Cholelithiasis. Journal of Gastroenterology, Springer Japan ISSN0944-1174 (Print) 1435-5922 , Volume 10, Number 1 / March, 1975
(11)U. Leuschner, M. Leuschner, J. Sieratzki, W. Kurtz and K. Hübner,Gallstone dissolution with ursodeoxycholic acid in patients with chronic active hepatitis and two years follow-up. Springer Netherlands, Digestive Diseases and Sciences, Volume 30, Number 7 / July, 1985
(12)William A. Gracie, M.D., and David F. Ransohoff, M.D.,The Natural History of Silent Gallstones — The Innocent Gallstone is Not a Myth, N Engl J Med 1982; 307:798-800September 23, 1982
Burden of digestive diseases in the United States Part III: Liver, biliary tract, and pancreas. Everhart JE, Ruhl CE, Gastroenterology. 2009 Apr; 136(4):1134-44.
>800,000 cholecystectomies annually in US alone as of 2009