The Three Conditions for Gallstone Formation

There’s a long list of possible causes of gallstones and gallbladder diseases. However, in terms of mechanism, only three conditions must be satisfied before cholesterol gallstone formation begins. They are:

  • Cholesterol supersaturation of the bile
  • Excessive secretion of gallbladder mucus
  • Accelerated crystallization of cholesterol

Lithogenic Bile and Gallstone Formation

In Greek, ‘litho’ means stone. And as the root word suggests, lithogenic bile is a potential stone former. Sometimes, it is also called supersaturated bile. Lithogenic bile happens when there is excessive cholesterol production or reduced bile acid and phospholipid secretion in the liver. It may also be a combination of both conditions.

Under normal circumstances, the liver produces just enough cholesterol to support the body’s metabolic processes. Some of the functions of cholesterol in the body include:

  • Synthesis of certain hormones such as estrogen, testosterone, and adrenal hormones
  • Formation of cell membranes and cell structures
  • Vitamin D production
  • Bile acid production

Liver diseases such as nonalcoholic fatty liver disease (NAFLD), cirrhosis, and hepatitis may interfere with the liver’s standard cholesterol production rate. Other factors such as heredity, age, and sex may predispose an individual to high cholesterol levels. Foods high in saturated and trans fat also affect the blood and the bile’s cholesterol saturation.  

Aside from increasing the likelihood of gallstone formation, a lithogenic bile may also lead to increased free radical-mediated damage from hydrophobic bile salts. Free radicals also increase the chances of gallstone formation. Oxidative stress in the gallbladder prompts inflammation and induces cholesterol gallstone formation within the supersaturated bile.

Gallbladder Mucus Contributes to Gallstone Formation

The gallbladder, stomach, colon, and other peripheral organs naturally secrete mucus. It is made up of glycoproteins that protect and lubricate cell surfaces. Gastric mucus acts as a barrier for the stomach wall from acid and digestive enzymes within the stomach lumen. Mucus-secreting cells are the most abundant type of cell present in the stomach.

In the gallbladder, mucus is essential for bile movement. Gel-forming mucins also form polymers that serve as protection from the detergent effect of bile. Moreover, the mucous membrane lining the gallbladder increases the area of fluid absorption within the organ. The presence of gallbladder mucus helps the organ absorb water and inorganic salts from the bile. The cells of the mucous membrane cause the stored bile to be about 5 to 15 times more concentrated than when it was produced in the liver, making the gallbladder bile more effective in digesting fats and fat-soluble vitamins.

Unfortunately, some conditions may cause hypersecretion of gallbladder mucus. Although the exact causes and mechanisms of excessive gallbladder mucus production are still unknown, studies show that lithogenic bile, inflammation, allergy attacks, and a high cholesterol diet trigger overproduction.

As the body detects too much fat intake, it tries to produce more mucus to help with cholesterol transport. When there’s too much mucus, it accumulates as a viscous gel within the gallbladder lumen. This gel becomes a favorable environment for the crystallization of cholesterol particles. Studies also show that a component of lithogenic bile stimulates the hypersecretion of gallbladder mucin. So unless the trigger point is addressed, it becomes a cycle that ultimately results in cholesterol gallstone formation. 

Inflammation and Allergy

Another possible explanation why the gallbladder may produce too much mucin is the activation of prostaglandins. Prostaglandins are hormones created at the site of injury or inflammation. Under normal circumstances, they help the body heal and are a crucial part of the recovery process. Unfortunately, they also prompt the gallbladder to secrete too much mucus. Prostaglandins are activated when we ingest fatty foods and allergens. This reaction also happens when we are suffering from cholecystitis or other forms of chronic inflammation. 

A diet rich in cholesterol and riddled with allergens aggravates cholesterol supersaturation, hypersecretion of mucus, and accelerates the crystallization of accumulated cholesterol in the biliary system. For this reason, we need to become aware of our individual allergens and keep them entirely out of our diets.

Cholesterol Crystal Formation

The last step in gallstone formation is the nucleation of cholesterol crystals. It is the process wherein cholesterol particles are bound together, forming crystals. You may not immediately feel the effects of supersaturated bile. But over time, the cholesterol crystals and calcium salts in the bile combine and accumulate. This completes the self-perpetuating cycle of excessive mucus production, bile stasis, and cholesterol crystallization, resulting in cholesterol gallstones.

How to Avoid the Triangle of Trouble

Given these conditions for gallstone formation, there are many things that you can do to decrease your chances of gallstone development.

1. Watch your diet

A high-fat diet not only contributes to high cholesterol levels. It also affects mucin and prostaglandin production. Eating foods that may trigger or worsen an inflammation also increases your likelihood of gallstone development. Cut out all food allergens completely. Learn more about the allergy provocation diet here. Double your fresh fruit and vegetable intake, remove sugar and refined flours and significantly limit the quantity and frequency of meats.

2. Keep your bile flowing.

There are a lot of foods in our Gallbladder Diet list that can support healthy bile production and movement, such as beets, greens, ginger, turmeric, etc. A diet of primarily vegetables and fruits will also contribute to healthy bile. Supplements like Gallbladder Formula Elite and Bile Salts Booster can also help to thin the sluggish and cholesterol supersaturated bile.

3. Assume you have inflammation

Localized or systemic chronic inflammation, if not addressed, may not only contribute to gallstone formation but may also lead to a plethora of other health conditions. Sadly, low-grade inflammation often goes unnoticed until diseases arise. So if you have metabolic syndrome or any of its components (obesity, high blood sugar, high cholesterol), gallbladder disease of any kind, gastrointestinal symptoms, or digestive pain, it is best to assume you have inflammation.

Take steps now to manage your inflammation by committing to the following:

  • a lifestyle devoid of smoking, excessive drinking, and other vices
  • regular physical activity
  • enough sleep and regular rest, a time away from your stressful environment
  • a gallbladder-friendly and allergen-free diet

4. Get all the help you can from natural supplements.

To support your dietary changes, you may take natural supplements that help move the bile or support inflammation management. Zinc, glutathione, and turmeric are just some supplements that may promote a healthy inflammatory response. For bile movement, bile salts, beet root, and the herbs found in Gallbladder Formula Elite may also help.

 

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References:

Babb, R. R. (1993). Managing gallbladder disease with prostaglandin inhibitors. Postgraduate medicine, 94(1), 127-130.

Chuang, S. C., Hsi, E., & Lee, K. T. (2013). Genetics of gallstone disease. Advances in clinical chemistry, 60, 143-185.

Doty, J. E., Pitt, H. A., Kuchenbecker, S. L., Porter-Fink, V., & DenBesten, L. W. (1983). Role of gallbladder mucus in the pathogenesis of cholesterol gallstones. The American Journal of Surgery, 145(1), 54-61.

Jones, M. W., Gnanapandithan, K., Panneerselvam, D., & Ferguson, T. (2017). Chronic Cholecystitis.

Lamont, J. T., Smith, B. F., & Moore, J. R. (1984). Role of gallbladder mucin in pathophysiology of gallstones. Hepatology, 4(S2), 51S-56S.

Lee, S. P., Lamont, J. T., & Carey, M. C. (1981). Role of gallbladder mucus hypersecretion in the evolution of cholesterol gallstones: studies in the prairie dog. The Journal of clinical investigation, 67(6), 1712-1723.

Luo, X., Li, W., Bird, N., Chin, S. B., Hill, N. A., & Johnson, A. G. (2007). On the mechanical behavior of the human biliary system. World Journal of Gastroenterology: WJG, 13(9), 1384.

Smith, B. F. (1990). Gallbladder mucin as a pronucleating agent for cholesterol monohydrate crystals in bile. Hepatology (Baltimore, Md.), 12(3 Pt 2), 183S-186S.