What About Gallstones?

AMONG the more common surgical operations performed in the United States are those in which the gallbladder is removed because of stones. In fact, gallstones rank fifth among the reasons why people are hospitalized in the States. Gallstones are also quite common in certain Western European lands. However, they are practically unknown in some other lands, such as Indonesia.

The gallbladder, in which the stones are formed, is a pear-shaped pouch resting beneath the liver. When moderately distended in the adult male, it is about five inches long and three inches wide. A number of small ducts lead from the liver to form the “common duct,” which enters the upper part of the small intestine known as the Dodanim. Leading off from the common duct is the cystic duct, which connects with the gallbladder. By means of these ducts the bile produced by the liver reaches the small intestine, where it aids in the digestion of fats. Since the liver produces bile all the time, whereas it is only needed when food is being digested, the gallbladder serves as a storage receptacle for bile between meals; on an average it is able to hold about a pint. When food reaches the small intestine, a valve in the cystic duct opens, allowing the bile to enter the small intestine.

Malfunctioning of the gallbladder often results in the formation of stones. These may be in the gallbladder itself or in any of the tubes connected with it. They may be as small as grains of sand and be present by the hundreds, or they may be so large that just one stone fills the entire gallbladder. A chemical analysis of gallstones shows that they contain primarily cholesterol, bile pigment and calcium salts. One of the principal complications that demand urgent attention is that brought about by any obstruction of the bile duct system by stones.

How can you tell whether you have gallstones? One sure way is by having an X ray taken. Often surgeons discover them when operating on some other organ in the abdomen of a patient. Usually, however, gallstones make themselves felt by an acute pain in the upper right side of the abdomen. An attack is most likely to occur after a heavy dinner and may be accompanied by bloating, belching and other discomfort. There may be nausea, vomiting and even jaundice. But often gallstones are “silent,” being present without making themselves felt.

What Causes Gallstones?

Just what causes gallstones is a rather controversial matter, though modern research has thrown some light on the subject. It has found that eating a great deal of meat is conducive to growth of stones. Europeans who ate meat only once or twice a week rarely had gallstones; but when they migrated to Australia and there ate meat once or twice a day they soon had gallstones as often as the native Australians who eat meat that often.

Also experiments with hamsters (mouselike creatures) have shown that a diet high in sucrose, a form of sugar, is conducive to the forming of gallstones. There is also evidence that the eating of much animal fat tends to do the same, for an attack of gallstones often follows the eating of much fatty food. It is therefore not surprising to note that when Indonesians, among whom gallstones are practically unknown, moved to Western lands and adopted Western dietary habits, gallstones appeared among them as frequently as they do among the natives of Western lands.

But there are also other factors. Until middle age it is an affliction primarily of “the fair sex,” being at least twice as common among women as among men. Indeed, in times past physicians have joked that the most typical gallstone patient is “Fair, Fat, Forty, Flatulent and Fecund.” It is true that under fifty years of age, women operated on for gallstones averaged twenty-five pounds more in weight than women who did not have gallstone operations. It is also true that women of childbearing age are more likely to have gallstones than those either before or after that age, and that those actually bearing children are still more likely to have gallstones. And one of the symptoms of gallstones is indeed that of bloating or flatulence. But with advancing age men tend to have gallstones nearly as often as women.

Another factor that statistics show to have a bearing on gallstones is physical activity or exercise. People engaged in sedentary occupations, such as office workers, professors, teachers and lawyers are far more likely to have gallstones than are those engaged in physical labor, such as farmers, bricklayers and carpenters.

And still another condition that has been found to have a direct bearing on the production of gallstones is what is called stasis. By this is meant a failure of the gallbladder to empty itself into the small intestine. Bile has all the constituents for making gallstones and so when it remains for long periods of time in the gallbladder, gallstones may form.

To Operate or Not to Operate?

The fact that there are certain things that can be done to minimize the likelihood of formation of gallstones suggests that it is not always necessary to operate to remove the gallbladder when it is first detected to have stones. However, if a person is past sixty-five and requires an emergency operation for gallstones, he may have waited too long, for statistics show that death is from ten to twenty times as likely from such operations as from those performed earlier.

In times past some leading surgeons recommended removal of only the stones in certain cases rather than the removal of the gallbladder. However, often a second operation was required, and so today surgeons generally remove the gallbladder when stones give trouble, to avoid later complications, including perforation by the stones.

Obviously, prevention is better than operation. In view of what is known about gallstones, it would seem that one could minimize the likelihood of developing gallstones by watching one’s diet. One should be careful not to eat too much rich food, especially sweets, meats and animal fats. Getting plenty of vitamin A and fresh vegetables is recommended. There is also evidence that lecithin acts as a deterrent to the forming of gallstones. Among the foods rich in lecithin are egg yolks (even though they are also high in cholesterol), soy beans, vegetable and olive oils, beef purine products (liver, heart, kidneys), wheat and other cereal germs and nuts. Also deserving attention if one is a sedentary worker is some regular exercise.

By giving some thought now to such factors, you may save yourself serious trouble at a later time.