Gall stones are formed in the gallbladder from bile salts, bilirubin, calcium, and cholesterol. The most common types are cholesterol stones followed by pigment stones. This condition affects up to 15% of the population, women more so than men, the prevalence increasing with age.

The purpose of the gallbladder is to store bile after it is produced in the liver. When released into the duodenum via the common gall duct, bile emulsifies dietary fats so that they can be more-easily absorbed. Bile consists of bile salts, water, electrolytes, cholesterol, lecithin, and bilirubin.

While stored in the gall bladder, bile is normally concentrated by the removal of some electrolytes and water. This process can lead to stone formation when the contents of the gall bladder (biliary sludge) becomes static and over-saturated.

Gall stones are usually asymptomatic unless they enter the cystic or common bile ducts and become lodged. This causes acute colicky pain in the region of the liver on the upper right side of the abdomen, or under the right shoulder blade. Other symptoms are fever, jaundice, nausea, sweating, dark urine, and pale stools. Chronic obstruction by large stones can cause inflammation of the gallbladder (cholecystitis), the biliary duct (cholangitis), or the pancreas.

Gall stones are usually diagnosed on ultrasound and can be treated with medication, lithotripsy or by surgical removal of the gallbladder. Removal of the gallbladder results in a  direct connection between the liver and the intestines, so that bile is constantly dripped into the duodenum instead of being stored for secretion following a meal. This may result in post-operative symptoms such as persistent pain or chronic loose stool.

Treatment

General

While pigment stones are associated with parasites, infection, and haemolytic disease, cholesterol gall stones are associated with obesity, diabetes and liver disease, indicating the importance of a healthy diet, and plenty of exercise. Some pharmaceutical drugs are also causative (tamoxifen, statins, oral contraceptive pill, oestrogens). Gall stones are common during pregnancy.

The bile is an outlet for metabolites derived from liver detoxification, indicating the potential disruptive role for toxins in bile acid metabolism, and consequently stone formation as the bile is concentrated in the gallbladder. Avoid ultra-processed foods, additives, and agricultural residues where possible.

Bile salts also regulate gut flora, epithelial cell function and nutrient transport in the intestines, and alterations in the quality and consistency of them are observed in diseases such as chronic constipation, IBD, and pancreatitis. The Western factoryfood diet is implicated in an unfavourable bile acid profile, while a diet with less fat and red meat, as well as more fibre, is protective. Probiotics such as L. rhamnosus GG and L. Reuteri can also enhance bile quality and function through microbial cross-talk.¹

A well-known gallbladder ‘flush’ combines lemon juice and olive oil taken during the course of an evening, commencing after a 12 hour fast. Four tablespoons of olive oil and 1 tablespoon of lemon juice are taken in alternation, about fifteen minutes between each, for 8 cycles. This can be preceded by drinking plenty of fresh apple juice during the day to soften stones. The lemon stimulates bile secretion and the oil causes the gall bladder to spasm, thus expelling stones; however, this should only be tried with small stones capable of being passed through the narrow bile duct. Larger stones need to be softened and dissolved or they may lodge painfully and require surgery to remove them.

A safer, slower version of this procedure is to mix a teaspoon of olive oil and a teaspoon of lemon juice in a single cup of apple juice and drink it before bed. Repeat every evening for two or three months.

Diet

Constipation, nutrient deficiency (iron, vitamin D, vitamin C, fibre), an excess of refined carbohydrates, and dehydration are risk factors. This points to the importance of drinking plenty of water throughout the day, and eating a nutrient-dense wholefood diet that is rich in fibre. Fibre such as that derived from eating oats, flax, psyllium, pectin, and wholegrains also prevents bile salts being recycled in the intestines, thereby increasing the excretion of cholesterol from which they are made.

Fibre and protective polyunsaturated fats are sacrificed when convenience foods make up a large portion of the diet. A high consumption of beef, pork and fried food are associated with cholesterol stones as with dyslipidemia.²

The Nurses’ Health Study indicated that a higher consumption of nuts was protective. A vegetarian diet may prevent stones in those who are susceptible. Lecithin will help reduce the stone-forming properties of bile.³

The standard Mediterranean dressing for salads or steamed vegetables is olive oil and lemon juice, and the long-term protective effect should be obvious. Eat plenty of bitter greens with this dressing as a liver support and prophylactic against stones.

Herbs

Artichoke, milk thistle, greater celandine, fumitory or dandelion root taken daily as a preventative or to reduce the size of small stones (these herbs increase bile flow and prevent bile stasis). Turmeric is also a liver herb, with anti-inflammatory properties. Gravel root and hydrangea combined with marshmallow are used to dissolve stones. Echinacea is used for infection.

Cell Salts

Nat-sulph for liver and gallbladder problems with biliousness, acidity and gas. Nat-phos can normalise acidity. Ferrum phos is used for treating inflammation.

Homeopathic Remedies:

Homeopathic remedies are given in 6x or 6c, two or three times a day for chronic cases. 30c can be used every few hours until acute symptoms of pain resolve (3 pillules under the tongue, or dissolved in 100ml of water and taken one tsp. at a time).

Belladonna—Cramping, colic, pain in spasms, pain radiates, worse pressure; distended abdomen; fever, thirstless.

Berberis-v—colic from stones, grey stool, jaundice.

Bryonia—pain better pressure or lying still on right hand side; thirsty.

Calc-carb—gall stones in obese patients; chilly patient; sweaty; craving for eggs or inedible things.

Carduus-m—inflamed gallbladder, dull ache in region of liver.

Chelidonium—obstruction of the gall duct leading to pain under the right shoulder blade and jaundice; nausea or vomiting; desire for hot water.

China—liver enlarged, gas, bloating; colic better bending double; jaundice.

Lycopodium—gall stone pain with gas, bloating, acidity; worse 4-8pm, starchy food; craves sweets and hot drinks.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.

References:

1.         Hegyi P, Maléth J, Walters JR, Hofmann AF, Keely SJ. Guts and Gall: Bile Acids in Regulation of Intestinal Epithelial Function in Health and Disease. Physiol Rev 2018;98:1983–2023.

2.         Park Y, Kim D, Lee JS, et al. Association between diet and gallstones of cholesterol and pigment among patients with cholecystectomy: a case-control study in Korea. J Health Popul Nutr 2017;36:39.

3.         Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Altern Med Rev J Clin Ther 2009;14:258–67.