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How the body creates gallstones

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Breaking the bodily functions down to the important parts:

1) The liver creates bile. It’s made up of cholesterol, bile salts and bilirubin

2) Bile is used to break down fats, which enable you to absorb fat soluble vitamins (A,D,E and K). When you eat a fatty meal, your body then needs the bile to break it down. This explains why some doctors might advise people with gallstones to go on a low-fat diet, to prevent the gallbladder from emptying. You’ll see later – this is a really really bad idea

3) Bile is also used to dispose of waste products

4) Cholesterol is used to make bile. Cholesterol can be made by the body, and you can also get it from animal foods (known as dietary cholesterol). The body balances out the amount of cholesterol by excreting what it doesn’t need, and recirculating what it wants to keep.

So why do you get gallstones?

You need two things to happen by most accounts – you need the bile to be held in the gallbladder for longer than normal, otherwise known as bile stasis, together with excess levels of cholesterol or bilirubin:

-          If your bile is inbalanced in the form of too much cholesterol, you get cholesterol gallstones (the most common and the ones I’ll focus on here). If your bile is inbalanced with too much bilirubin, you can get pigment gallstones. Bilirubin is thought to be an antioxidant  - it’s gives you the yellow/browny effect when you get a bruise.

-          If your bile has too few salts, then either cholesterol or bilirubin will be a much higher level, and so in combination with stasis, you get gallstones

1) Supersaturation of cholesterol in the gallbladder

Let’s look at this first then. Too much cholesterol in the gallbladder contributes to gallstones:

“Cholesterol crystallization is probably a prerequisite for the formation of cholesterol gallstones”. But that’s not enough; it’s been proven many people have supersaturated bile but no gallstones

OK, so that makes sense. Given bile is used to transport excess cholesterol, if all you needed was excess cholesterol to raise your cholesterol levels, it would mean that any food high in dietary cholesterol would give you a high rates of blood cholesterol, heart attacks, and of course gallstones. That’s not true at all – if it were, it would mean eggs are bad for your health (they’re not). Just because you eat a lot of foods containing cholesterol, it doesn’t follow your own blood cholesterol levels shoot up. You can find plenty of studies proving this, but this one stands out for the guy’s extreme egg eating antics - snappily titled, “Normal plasma cholesterol levels in an 88 year old man who eats 25 eggs a day”. Eggsactly. Note that this guy would have had supersaturated bile, but his blood levels – where it counts - were low. So to conclude, you need supersaturated bile, but you need something else for gallstones to form. As a side note, if you lose weight, the cholesterol levels in your bile increase

2) Wonky levels of bile salts

This is crucial. Even if your levels of cholesterol were strictly normal, if you have fewer bile salts, then the overall effect is the same – high levels of cholesterol.

What’s in bile salts? Have a read of this (big pdf alert) – it shows you exactly what human bile contains. In particular, note the mineral composition: chloride, sodium, potassium, calcium, magnesium, all of which you get through your diet. Sometimes those levels are out of kilter with gallstone patients, but in almost all suffers, the overall amount of bile (known as the bile pool) is lesser than a one in a healthy gallbladder.

So, what happens when you artificially increase the levels of calcium and magnesium in human bile? In a study here they increased levels of magnesium and calcium in human bile, and sure enough, it reduced the number of cholesterol microcrystals. Ever hesitant, they summise “The concentrations of calcium and magnesium present in bile may therefore influence the rate of development of gall stones”.

We’re getting warmer…

3)  Bile stasis in the gallbladder

Plenty of evidence for this. To form gallstones, the bile must remain in the gallbladder for longer than normal – called bile stasis. Importantly, they conclude “stasis is essential to gallstone formation” and while the experiment was tested using dogs, it’s widely held belief that it’s the combination of stasis and concentration of cholesterol in your bile that cause gallstones.

Piecing this together

So it’s safe to say cholesterol per se isn’t the problem. It’s having bile that’s got excess cholesterol in it that’s hanging around in your gallbladder for too long that’s the real issue here. So why is this happening? Why is the body holding onto this bile in your gallbladder for such a long time? Hmm?

What you will find incredible reading these papers is the total absence of links between diet and composition of bile. It’s fascinating – they talk about the gallbladder like there wasn’t a human attached to it determining what to feed the body that has to create the bile they’re studying.

Next up  - current studies and what they show about risks

Tightrope walker pic by Wiros

1 >> Why do you get gallstones?

2 >> How the body creates gallstones?

3 >> Medical studies

4 >> Current gallstone cures

5 >> The gallstone cure

6 >> D Day updates

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