How Does Diet Affect Gallstones?

Gallstones are fairly common, affecting around 10-20% of people in Western nations, with fewer affected in lesser-‘developed’ areas. Around 80% of gallstone cases are asymptomatic.

A gallstone is formed within the gallbladder from components of bile. Cholelithiasis refers to the presence of gallstones or any disease caused by gallstones, and choledocholithiasis refers to the presence of gallstones within the bile ducts.

Risk factors for gallstones

There are several known risk factors for gallstones, including^1-6:

• Being female
• Hereditary predisposition
• Increasing age
• Body-mass index (BMI)
• Higher carbohydrate diets
• High GI / high sugar or fructose diets
• Low fibre diets
• Diets high in ‘fast foods’
• Low vitamin C intake
• Reduced energy availability from very-low-calorie diets
• Fasting-associated and total parenteral nutrition is associated with gallstones in children and adults.

Other associated factors

Distortions in cellular lipid transport and metabolism are likely to play a role in the formation of gallstones. For example, CD36 knockout mice appear to be protected against lithogenic diet-induced gallstones.⁷ Commonly, gallstone formation is concurrent with increases in total and LDL-cholesterol and triglycerides in animals, although an observational study has reported reduced gallstone prevalence associated with higher total cholesterol in humans.¹

Can diet help?

Evidence suggests that generally health-promoting diets lower on the glycaemic index and load and lower in overall energy and higher in vegetables and fruit are associated with reduced incidence of gallstones.^{1-3, 8, 9} Additionally, high intakes of monounsaturated fats and fibre, olive oil and fish (n-3 fatty acids), vegetable protein intake, fruit, coffee, moderate alcohol consumption exert a protective role.⁴ Garlic, onion,¹⁰ and turmeric¹¹ might also mitigate gallstone risk (from animal research).

The greatest impact on gallstone incidence is likely to be from ultra-refined diets as both fat from fried foods and high sugar, higher-GI, and high carbohydrate from ultra-processed foods like noodles are associated with gallstone formation.^{1-3, 9}

What about supplements?

Much of the evidence for the value of supplementation comes from animal studies. For example, based on animal evidence, ‘liver nourishing’ Chinese herbal medicines might reduce gallstone formation,^{12, 13} omega-3 fatty acids,¹⁴ and curcumin with piperine reduced gallstone formation in mice.¹¹

In humans, it has been observed that vitamin C supplementation reduces gallstone formation,^{1, 4} and magnesium may also help to mitigate gallstone formation.¹⁵

Exercise

Higher levels of activity are also associated with reduced gallstone formation.¹

What actions can I take to reduce my risk of gallstones?

Move

Exercise is good for ya!

Getting minimum effective levels of exercise each week is associated with a host of health benefits AND reduces your risk of gallstones.

Check out the recommended levels of exercise for health HERE.

Eat Whole

There are several diet-related factors involved in gallstone formation, but most of these are involved with a diet that is high in ultra-refined convenience foods. Therefore, the first step should be to switch to a diet that is based on mostly (i.e., 80%+) natural, whole, unrefined foods. A good diet for health should contain:

• A serve of protein at each meal (i.e., 1-2 palm-sized portions of a protein food)
• 6+ serves of vegetables and berries per day
• Some added healthy fats
• Garlic, onion, and turmeric might also help to mitigate risk

Check out a ‘modular approach to nutrition’ HERE

Consider supplementing

Most of the research supporting supplementation is the inverse of the dietary recommendations. In other words, supplements likely to help are typically the same nutrients as those which are risk factors when too low in the diet. However, even considering this, if you are concerned about gallstone formation, supporting several key nutrients can mitigate risk.

• Omega 3 fatty acids from fish oil (e.g., at least 1000mg of combined DHA/EPA per day)
• Vitamin C (E.g., 1000 mg per day)
• Magnesium (<400 mg per day from a bioavailable form, e.g., magnesium citrate)

References

1.         Walcher T, Haenle MM, Kron M, Hay B, Mason RA, Walcher D, et al. Vitamin C supplement use may protect against gallstones: an observational study on a randomly selected population. BMC Gastroenterology. 2009;9(1):74.

2.         Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Dietary carbohydrates and glycaemic load and the incidence of symptomatic gall stone disease in men. Gut. 2005;54(6):823-8.

3.         Johansson K, Sundström J, Marcus C, Hemmingsson E, Neovius M. Risk of symptomatic gallstones and cholecystectomy after a very-low-calorie diet or low-calorie diet in a commercial weight loss program: 1-year matched cohort study. International Journal of Obesity. 2014;38(2):279-84.

4.         Di Ciaula A, Garruti G, Frühbeck G, De Angelis M, de Bari O, Wang DQH, et al. The Role of Diet in the Pathogenesis of Cholesterol Gallstones. Current Medicinal Chemistry. 2019;26(19):3620-38.

5.         H D, C H, C B, B H, J H. P-46: Gallstones in Children on Long-term Parenteral Nutrition. Transplantation. 2021;105(7S):S72.

6.         Rodríguez Santiago J, Targarona EM, Ros E, Martínez J, Poca E, Vela M, et al. [Increased bile lithogenicity after simultaneous total parenteral nutrition and octrotide. A model of calcium palmitate Gallstones]. Gastroenterol Hepatol. 2001;24(7):321-6.

7.         Xie Y, Cifarelli V, Pietka T, Newberry EP, Kennedy SM, Khalifeh-Soltani A, et al. <em>Cd36</em> knockout mice are protected against lithogenic diet-induced gallstones. Journal of Lipid Research. 2017;58(8):1692-701.

8.         Kurbanov SK. [Optimization of diet therapy in patients with gallstones complicated with obesity and impaired glucose tolerance]. Vopr Pitan. 2003;72(5):22-4.

9.         Park Y, Kim D, Lee JS, Kim YN, Jeong YK, Lee KG, et al. Association between diet and gallstones of cholesterol and pigment among patients with cholecystectomy: a case-control study in Korea. Journal of Health, Population and Nutrition. 2017;36(1):39.

10.       Vidyashankar S, Sambaiah K, Srinivasan K. Dietary garlic and onion reduce the incidence of atherogenic diet-induced cholesterol gallstones in experimental mice. British Journal of Nutrition. 2008;101(11):1621-9.

11.       Shen P, Fang B-j, Zhu P-t, Zhang J-z, Pei X-j. [Effect of traditional Chinese herbs for nourishing the liver on intracellular free calcium level in gallbladder cells of guinea pigs with gallstones]. Zhong Xi Yi Jie He Xue Bao. 2007;5(2):179-82.

12.       Zhang J-z, Zhang X-l, Liang X-q, Gu H-g, Zhu P-t. [Effects of different Chinese herbal medicines on biochemical parameters in guinea-pig with pigment gallstones]. Zhong Xi Yi Jie He Xue Bao. 2008;6(8):856-9.

13.       Kim JK, Cho SM, Kang SH, Kim E, Yi H, Yun ES, et al. N-3 polyunsaturated fatty acid attenuates cholesterol gallstones by suppressing mucin production with a high cholesterol diet in mice. Journal of Gastroenterology and Hepatology. 2012;27(11):1745-51.

14.       Li Y, Li M, Wu S, Tian Y. Combination of curcumin and piperine prevents formation of gallstones in C57BL6 mice fed on lithogenic diet: whether NPC1L1/SREBP2 participates in this process? Lipids in Health and Disease. 2015;14(1):100.

15.       Ko CW. Magnesium: Does a Mineral Prevent Gallstones? Official journal of the American College of Gastroenterology | ACG. 2008;103(2).