If you sit around all day wondering what causes gallstones, what they are made of and what your gallbladder is actually for, I would love to explain. As I mentioned earlier, I didn’t know six months ago what the gallbladder was, where it was in the body, or what it was for. But now I know the following, which I can share with you.

What is the gallbladder?

The gallbladder is a pear-shaped organ that sits just below the liver. It is linked to the liver by the hepatic biliary ducts and then links through to the first part of the small intestine (the duodenum) via the bile duct and the ‘common’ bile duct. A diagram makes it much easier to understand that – see Figure 1 on the next page.

Figure 1: The gallbladder in relation to the liver and gut

What are gallstones?

Gallstones occur when bile creates stones that most commonly contain lumps of fatty (cholesterol-like) material that has solidified and hardened. The stones can be as small as a grain of sand or as big as a golf ball.

There are three types of gallstones – cholesterol stones, which account for 80% of gallstones; pigment stones, which are composed of bilirubin, a brownish-yellow substance found in bile and made from broken-down haemoglobin (the red pigment in blood that carries oxygen); and the least common stones, known as ‘mixed composition stones’, which contain varying proportions of cholesterol, bilirubin and other substances, such as calcium carbonate, calcium phosphate and calcium palmitate.

Sometimes just a few small stones are formed; other times a great many. In my case, many stones had formed, including a giant one. I’m a bit competitive, so what I am trying to say is I had more stones than you, so there.

Do many people get gallstones?

About one in three women and one in six men form gallstones at some stage in their lives, and they become increasingly common with age. Around 12-15% of the population in both the UK and the USA have gallstones. However, not everyone who has gallstones will experience their pain. It is thought that only around 20% of people with gallstones will ever know about it. But that equates to a lot of people in a lot of pain.

Gallstones are known to be more prevalent in North America, Europe and Australia, and are less prevalent in Africa, India, China, Japan and Egypt. This suggests that a Western diet – high in refined carbs, trans fats and dairy – could well play a part in the formation of gallstones.

As well as a generally unhealthy diet, the risk of forming gallstones increases as a result of:

  • Pregnancy
  • Obesity
  • Diabetes
  • Smoking
  • Rapid weight loss
  • Having a close relative with gallstones
  • Taking certain medicines, such as the contraceptive pill.
Look out for the Four Fs!

According to common belief within the medical field, if you fall into any of the following categories, you are at a higher risk of developing gallstones:

Female

Fat

Fertile

Forty.

In my extensive research for this book, I discovered that the famous gallstone sufferers of the world include the Dalai Lama. So, you see, even llamas can get gallstones.

Wait. I got a bit confused, sorry.

To clarify: the famous gallstone sufferers of the world, other than me, include the Dalai Lama (a man!), Andy Warhol (a man!), the singer Pink (female but not fat, not 40!), Eric Clapton (also a man!) and the Princess of Denmark (female but also not fat, also not 40!).

The fact is, there are many factors involved in developing these nasty little stones, not least of which is something to do with genetics. Thanks, Mum.

Before those heady gallstone days, I didn’t give my gallbladder a whole lot of thought. Although there was that one time years ago when I was contemplating my general health, and I decided to start looking after, cherishing and appreciating my gallbladder.

That’s not true; no-one has ever done that – until they got gallstones, that is. This organ does not rank on the same ‘popularity’ scale as, say, the heart, or the liver, or even one of the other organs we can do without – the appendix, or the tonsils (why do we have so many pointless parts?).

But, wait – is the gallbladder pointless? And if not, how come surgeons are so happy to whip it out? Firstly, we have to understand what the gallbladder actually does.

What is the gallbladder for?

The gallbladder collects and stores bile, made by the liver as a result of its many detoxification processes. It then releases the bile into the small intestine when food enters from the stomach. This helps with the digestion of food because the gallbladder contains bile salts and other substances that neutralise the acid contents of the stomach as they arrive in the duodenum and emulsify and break down fat.

The bile duct, which connects the gallbladder to the small intestine, can become blocked by gallstones, making it difficult for bile to be released from the bile duct. This is what may cause symptoms - the extreme pain, bloating, nausea and vomiting associated with a gallstone attack.

Can we live without the gallbladder?

I really hope so, as I no longer have one. To be serious for a minute, the answer is, ‘Yes’! But.

According to Dr Sandra Cabot MD, in her book (co-authored with naturopath Margaret Jasinska ND) Save Your Gallbladder Naturally and What to do if you’ve already lost it:

A significant number of patients who have had their gallbladder removed continue to suffer with pain and digestive problems. According to a study published in the British Journal of General Practice it was found that having the gallbladder surgically removed does not always relieve upper abdomen pain.*

Without a gallbladder, your liver continues to manufacture bile, but there is no longer a place to store it or concentrate it. Therefore bile continually slowly trickles into the intestines. If you eat a fatty meal, you will not be able to secrete a large enough amount of bile into your intestines, therefore the fat will be poorly digested. This means many people experience diarrhoea, bloating, nausea or indigestion.

Not digesting fat well means you will not be able to digest essential fatty acids, including omega 3 and omega 6 fats, which are necessary for good health. It also means you’ll have a hard time absorbing fat-soluble vitamins, such as vitamins D, E, A and K. A lot of the antioxidants in vegetables are fat soluble: lycopene, lutein and carotenoids are all fat soluble. If you don’t produce adequate bile, you will not be adequately absorbing these life-saving compounds from foods.

Some common symptoms of poor fat digestion are dry, brittle hair; dry skin and premature aging of the skin; weak nails and painful joints. Essential fatty acids are important for optimal brain health, therefore low mood, anxiety, depression and impaired cognitive function are all possible manifestations of poor fat digestion.

Once your gallbladder has been removed:

•   Keep your intake of dairy products and grains to a minimum, or avoid them altogether. Dairy products (milk, cheese, ice-cream, yoghurt) worsen all cases of gallbladder disease and liver disease and they are very difficult to digest. Food intolerance is a common cause of gallbladder problems, and there is research that links gluten intolerance with gallstones. A good reason to keep your intake of grains low is to reduce the risk of developing a fatty liver.

•   Take a good quality liver tonic, such as Livatone. The herbs St Mary’s thistle, dandelion root and globe artichoke leaves all increase bile production and bile flow. Taurine is an amino acid necessary for bile production. This should help to make you feel more comfortable after a meal, and should reduce the risk of stones forming inside your liver.

•   Take an ox bile supplement. A lack of bile can produce symptoms such as bloating and indigestion after meals, light coloured stools, diarrhoea, fatigue after meals and nutrient deficiencies. Taking a good quality ox bile supplement with each meal is wonderful for completely eliminating these symptoms in most individuals.

•   Take a digestive-enzymes supplement. The majority of people who develop a gallbladder problem have suffered with poor digestion for many years. If your stomach and intestines are not in optimal health, they will not send signals to your gallbladder, telling it to contract properly. Irritable bowel syndrome, dysbiosis, small intestinal bacterial overgrowth and candida overgrowth are common in people with a gallbladder problem. If you have had your gallbladder removed, you may continue to suffer symptoms due to those conditions. These digestive problems also cause insufficient digestive enzyme production. Taking digestive enzymes in supplement form helps to restore good digestive health and reduces symptoms of indigestion.

•   Eat some good fats and avoid the bad fats. Your doctor may have recommended you follow a low-fat diet after having your gallbladder removed. This is not necessary and in fact it is harmful. Your body desperately needs good fats and I recommend you include moderate quantities of extra virgin olive oil, avocados, coconut milk and oil, nuts and seeds in your diet.

•   You may need a vitamin D3 supplement. People with compromised liver or digestive function are often vitamin D deficient. Exposure of your skin to the sun’s UVB rays enables your body to manufacture vitamin D. However, this process occurs in your liver and kidneys. People with a sluggish liver often do not manufacture vitamin D adequately. Therefore it’s a good idea to get a blood test and take a supplement; 5000 IU of vitamin D3 is a safe and effective dose for most people, but it’s best to be guided by your own doctor.

•   Include some bitter and sour foods in your diet. They should help to improve your digestion and make it easier to tolerate good fats in your diet. Suitable bitter and sour foods include lemons, limes, radicchio lettuce, chicory, endive and dandelion leaves.

•   Find out if you have a food allergy or sensitivity. If you still experience pain or digestive problems after having your gallbladder removed, there is a very good chance you are eating foods your body considers harmful. The biggest culprits are gluten, eggs, onions, pork, corn and soy. You may need the help of a naturopath or nutritionist to help you identify your food sensitivities.

Prevention of gallstones

If you are reading this book, I would assume that you already suffer from the charming little nuggets of delight. But, if there are some people in your life who don’t have gallstones (and I really hope there are), then you may wish to impart the following information to help them in what I must insist should be their new anti-gallstone-formation quest. They will thank you. And me.

Here are some suggested ways to ward them off:

Options for treating gallstones

I was made to feel like I didn’t have a choice in treating my gallstones. (I love referring to them as ‘my gallstones’, like they are an old boyfriend. Though I have to say, things didn’t end well for that particular boyfriend.)

I was told, ‘You need to have your gallbladder removed,’ and that was that. No discussion; no question and answer session; no apologies; nothing. But the reality is that surgery does not have to be the default solution.

Many doctors will employ a ‘wait and watch’ approach if your gallstones are not symptomatic; but if they are, the options are generally as follows:

  • Symptom management through nutritional and lifestyle changes to help prevent gallstone pain
  • Surgery
  • Medical intervention, such as pain killers and antispasmodic medication when needed
  • Attempts to dissolve the stones or reduce their size, using the chemicals ursodiol or chenodiol (although the stones can recur)
  • The natural approach, which includes the ‘gallbladder flush’ – not for the faint-hearted (in my opinion).

In her book Overcoming Gallstones, Dr Sarah Brewer gives some information on this:

The gallbladder flush

The gallbladder flush is a folk remedy said to promote the passage of gallstones. The ‘flush’ typically involves fasting for 12 hours and then drinking a large amount of olive oil and lemon juice. Usually, a laxative and/or enema is also used. This produces diarrhoea, abdominal pain and the passage of multiple green, brown, yellow or black spheres which resemble gallstones.

However, analysis shows that these hardened blobs are not stones, but bile-stained ‘soaps’ produced by an interaction between the ingested oil and other ingredients of the flush. They are often produced in quantities far greater than could be stored in a gallbladder and could be told apart from real stones because the ‘soap’ blobs:

•   are soft, waxy or gelatinous whilst real gallstones are either hard or dry and crumbly in texture

•   float on toilet water as they are largely composed of oil, whereas genuine gallstones would sink

•   do not have the sharp facets produced when real gallstones rub against each other in the gallbladder

•   can be cut cleanly with a knife (unlike real gallstones) and often have bright green translucency that is never seen with real stones

•   disintegrate over time unless frozen, whereas gallstones are stable.

There is no scientific evidence that the gallbladder flush works, and it may in fact be harmful. Even if the large amount of oil did promote ejection of a small gallstone into the cystic duct and out into the bile duct, this would be immensely painful and debilitating and would probably involve admission to hospital for investigations and pain relief.

Other natural options which I did not try but are said to help gallstone symptoms and may warrant further investigation include black seed oil and turmeric. I would recommend testing these in small quantities though before committing to regular consumption.

Foods that are said to aid the secretion of digestive enzymes and promote bile secretion include:

Raw beetroot juice

Radishes

Limes

Apples

Pears

Grapefruit

Chamomile tea.

Again, though, it might be a good idea to test these foods in small quantities, and try them out individually rather than consuming them all in one go.

Why do I need a gallstone-friendly diet?

Whether you have opted for natural treatment, or you are waiting for surgery, you will need to watch your diet. Although experts believe that a no-fat diet can be harmful, it does seem to be universally accepted that cutting down on fat intake does reduce the likelihood of a gallstone attack, as, without fat, the gallbladder will not be stimulated to release bile into the small intestine.

Here are some easy ways to cut down on fat:

  • Avoid processed foods and cook from scratch wherever possible. This will give you control over how much fat goes into your food.
  • Check labels for high-fat content.
  • Bulk out meals with vegetables and pulses. For example, you could make a gallstone-friendly Bolognese by replacing the meat with lentils, kidney beans and mushrooms.
  • Use oil spray when cooking – this will become your new best friend.
  • If you are cooking anything that is sticking to the pan, use a few drops of water rather than oil. This is known as ‘steam frying’. I have also used wine to ‘fry’ food. Wine adds moisture as well as flavour. Most of the alcohol will burn off in the cooking process.
  • Make your own dressings using low-fat yoghurt, lemon/lime juice and herbs. (More on this later in the book.)
  • Remove all visible fat and skin from meat and choose leaner cuts. I avoided all red meat while I waited for my op, but I did eat some chicken, turkey and fish.
  • Avoid eating out, but if you do, ask the kitchen to dry-roast, grill or bake your food. Some will agree to do this. Avoid sauces, dressings and gravies. Expect to resent everyone in the restaurant who is eating ‘normally’.

Some personal recommendations

Suggested supplements
Apple cider vinegar

A quick Google search (not recommended – but this is unlikely to stop you!) will reveal a whole load of advice on how to alleviate gallstone pain, and high on the list is usually apple cider vinegar. There is no supported evidence to suggest that it alleviates pain or (as is sometimes claimed) dissolves the stones, but apple cider vinegar does have anti-inflammatory properties, which in turn can help most digestive-related diseases.

Instructions for use: Mix two tablespoons of good quality apple cider vinegar with a small glass of organic apple juice.

I drank this every day because it felt like the right thing to do. I cannot say for certain whether or not it helped, but it certainly didn’t hurt.

Omega-3 capsules

In the absence of much fat in my diet, good or bad, I opted for an omega-3 capsule every day. I also took an evening primrose oil capsule daily, as it contains omega-6. It is important to balance omega-3 with omega-6, ideally on a 1:1 ratio. A balanced combination of the two essential fatty acids promotes good health and keeps inflammation in the body in check.

Psyllium husks

Psyllium husks are also a great help with gallstones. Psyllium cleanses the colon, which is important, since constipation is linked with gallstone formation. You should take 1-3 teaspoons in 300 ml of water each morning, and again last thing at night.

Magnesium

I am middle-aged (even though I don’t look it, according to my lovely anaesthetist), so magnesium is important, not just for bone health and calcium absorption, but magnesium also helps in the metabolism of food and synthesis of fatty acids and proteins.

Probiotics

A good daily probiotic is essential for a healthy gut. My gut is not healthy, but one day it will be again. Although I found no recommendations advising the consumption of probiotics to help with this condition, I felt that I needed to address a generally unhealthy gut. Probiotics are said to boost the immune system, help ward off infection and reduce the population of harmful bacteria in the gut – which all seemed like a good idea. I took a probiotic containing Lactobacillus rhamnosus GG (LGG) which is said to help the digestive system work better generally.

Vitamin C

Studies‡ have shown that taking regular supplements of vitamin C may be associated with a reduced prevalence of gallstones.

Milk thistle

Milk thistle (also known as Silymarin marianum and St Mary’s thistle – see page 151) is a prickly composite herb from the Mediterranean region and has been used extensively in traditional folk medicine to treat liver and gallbladder diseases. Milk thistle is sometimes used to shrink gallstones, but it is essential that you speak to your doctor before embarking on a milk thistle regime.

Peppermint tea

Peppermint contains menthol, a soothing compound that promotes pain relief. It can be used to ease stomach pain, improve digestion and relieve nausea.

A note about exercise

I am a ‘serial occasional’ exerciser. I have been through times in my life where exercise was an everyday part of my routine, and times when the treadmill was gathering dust in the corner.

Prior to my gallstones nightmare, I had been indulging in some light yoga as well as a bit of circuit training, but I quickly gave it up based on the logic of ‘any old excuse’. I think the key here is: if you feel okay, do it.

I rarely felt fit enough to exercise during the five-and-a-half months of my gallstone days. I felt like a pain in my chest was always lurking, and I just never felt like myself. Other than walking every day, I avoided anything strenuous. I have read that yoga is a good option and, based solely on that, I would highly recommend it.

Also, I would always, in any situation, for any reason, recommend swimming. Swimming is the best low-impact, stress-relieving, health-promoting exercise out there. I just didn’t feel like doing it.

Everyone is different, though, and hopefully you’re not as lazy as me.

Food!

And now, for the exciting part: food! In the following pages I will list the recipes that I found, adapted, or just plain made up to suit this new regime. These recipes all rely on eating a minimal amount of fat.

If you do not have gallstones (or after you have got rid of the nasty little darlings), these recipes can still be used but should not be wholly relied upon as part of a balanced diet. Good fat should be part of your diet if you are gallstone- or gallbladder-free.

Top tip: Eat little and often!

* Berger MY, et al. Is biliary pain exclusively related to gallbladder stones? A controlled prospective study. British Journal of General Practice 2004; 54: 574-579

† Barré A, Gusto G, Cadeau C, Carbonnel F, Boutron-Ruault MC. Diet and risk of cholecystectomy. A prospective study based on the French E3N cohort. Am J Gastroenterol 2017; 112(9): 1448-1456. doi: 10.1038/ajg.2017.216. Epub 2017 Jul 25.

‡ Gustafsson U, Wang FH, Axelson M, Kallner A, Sahlin S, Einarsson K. The effect of vitamin C in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones: prolongation of the nucleation time. European Journal of Clinical Investigation 1997; 27(5): 387-391. PubMed PMID: 9179545.