29 January 2011

Losing weight without developing gallstones

Gallstones are estimated to affect 1 in 10 people in North America. Those who are obese have a higher likelihood of developing gallstones. Most at risk of gallstones as a result of obesity are Native Americans, the elderly, and Caucasian women in their forties who haven’t yet reached menopause.

Gallstones are so named because they develop in the gallbladder, a small organ that stores and releases the bile made by the liver. Bile is a dark green fluid containing bile salts and cholesterol. The gallbladder releases bile into the small intestine to assist in digesting fats more efficiently. However, if the bile contains high concentrations of cholesterol, then stones too difficult for the bile salts to dissolve may develop.

Because gallstones usually form without any symptoms, most people don’t know they have them or may feel only minor symptoms such as abdominal pain after eating a fatty meal. However, if a stone becomes lodged in a bile duct causing blockage, it can result in sudden pain in the abdomen, back or right shoulder.

Cholecystitis, or gallbladder disease, which is caused by duct blockage, infection or inflammation, is one of the most common digestive diseases. Pain from duct blockage can become intense and lead to hospitalization and surgery. In the U.S. alone, gallbladder surgeries approach 700,000 annually, costing approximately $6.5 million.

Surgery costs increase if gallstones and duct blockage or infection cause the pancreas to become inflamed. The resulting pancreatitis can lead to severe or life-threatening complications. The major cause of acute pancreatitis in North America is gallstones.

Link to Obesity and Losing Weight Too Quickly

Because of obesity’s major role in the formation of gallstones, weight management is critical for decreasing the likelihood of developing them. Obesity is thought to increase risk of gallstones because of elevated production of cholesterol, which in turn increases the concentration of cholesterol in bile.

Paradoxically, losing weight actually increases risk of developing gallstones among obese people, especially amongst those who lose large amounts of weight rapidly. Although not entirely understood, nutritional and medical scientists think that losing weight too quickly may shift the balance of bile salts and cholesterol, causing increased concentrations of cholesterol. Gallstone risk may also be increased by consuming a diet too low in fat or avoiding fat, which reduces the frequency of gallbladder contractions and results in fewer chances of gallbladder emptying.

As always, individuals with a high risk for gallstones should follow medical advice in treatment. Medical researchers have studied methods that obese people can lose weight while reducing risk of gallstone developments. Statin regimens and bile salt therapies have had mixed results. A drug called ursodiol has shown much promise in helping to dissolve cholesterol in bile and prevent gallstones.

There have also been successes such as employing modifications in diet to help reduce risk of gallstones. Along with following a doctor’s advice, individuals can consider these weight-management strategies, which have shown promise based on epidemiologic studies or in clinical trials for losing weight as naturally and safely as possible.

Three Steps to Help Lower Risk of Gallstones While Losing Weight

Step 1: Avoid very low-calorie dieting, losing no more than 1-2 pounds per week.

Overall, research studies have found that obese people who lost 3 pounds or more weekly had a greater likelihood of developing gallstones. This may be because they are more likely to experience an imbalance between bile salts and cholesterol, as well as irregular gallbladder emptying.

For these reasons, people who are obese or who are at high risk for developing gallstones should also avoid skipping meals or fasting.

By eating three steady meals throughout the day and losing weight at a slower rate, obese people can reduce the weight-loss risk factor in gallstone formation. To ensure steady weight loss at 1-2 pounds per week, calorie intake should be reduced by only 500 to 1,000 calories. Weight loss is also influenced by activity, which may require eating more calories to compensate for calories burned.

Step 2: Avoid saturated fats and eat small amounts of monounsaturated or polyunsaturated dietary fat daily.

Foods high in saturated fats, trans fats and cholesterol are all associated with increased risk in gallstone formation. However, foods high in polyunsaturated or monounsaturated fats (from olive oil or high-oleic sunflower oil) may help lower cholesterol saturation and reduce risk of gallstone formation.

A randomized clinical trial on obese subjects compared a low-calorie diet (900 kcal/d) with 30 grams of fat per day with a low-calorie diet (520 kcal/d) with less than 2 grams of fat per day. After eight weeks, not one of the subjects on the diet with 30 grams of fat per day had developed gallstones. The researchers were led to conclude that dietary fat ensured regular gallbladder emptying and reduced bile cholesterol saturation.

A 10g threshold of fat per meal is now considered to be most efficient at maximizing gallbladder emptying, which can support healthy weight loss while reducing risk of formation of gallstones.

Furthermore, according to one randomized, double-blind, placebo-controlled clinical trial, fish oil in amounts of almost 12 grams per day may work comparatively to ursodiol in reducing risk of gallstone formation in low calorie diets.

Step 3: Avoid refined sugar and strive for a diet high in fiber.

In epidemiologic studies, there is a higher association of gallstones in those who ate greater amounts of refined sugars. In contrast, long-term consumption of relatively high amounts of dietary fiber has been correlated with reduced risk of gallstone diseases.

The risk appears to be even lower if the amount of fiber consumed comes from sources rich in insoluble fiber found in whole grains, fruits and vegetables. Soluble dietary fiber such as found in oats and legumes also appears to be protective, showing reduction of gallstone formation in animal studies.

Diets higher in fiber and lower in refined sugars will also assist in weight loss. Refined sugars, found in high amounts in sodas and desserts, contribute to high calorie intake, which contributes to obesity. Dietary fiber is filling, providing a satiety effect, but offers little or no calories that would contribute to weight gain.

Individuals should increase dietary fiber to recommended levels (25 to 30 grams daily) gradually.

Safe Road to Optimal Health

Once again, each of these steps is a natural dietary habit that will help lower the risk of developing gallstones and support losing weight safely. Apart from diet, getting regular exercise daily is also helpful. And, for every pound lost gradually, the ultimate achievement is reduced risk of gallstones in the future.

Beyond reduced risk of gallstones, the end-benefits of healthy weight management are profound including improved activity and mobility, improved health of organs such as the heart and brain, and reduced risk of diseases such as type 2 diabetes and cardiovascular disease. Healthy weight management improves overall health and wellness at every level.

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