October 2004

Women, gallbladder surgery, and vegetables

by Dr. Howard Loomis

Women who eat vegetables to fulfill their dietary requirement of protein are less likely to be at risk for having their gallbladder removed. This was the finding reported in the July issue of American Journal of Epidemiology.

Gallbladder dysfunction is one of the most common health problems encountered in clinical practice today. Unfortunately, it's also one of the most misunderstood.

Commonly, clinicians refer to it as the 5‑F Syndrome: fair, fat, female, fertile and over forty. Right shoulder pain accompanied by flatulent dyspepsia was once considered to be the best indicator.

When the presence of gallstones is confirmed, the usual procedure is to schedule surgical removal of the gallbladder. More than 600,000 cholecystectomies are performed in this country every year despite overwhelming evidence that most are not necessary. A recent 20‑year follow‑up on a study of 121,000 women revealed that 7,831 of the women had their gallbladders removed.

It has long been known that protein derived from vegetables could prevent gallstones from forming in animals. However, few studies tested that effect in humans. Findings from the data on the women who underwent a cholecystectomy showed that total protein and animal protein intake had no bearing on the potential risk of cholecystectomy. On the other hand, the risk of undergoing a cholecystectomy decreased when there was a high intake of vegetable protein.

The question is why vegetable protein prevents gallstone formation and animal protein does not. The answer is that it is not just the protein, it's something else in the vegetables.

I always told my patients who suffered from biliary stasis to avoid not only fried food and pork but also apples, onions, radishes, cucumbers, tomatoes, and cabbage, including sauerkraut. Of course the fried food and pork were very difficult for them to digest, but the fruits and vegetables strongly stimulate the flow of bile. The reason to avoid these items is to avoid a biliary attack if stones block the flow of bile.

For many years it was believed that the presence of fat in the diet stimulated production of the hormone cholecystokinin in the wall of the duodenum. Cholecystokinin then stimulated the muscles of the gallbladder and relaxed the sphincter of Oddi, thus allowing the bile to flow into the duodenum.

Yet, increasingly more evidence is accumulating that points to secondary metabolites found in fruits and vegetables as being responsible for either stimulating the musculature or relaxing the sphincter of Oddi.

To fully appreciate this point, consider that malic acid in apples can cause painful gallbladder attacks. The Lancet published an article in its December 1999 edition that to avoid gallbladder attacks one should consume one quart of pure apple juice daily. After one week, drink one cup of olive oil just before going to bed and lay on your left side during the night. I believe this would be effective but it could also trigger an attack if the stones cannot pass.

Another remedy is to eat one‑to‑two radishes per day for 21 days while also consuming three‑to‑five cups of cleavers or chamomile tea each day. In addition to apples, cucumbers, onions, cabbage and tomatoes, the following are also thought to hasten the removal of gallstones: pears, parsnips, seaweed, lemons, limes, and tumeric. There is not much vegetable protein in any of these remedies.

The following key points should always be stressed when discussing biliary dysfunction and gallstones with patients:

***  Gallstone formation is extremely common. Their occurrence in women is roughly double their occurrence in men. The occurrence and size of the stones increase with age and depending on the ethnic group being examined their incidence can range as high as 25% to 44% of the population.

***  Gallstones usually do not cause symptoms. Three major studies involving more than 3,000 patients found that 67% of all confirmed cases of gallstones were asymptomatic. Other studies put the figure at above 80%.

***  Patients with gallstones who are asymptomatic are likely to remain so. Studies indicate the chance of asymptomatic gallstones becoming symptomatic in the next five years is less than 10%. Not only that, but the rate decreases as time goes by ‑‑ to less than one percent after 10 years.

***  The majority of gallstones are found by chance ‑‑ even in patients with abdominal pain. Because the use of abdominal ultrasound is increasing, more gallstones are being detected incidentally. Therefore, the opportunity to recommend gallbladder removal is increasing.

***  Cholecystectomy does not always relieve symptoms traditionally thought to be caused by gallstones. Most studies show complete relief of symptoms in 75‑80% of patients after surgery. However, studies concentrating on the relief of symptoms in those that had symptoms before surgery indicate relief in only about one‑half of the cases! The most persistent symptoms remaining after surgery are flatulent dyspepsia and chronic, dull pain in the upper right quadrant.

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment, ask a question, or request a free copy of his video, "Using Enzymes in Clinical Practice: The Loomis System," call 800‑662‑2630 or write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit www.loomisenzymes.com online for information on upcoming Loomis Institute seminars.)

*************