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Nutrition and Gallstones

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Introduction

Gallstones, as well as those of the bile ducts (of the cystic duct, of the common bile duct but also of the pancreatic duct), represent the most frequent disorders and/or complications of the biliary tract; furthermore, it seems that (in addition to an individual predisposition) both the onset and prevention of relapses strongly depend on the subject's diet.

Characteristics of Gallstones

In medicine, gallstones are better known as gallstones. It is estimated that they affect 6-10% of the general adult population with almost double the frequency in females compared to males, for a total (in Italy) of approximately 3,000,000 people. In this regard, see the article relating to the epidemiology and risk factors for the appearance of gallstones.
Gallstones are not all the same; Regardless of subjective differences in size and quantity, it is possible to distinguish TWO main types of gallstones:

NB: Cholesterol-based gallstones predominate in Western patients. These depend significantly on nutrition and are formed in three stages:

  • Bile saturation;
  • Nucleation;
  • Training.

Nutrition as a Cause

Diet and cholesterol gallstone formation

Cholesterol-based gallstones are formed following the alteration of the balance between:

  • Biliary cholesterol (fundamental to the formation of BILE, a chemical digestive juice that can be physically defined as a suspension);
  • Bile salts
  • Phospholipids.

Salt'diet turns out particularly RICH in cholesterol*, it is possible that the excess of this lipid-steroid in the bile breaks the equilibrium of the suspension”. In short, the alteration of the balance of bile suspension promotes the “precipitation” (deposition) of cholesterol which subsequently crystallizes and then aggregates and forms gallstones.
*See: “Foods with cholesterol”

Another extremely important risk factor – and, like the previous one, closely related to the subject's diet – is reduced motility/contractility of the gallbladder. This (which in itself could be pathologically lazy) by contracting, mixes and empties the bile, preventing the precipitation of cholesterol. Considering that the gallbladder is stressed by meals and in particular by those containing dietary fats, it can be deduced that: a diet characterized by long periods of fasting… or even simply from long periods of diet in lack of lipids… determines the reduction of the motility of the gallbladder which prevents both the mixing and the emptying of the bile (biliary stasis), favoring the precipitation of cholesterol with subsequent formation of gallstones “.

It is also worth mentioning other diet-dependent risk factors for the formation of gallstones: dyslipidemiadiabetes, obesity, estrogen therapies and excessively rapid weight loss.

Nutrition in the presence of gallstones and to prevent their formation

The first advice to limit the onset of gallstones is to return to normal weight; therefore, in conditions of overweight or obesity, the NORMO-divided low-calorie slimming therapy is necessary: ​​25-30% of the calories supplied by lipids, 13% by proteins (or 0.75-1.2g of proteins per kg of body weight), and the remainder from carbohydrates.
Secondly, the subject's diet MUST be aimed at reducing the dysmetabolic conditions mentioned above, therefore useful for returning to normal parameters relating above all to cholesterolemia, triglycerides and blood sugar levels.
As already specified, the diet of the subject potentially at risk must NOT be characterized by long periods of fasting, indeed, better if (from an organizational point of view) it is divided into at least 5 daily meals.
It is also advisable that the water balance supplied with the diet is sufficient to maintain hydration; bile is a suspension and as such is also characterized by an aqueous portion. A constant state of dehydration could favor the precipitation of cholesterol, therefore it is advisable to treat:

  1. The choice of foods with the greatest quantity of water (first courses, broths, vegetables and fruit);
  2. The habit of drinking approximately 1ml of water for every kcal introduced; for example, in an 1800 kcal diet you need at least 1.8 liters of water.

Some statistical studies have then demonstrated a correlation between a diet rich in refined sugars, low in dietary fibre, and a high incidence of gallstones. This is probably an indirect relationship but, to confirm this, it emerged that predominantly vegetarian diets (which, contrary to what one might think, are NOT hypolipidic) are more protective than those with a greater component of foods of animal origin .
It should also be taken into account that, in long-term patients (worse if fed parenterally), the contractility of the gallbladder is severely limited by the scarcity of stimuli induced by nutrition, posture and the absence of physical movement.
Finally, regular physical activity is recommended which, probably due to mechanical and/or chemical stress, favors the mixing of bile juices.

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