I am frequently amused by the simplest of things that crop up during the course of my working day. There are patients who attempt to earnestly explain their predicament but don’t quite manage the medical words, for instance the very overweight woman who returned to surgery following a visit to the dietician and who was desperately offended because ‘She told me I’m a beast’ (obese), and I spend many hours listening to tales of great, often far-fetched adventures that have ended in tears and a need for medical attention, but my favourite by a long way is when I hear a well meaning, very guilty sounding ‘So there’s nothing wrong? I’m sorry I wasted your time....
’Wasted my time??? Do these people think I am some kind of sick monster who wants everyone to be falling apart? I am always delighted to be able to reassure someone that as far as the medical world knows they are in perfect health and that whatever they have brought to my attention is either entirely normal or harmless, or at the very least will disappear by itself. Obviously this isn’t always possible and the next best thing is to be able to say that I know what the problem is and that it is nothing serious, which is why I am generally very pleased when I discover a new case of gall stones. Usually the person in question has turned up with a collection of symptoms that could be caused by a whole range of conditions, some of which are frankly nasty, and an ultrasound report that says essentially ‘It’s only gallstones’ is fantastic news in the scheme of things.
Gallstones are made of either cholesterol or pigment from old blood cells. In the UK most gallstones are the cholesterol type and are largely caused by the Western diet. They develop in the gall bladder which is a small sack like structure next to the liver and if they do not cause any symptoms then they are harmless, in fact many people have them without knowing it. If they irritate or move out of the gall bladder then they can cause abdominal pain and various other problems depending on where – and if – they get stuck, more of this later.
So who gets gallstones? You have probably correctly guessed by now that overweight people are more likely to develop them, which is why I am writing about them on a weight loss web site – 10-15% of the adult British population are diagnosed with gallstones at some point in their lives, in obese people this figure increases to 25%.
There are other risk factors:
- family history of gallstones
- increasing age
- losing weight rapidly, for instance after weight loss surgery
- too much oestrogen - pregnancy and hormone replacement therapy (HRT) can increase your chance of developing gallstones
- diabetes
- liver disease
- Crohn's disease
- Female gender
Traditionally doctors have been taught that the typical patient with gallstones will be 5 Fs: fair, fat, fertile, female and forty. From the list above it is easy to see why! However, it is perfectly possible to have gallstones with none of the above factors.
The symptoms of gallstones are many and varied, depending on exactly what sort of mischief they are causing. If they irritate the gall bladder itself then cholecystitis can occur, while if a stone becomes stuck just outside the gall bladder then this causes biliary colic. Another possibility is that a stone may block the duct leading to the pancreas and this can result in acute pancreatitis which is one of the more serious possibilities. These all cause slightly different combinations of symptoms but in general terms you should suspect gallstones if you have pain in the right upper part of the abdomen that appears suddenly and shortly after a fatty meal and any of the following:
Nausea
Vomiting
Bloating /gassiness/belching
Indigestion
Pale coloured stools
Jaundice – a condition where your skin or eyes turn yellow
Chills, sweating and fever in the case of cholecystitis
If any of this sounds familiar then it is well worth a visit to your GP to investigate matter further. Your doctor will want to examine you and probably arrange some basic blood tests along with an ultrasound scan, which is the easiest way to spot gallstones. If they do show up on your scan then there are various options available to you:
1. A low fat diet. This should lessen your chances of developing problems with your gallstones and legend has it that Rosemary Conley discovered the Hip and Thigh diet this way – her GP advised her to eat a low fat diet to help control her gallstones and she noticed that she lost weight from her hips and thighs, wrote a book about it, and the rest is history!
2. Surgery to have your gall bladder removed, known as a cholecystectomy. This can be performed either by ‘keyhole’ or traditional ‘open’ surgery depending on a number of factors.
3. ERCP (long technical name!), essentially you can have an endoscopy and a small instrument can pass into your intestines and retrieve the gallstones without surgery. This is only suitable if your gallstones are no longer in your gall bladder
As with any condition prevention is far preferable to cure and while many of the risk factors are things you can do nothing about like age, family history and gender, never concede defeat! If you are keen to prevent gallstones in the first place then you can help yourself by maintaining a healthy weight and eating regular healthy meals. You should avoid saturated fats and foods high in cholesterol but eating healthy monounsaturated or polyunsaturated fats in vegetable oils, nuts, seeds, oily fish etc is positively beneficial as they cause the gall bladder to empty itself, reducing the chances of its contents becoming stagnant and forming stones. Regular exercise also helps, and it is worth considering your increased chances of gallstones with oestrogen containing contraceptives and HRT although this is only one of many other issues to cover when deciding whether or not to take these.
If you can relate to any of this then it is worth making an appointment to see your GP because you need to make sure that it is just gallstones and take their advice about how you as an individual should deal with your situation. They will be more than happy to help and you can be pretty sure that they won’t think you are wasting their time........
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