Gallstones - Basic Nutritional Guidelines

In the gallbladder, deposits of insoluble bile components form hard crystals (stones) that hinder the flow of bile and can partially or completely block its entry into the intestine. Nearly ⅔ of patients do not exhibit symptoms of gallbladder dysfunction. In individuals with symptoms, a condition known as biliary colic may occur, characterized by sudden pain in the right upper abdomen that may radiate to the right shoulder. This pain is often associated with the movement of the stone that blocks the exit of the bile duct, leading to an increase in pressure inside the duct. The pain often precedes nausea and vomiting and usually resolves on its own. However, if it persists for longer than 6 hours and the body temperature is elevated, this may indicate complications. These include inflammation of the gallbladder, bile ducts, and pancreas, perforation (rupture) of the gallbladder, and intestinal obstruction. Non-specific symptoms, which may also occur in other conditions and do not definitively indicate gallstones, include heartburn, bloating, and discomfort after consuming fatty food.

The diagnosis relies on an ultrasound (USG) examination of the abdominal cavity; laboratory tests (elevated levels of liver enzymes - AlAT, AspAT, ALP, amylase, lipase) may also be beneficial. In managing this condition, two primary procedures are employed: symptomatic treatment of gallstones (taking painkillers and antispasmodics) and surgical interventions used in symptomatic gallstones, such as removal of the gallbladder along with stones via laparoscopy or, if that is not feasible, by opening the abdominal walls.

In order to discuss the dietary management of gallstones, it is important to first understand the role of nutrition in the development of this disease. Sources indicate that a nutritional model that promotes the development of gallstones is one that is high in energy, high in saturated and trans unsaturated fatty acids, refined sugars, and fructose, and low in vitamin C and fiber (A.S.P. 2019). Gallstones are also commonly found in individuals with other conditions such as obesity, diabetes, and hypertriglyceridemia. In the prevention and management of gallstones, it is important to follow a normal diet and maintain a balanced diet. The diet should contain a normal amount of fat (20–35% total energy) and be rich in monounsaturated and polyunsaturated fatty acids derived from fish, plant oils, seeds, and nuts. It is important to limit the intake of saturated and trans-unsaturated fats present in fatty meats, animal fats, hardened plant fats, and processed foods. It is also important to reduce meat consumption and replace it with fish, legumes, and their derivatives. It is important that the diet is rich in fiber-rich foods such as fruits and vegetables (with the latter predominating) and whole grain products. Fiber accelerates the digestive process and reduces cholesterol absorption from food. It is important to avoid foods with high energy density, especially those rich in sugar such as sweets, sweet drinks or sweet dairy products. High glycemic index also promotes the development of gallstones, so it is important to choose products with low and medium glycemic index. It is also important to eat regularly and avoid long breaks between meals. In this way, the gallbladder is emptied regularly, preventing the formation of gallbladder stasis, which is crucial in the development of gallstones. It is also important to avoid long night breaks of more than 12 hours and fasting or intermittent fasting diets.

Patients suffering from symptoms of gallstone disease (gallstone attacks) usually require dietary intervention to reduce the frequency and severity of the attacks. In many cases, cholecystectomy is necessary, which involves the removal of the gallbladder along with its stones. Post-operatively and often permanently, dietary modification is required to prevent the recurrence of attacks. In both cases, the dietary recommendations should be based on a low-fat diet with a limitation of fat to about 20%.

– Vegetables: carrots, squash, zucchini, parsley, celery, tomatoes and cucumbers without skin, spinach, rhubarb, beets, broccoli, cauliflower, asparagus, boiled potatoes and vegetables, vegetable juices. Fruits: berries, seedless grapes, citrus fruits, peaches, apricots, bananas, apples, kiwi, melons, cherries. – Grain products: wheat bread and rolls, baked goods, small-grained cereals (e.g. millet, fine barley, semolina, corn), wheat and rice pasta, white rice, refined wheat flour. – Dairy and eggs: milk, kefir, yogurt, low-fat buttermilk (up to 1.5%), lean cottage cheese, egg whites. – Meat and fish: lean poultry (chicken, turkey), beef, veal, rabbit, cod, trout, halibut, pike and other lean fish species. – Fats: sunflower and refined rapeseed oil, olive oil, small amounts of butter and soft margarine. – Spices: lemon juice, parsley leaves, chives, cinnamon, vanilla, marjoram, lemon balm and other mild herbs (fresh and dried).

– Vegetables: cabbage, onion, garlic, leek, dried seeds of leguminous plants, fried potatoes, fries, salads and mixtures with fatty sauces. – Fruits: pears, dates, cherries, gooseberries, redcurrants. – Grain products: rye bread, buttermilk, graham, whole grain pasta, coarse beans (coarse rice, bulgur), natural rice, whole grain flour, fried products and fatty creams. – Dairy products and eggs: fatty milk (3.2%), Greek yogurt, semi-fat quark and full-fat quark, egg yolk, fatty yellow cheese, mold and quark cheese (e.g. Fromage), cream, mayonnaise. – Meat and fish: fatty beef, pork, duck, offal, mutton, goose, game, fatty fish (e.g. salmon, eel, catfish, herring), fried meat, smoked, cured. – Fats: lard, bacon, hard margarine. – Spices: vinegar, hot pepper, chili, mustard, large amount of black pepper. Preferred processing methods should be baking, steaming, boiling or stewing; however, it is advisable to avoid fried dishes, especially in deep fat. In case of a light diet, freshness is of utmost importance - it is recommended to avoid consuming long-stored products and dishes in the freezer. This reduces the risk of food poisoning, which is particularly dangerous for people with digestive disorders.