Dietary considerations for patients with cholelithiasis

Diet control is one of the major interventions used to control gallstones. I will attempt to highlight some of the major factors contributing to cholelithiasis, some dietary methods of control and what can be done about it

Dietary factors

• Obesity and Weight Loss
• Being overweight or obese has been linked to an increased risk of gallstones. However, while weight loss is often a means to control this disease, excessive weight loss has also been linked to formation of gallstones due to an increased cholesterol to bile salts ratio. Excessive weight loss also may cause asymptomatic gallstones to suddenly become symptomatic 
• Food Allergy
• Failure to recognize and act accordingly to allergies has been linked to symptomatic gallstones and thus preventable cholecystectomies. This is because an inflammatory response from a food allergy or intolerance inhibits and delays gallbladder emptying, a major cause of gallstone formation. There is a strong correlation between untreated celiac disease and cholelithiasis due to stagnant bile 
• Dietary Cholesterol and Fat
• Excessive cholesterol intake causes an increase in biliary cholesterol saturation which would presumable increase the risk of gallstone formation or cause symptoms in asymptomatic gallstones. Observational studies indicate a positive correlation between saturated and trans fat intake and increased incidence of gallstones. Conversely, higher intake of polyunsaturated or monounsaturated fatty acids indicated a negative correlation, yielding a decreased risk of gallstones. Studies have been conducted where patients with gallstones are supplemented with 11.3 g/day of fish oil and their cholesterol saturation of bile decreased 25%
• Refined Sugar
• Through observational studies we see a correlation between high intake of sucrose and fructose and high gallstone incidence. This correlation, however, may be as simple as the link between excessive sugar intake and obesity, which in turn is linked to gallstones. However, some studies suggest that refined sugars in a and of themselves are lithogenic
• Vegetarian Diet
• Cross-sectional studies noting the prevalence of gallbladder disease in vegetarians vs omnivores notes that increased consumption of vegetable protein (as opposed to animal) is associated with a decreased risk of developing gallstones. A separate study in the same cohort indicated that high intake of fruits and vegetables is linked with a decreased prevalence of gallbladder disease
• Dietary Fiber
• Observational studies indicate high fiber intake is associated with lower prevalence of gallstones. Supplementation of 10-50 g of bran per day for 4-6 weeks yielded low cholesterol saturation of bile in participants. Fiber works primarily on the colon, decreasing the formation of deoxycholic acid which is a lithogenic agent of bile. Fiber also increases the synthesis of chenodeoxycholic acid which is used in gallstone dissolution therapy. 

Based on these recommendations, patients can change their diet to help control symptoms of gallstones.

 Gaby M.D., A. (2009). Nutritional Approaches to Prevention and Treatment of Gallstones. Alternative Medicine Review, 258-267.