As a nutritional support pharmacist, you should know that gallstones are closely linked to diets rich in animal fat and protein, lacking in fiber. Traditional Asian and African diets, predominantly plant-based, show lower incidences of gallstones compared to Westernized diets. Key dietary factors associated with reduced gallstone risk include...
- Plant-based Diets: Rich in unsaturated fats, they mitigate the risk associated with animal fats and proteins, potentially reducing cholesterol stone formation by up to 90%.
- Vitamin C: Found in plants but not in meat, it may offer protective effects against gallstone development.
- High-fiber Foods: Substituting refined carbohydrates with high-fiber alternatives reduces the cholesterol saturation index of bile, lowering gallstone risk.
- Weight Management: Maintaining a healthy weight, avoiding weight cycling, and incorporating a modest amount of fat in calorie-restricted diets (< 800 kcal/day) can mitigate gallstone formation.
- Moderate Alcohol Intake: Moderate alcohol consumption shows an inverse association with gallstone risk, but potential health risks necessitate caution.
PHARMACOTHERAPY OF GALLSTONES
See our note, "Gallstones: Summary of NICE guideline". Laparoscopic cholecystectomy stands as the preferred treatment for symptomatic gallbladder disease, suitable for cases of cholecystitis within 72 hours, recurrent symptoms like biliary colic, nausea, vomiting, or suspicious ultrasound findings such as calcified gallbladder. For patients declining cholecystectomy, alternative options include:
- Hyoscine (Buscopan): Prescribed at 10 mg thrice daily.
- Ursodeoxycholic acid (Ursofalk, Ursodiol): Administered orally at 10 mg/kg. This medication proves most efficacious for patients with small "floating" gallstones (> 1 cm) and can dissolve certain cholesterol stones. Daily intake of 500-600 mg reduces the risk of gallstone formation attributable to rapid weight loss or high-fat diets. However, gallstones may recur in about 50% of patients within 5 years post-treatment cessation.
- Rowachol capsules: Dosing involves 1-2 capsules thrice daily, taken before meals. This medication alleviates bile duct spasms and enhances metabolic liver function.
REFERENCES
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Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. Available at: https://www.gutnliver.org/journal/view.html?volume=6&number=2&spage=172&year=2012
Ahmed A, Cheung RC, Keeffe EB. Management of gallstones and their complications. Am Fam Physician. 2000;61(6):1673-80, 1687-8. Available at: https://www.aafp.org/pubs/afp/issues/2000/0315/p1673.html
Halldestam I, Kullman E, Borch K. Incidence of and potential risk factors for gallstone disease in a general population sample. Br J Surg. 2009;96(11):1315-22. Available at: https://academic.oup.com/bjs/article/96/11/1315/6148336?login=false
Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000;12(12):1347-52. Available at: https://journals.lww.com/eurojgh/abstract/2000/12120/gallstones_in_obesity_and_weight_loss.15.aspx
Leitzmann MF, Giovannucci EL, Stampfer MJ, et al. Prospective study of alcohol consumption patterns in relation to symptomatic gallstone disease in men. Alcohol Clin Exp Res. 1999;23(5):835-41. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.1999.tb04191.x?sid=nlm%3Apubmed
NICE 2014. Overview: Gallstone Disease: Diagnosis and Management. Available at: https://www.nice.org.uk/guidance/cg188
Tazuma S, Unno M, Igarashi Y, Inui K, Uchiyama K, Kai M, Tsuyuguchi T, Maguchi H, Mori T, Yamaguchi K, Ryozawa S, Nimura Y, Fujita N, Kubota K, Shoda J, Tabata M, Mine T, Sugano K, Watanabe M, Shimosegawa T. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol. 2017 Mar;52(3):276-300. Available at: https://link.springer.com/article/10.1007/s00535-016-1289-7