Written by Tazneem NHS junior doctor and associate nutritionist.
Recent studies have shown that there has been a rise in the number of cases of gallstone disease post-lockdown and the COVID-19 pandemic (1).
What are gallstones?
The gallbladder produces bile which is required to break down fats. Excess cholesterol and fat in the blood can precipitate in the bile and crystallize to form gallstones(2). Usually, they cause no problems, but occasionally they get impacted in the cystic duct resulting in the blockage of bile flow. Consequently, the bile builds up and causes inflammation of the gallbladder known as cholecystitis. Symptoms experienced include pain, vomiting, bloating and nausea. Treatment involves retrieval of the stone and removal of the gallbladder via a keyhole operation.
Risk factors of gallstone disease include female gender, obesity/overweight, age and people with Crohn’s or irritable bowel syndrome(3). It is thought that gallstone disease has increased because of increased fat consumption which correlates with increased supermarket expenditure. So how can we reduce the risk of gallstone disease? The most important way we can reduce the risk is by adopting a healthy balanced diet.
What is a healthy balanced diet?
It is recommended a healthy balanced diet is followed to prevent gallstone formation. The Eatwell guide recommends(4):
At least 5 portions of fruit and veg a day
Carbohydrates should form a 3rd of the diet such as bread and pasta
Including protein in the diet- 2 portions of fish (one of which should be oily), meat and eggs
Reduce saturated fats and sugars
Reduce salt
If you already have gallstones, a healthy diet can prevent or reduce symptoms experienced.
Should I adopt a low-fat diet if I have gallstones or to prevent gallstone formation?
There is no concrete evidence to suggest that a low-fat diet should be adopted. Fat mustn't be eliminated from the diet completely. However, studies have shown that reducing the intake of cholesterol and saturated fats reduces the risk of gallstone formation(2,5,6). Saturated fats and cholesterol stimulate gallbladder contraction to release bile, and this can cause pain if the gallbladder is inflamed.
Studies have shown increasing unsaturated fats and omega-3 prevents gallstone formation because it helps the gallbladder empty regularly(5). It is important to increase the quantity consumed if you already have gallstones.
You can also reduce fat by choosing low-fat dairy products. For example, opting for skimmed or semi-skimmed milk instead of whole milk. You should not cut out dairy completely because they are an important source of calcium. The low-fat dairy products contain the equivalent amount of calcium as the high-fat dairy options.
Should I cut out carbohydrates?
There is no evidence to suggest carbohydrates should be cut out completely. However, it is advised that carbohydrates with a high glycaemic index i.e., those that are broken down quickly, should be reduced, such as white rice, white bread, and potatoes(5,6). Fibres should be increased because it reduces the amount of cholesterol saturation. Foods include fruit, veg, wholegrain bread/pasta, oats and nuts.
Will weight loss reduce my risk of gallstone formation?
Though obesity is a risk factor for gallstone disease, rapid weight loss is also a risk factor. Studies have shown a correlation between increased weight loss and gallstone formation. It is thought, this is likely due to bile stasis as the gallbladder is contracting less. The bile then accumulates and is more likely to crystallise.
Do I need to cut out caffeine?
The simple answer is no! There have been studies to show that the risk of gallstones reduces with caffeine consumption (5). This could be because caffeine stimulates the gallbladder to contract and drain the bile, so cholesterol and fat do not accumulate. This does not mean you should go overboard with it though! Ensure you still consume in moderation because there are other risks associated with excess caffeine.
Is there a special diet I need to start post-surgery after I have had my gallbladder removed?
There is no specific diet post-surgery, though, it is recommended that a low-fat diet is implemented for 3 months to reduce symptoms. Fibre should be gradually increased and not too quickly because this can lead to constipation.
Top 10 tips:
Eat a balanced diet that consists of all food groups
If you have gallstones or cholecystitis, avoid foods that make your pain worse
There is no concrete evidence that a low-fat diet is beneficial, and it is important to still have some fat
Increase the amounts of oily fish and reduce the amount of saturated fats consumed
Increase the amount of fibre
Reduce the amount of white rice, white bread, and potatoes
Increase wholegrain foods
There is no special diet for pre- or post-surgery if you have cholecystitis
Eat at least 5 portions of fruit and veg a day whether that be dried, fresh, cooked or juiced
Keep yourself well hydrated- at least 8-10 cups a day
Tazneem is a junior doctor in the NHS and a qualified ANutr nutritionist. If you need advice on gallstones or nutrition in general please contact us to book Tazneem.
1. Murphy MC, Dempsey PJ, Gillespie CD, Murphy AN, McNicholas MMJ. Increased incidence of acute calculous cholecystitis observed during COVID-19 social restrictions. Irish Journal of Medical Science. [Online] 2021; 1–4. Available from: doi:10.1007/s11845-021-02587-2
2. Madden AM, Trivedi D, Smeeton NC, Culkin A. Modified dietary fat intake for treatment of gallstone disease. The Cochrane Database of Systematic Reviews. [Online] 2017;2017(3): CD012608. Available from: doi:10.1002/14651858.CD012608
3. Gallstones - Causes. [Online] nhs.uk. Available from: https://www.nhs.uk/conditions/gallstones/causes/ [Accessed: 6th October 2021]
4. The Eatwell Guide. [Online] GOV.UK. Available from: https://www.gov.uk/government/publications/the-eatwell-guide [Accessed: 18th October 2021]
5. Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Alternative Medicine Review: A Journal of Clinical Therapeutic. 2009;14(3): 258–267.
6. Brand C, Craft J, Christensen M. Post-cholecystectomy dietary factors and implications for nursing practice. Gastrointestinal Nursing. [Online] Mark Allen Group; 2018;16(7): 44–50. Available from: doi:10.12968/gasn.2018.16.7.44