Gallstones, or cholelithiasis, are a relatively common condition that frequently causes no symptoms and goes undiagnosed. Gallstones can be as small as a grain of sand or as big as a ping pong ball and are mainly concentrated bile material containing cholesterol, bilirubin, bile salts, and lecithin. A small stone may be ejected from the gallbladder into the bile duct, causing a blockage and leading to a gallbladder attack, also known as cholecystitis.

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CC: Cholelithiasis with Recent Acute Cholecystitis

Kevin was a 49-year-old male recently diagnosed with gallstones following a trip to the emergency room for severe upper abdominal pain. MRI at the hospital showed diffuse gallbladder wall thickening with mild edema, indicating acute cholelithiasis, and his pancreatic enzymes amylase and lipase were within normal limits. He was told there was no treatment, and surgery was recommended. However, the patient began looking into diet management and was interested in a more conservative direction. He had not had another attack since leaving the hospital four weeks prior.

Additional History

Kevin ate a typical American diet of eggs and meat for breakfast, take-out for lunch, and a more complete dinner with protein, vegetables, and grain or starches. He had never had high cholesterol or blood pressure in the past and was very active most of his life until the last ten years, which he attributed to fatigue and fatherhood.

There were no close or distant family members the patient could recall having gallbladder issues or gallstones.

Initial Lab Work

Lab Analysis

Due to Kevin's asymptomatic state, elevated lab markers weren't expected; however, I requested them to rule out other contributing factors.

Kevin's labs showed elevated total cholesterol, LDL, and triglycerides. He also had low HDL. As a large percentage of gallstones consist of cholesterol, high levels of total cholesterol and a lack of fiber in the diet can contribute to gallstone formation. Due to his cholesterol levels being normal up until this point, he chose to forgo the option of a statin prescription and try a nutrition and supplemental approach.

Kevin also had multiple low-level food sensitivities to foods commonly in his diet; high levels of food intolerances contribute to gallstone formation through the local inflammation caused within the gallbladder wall itself, which was also noted on the patient's MRI.

Interventions

Supplemental Support

• Biogest digestive enzymes: a combination of ox bile, betaine HCl, and additional pancreatic digestive enzymes to support the breakdown of food with high fat and protein. One cap with each meal, 2 with large meals.
• High-dose omega fatty acid liquid with a combined EPA/DHA of 3 grams daily. This is to support ideal cholesterol output and prevent future stone formation.

Nutrition

• Begin an elimination diet, avoid all gluten, dairy, soy, peanuts, and lentils for 30 days, then reintroduce one at a time. Also, remove all beef, pork, and all deep-fried and processed foods.
• A whole food diet was reviewed thoroughly, with fat, protein, and carbohydrate ratios explained.
• Add high-quality fats (cold water fish, olive oil, avocados, nuts & seeds) in small portions; 1 TBSP Extra virgin olive oil, ¼ standard size avocado.
• Keep protein 80:20 plant-based to animal-based; vegetarian diet during the week and meat on the weekend. Focus on beans, legumes, and reintroducing lentils after elimination for high fiber and nutrient content.
• Increase complex carbohydrates and resistant starches such as sweet potatoes, cooked and cooled white potatoes, and rice.
• Fiber should be optimized at each meal, with a goal of 40 grams daily.
• 5 grams of sugar per serving, 25 grams daily

1 Month Follow Up

Due to the dramatic diet changes recommended, a quick follow-up was needed to ensure the patient was able to comply. As the patient's wife was a vegetarian, transitioning to this was easy, and he was eating fish twice a week and one portion of other animal protein on the weekend.

He effectively avoided gluten, processed foods, and sugar; however, dairy was the patient's only treat, and he struggled to remove it.

He had noticed an improvement in energy and sleep quality one week into the diet and supplement regime and had no gallbladder-related pain.

1 Month Interventions

• Include dairy-free alternatives to replace cheese, yogurt, and ice cream so Kevin could still enjoy these foods and not feel deprived.
• Continue avoiding eliminated foods and eliminate dairy for a full avoidance period.

3 Months Follow Up

Kevin was doing great after our second follow-up. Since his original gall bladder attack, he had not experienced a single episode of upper abdominal pain or post-meal colicky symptoms. He had recently taken up kayaking and was working out multiple times a week due to his overall increased energy. He was able to reduce his digestive enzyme use to 1 capsule with high-fat or large meals and had not experienced any upper abdominal pain or gallbladder-related symptoms. After repeated labs, we were able to confirm that diet and lifestyle modifications had also reduced Keven's cholesterol and triglyceride levels back to a healthy range.

Summary

Kevin's case is a common presentation of poor diet and lack of physical activity leading to inflammatory-related diseases like gallstones, as the patient had no genetic predispositions. With a shift to a primarily vegetarian, whole food, plant-focused diet, the patient was able to see dramatic positive changes to his cholesterol panel within three months, which heavily contributed to the prevention of continual gallstone formation and future gallbladder attacks. More importantly, he saw a positive shift in his overall energy, sleep, and quality of life. He planned on continuing the diet changes to prevent future gallstone development and additional gallbladder attacks.