Gallstones – Causes, Symptoms, Diagnosis, Treatment

Gallstones/Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in your gallbladder. The gallbladder is a small organ located just beneath the liver. The gallbladder holds a digestive fluid known as bile that is released into your small intestine. In the United States, 6% of men and 9% of women have gallstones, most of which are asymptomatic. In patients with asymptomatic gallstones discovered incidentally, the likelihood of developing symptoms or complications is 1% to 2% per year. Asymptomatic gallbladder stones found in a normal gallbladder and normal biliary tree do not need treatment unless they develop symptoms.

Gallstones or cholelithiasis are responsible for one of the most prevalent digestive disorders in the United States. They are considered a disease of developed populations but are present around the world. It is both the result of a chronic disease process and the cause of subsequent acute disorders of the pancreatic, biliary, hepatic, and gastrointestinal tract.

Types of Gallstones

Depending on the etiology, gallstones have different compositions. The three most common types are

• Cholesterol gallstones
• Black pigment gallstones
• Brown pigment gallstones – Ninety percent of gallstones are cholesterol gallstones.
• Mixed stones –  Mixed (brown pigment stones) typically contain 20–80% cholesterol (or 30–70%, according to the Japanese- classification system). Other common constituents are calcium carbonate, palmitate phosphate, bilirubin, and other bile pigments (calcium bilirubin, calcium palmitate and calcium stearate). Because of their calcium content, they are often radiographically visible.

The two main kinds of gallstones are

• Cholesterol stones – These are usually yellow-green. They’re the most common, making up 80% of gallstones.
• Pigment stones – These are smaller and darker. They’re made of bilirubin.

Causes of Gallstones

There are three main pathways in the formation of gallstones

• Cholesterol supersaturation – Normally, bile can dissolve the amount of cholesterol excreted by the liver. But if the liver produces more cholesterol than bile can dissolve, the excess cholesterol may precipitate as crystals. Crystals are trapped in gallbladder mucus, producing gallbladder sludge. With time, the crystals may grow to form stones and occlude the ducts which ultimately produce the gallstone disease.
• Excess bilirubin – Bilirubin, a yellow pigment derived from the breakdown of red blood cells, is secreted into bile by liver cells. Certain hematologic conditions cause the liver to make too much bilirubin through the processing of breakdown of hemoglobin. This excess bilirubin may also cause gallstone formation.
• Gallbladder hypomotility or impaired contractility – If the gallbladder does not empty effectively, bile may become concentrated and form gallstones.
• There’s too much bilirubin in your bile – Conditions like cirrhosis, infections, and blood disorders can cause your liver to make too much bilirubin.
• Your gallbladder doesn’t empty all the way – This can make your bile very concentrated.
• There’s too much cholesterol in your bile – Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might form stones.
• Your gallbladder doesn’t empty correctly – If your gallbladder doesn’t empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.

The following factors are known to increase the risk of gallstones

• Age – The risk of developing gallstones increases with age, especially after you reach the age of 40.
• Genes – If someone in your family has had gallstones.
• Sex – Women are more likely to get gallstones than men. The female sex hormone estrogen is believed to increase the risk of gallstones.
• Cirrhosis – A severe liver disease caused by metabolic disorders or excessive consumption of alcohol.
• Being very overweight.
• Losing a lot of weight in a short time – This happens a lot in very obese people who have surgery to make their stomach smaller.
• Functional problems of the gallbladder – The organ cannot contract (squeeze bile out) properly.
• Short bowel syndrome – A disorder that can develop after surgical removal of a large segment of the small bowel.
• Special high – calorie liquid food.
• Hemolysis – A disease that causes an increased breakdown of red blood cells.
• Pregnancy.
• Using the contraceptive pill or estrogen tablets during menopause (hormone therapy).
• Diabetes.

Symptoms of Gallstones

• Sudden and rapidly intensifying pain in the upper right portion of your abdomen
• Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting
• Pain in your upper belly, often on the right, just under your ribs
• Pain in your right shoulder or back
• An upset stomach
• Other digestive problems, including indigestion, heartburn, and gas

See your doctor or go to the hospital if you have signs of a serious infection or inflammation

• Belly pain that lasts several hours
• Fever and chills
• Yellow skin or eyes
• Dark urine and light-colored poop

Diagnosis of Gallstones

Your doctor will do a physical exam and might order tests including

• Blood tests – These check for signs of infection or blockage and rule out other conditions.
• Ultrasound – This makes images of the inside of your body.
• Abdominal ultrasound – This test is the one most commonly used to look for signs of gallstones. Abdominal ultrasound involves moving a device (transducer) back and forth across your stomach area. The transducer sends signals to a computer, which creates images that show the structures in your abdomen.
• CT scan – Specialized X-rays let your doctor see inside your body, including your gallbladder.
• Magnetic resonance cholangiopancreatography (MRCP) – This test uses a magnetic field and pulses of radio wave energy to take pictures of the inside of your body, including your liver and gallbladder.
• Cholescintigraphy (HIDA scan) – This test can check whether your gallbladder squeezes correctly. Your doctor injects a harmless radioactive material that makes its way to the organ. A technician can then watch its movement.
• Endoscopic retrograde cholangiopancreatography (ERCP) – Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts.
• Endoscopic ultrasound (EUS) – This procedure can help identify smaller stones that may be missed on an abdominal ultrasound. During EUS your doctor passes a thin, flexible tube (endoscope) through your mouth and through your digestive tract. A small ultrasound device (transducer) in the tube produces sound waves that create a precise image of surrounding tissue.

Treatment of Gallstones

Non-Pharmacological

(These are supportive approaches used alongside medical care. They help manage symptoms, lower triggers, and reduce attacks. They do not dissolve most stones; definitive cure for symptomatic disease is usually surgery.)

1. Supportive therapy and dietary modifications –  elective cholecystectomy only for symptomatic patients who are surgical candidates or asymptomatic patients at risk of gallbladder cancer
2. Supportive therapy – Fasting or dietary modification (decreased fat intake)

3. Low-fat meal pattern
   Purpose: Reduce gallbladder squeezing after meals and lower pain episodes.
   Mechanism: Less fat → less cholecystokinin (CCK) release → milder gallbladder contraction → fewer colic attacks.

4. Small, frequent meals
   Purpose: Avoid long fasting that thickens bile.
   Mechanism: Regular meals keep bile flowing and reduce sludge formation.

5. Hydration (water first)
   Purpose: Prevent bile concentration and sludge.
   Mechanism: Adequate fluid keeps bile less viscous and supports normal flow.

6. Gradual weight loss (not crash diets)
   Purpose: Prevent gallstone formation during weight loss.
   Mechanism: Rapid fat breakdown dumps cholesterol into bile; slow, steady loss lowers this surge.

7. Regular moderate exercise (150–300 min/week)
   Purpose: Improve weight, insulin sensitivity, and lipid profile.
   Mechanism: Exercise reduces hepatic cholesterol secretion into bile and improves gallbladder motility.

8. Dietary fiber emphasis (vegetables, fruits, legumes, oats, psyllium)
   Purpose: Lower cholesterol reabsorption and improve stool bile acid binding.
   Mechanism: Soluble fiber binds bile acids and reduces enterohepatic cycling of cholesterol.

9. Plant-forward pattern with lean proteins
   Purpose: Lower saturated fat and total fat triggers.
   Mechanism: Less saturated fat → less cholesterol in bile; lean meats/fish are gentler on gallbladder.

10. Use of monounsaturated fats (e.g., olive oil) in modest amounts
    Purpose: Heart-healthy fat with lower CCK spikes compared to heavy saturated fats.
    Mechanism: Balanced fat quality may improve lipid handling and bile composition.

11. Limit refined carbs and sugar-sweetened beverages
    Purpose: Reduce insulin spikes and hepatic de novo lipogenesis.
    Mechanism: Lower triglyceride production → less cholesterol saturation of bile.

12. Coffee (moderation if tolerated)
    Purpose: Some studies link coffee to lower gallstone risk.
    Mechanism: Coffee may stimulate gallbladder emptying and alter bile composition.

13. Avoid long fasting windows (especially >12–14 h if symptomatic)
    Purpose: Prevent bile concentration and sludge.
    Mechanism: Regular CCK pulses keep bile moving.

14. Heat therapy for acute biliary colic (hot pack)
    Purpose: Comfort measure to relax abdominal wall muscles.
    Mechanism: Local heat reduces muscle spasm and perceived pain.

15. Breathing/relaxation techniques during pain waves
    Purpose: Lower pain perception and sympathetic stress.
    Mechanism: Slow diaphragmatic breathing modulates pain pathways.

16. Sleep hygiene (7–9 hours/night)
    Purpose: Support weight regulation and reduce inflammatory tone.
    Mechanism: Better sleep improves metabolic hormones (leptin/ghrelin) and insulin sensitivity.

17. Glycemic control if diabetic
    Purpose: Reduce gallstone risk and complications.
    Mechanism: Better insulin sensitivity reduces biliary cholesterol saturation and infection risk.

18. Post-bariatric surgery prevention strategies
    Purpose: High-risk period for stones.
    Mechanism: Discuss with clinicians; sometimes short-term ursodiol is used (drug; see below) and diet is adjusted to slow weight loss rate.

19. Avoid high-fat trigger foods (fried, creamy, greasy)
    Purpose: Fewer colic attacks.
    Mechanism: Less CCK surge → less painful contraction against obstructed cystic duct.

20. Avoid heavy alcohol binges
    Purpose: Reduce pancreatitis risk if stones migrate.
    Mechanism: Alcohol can amplify pancreatic inflammation.

21. Early medical evaluation of red-flag symptoms
    Purpose: Prevent severe complications.
    Mechanism: Timely imaging and intervention if duct obstruction or infection.

22. Education & action plan
    Purpose: Know when to act, what to eat, and how to prevent recurrences.
    Mechanism: Informed choices reduce attacks and speed care.

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Drug Treatments

(Always individualized by a clinician; doses are typical adult ranges and may vary by country and patient factors.)

1. Ursodeoxycholic acid (UDCA, ursodiol) – Bile acid; stone dissolution and prevention
   Dose/Time: 8–10 mg/kg/day in 2–3 divided doses for 6–24 months for selected small radiolucent cholesterol stones; also used 300 mg twice daily prophylactically in high-risk rapid weight loss (per clinician).
   Purpose: Dissolve some small cholesterol stones and prevent new ones during rapid weight loss.
   Mechanism: Replaces hydrophobic bile acids, reduces cholesterol saturation, improves bile flow.
   Side effects: Diarrhea, mild GI upset; rare liver enzyme changes. Not effective for calcified/pigment stones; stones can recur after stopping.

2. Diclofenac / Ibuprofen / Ketorolac (NSAIDs) – Analgesics
   Dose/Time:

• Diclofenac 50–75 mg orally or IM;

• Ibuprofen 400–600 mg orally q6–8h;

• Ketorolac 10 mg PO q6h (short course) or 30 mg IM.
  Purpose: First-line pain relief for biliary colic; NSAIDs can reduce progression to cholecystitis.
  Mechanism: Inhibit prostaglandins and cystic duct inflammation.
  Side effects: Gastritis, GI bleeding risk, kidney effects; avoid in severe renal disease, peptic ulcer, late pregnancy.

3. Antiemetics (Ondansetron) – 5-HT3 antagonist
   Dose/Time: 4–8 mg PO/IV q8–12h as needed.
   Purpose: Control nausea/vomiting during attacks.
   Mechanism: Blocks serotonin receptors in gut/chemoreceptor trigger zone.
   Side effects: Headache, constipation; rare QT prolongation.

4. Antispasmodic (Hyoscine butylbromide / Dicyclomine)
   Dose/Time: Hyoscine butylbromide 10–20 mg PO/IM q6–8h PRN; Dicyclomine 20 mg PO q6–8h.
   Purpose: Reduce biliary colic spasm.
   Mechanism: Anticholinergic smooth-muscle relaxation.
   Side effects: Dry mouth, blurred vision, urinary retention; caution in glaucoma/BPH.

5. Opioid analgesic (if severe pain not relieved by NSAIDs) – e.g., Morphine, Hydromorphone (clinical judgment)
   Dose/Time: Titrated IV/SC/PO in monitored settings.
   Purpose: Rescue analgesia for severe colic.
   Mechanism: μ-opioid receptor–mediated analgesia.
   Side effects: Nausea, constipation, drowsiness, respiratory depression. (Traditional teaching warned about sphincter of Oddi spasm; in practice, opioids are used when needed under supervision.)

6. Antibiotics for acute cholecystitis/cholangitis (per local guidelines)
   Options/Doses (examples):

• Ceftriaxone 1–2 g IV daily ± Metronidazole 500 mg IV q8h;

• Piperacillin–tazobactam 3.375–4.5 g IV q6–8h;

• Ertapenem 1 g IV daily (selected cases).
  Purpose: Treat infection while arranging source control (ERCP/cholecystectomy).
  Mechanism: Broad coverage of Gram-negatives/anaerobes common in biliary infections.
  Side effects: Allergy, C. difficile risk; renal dose adjustment may be needed.

7. Antipruritic for cholestasis (Cholestyramine) – Bile acid sequestrant
   Dose/Time: 4 g powder once or twice daily; separate from other meds by ≥2–4 h.
   Purpose: Relieve itching in obstructive jaundice.
   Mechanism: Binds bile acids in gut to reduce systemic pruritus.
   Side effects: Constipation, bloating; interferes with absorption of other drugs and fat-soluble vitamins.

8. Proton pump inhibitor (e.g., Omeprazole 20–40 mg daily)
   Purpose: Protect stomach if NSAIDs needed and patient has GI-risk factors; treat concurrent dyspepsia.
   Mechanism: Suppresses gastric acid secretion.
   Side effects: Headache, diarrhea; long-term use considerations (B12, Mg, bone).

9. CDCA (Chenodeoxycholic acid) – Historical/limited
   Dose/Time: Formerly 12–15 mg/kg/day; now rarely used due to side effects.
   Purpose: Dissolve cholesterol stones (less favored than UDCA).
   Mechanism: Reduces hepatic cholesterol secretion.
   Side effects: Diarrhea, hepatotoxicity, increased LDL; largely supplanted by UDCA.

10. Adjunct lipid therapy when indicated for cardiovascular risk (Statins)
    Dose/Time: E.g., Atorvastatin 10–40 mg daily for dyslipidemia per guidelines.
    Purpose: Not a gallstone treatment, but statin therapy may reduce formation risk over time while managing CV risk.
    Mechanism: Lower hepatic cholesterol production; may alter bile composition.
    Side effects: Myalgias, rare liver enzyme elevation.

Important: Drug choices depend on your situation (pregnancy, age, kidney/liver function, allergies). Antibiotics are for confirmed or strongly suspected infection. UDCA only works for selected cholesterol stones and takes months; surgery remains the definitive fix for symptomatic disease.

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Dietary Molecular Supplements

(Evidence ranges from modest to limited; always discuss with a clinician, especially if you have stones or obstruction.)

1. Psyllium (soluble fiber): 5–10 g/day in water.
   Function: Improves lipid profile, regularity.
   Mechanism: Binds bile acids, reduces cholesterol reabsorption; may lower bile cholesterol saturation.

2. Vitamin C: 200–500 mg/day (diet first; supplement if deficient).
   Function: Supports bile acid synthesis enzymes.
   Mechanism: Vitamin C is a cofactor for 7α-hydroxylase; low C may increase cholesterol stone risk.

3. Omega-3 (fish oil, EPA/DHA): 1–2 g/day combined EPA/DHA.
   Function: Improves triglycerides; anti-inflammatory.
   Mechanism: Alters hepatic lipid handling; may reduce bile lithogenicity.

4. Phosphatidylcholine (lecithin): 1–3 g/day (food sources: egg yolk, soy; supplements exist).
   Function: Major bile phospholipid.
   Mechanism: In bile, phosphatidylcholine solubilizes cholesterol; dietary supplementation may influence bile composition (evidence limited).

5. Magnesium: 200–400 mg/day (elemental), if dietary intake is low; avoid in renal failure.
   Function: General smooth-muscle and metabolic support.
   Mechanism: May help GI motility and reduce cramping; evidence for gallstones is indirect.

6. Taurine: 500–1,000 mg/day (discuss with clinician).
   Function: Bile acid conjugation uses taurine.
   Mechanism: May support bile flow and composition; human data specific to gallstones are limited.

7. Artichoke leaf extract: per label (e.g., 320–640 mg/day standardized).
   Function: Digestive support.
   Mechanism: Choleretic effects reported; evidence modest and not a cure for stones.

8. Probiotics (e.g., Lactobacillus/Bifidobacterium blends): per label daily.
   Function: Gut microbiome balance.
   Mechanism: May influence bile acid metabolism via the enterohepatic cycle; evidence evolving.

9. Curcumin (turmeric extract): 500–1,000 mg/day curcumin with piperine unless contraindicated.
   Function: Anti-inflammatory, choleretic in some models.
   Mechanism: Modulates bile acid transporters; caution—can trigger colic in some with stones.

10. N-acetylcysteine (NAC): 600 mg once or twice daily (individualize).
    Function: Antioxidant; mucus-modulating.
    Mechanism: Limited data; theoretical benefits on bile viscosity; not a stone treatment.

Cautions: Supplements can interact with medications and may aggravate symptoms in some people with stones. Avoid “gallbladder flushes” or extreme regimens—these can be dangerous.

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Regenerative / Stem-Cell” Drugs

There are no approved stem-cell or regenerative drugs for cholelithiasis, and no immune-booster pills that shrink stones. To stay accurate and safe, here are 6 evidence-grounded supportive medical strategies sometimes used around gallstone care (not to dissolve stones):

1. Vaccination updates (e.g., influenza, pneumococcal as indicated)
   Dose/Timing: Per national schedules.
   Function/Mechanism: Lowers risk of secondary infections and hospital complications during acute illness or postoperative period.

2. Nutritional repletion if deficient (Vitamin D, B12, iron, folate—lab-guided)
   Mechanism: Correcting deficiencies supports immune function and recovery after procedures.

3. Glycemic optimization in diabetes (medications individualized)
   Mechanism: Better neutrophil function and healing; fewer infections.

4. Antibiotic prophylaxis (only when procedure-indicated, e.g., ERCP with obstruction or cholangitis)
   Mechanism: Prevents bacteremia/cholangitis during high-risk interventions.

5. Smoking cessation aids (NRT, varenicline, bupropion—clinician-guided)
   Mechanism: Improves tissue oxygenation, immune function, and postoperative healing.

6. Evidence-based perioperative ERAS protocols (multimodal analgesia, early mobilization, nutrition)
   Mechanism: Enhance recovery after surgery; reduce complications and inflammation.

If you see claims of “stem-cell cures for gallstones,” treat them skeptically—these are not standard of care.

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Surgeries/Procedures

1. Laparoscopic cholecystectomy (standard of care)
   What: Keyhole surgery to remove the gallbladder through 3–4 tiny cuts.
   Why: Definitive cure for symptomatic gallstones, recurrent biliary colic, acute cholecystitis (after stabilization), gallstone pancreatitis (after recovery), and complications.

2. Open cholecystectomy
   What: Traditional larger incision operation.
   Why: Used when laparoscopy is unsafe or conversion is required (severe inflammation, adhesions, abnormal anatomy, bleeding).

3. ERCP with sphincterotomy and stone extraction
   What: Endoscopic procedure via the mouth to access the bile duct, cut the sphincter if needed, and remove duct stones; sometimes place stents.
   Why: Treat choledocholithiasis and cholangitis (urgent source control).

4. Laparoscopic common bile duct exploration (LCBDE)
   What: During laparoscopic surgery, surgeons explore the bile duct and remove stones.
   Why: One-stage treatment for gallbladder and duct stones when expertise is available.

5. Percutaneous cholecystostomy (tube drainage)
   What: Radiology-guided tube placed through the skin into the gallbladder to drain infection.
   Why: For very sick/high-risk patients with acute cholecystitis as a bridge until they can safely undergo surgery.

6. Cholesterol gallstones – can sometimes be dissolved with ursodeoxycholic acid taken by mouth, but it may be necessary for the person to take this medication for years.^[rx]
7. Gallstones may recur, however, once the drug is stopped. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP).^[rx]

There are two surgical options for cholecystectomy

• Open cholecystectomy is performed via an abdominal incision (laparotomy) below the lower right ribs. Recovery typically requires 3–5 days of hospitalization, with a return to normal diet a week after release and to normal activity several weeks after release.^[rx]
• Laparoscopic cholecystectomy, introduced in the 1980s, is performed via three to four small puncture holes for a camera and instruments. Post-operative care typically includes a same-day release or a one-night hospital stay, followed by a few days of home rest and pain medication.^[rx]
• Laparoscopic cholecystectomy (removal of the gallbladder through multiple small incisions; this is less invasive and a more commonly used technique)
• Lithotripsy (the technique that uses electric shock waves to dissolve gallstones; it is not commonly used today)
• Open cholecystectomy (removal of the gallbladder through a single, large incision; this is a more invasive and less commonly used technique)

Complications of Gallstones

Complications of gallstones may include:

• Inflammation of the gallbladder – A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
• Blockage of the common bile duct – Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice, and bile duct infection can result.
• Blockage of the pancreatic duct – The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
• Gallbladder cancer – People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

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Preventions

1. Maintain a healthy body weight; avoid obesity.

2. If losing weight, go slow (about 0.5–1 kg/week), not crash diets.

3. Balanced diet: high in fiber, plant foods, and lean proteins; low in saturated fat.

4. Regular exercise most days of the week.

5. Don’t skip meals or fast for long periods.

6. Limit refined carbs and sugary drinks.

7. Manage diabetes and metabolic syndrome.

8. Review estrogen therapy risks and benefits with your clinician if you’re at high risk.

9. Take statins if you need them for heart health—may also lower stone risk over time.

10. Hydrate; water should be your main drink; moderate coffee may help some people.

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When to See a Doctor

• Severe right-upper-abdominal pain lasting >4–6 hours, especially after a fatty meal.

• Fever, chills, or feeling very unwell (possible infection).

• Jaundice (yellow eyes/skin), dark urine, pale stools (possible duct blockage).

• Persistent vomiting and dehydration.

• Pain radiating to the back or right shoulder, especially with nausea (biliary colic) or severe, constant pain (cholecystitis).

• Signs of pancreatitis: severe upper abdominal pain radiating straight to the back, vomiting.

• Pregnancy, older age, diabetes, immunocompromised, or gallbladder attacks recurring—seek prompt assessment.

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What to Eat and What to Avoid

Eat more of 

1. Vegetables and salads (variety, colors).

2. Fruits (especially citrus/berries; watch portions for diabetes).

3. Whole grains (oats, brown rice, whole-wheat bread).

4. Legumes (lentils, chickpeas, beans).

5. Lean proteins (skinless poultry, fish).

6. Moderate nuts and seeds (almonds, walnuts, flax).

7. Low-fat dairy or fortified alternatives.

8. Olive oil in small amounts for cooking/dressing.

9. Plenty of water as your main beverage.

10. Coffee in moderation if you tolerate it.

Limit/avoid 

1. Deep-fried foods (fries, fried chicken, samosas).

2. High-fat meats (sausages, fatty red meat).

3. Creamy sauces, heavy gravies, butter-laden dishes.

4. Full-fat cheese and ice cream.

5. Pastries and sweets high in sugar and fat.

6. Refined carbs (white bread, white rice—choose whole grain instead).

7. Very large meals (prefer smaller, regular meals).

8. Alcohol binges (avoid; alcohol may worsen pancreatitis risk).

9. Crash diets or prolonged fasting.

10. “Detox” or “flush” cleanses (unsafe and not evidence-based).

1. Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. The lack of a gallbladder may have no negative consequences in many people. However, there is a portion of the population—between 10 and 15%—who develop a condition called postcholecystectomy syndrome^[rx] which may cause nausea, indigestion, diarrhea, and episodes of abdominal pain.^[rx]

References

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