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Fifteen to 20 percent of all North Americans have gallstones, and gallbladder surgery is the most commonly performed abdominal surgery in both Canada and the United States. More than 50,000 gallbladders are removed annually in Canada and about 500,000 in the U.S. The good news is that gallstones is probably another health problem related to the excesses of the Western diet, and there is much that a woman can do to prevent their occurrence.

Women are three times more likely to develop gallstones than men. North American native women have the highest gallstone incidence in the world. The incidence of gallstones also increases with age. Recent studies reviewed in the Lancet medical journal (January 1990), have shown that "women not only have more gallstones, but also more often complain of symptoms and are more often aware of their condition than men."

What Does Your Gallbladder Do ?

Your liver is constantly making bile and delivering it to your gallbladder, which is a small muscular sac located under the liver. Your gallbladder concentrates bile five to ten times and then stores it until it is needed after you eat a meal containing fat. The purpose of bile is to remove waste products from the liver and to carry the bile salts which digest fat. Bile salts are essential to break down and absorb fats and the fat soluble vitamins A, D, E, and K.

As soon as your food arrives in the first part of the small intestine from the stomach, your gallbladder contracts and empties its contents of bile. The bile travels through a special passageway called the common bile duct and is released into the intestine.

Remarkably, one half to one-and-a-half litres (32 to 48 ounces) of bile are secreted by the liver every day, and concentrated in a gallbladder that can only hold 40 to 70 cc of bile (roughly one to two ounces) at a time. Ninety percent of the bile salts are reabsorbed from the intestine and are used about ten times before being lost through the stool.

What Gallstones Are Made Of

Gallstones can be round or oval, smooth or lumpy. They can be one to ten or more stones ranging in size from one to 25 mm across (up to about an inch in diameter). Eighty-five to 90 percent of gallstones are made predominantly of cholesterol. The remaining ten to 15 percent of stones are made predominantly of calcium. Calcium stones are much more common in the Orient than in Western countries.

Cholesterol will not dissolve in water, and thus certain substances made in the liver (the bile salts) keep the cholesterol dissolved. If the amount of cholesterol in the bile increases, or if anything happens to reduce the concentration of these bile salts, then the cholesterol can precipitate out and form gallstones.

For example, increased secretion of cholesterol can be caused by obesity, pregnancy, birth control pills, a diet high in saturated fats and rapid weight loss (either surgically or through dieting or fasting). Increased loss of bile salts can occur when the last part of the small intestine is inflamed (as in Crohn's disease) and cannot absorb back the bile salts.

The incidence of cholesterol gallstones is highest in the Native population, lower in Caucasians, and lowest among those of African and Oriental descent.