Gallstones, Weight loss and Low Fat Diet

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Gallstones, Weight loss and Low Fat Diet

Postby Jaggu » Tue Dec 30, 2008 8:49 am

Hi Jeff,

Low Fat Diet such as one recommended here coupled with exercise can cause rapid weight loss. I did experience this rapid weight loss(50 lbs in 1 year) and recently was diagnosed with Gallstones after abdominal pain thrice in last four months. Never had this problem before I started this Low fat diet and exercise program about a year ago.

Do you think the rapid weight loss through above approach(voluntary) can cause Gallstones. or it is the calorie restricted diet that could cause Gallstones.

Is this one of the downside of rapid weight loss? Some say you need at least 10 grams of fat in a meal for bile to contract not sure of validity.

May be you could shed some light on this.
Jaggu
 

Re: Gallstones, Weight loss and Low Fat Diet

Postby JeffN » Tue Dec 30, 2008 9:25 am

Hi Jaggu,

Congratulations on your weight loss but sorry to hear about your situation.

Jaggu wrote:Low Fat Diet such as one recommended here coupled with exercise can cause rapid weight loss.


Any diet, that is very low in calories, with or without exercise, that causes a large energy deficit, can cause rapid weight loss. Weight is a function of energy balance.

Jaggu wrote:
Do you think the rapid weight loss through above approach(voluntary) can cause Gallstones. or it is the calorie restricted diet that could cause Gallstones.

Is this one of the downside of rapid weight loss? Some say you need at least 10 grams of fat in a meal for bile to contract not sure of validity.

May be you could shed some light on this.


Gallbladder attacks can occur as a side effect of very rapid weight loss, very low calorie diets, and long periods without eating, regardless of how one loses weight. But first, very rapid weight loss and very low calorie diets are not a good idea for many reasons, not just the potential risk of gallbladder attacks. Now, this risk happens mostly in women and is a result of increased cholesterol levels in the gallbladder. And if appropriate, there are some medications that can be prescribed short term to minimize this risk.

People who lose a large amount of weight quickly are at greater risk for gallstones than those who lose weight more slowly. Rapid weight loss may also cause silent gallstones to become symptomatic. Studies have shown that people who lose more than 3 lbs per week may have a greater risk of developing gallstones than those who lose weight at slower rates. While certain people say fat may be an issue, no studies have directly linked a diet's nutrient composition or fat content to the risk of gallstones.. It only takes about 10 grams of fat to cause the gallbladder to contract. A 2000 calorie diet that is 10% fat provides around 23 grams of fat per day. A 1500 calorie diet that is 10% fat provides around 17 grams of fat

High fiber intake and regular exercise also lower your risk

However, this recent study on 120 patients who have lost over 100 pounds,recently came out in the AJCN, which confirms these comments. The average weight loss was around 3# per week (which is over what is typically recommended) for over 44 weeks. And, all showed significant health improvements and were followed up for 5 years. Only 2 people had serious side effects and as far as I could tell from the study, none had gallbladder issues.

James W Anderson, Shannon B Conley, and Amy S Nicholas
One hundred-pound weight losses with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up.
Am J Clin Nutr 2007 86: 301-7.

quoting...

Side effects were mild, and only 2 patients had severe or serious adverse events. At an average of 5 y of follow-up, patients were maintaining an average weight loss of 30 kg.

Conclusion: Intensive behavioral intervention can be very effective with minimal risk for certain severely obese persons

In the National Weight Control Registry, over 5000 members have lost on average over 65 pounds can kept it off on average for over 6 years. Some of the them lost over 100 lbs and some of them have kept it off for over 10 years. Most of them followed a low fat diet (under 23%) with 1/3 of them following a diet with less than 20% fat. Gallblader problems was not an issue.

So, the gallbladder issue is more of a very low calorie and/or rapid weight loss issue and is not a common problem. However, it can be dealt with if it does occur.

This is not a low fat issue and just adding fat doesn't fix it. Recommending a healthy calorie level and a healthy rate of weight loss from a high fiber diet along with regular exercise is the solution.

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Re: Gallstones, Weight loss and Low Fat Diet

Postby Jaggu » Tue Dec 30, 2008 10:48 am

JeffN wrote:So, the gallbladder issue is more of a very low calorie and/or rapid weight loss issue and is not a common problem. However, it can be dealt with if it does occur.


In Health
Jeff


What would you consider as a very low calorie level?

3 lbs and over per week is considered as rapid weight loss but what about continuous weight loss let's say on an average 2-2 1/2 lbs per week for few weeks initially and then 1 lb a week and then 0.5 lbs per week till reaching the final weight with a total weight loss of 50-55 lbs over a period of year. Would you consider that as a rapid weight loss?

Can the gallstones form in matter of say six months or it takes much longer than that?

Minimum 10 grams of fat required for Bile contraction, is that 10 grams for the entire day or 10 grams per meal?

You said, GB issue can be dealt with if it develops. How do you deal with it? Is there a way to deal with it without surgery or removing it?

Thanks for your timely post. Appreciate it.
Jaggu
 

Re: Gallstones, Weight loss and Low Fat Diet

Postby JeffN » Tue Dec 30, 2008 12:20 pm

Jaggu wrote:What would you consider as a very low calorie level? .


It would depend on the person, their height, weight, activity levels, etc etc, but remember I am not recommending calorie levels or calorie counting. Therefore, the best marker would be how quickly the weight is being lost. Most professionals in the field recommend no more than 1/2-2# per week and that is why the weight loss in the above study is considered "rapid", though I am not sure I agree. Studies have shown that people who lose more than 3 pounds per week may have a greater risk of developing gallstones than those who lose weight at slower rates and that is probably one of the places where the above recommendations of no more than 2#/week comes from.

However, again, we have to put this in perspective. Often these results are from studies using a very low-calorie diet (VLCD) which by traditional definition, provides about 800 calories per day in food and/or liquid form. Studies on these diets have shown that 10 to 25 percent of people on a VLCD developed gallstones. These gallstones are usually what are called "silent" which means they did not produce any symptoms. However, about one-third of the dieters who developed gallstones, did have symptoms. So, 1/3 of 10-25 is 3-8% had symptoms and this is on a 800 calorie diet. But, no one here is recommending such a regime so the results may not (and most likely do not) apply here to you or to anyone following the MWL which encourages you to eat whenever hungry till comfortably full. Those VLCD diets are also very low in fiber which is another contributing factor to this issue. The MWL is very high in fiber, so again, these results may not apply.

Also remember, that in spite of all the cautions, there is really little evidence for serious side effects of rapid weight loss, if it is done in a healthy way, and for many, the risk of the excess weight and the benefit of getting the weight off quickly, may outweigh any potential risks. As the study in my above post showed, there were few if any problems and those subjects lost a very substantial amount of weight in a short period.

Jaggu wrote:3 lbs and over per week is considered as rapid weight loss but what about continuous weight loss let's say on an average 2-2 1/2 lbs per week for few weeks initially and then 1 lb a week and then 0.5 lbs per week till reaching the final weight with a total weight loss of 50-55 lbs over a period of year. Would you consider that as a rapid weight loss?.


Again, there is no single answer. All these questions and their answers depend on the specific situation and the specific person. The answer would be very different for someone trying to lose weight weighing 300 lbs and someone trying to lose weight weighing 145 lbs. Another recommendation you often hear is 1% of body weight per week. For a 300 lbs person this would be 3#/wk and for a 145 pound person this would be 1.45/wk. That makes more sense to me as this is relative to the person and their weight and not just a random absolute number. But again, remember, most all recommendations are "general" recommendation and again, I am not sure I always agree with them or if they always apply here and to anyone's specific situation here.

The real irony is that the risk for gallstones increases as BMI increases. Studies have shown that the risk may triple in women who have a BMI greater than 32 compared to those with a BMI of 24 to 25. The risk may be seven times higher in women with a BMI above 45 than in those with a BMI below 24. A BMI of 45 is very high and related to many serious health problems and not just gallstones. So in this case, both the current weight, and the need to get it off quickly both could increase risk for gallstones. Yet for someone with a BMI Of 45, which is around 300# for someone around 5'8, losing 2#/week is not very much at all and would take them over 50 weeks just to get to a BMI of 30 where they are still at risk for weight related issue and gallstones. Would you recommend they lose 2# or less per week or more?

This is why there is never a simple answer or a single answer that always applies to every individuals specific situation.

The problem here today is that when you hear a risk like say, 1 in 10,000, you figure maybe it is not a serious risk or issue. But, when you are the one, (as you are here) it is suddenly a serious issue.

Jaggu wrote:Can the gallstones form in matter of say six months ...?.


Yes.

Jaggu wrote:You said, GB issue can be dealt with if it develops. How do you deal with it? Is there a way to deal with it without surgery or removing it? .


There are both surgical and not surgical (drug, sound waves) methods that are commonly used. However, I am not sure it applies in the situation of someone who experiences them from rapid weight loss if they are done with the rapid weight loss. My recommendation would be to discuss this with your MD and/or email Dr McDougall to see what they say. My guess is, that if the problem was from rapid weight loss and the weight has stabilized, this may no longer be a problem.

BTW, the traditional dietary treatment recommended for issues surrounding gallstones (prevention, treatment, etc) is to follow a low fat (especiallylow animal fat) healthy diet based on fresh fruits, veggies, whole grains, etc and to lose excess weight if necessary and to maintain an active lifestyle.

Jaggu wrote:Thanks for your timely post. Appreciate it.


You are welcome,

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Postby landog » Tue Dec 30, 2008 9:15 pm

From Dr. McDougall's Digestive Tune-Up:

Check out this link!

It's a good book!

Be well,
-dog
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Re: Gallstones, Weight loss and Low Fat Diet

Postby Jaggu » Fri Jan 09, 2009 9:05 am

JeffN wrote:It only takes about 10 grams of fat to cause the gallbladder to contract. A 2000 calorie diet that is 10% fat provides around 23 grams of fat per day. A 1500 calorie diet that is 10% fat provides around 17 grams of fat

In Health
Jeff


Jeff,

Is this 10 grams of fat requirement for GB contraction, is that per meal or per day? I assume that GB needs to contract every time you have a meal/lunch or dinner. But your post seems to suggest 10 grams per day.
Jaggu
 

Re: Gallstones, Weight loss and Low Fat Diet

Postby JeffN » Sat Jan 10, 2009 7:52 am

Jaggu wrote:
JeffN wrote:It only takes about 10 grams of fat to cause the gallbladder to contract. A 2000 calorie diet that is 10% fat provides around 23 grams of fat per day. A 1500 calorie diet that is 10% fat provides around 17 grams of fat

In Health
Jeff


Jeff,

Is this 10 grams of fat requirement for GB contraction, is that per meal or per day? I assume that GB needs to contract every time you have a meal/lunch or dinner. But your post seems to suggest 10 grams per day.


Hi Jaggu

I dont think there is an exact answer and I have not been able to find the actual reference for that comment, which I did make.

For the record, if you consumed 2000 calories and got 10% of your calories from fat, that would be 200 calories, and about 23 grams of fat. Over three meals that would be almost 8 grams. I do not think this would be an issue, either way, nor do I know of it being an issue.

In addition, as you can see from the references to Dr McDougall comments on the topic, and to the large study I posted, he has seen no higher incidence in the patients he works with over the decades, neither have I, the literature, and neither have the fasting places (which feed no food or fat) I know of.

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Re: Gallstones, Weight loss and Low Fat Diet

Postby JeffN » Thu Mar 09, 2017 8:53 am

When vegan is not enough...

From the author...

"Our study of diet in relation to gallstone disease has just been
published online in the European Journal of Clinical Nutrition (abstract
below). Contrary to previous studies, ours shows a moderately raised
risk of gallstone disease in vegetarians compared with non-vegetarians,
although body mass index is by far the most important determinant of
risk."

Vegetarian diet as a risk factor for symptomatic gallstone
disease
TJ McConnell, PN Appleby and TJ Key

BACKGROUND/OBJECTIVES: Previous small studies have shown either no
difference or a lower risk of symptomatic gallstone disease
in vegetarians than in non-vegetarians. This study examined the
incidence of symptomatic gallstone disease in a cohort of British
vegetarians and non-vegetarians, and investigated the associations
between nutrient intake and risk of symptomatic gallstone disease.

SUBJECTS/METHODS: The data were analysed from 49,652 adults enroled in
the European Prospective Investigation into Cancer
and Nutrition (EPIC)-Oxford study, one-third of whom were vegetarian.
The linked databases of hospital records were used to
identify incident cases. Risk by diet group was estimated using Cox
proportional hazards models. Further analysis quantified risk by
intakes of selected macronutrients.

RESULTS: There were 1182 cases of symptomatic gallstone disease during
687,822 person-years of follow-up (mean = 13.85 years).
There was a large significant association between increasing body mass
index (BMI) and risk of developing symptomatic gallstone
disease (overall trend P<0.001). After adjustment for BMI and other risk
factors, vegetarians had a moderately increased risk
compared with non-vegetarians (HR: 1.22; 95% CI: 1.06–1.41; P = 0.006).
Although starch consumption was positively associated
with gallstones risk (P = 0.002 for trend), it did not explain the
increased risk in vegetarians.

CONCLUSIONS: There is a highly significant association of increased BMI
with risk of symptomatic gallstone disease. After adjusting
for BMI, there is a small but statistically significant positive
association between vegetarian diet and symptomatic gallstone disease.

European Journal of Clinical Nutrition advance online publication, 8
March 2017; doi:10.1038/ejcn.2016.252
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