Why smaller stones can be MORE painful

‘AROUND 80 per cent of people can have gallstones and no symptoms — but if stones form and block a bile duct they can cause severe pain called biliary colic,’ says Steve Ryder, a professor of hepatology at The Queen’s Medical Centre in Nottingham and medical adviser to the British Liver Trust.

‘The pain starts an hour or two after a meal and can be mistaken for a heart attack, as it is in the upper abdomen/lower chest and can be very intense. It can also radiate through to the back and may be accompanied by nausea and sickness.’

A gallstone attack is often described as a ‘griping’ pain coming in waves. It may go away after a couple of minutes but can last five hours or even longer, sometimes recurring. The pain is caused by the gallbladder contracting as it tries to expel the stone. This will usually occur after a high-fat meal, when more bile is produced.

‘The stones can be as tiny as a piece of grit or as large as a small pebble and their size has no bearing on whether they will cause problems,’ explains Professor Ryder, who also works at the BMI The Park Hospital in Nottingham. ‘People can have the most terrible symptoms and have a tiny stone — it’s more a question of whether the stones block a duct or irritate the lining of the gallbladder, causing inflammation.’

In fact, smaller stones — about the size of a lentil — are more likely to block a bile duct than larger ones and can be more problematic, agrees Julian Walters, a professor of gastroenterology at Imperial College London. ‘The larger ones won’t block a duct and won’t be passed out but just fall back into the gallbladder,’ he says.

Gallstones may also cause much vaguer ‘grumbling’ symptoms, adds Professor Walters. ‘People can have what they believe is niggling indigestion pain for years and this can be difficult to diagnose —they may have taken indigestion remedies for years and had no relief.’ (It is best is not to take such remedies longterm without seeking medical advice, to rule out more serious problems.) ‘ Many other people have gallstones that cause no symptoms and are only diagnosed when they have a scan for another medical condition.’

WHAT CAN I DO FOR MY GALLSTONES?

‘SOMETIMES “grumbling” gallstones just settle down on their own over the course of a few months,’ says Professor Walters.

The stone that blocked a duct may have finally pushed through and passed out of the body via the bowel. ‘That person may never have another attack, so we often just “watch and wait” to see what happens,’ he adds, ‘ although if someone has had a very painful attack, they may decide to have gallbladder removal surgery sooner rather than later.

‘In the past we used various techniques for removing stones but found a high percentage re-formed, so now we either wait to see if they settle or remove the gallbladder,’ adds Professor Walters.

‘But if patients have grumbling symptoms or infrequent attacks that aren’t troubling them too much, they may choose to make some changes to their diet to reduce the chances of stones flaring up again. This involves following a low-fat diet — high amounts of fat will cause the gallbladder to contract and cause pain.’

This doesn’t just mean cutting down on saturated fat such as cream and butter, but all fats including the ‘good’ types such as olive oil.

Dr Amanda Squire, of the British Dietetic Association, adds: ‘People have different tolerance levels for

RAPID weight loss can trigger gallstones by upsetting the balance between salts and cholesterol in the bile. A study in the journal Obesity found that anyone losing more than 3.3lb (1.5kg) a week was at higher risk

fat. Some will be able to eat fish and chips once a week, others will only need to have one chip and it will set them off. ‘Hard cheeses such as Cheddar have the highest fat content and are most likely to cause problems, so eat low-fat cottage cheese instead. I always advise patients with gallstones to avoid takeys, as they almost all contain too much fat. 'Some people find spicy food and alcohol can be triggers, too.’

TRIGGER FOODS TO AVOID OR LIMIT

Butter, lard, ghee, oils and spreads.

Whole milk, cream, creamy full fat yoghurts, mayonnaise and creamy sauces.

Full-fat cheeses such as Cheddar and Stilton.

Highly processed foods such as cake , biscuits and pastries.

Ice cream and custard.

Sausages, salami, lamb, beef, corned beef, pork and mince (all high in fat).