Gallstones; raised liver enzymes

The liver is the largest organ in the body, and one of the most important.  It has many vital functions relating to the blood, and others relating to the digestion, absorption and storage of nutrients.  The gall – bladder nestles below the liver and supports it in the digestion of far: it acts as a reservoir for bile, the fat – digesting fluid produced by the liver.  The gall – bladder stores the bile until it is discharged during digestion into the duodenum, the first part of the intestine.  The majority of people don’t realize they have a gall-bladder until they are hit with the excruciating pain that accompanies gallstones and inflammation of the gall bladder.  It has been estimated that ten per cent of the Western population suffer from gallstones.  Gallstones are pebble – like balls of cholesterol – rich crystals which form within the gall bladder.

There may be one walnut – sized gallstone or hundreds of them, smaller than grains of rice.  Problems occur when they block the route of the bile to the intestine and irritate the lining of the gall-bladder, causing it to become inflamed (cholecystitis).  If the bile’s exit is blocked, its yellowish pigment will be returned to the blood via the liver, and the body can become jaundiced (the skin and whites of the eyes turn yellowy orange).  Jaundice requires medical investigation and treatment, along with specific dietary advice from your doctor.  Since the major function of bile is to help the body digest fat, the lack of bile causes fat malabsorption, which leads to other symptoms bloating, nausea, diarrhea and steatorrhea (fatty. Smelly stools) Nutritionally, the best way to prevent and treat gall – Bladder disease is to make sure that you eat plenty of high fiber foods, as these help your body rid itself of unwanted fat.  Having said this, some people seem to have a genetic predisposition to developing gallstones, however healthy and well balanced their diet is.

 Prevention of gallstones

Understanding your nutritional needs explains the elements of a balanced, healthy diet.  The general principles apply to anyone who wants to maintain good health

and prevent disease. While high fat, low fiber diets have been linked with the formation of gallstones, there is little evidence to say that you need to avoid fat completely.  You need a certain amount of fatty provide and metabolize nutrients within your body.  However, many people in Western society eat far too much fat.  If you eat a lot of fried foods, takeaways, high fat snacks such as crisps and chocolate, butter and cheese.  I suggest you think seriously about your eating habits.  Take things gradually: grill or bake rather than fry, plan a big healthy salad instead of a takeaway, make crisps and chocolate an occasional treat rather than an everyday snack.

Many people would also benefit from boosting their fiber intake.  Fruits and vegetables, beans and lentils, wholegrain cereals, bread and rice should all feature in your daily or weekly eating plan.  Make sure you drink plenty of water to help the fiber work efficiently in your body.  Some studies have suggested that coffee and tea can reduce the production of gallstones, but do not take this to mean that copious consumption will dissolve the stones, it will not.  The disadvantages of excessive tea and coffee drinking far outweigh the benefits, so enjoy two to three cups a day, but no more.

Dealing with gall – bladder problems

Managing gall – bladder disease is all about discovering which foods upset you and which foods you can tolerate.  To investigate how different foods affect your symptoms, try keeping a food diary: for a couple of weeks.  Some people think that fat will upset them, but when they keep a note of everything, they eat they find that there is no correlation between fat and their symptoms.  The reason why fat can cause pain and nausea is that the presence of fat in the stomach stimulates the gall – bladder to contract and release bile.  If there are stones in the gall – bladder or the gall – bladder ducts are inflamed, this contraction can bring about pain.

Many patients diagnosed with gall-bladder problems think they need to shop for low fat products.  I do not generally recommend these because they don’t really contribute to a healthy diet: they can be very high in sugar, artificial additives and preservatives, and the taste often leaves a lot to be desired.  It is much better for you to stick to natural fats like olive oil and butter, but cut down on the amount you use.

The gall-bladder does not react any differently to saturated fats (found mainly in meat, butter and other dairy products) and unsaturated fats (found in vegetable fats such as olive oil, and in oily fish).  However, if you have a raised cholesterol level consider choosing olive oil rather than butter.  Women with gallstones need to be particularly careful when cutting out dairy products, because these provide such a significant amount of calcium.  Calcium is vital for maintaining healthy bones, and lack of it can increase the risk of osteoporosis, a common condition in women after menopause.  Younger women should be aware that they need to maintain bone density throughout their lives.

The best way to approach this and prevent gall – bladder discomfort is to avoid having large lumps of cheese or glasses of full cream milk on an empty stomach. Instead, incorporate small amounts of dairy products – semi – skimmed or skimmed milk, yoghurt, cheese – within meals.  these foods.  It is usually the large load of fat that causes problems.  Instead, stagger your intake of fat throughout the day, and combine it with high fiber foods, for instance having butter on whole meal bread or a light vinaigrette dressing on salads.  People sometimes forget that if you eat a lot the stomach may swell and press against the inflamed gall bladder and cause pain.

It may be nothing to do with the fat content of your meal, but simply the sheer volume of food in your stomach.  Small meals are often the best eating style, as this not only limits the pressure on the gall-bladder, it also allows the body to digest the food most efficiently.  Of course, if you are carrying excess body weight, a gall – bladder problem may be the spur you need to lose weight by reducing the amount of fat and other concentrated sources of calories in your diet.  But as with all weight loss programs it is best to lose weight gradually and to find an eating style which doesn’t make you feel deprived (see Achieving your ideal weight).

The majority of my patients with gall-bladder problems find that, if they increase their intake of high fiber foods, this has a cushioning effect which stops the fat within the meal setting off any pain.  Some patients notice that certain high fiber foods such as cauliflower and broccoli have a tendency to produce wind and bloating, which can set their gall-bladder pain off.  This is nothing to do with the fat content of the diet.  In this instance I suggest experimenting with different types of high fiber foods, drinking plenty of water and protecting the healthy bacteria in your gut. Some people find that excess tea and coffee can cause bloating, which can trigger pain, so limit yourself to two or three.  cups a day.

Removal of the gall – bladder

in the past the majority of people with gallstones had to have surgery to remove the gall – bladder, but now there are simpler, non – invasive treatments which can either dissolve the gallstones or smash them up with ultrasound.  The symptoms usually disappear almost immediately, although the gall bladder may remain inflamed for a few days after the procedure.  Some patients come to me having been told by their surgeon to lose excess weight before they can have the operation to remove the gall-bladder.  It is tempting to go on a crash diet to lose the weight so you can be relieved of the pain, but it is better to try to lose it gradually by adjusting you’re eating habits.  so that it stays off after the operation.

You should be able to lose weight while managing your symptoms by adopting a higher fiber, lower fat diet, so that the overall efficiency of your treatment is good.  If you have your gall – bladder removed, you will need to address the fat content of your diet if you are to remain symptom – free.  There is no reason why Your body cannot digest fat, as it is the liver that produces the bile, not the gall bladder.  So, when you have your gall – bladder removed the liver will still produce bile, but your body won’t have a reservoir on which it can draw if you have a fatty meal.  Most people find that keeping their intake of fat at a healthy level helps their digestive system to cope.

Try to have small amounts of fat regularly, taken with high fiber foods, such as a slice of cheese on whole meal bread with a bunch of grapes, rather than gorging on a plate of cheese on its own.  This eating pattern will enable your liver to judge how much bile to produce.  Don’t go for long, relatively fat – free periods and then expect your liver to produce a large amount of bile to digest a fatty meal, as the liver takes time to respond.  People who have the stone dissolved or smashed by ultrasound shouldn’t have any further problems digesting fat, but I suggest you keep a food diary for a few weeks to check your overall nutritional balance.

Raised liver enzymes

Routine blood tests can occasionally show raised liver enzymes.  The presence of abnormally raised enzymes in the blood suggests that the liver is working at a reduced capacity.  This can occur for many reasons and your doctor will need to investigate further.  The most common causes are infections such as those caused by the hepatitis virus (hepatitis A, B or C), or the side effects of certain drugs.  In some cases, a cancerous tumor will produce significantly higher enzyme levels.  Often there is no underlying cause for the raised enzymes other than that the liver is not coping with your eating and drinking habits.

In these cases, raised liver enzymes are a warning that you need to take your body seriously and start looking after it.  Your doctor will be able to tell whether the Gamma GT level is raised, which usually suggests that you are drinking too much alcohol.  However, some livers are just more sensitive than others.  There are people who, despite leading a healthy lifestyle, always show raised liver enzymes.  This may happen because of an earlier illness or as an unexplainable phenomenon, which many doctors don’t worry about unless the levels change significantly.

If you have been diagnosed as having raised liver enzyme levels and your doctor reassures you that all you need to do is start looking after your liver there are several nutritional issues you can address which will allow your liver to recover and stay healthy.  This is definitely in your best interest, as liver failure is one of the most debilitating illnesses.

DISCUSS ALL MEDICATION WITH YOUR GP

Remember that everything you put into your body is metabolized by the liver.  This includes nutritional supplements and homeopathic remedies, so don’t take any medication, whether wholly natural or over-the-counter drugs, unless you have discussed them with your GP.  It is important not to overload your liver with substances, be they food or drugs, that might compound the problem.

TAKE YOUR DOCTOR’S ADVICE ABOUT ALCOHOL

Your doctor may suggest that you abstain from alcohol until your liver enzymes return to normal.  There are plenty of alcohol – free drinks, such as sparkling and fruit – flavored waters, elderflower cordials, apple, cranberry and other fruit juices, that are quite delicious.  Remember that you are saving your liver.  In other circumstances you may simply be advised to cut down your alcohol intake.  Many people find that spirits – whiskey, brandy gin, vodka – hit the liver harder than wines, probably due to their high alcohol content.

I advise that you stick to wine and don’t drink on an empty stomach, as this causes a rush of alcohol into your system, which your liver has to work overtime to deal with Drinking a small amount of wine with food is the best plan.  Beware of dessert wines such as Sauternes and Taraji, as these tend to be hard on the liver.  Beers seem to be reasonably well tolerated, their main drawback being that you tend to drink them without food, which can cause your liver to complain.

CUT DOWN ON CAFFEINE

caffeine irritates the liver, so cutting down on caffeine – containing drinks – tea, coffee, cola, hot chocolate – to no more than two cups a day will help your liver recover more quickly.

BE FOOD WISE If

you have raised liver enzymes but no other medical problem such as hepatitis, a well-balanced, healthy diet, as discussed in the chapter on Understanding your nutritional needs, will enable your liver to recover as quickly as possible.  There is one area to which you should pay particular attention: fats.  Fat is one of the hardest foods for the body to break down and metabolize, and it is often even more difficult for people with raised liver enzymes.

They may suffer from indigestion, bloating, wind and a general feeling of heaviness when they eat fatty foods.  It is therefore best to avoid fried foods, cream, butter – rich pastries and large pieces of cheese on their own.  Keep food simple.  Chargrilled fish, roast lean meats, steamed, baked or roasted vegetables can all be flavored with herbs for plenty of variety: they don’t need to be cooked with lashings of oil, butter or cream.

Eat pasta with a tomato sauce rather than a creamy one, look to desserts based on fresh fruits.  If your body weight is on the low side and you are worried about cutting such a rich source of calories out of your diet, step up your intake of starchy foods (carbohydrates) such as pasta, rice, potatoes and bread, as well as pulses and lean proteins, to give your body the energy it needs.  Some people with raised liver enzymes get indigestion from certain foods such as bread or pasta.

If you suspect a particular food, keep a diary of your food, drink and symptoms If one item seems to be responsible, avoid it for a week or two, replacing it with an equally nutritious food, and see if there is any difference. I suggest you also read the Managing allergies.