Gallstones are a common health issue here in Malaysia that are occurring more and more frequently.
Routine ultrasound scans – often done as part of an annual medical check-up – can identify gallstones for many.
But this condition is typically only identified after the person experiences discomfort (including pain in the upper abdomen), bloating, nausea and a feeling of heaviness after eating.
For some Malaysians, gallstones stay silent for years without causing harm.
For others, they cause repetitive bouts of pain, which can interfere with daily life and induce anxiety.
Knowing why gallstones develop and why it is occurring more frequently can help us manage them in a safer, more enduring way.
When bile becomes ‘thick’
The gallbladder is a small, pear-shaped organ located below the liver.
Its primary job is to store bile, which is a digestive fluid produced by the liver.
Bile is crucial for the breakdown of fat, converting fats into vitamins and aiding bowel activity.
Under healthy conditions, the bile is liquid.
However, trouble arises if it becomes too concentrated or “thick”.
In these cases, the bile can coalesce into small solid pieces, which over time, may turn into fine, brittle stones.
Most gallstones are cholesterol stones, formed when the bile is too cholesterol-rich.
A smaller percentage of gallstones are pigment stones, which are more associated with liver- or blood-related causes.
Gallstones vary widely in size, from as small as a grain of sand to large enough to block the bile ducts.
In cases of blockage, patients can develop more severe symptoms, leading to more serious complications.
Related factors
The increasing occurrence of gallstones in Malaysia mirrors worldwide changes in lifestyle and diet over the past three decades.
Our metabolic health has shifted as we increasingly consume refined carbohydrates, sugar- sweetened beverages and processed food – and eat out regularly.
Meanwhile, contemporary work practices tend to lead to long hours of sitting still, relatively little physical activity and a more sedentary lifestyle than ever before.
Chronic stress also compounds the stress burden by disrupting digestion and the natural flow of the gut.
These patterns contribute to heightened rates of obesity, insulin resistance, type 2 diabetes, fatty liver disease and polycystic ovary syndrome (PCOS) – conditions highly implicated in gallstone risk.
Obesity raises the risk because weight gain is associated with less contraction of the gallbladder.
When the gallbladder fails to empty effectively, the bile sits longer and goes stagnant, stimulating concentration and stone formation.
People affected by insulin resistance often have increased insulin production to compensate for the body becoming resistant to its effects.
This metabolic setting adds to the percentage of cholesterol going into bile, thus increasing the risk for cholesterol stones.
Irregular eating patterns, like skipping meals, eating late at night, and cycling between overeating and restrictive dieting, can also damage gallbladder function.
This is as the gallbladder relies on regular contractions to efficiently drain bile.
Rapid fat loss caused by aggressive dieting also brings more cholesterol into bile, in addition to causing the gallbladder to drain with less frequency.
These factors create a good environment for gallstone formation.
Similarly, hormonal variations, such as increased oestrogen states, also serve to inflate bile with cholesterol and decrease gallbladder contractions.
This can occur in women with PCOS, perimenopause, menopause, high oestrogen levels, low SHBG (sex hormone-binding globulin), or those treated with hormonal therapies or who are pregnant.
The gallbladder’s hormone-related responses explain the higher occurrence of gallstone formation during certain stages of life for women.
Preventive approaches
Dietary habits should be re-evaluated to effectively manage gallstones.
While some contend that removing fats completely is required, low-fat diets that are too restrictive can actually worsen gallstone conditions.
Inadequate fat leads to bile going into stagnation, which further increases the chances of stone formation.
Healthy fats are also essential for the contraction of the gallbladder and the release of bile.
A balanced intake of healthful fats, i.e. olive oil, coconut oil, ghee, avocados and fatty fish (e.g. sardines, mackerel), is essential for gallbladder functioning.
Balance is important: too much greasy food can worsen symptoms, while totally eliminating fat can be detrimental to gallbladder health.
A diet high in fibre promotes bile health as it reduces cholesterol and helps with digestion.
Good sources of fibre include water spinach (kangkung), mustard greens (sawi), broccoli, cabbage, long beans, papaya, guava, apples and berries.
Whole grains (e.g. oats, brown rice) and legumes are good for digestion.
Frequent bowel movements are needed to avoid reabsorbing bile and gallstones, and to decrease the risk of bile-borne diseases.
Traditional Malaysian foods such as bitter gourd, turmeric, ginger and pegaga aid in digestion and bile flow, compatible with the principles of functional medicine.
It’s just as essential to restrict the types of foods that may increase your chances of getting a gallstone.
Sugary drinks, such as soft drinks and sweetened teas, are known to negatively affect blood sugar and insulin levels.
Eating too many sweets, pastries and fried foods can make insulin resistance even worse and may contribute to the formation of gallstones.
Consuming less highly-processed food may minimise inflammation and metabolic stress.
For women with hormonal imbalances, promoting the excretion of oestrogen by taking the following could help lower their risk of gallstones:
- DIM (diindolylmethane) – helps to normalise the metabolism of oestrogen; however, it should be avoided during pregnancy or if oestrogen levels are very low, unless under the supervision of a healthcare professional.
- Calcium – inhibits the reabsorption of oestrogen within the gastrointestinal system
- B-complex vitamins – helps with liver detoxification and methylation, thus supporting overall liver metabolism, which helps increase SHBG.
Some harmful gut bacteria produce an enzyme known as glucuronidase, which promotes the reabsorption, rather than the excretion, of oestrogen.
This recycled oestrogen might worsen bile thickening.
To help improve gut health and prevent this:
- Include probiotics of multiple strains in your diet.
- Talk mild prebiotic fibres, e.g. 5-10g of partially hydrolysed guar gum (PHGG) or acacia fibre daily.
Frequent bowel movements are essential as constipation can cause reabsorption of bile and hormones instead of their removal.
Promoting gut health with high-fibre foods, fermented foods such as yoghurt and kefir, and tempeh, while also treating issues like constipation and bloating, provide additional support for good gallbladder function.
Manage it right
For many Malaysians who have stable gallstones (either incidentally or presenting only with small, occasional symptoms), the strategies above that can help with metabolic health, digestion and bile flow can be both practical and empowering.
However, it is crucial to seek medical care in certain cases, especially when the signs of duct obstruction or infection are evident.
Severe or recurring right-upper abdominal pain, fever, jaundice, frequent vomiting or worsening symptoms must never be treated independently and should require prompt medical assistance.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
