Rolling Stones
24 April 2015

“I’d rather go through labour than experience that again!” was Rachel’s opening line when she came to see me in my clinic this week. A sudden attack of upper abdominal pain had caused me to admit her to hospital the week before. The diagnosis was gall-stones. Often said to be the worse pain you could ever experience (I’m sure it must have been a bloke who said that), gall-stones can strike at any time. In some cases they can roll down the bile-duct and obstruct the gall-bladder, causing yellow jaundice. And the only long term solution is to remove them, a cholecystectomy operation. Usually there are a handful of stones in the gall-bladder. But I think the record is over 3000 in one patient.

When I was a medical student I was taught that gall-stones were more likely in people who were, as the “5 F’s” state, “fair, forty, female, fertile, and……fat.”. I often recall the wise words of one of my professors who, at the beginning of a lecture, warned us that “half of what I am about to teach you will one day turn out to be untrue. The only problem is I don’t know which half it is”! And so when I reflect back on the “5 F’s” I have seen no evidence that fair people are more likely to have gall-stones. And though the risk increases with age I’ve had patients who’ve developed gall-stones in their 20’s. Certainly they are more common in women. And even more common the more pregnancies they have had. So it stands true that there are at least 3 F’s. So what about the fifth, fat? Fact or fiction? (those F’s don’t count!).

It’s seems to be fact. The more overweight you are, the greater the risk of gall-stones. A body mass index of 30 (roughly 2 stones overweight) increases the risk by 4 times. A BMI of 40 (maybe 5 stones overweight) increases the risk by 7 times. The reasons for this are not entirely clear. It’s not just weight that has a bearing, it’s also the way fat is distributed. Central fat, or a bulging waistline, seems to carry a greater risk overall. It’s probably because being overweight raises levels of cholesterol in the blood. Most gall-stones are formed from crystallised cholesterol in the gall-bladder. The irony is that even though being overweight increases the risk, losing weight might actually increase your risk yet again. But evidence shows that it’s rapid weight loss, or after weight loss surgery that the risk increases. There’s some evidence in fact that a more gradual weight loss, of around 2 pounds a week on average, will actually decrease your risk. Like most things medical, prevention is better than cure, and the best way of decreasing your risk of gall-stones is to work towards a return to normal body weight through steady, gradual weight loss.

Rachel has now decided that she wants to live a healthier lifestyle and lose a bit of weight. I’m sure she’ll be successful. She might not be at risk of gall-stones any more, but she’s now acutely aware of the other health risks being overweight can pose. And dieting could never be as tough as going through childbirth. Right?