"The increase in wisdom can be measured precisely by the decrease in bile."

Friedrich Nietzsche (1844-1900)

German philosopher

Aphorism 348

"A Gauge for Wisdom" (1880)

NEVER mind if Nietzsche meant "an inclination to anger" for "bile."

You would get angry anyway - and distraught, and maybe helpless, if your bile was blocked. This is what gallstones can do.

Gallbladder Basics. Under the liver and connected to it is a muscular sac called the gallbladder. Stored in the gallbladder is bile which is made in the liver. It is a greenish-brown fluid made of salts, cholesterol, fatty acids like lecithin, and other chemicals released in the small intestine to help digest fat. It's the body's own heavy-duty turpentine if you think about it. Sometimes, an imbalance in the composition of bile fluid occurs and sludge results. Eventually, the particles in the sludge grow into stones - gallstones.

Types of Gallstones. Gallstones that form can be as small as a grain of sand or as big as a golf ball. By composition, the most common are yellow cholesterol gallstones (around 80%) made from undissolved cholesterol. Pigment gallstones are dark brown to black made from the residue in the breakdown of red blood cells. The rarest are primary bile duct stones that form not in the gallbladder but in the ducts or passageways. Lifestyle contributes a lot to getting gallstones. For example, if you regularly skip breakfast, eat too little fat, or go for long periods without eating (programmed fasts), the gallbladder is stimulated less and does not empty completely. The result is more concentrated bile, the type predisposed to turning into sludge and stones.

Risk Factors. Gallstones can run in families. Women between 20 and 60 are more likely to develop gallstones for these reasons: The female hormone estrogen increases more cholesterol in the bile; pregnancy means an increase in estrogen as well. Birth control pills and hormone therapy (for the menopausal) increase bile cholesterol levels and decrease healthy gallbladder contraction. Being overweight is a risk factor because there is more cholesterol in the bile, less bile salts, and less gallbladder contraction. Age is also a factor - older people, those past 60, are more likely to develop gallstones than younger ones. Finally, diet has been implicated particularly those involving rapid weight loss and low-calorie. These restrictive diets disrupt bile chemistry and interfere with normal gallbladder emptying. Risk increases in people who lose more than 3 pounds a week.

Signs and Symptoms. The classic signals are:

* Pain in the right side of the abdomen, usually upper right or upper middle lasting from 15 to 30 minutes one to two hours after a meal

* Chronic indigestion - nausea, vomiting, gas, bloating especially after a fatty meal

Sometimes, the gallstone obstructs and pain persists with fever.


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