Here's how to recognize and prevent a condition that strikes about 5 million people each year

The pain hits you suddenly.
Severe and steady, it lasts all afternoon. It starts down in your lower right side, then shoots up to your shoulder blades, and snakes over to your right shoulder. You break into a sweat. You feel like throwing up.

"What fresh hell is this?" you wonder. You may think that your appendix is on the fritz. Or worse, maybe it's your heart. Your doctor may even suspect ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, or even hepatitis. But for more than 5 million Americans, these symptoms signal gallstones-hardened components of bile ranging in size from a grain of sand to a golf ball-that form in the gallbladder.

The good news about gallstones? There are some fairly simple ways to prevent them, including simple dietary changes and a daily walk-and for most people who need treatment, same-day surgery does the trick.

Don't Ignore Them!
Gallstones form when components of bile-the greenish-brown fluid secreted by the liver that helps you digest and absorb fats-crystallize in the gallbladder into "stones." Bile is made up of cholesterol, water, fats, bile salts, and a substance called bilirubin. If your bile contains too much cholesterol, bile salts, or bilirubin, it can harden.

Gallstones probably cause pain when they block the gallbladder duct. If the blockage continues over several hours, your gallbladder may become inflamed; this is called acute cholecystitis. Fever, prolonged pain, and eventually a gallbladder infection may occur if you don't get treated. At that point, a stay in the hospital, pain and antibiotic medications, and even surgery are sometimes necessary.

Consult your doctor if you experience unusual abdominal pain that doesn't go away on its own or if you have any of the symptoms mentioned in "When to See the Doctor" on p. 147.

Ignore gallstones, and you run the risk of developing a serious bile duct infection or even an inflammation of the pancreas if the stones pass out of the gallbladder duct and into the main bile duct.

Who's at Risk?
There's no clear-cut reason why some people are prone to gallstones and others aren't, but there are clear-cut risk factors, says Michael F. Leitzmann, MD, MPH, an epidemiologist in the department of nutrition at Harvard University School of Public Health. Simply being female is one: Women between the ages of 20 and 60 are twice as likely to develop gallstones as men.

"The best way to avoid gallstones is to avoid being overweight-and also to avoid rapid weight loss," says Dr. Leitzmann. "Other risk factors include smoking, low intake of dietary fiber, and high intake of carbohydrates." And he's talking about the simple carbohydrates-the fatty, sweetened junk food variety, not good-for-you complex carbs such as fruits, vegetables, and whole grains.

Here are some other risk factors:
Cholesterol-lowering drugs. Drugs that lower your cholesterol actually increase the amount secreted in bile, which increases your risk of gallstones.
Diabetes. If you have diabetes, it's likely that you also have high levels of triglycerides. These fatty acids increase the risk of gallstones.
Estrogen. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and to decrease gallbladder movement, which can lead to gallstones.
Ethnicity. Native Americans and Mexican-Americans have a genetic predisposition to secrete high levels of cholesterol in bile, which can cause gallstones.
Fasting. Since fasting decreases gallbladder movement, it causes bile to become overconcentrated with cholesterol, another risk factor.
How to Prevent Gallstones
Along with maintaining your ideal weight and eating a high-fiber diet, exercise may be one of the best ways to protect yourself against gallstones, says Dr. Leitzmann. In a recent study of more than 3,000 women ages 40 to 60 whose gallbladder had been surgically removed, he and his colleagues found that women who walk briskly 20 minutes a day, 5 to 7 days a week, can reduce their chances of developing gallstones by 20%.

The more physically active you are, the more you lower your risk. Any leisure activity works just fine, he says -walking, jogging, tennis, swimming, and cycling are all terrific choices.

Surgery: Best Choice for Recurrent Gallstones Most doctors believe that surgery is the best treatment for gallstones that cause painful symptoms. Though several nonsurgical therapies exist, they're generally reserved for people who can't be given a general anesthetic. Stones tend to recur about half the time when nonsurgical treatments are used.

By far the most common treatment for symptomatic gallstones is cholecystectomy, a surgical procedure that removes the gallbladder. For about 95% of people, the surgery can be performed laparoscopically (a tiny incision is made in the abdomen). You typically spend 1 day in the hospital, followed by a few days of at-home rest.

If you have an infection or there's scarring from infection, you may need a procedure called an "open" cholecystectomy. Your surgeon makes a 5- to 8-inch incision in the abdomen through which he removes the gallbladder. This major surgery requires a 2- to 7-day hospital stay and several more weeks at home to recover.

Some people may experience diarrhea following a cholecystectomy. That's because bile that was once stored in the gallbladder now flows directly into the small intestine. If you have problems with diarrhea after your surgery, be sure to tell your doctor.

Removing the gallbladder can also cause higher blood cholesterol levels, so your doctor will probably suggest that you get tested occasionally.

But you don't really need to be worried about losing your gallbladder. It's an organ you can easily live without, and you probably won't even miss it. (You certainly won't miss those agonizing stones!)

When to See the Doctor
Seek medical attention immediately if you experience any of the symptoms listed below, in addition to the common signs of a gallstone attack: sharp pain in the upper right or central abdomen lasting from 30 minutes to several hours, and nausea and vomiting.

Low-grade fever
Yellowish color of the skin or whites of the eyes
Clay-colored stools
PHOTO (COLOR): Break up those gallstones with a nice, brisk walk

PHOTO (COLOR): Weird abdominal pain? That's your cue to see a doctor


By Sara Altshul

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