Lesson learned: Jane now eats much more carefully after she developed gallstones from rapid weightloss
From cabbage soup to Atkins, WeightWatchers to Slimming World, I’ve tried every diet going over the past 30 years. But the story was always the same: having lost a few pounds I would bask victoriously — only to put the weight straight back on.
So it was a pleasant surprise when, about 18 months ago, I lost nearly four stone after becoming a vegetarian and giving up alcohol. My weight dropped from over 14st to around 10st, the first three stone disappearing within a couple of months.
I hadn’t planned to lose weight so quickly, but I wasn’t complaining. Wearing size 8 jeans felt great (I dropped three dress sizes) and I was lapping up the compliments. My husband was stunned, while my 13-year-old son loved that I was able to run around playing cricket with him.
But ten months after reaching a stable weight, I discovered a disturbing downside to shedding the pounds.
I’d met a friend in Bristol for a pub lunch, and as I drove back down the M5 to my home on Exmoor, my stomach started griping. I put it down to indigestion but by 9pm I was in agony: it felt like being in labour, with waves of intense pain. The room was spinning. Painkillers didn’t touch it, and I was gasping as I struggled to talk on the phone to NHS Direct.
By the time the emergency doctor arrived around 11pm I was curled up on the bed in a foetal position. I wondered if I had ruptured my appendix. Then the doctor prodded a point under my ribcage on the right-hand side and I nearly hit the ceiling.
‘It’s your gall bladder,’ he said. ‘You’ve got gallstones.’ An ultrasound scan a few days later confirmed I had not one but three gallstones, one a centimetre across.
I was puzzled. I’m now an ideal weight for my height and I exercise nearly every day. My old diet was never that bad (I just ate too much), but my new regime is filled with fruit and veg.
Surely, I thought, gallstones come from a rich, fatty diet? ‘They do,’ said the radiographer. ‘But there are other causes. Have you lost weight?’
'My stomach started griping. I put it down to indigestion but by 9pm I was in agony: it felt like being in labour, with waves of intense pain'
He explained that there can be a direct correlation between rapid weight loss and gallstones. ‘It’s not just older people either,’ he warned, telling me his daughter, in her early 20s, developed them after losing about two stone very quickly on a well-known diet plan. I was stunned.
To be fair, the information is out there — it’s just not stressed.
People don’t tend to think about gallstones until they cause problems, yet they are extremely common. About one in four women and one in eight men will develop gallstones at some stage, according to the British Liver Trust.
And the numbers are rising. Gall bladder removal has increased by nearly 34 per cent from 2004 to 2011, according to NHS statistics. In fact, it’s now the most common elective surgery in the UK.
‘No one is sure why people develop gallstones,’ says Emer Delaney, of the British Dietetic Association. ‘However, we know they are more common if you are overweight, pregnant, or taking high-dose hormone replacement therapy, and in those who have recently lost weight.’
Doctors are also seeing the condition in much younger women than before, even teenagers. This may be due to changes in our diet over the past two generations.
Slow and steady: The best way to lose weight to avoid other health problems (posed by model)
Gallstones are lumps of cholesterol that form in the gall bladder, ranging in size from fine gravel to a golf ball. The gall bladder is a pear-shaped bag that lies under the liver. It acts as a reservoir for bile, a liquid produced by the liver which helps digest food and, in particular, fat.
When we eat, the gall bladder empties bile through the bile duct into the intestine.
Bile has three main components: bile salts (that act like detergent, removing fats), pigments and cholesterol. Crash dieting upsets the balance between bile salts and the cholesterol the body produces (as opposed to the cholesterol we consume), says Simon Bramhall, liver transplant surgeon at Queen Elizabeth Hospital, Birmingham.
‘When bile is supersaturated with cholesterol, it’s more likely to form crystals which become stones,’ he says. Skipping meals may also stop the gall bladder emptying regularly, making bile more concentrated.
Combine these factors and you have the optimum conditions for gallstones to develop. The major symptom is abdominal pain, often triggered by fatty food.
I’ve been told it was likely to have been the creamy mushroom risotto I’d had in Bristol that caused my discomfort.
The gall bladder contracts in response to the fat and may move a gallstone to block the bile duct, causing inflammation and pain. Some people feel nauseous or have pain between the shoulder blades.
So here’s the tricky part. In order to lessen your risk of gallstones, you should lose weight, but not too quickly.
But how much weight, how fast? Many studies have looked at the threshold at which gallstones develop and, according to an overview in the journal Obesity, anyone losing over 3.3lb (1.5kg) a week is at risk.
Units of alcohol a day may reduce your risk of developing gallstones
The report pinpoints very low-fat diets as a risk factor — we need a certain amount of healthy fat for our digestion to work properly.
‘If you do need to lose weight, aim to eat 500 calories fewer per day, combined with regular exercise,’ agrees Emer Delaney. ‘This will help you lose the recommended amount of 1-2lbs (0.5-1kg) per week.’
It’s possible to have gallstones for years without symptoms, and it seems mine were forming in the 18 months since I began losing weight.
But up to 4 per cent of people with gallstones suffer from biliary colic, when a stone moves to the neck of the gall bladder. This was responsible for my initial excruciating pain. Further complications can include jaundice, infection of the bile duct, inflammation of the pancreas (pancreatitis) or bowel obstruction.
Once you have had a bout of biliary colic, it’s likely to become a recurring problem and doctors usually recommend removing the gall bladder by keyhole surgery (you can live normally without a gall bladder — the bile dribbles continuously into the intestine, rather than emptying after meals.)
There are drugs which can dissolve stones, but they don’t always work and, once treatment stops, the stones may form again.
Prevention is obviously better than cure. The British Liver Trust points out many of the risk factors, such as age and gender, are fixed. Yet others, such as obesity, smoking, lack of exercise and high levels of cholesterol, can be addressed with lifestyle changes.
And, if you already have gallstones, the best way to keep them quiet is to get your weight under control and eat a balanced diet, avoiding ‘bad’ cholesterol (in saturated fats, fatty meats and fast food).
However, don’t cut out fat altogether: sources of ‘healthy’ fat include olive oil, avocados, nuts, seeds and oily fish such as mackerel and tuna. It may also be worth upping your magnesium intake. A 2007 report in the American Journal of Gastroenterology suggested that a diet low in magnesium may increase cholesterol.
Meanwhile, my GP and I agree to disagree for now. He wants me to have my gall bladder removed, while I am hoping to keep my gallstones quiet by saying no to risotto.
All surgery carries risks and I’d like to avoid it if I can. Despite the gallstones, I don’t regret losing weight — being slim and fit feels fantastic. But it’s worth remembering that slow and steady really is the best way to do it.
Britishlivertrust.org.uk; 0800 652 7330.