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Are women who are forty, fat and fair more likely to get gallstones?

Asked by Sonia Axtens of Sacramento, California

The old wives’ tale that women who are forty, fat, and fair are more likely to get gallstones has some basis in fact, but not in its entirety.

According to Dr. Terry Bolin, a gastroenterologist at the Gut Foundation Institute at the Prince of Wales Hospital and the University of New South Wales in Sydney, Australia, women who are in this category are indeed at some risk of developing gallstones. However, many who are older or younger are also sometimes affected.

Weight is a definite factor. Obesity, rapid weight loss, pregnancy, taking birth control pills, or undergoing hormone replacement therapy may be contributing factors to developing gallstones. According to the American Liver Society of Nashville, Tennessee, rapid weight-loss dieting (more than 3 pounds per week) increases the risk of developing gallstones more so than a slower rate of weight loss. However, claims Dr. Bolin, fair hair or fair complexion does not increase risk of developing gallstones.

In the folk medicines of certain cultures, bovine gallstones are believed to be an aphrodisiac. Today, the gallstones of dairy cows constitute a valuable commodity that fetch up to $1000 per ounce. In the meat-packing industries of some nations, workers are checked before they leave to be sure they have not stolen bovine gallstones. This is rather like what happens in the diamond mines of South Africa.

“Porcelain gallbladder” is a condition in which deposits of calcium build up in the wall of the gallbladder resulting in the gallbladder becoming calcified, fragile, and brittle. The gallbladder becomes breakable like a small porcelain vase, hence the name.

The condition was named by Dr. R.H. Kazmierski in a 1951 article in the American Journal of Surgery. According to Dr. Tsung-Chun Lee and three colleagues from the National Taiwan University Hospital in Taiwan, writing in the American Journal of Medicine in October 2005, fortunately porcelain gallbladder is rare, occurring in less than one in every 1000 gall bladder patients requiring hospitalization.

What are gallstones?

Gallstones are crystalline bodies formed within the gallbladder. The gallbladder is a small and rather pear-shaped organ beneath the liver on the right side of the abdomen. The gallbladder is only about 3 inches (7.62 cm) long and one inch (2.54 cm) wide. The liver manufactures bile which is stored in the gallbladder.

The gallbladder contracts and releases the bile into the intestines greatly assisting digestion by helping to break down fats in food. The medical term for a gallstone is a choleith. 80 per cent of gallstones are actually cholesterol stones since they are made up mostly of cholesterol. The other 20 per cent of gallstones are pigment stones since they are made up mostly of bilirubin, a reddish-yellow pigment, and calcium salts. A gallstone can be the size of a grain of sand or as large as a golf ball. They can occur one at a time or many together - even in their thousands.

The American Liver Society of Nashville, Tennessee estimates that one of every 12 Americans has gallstones. At that rate there are 25m people with gallstones in the US, 5m in the U.K., 2.7m in Canada, and 1.6m in Australia. Gallstones may form in one of three ways: when bile contains more cholesterol than it can dissolve, when there is too much of certain proteins or other substances in the bile that causes cholesterol to form hard crystals, or when the gallbladder does not contract and release bile regularly.

Most of the time gallstones are painless. This condition is called “silent gallstones”. However, when they are painful the condition is called “symptomatic gallstones”. Each year, just in the US, symptomatic gallstones trigger serious health problems, cause some 800,000 hospitalizations, and result in more than 500,000 operations.

Stephen Juan, Ph.D. is an anthropologist at the University of Sydney. Email your Odd Body questions to s.juan@edfac.usyd.edu.au

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