Gallstones are hardened lumps of cholesterol or bile acids that can build up in the gallbadder. If they get stuck in the bile duct, they can cause severe abdominal pain. Doctors think a number of risk factors can make the diagnosis of a gallstone more likely. Women are more susceptible than men, especially in middle age. Native Americans and Mexican Americans are also more vulnerable.
A sedentary lifestyle and the excess weight that may accompany it also add to the risk, along with a diet that is high in fat and low in fiber. Even though overweight is a risk factor, rapid weight loss can also bring on gallstones. In addition, a number of medications that can trigger gallstone formation. Estrogen is one, but there are others. One reader wondered about the cholesterol drug fenofibrate.
Does Fenofibrate Trigger Gallstones?
Q. I have recently been diagnosed with gallstones and my liver function tests are high. I’ve been taking fenofibrate for some time. I wonder if that may be the cause.
A. Fenofibrate, a drug prescribed to lower triglycerides and cholesterol in the bloodstream, can indeed trigger gallstone formation (Caroli-Bosc et al, Digestive Diseases and Sciences, March 2001). The official prescribing information advises doctors to discontinue fenofibrate if gallstones are discovered. This drug can also raise liver enzymes. Moreover, it may have a deleterious effect on kidney function (Kim et al, Korean Journal of Family Medicine, July 2017).
Statins don’t appear to elevate the risk of gallstone development, although they may affect liver enzymes occasionally. Restricting the amount of processed carbohydrates, including sugar and alcohol, can help reduce triglycerides without increasing the risk of gallstones. Following a Mediterranean dietary pattern can lower cholesterol. At the same time, it can reduce the chance of gallstone development. Other nondrug approaches to lowering blood fats should also prove useful, with or without lipid-lowering medications.
Previous research has shown that crash diets can precipitate gallstones. People who added a few pounds over the winter may become impatient about shedding them. When standard diets don’t do the trick as quickly as we would like, there is a great temptation to take extreme measures. That is especially true if there is an upcoming event like a family reunion or a wedding.
Restricting calories severely, however, has a serious downside (Johansson et al, International Journal of Obesity, Feb. 2014). Swedish researchers collected data from more than 6,000 dieters. Roughly 50 percent were on a low-calorie diet of around 1,200 to 1,500 calories daily. The other half were getting just 500 calories a day for up to 10 weeks.
Although people on the super-strict diet lost more weight, they were also three times more likely to land in the hospital with a gallstone attack. This complication is painful as well as dangerous.