The Analyst™

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Healthy

  Gallbladder Disease  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations

 

Gallstones are formed from bile, a fluid composed mostly of water, bile salts, lecithin, and cholesterol. Bile is first produced by the liver and then secreted through tiny channels within the liver into a duct. From here, bile passes through a larger tube called the common duct, which leads to the small intestines. Then, except for a small amount that drains directly into the small intestine, bile flows into the gallbladder through the cystic duct.

The gallbladder is a four inch sac with a muscular wall that is located under the liver. Here, most of the fluid (about two to five cups a day) is removed, leaving a few tablespoons of concentrated bile. The gallbladder serves as a reservoir until bile is needed in the small intestine for digestion of fat. When food enters the small intestine, a hormone called cholecystokinin is released, signaling the gallbladder to contract. The force of the contraction propels the bile back through the common bile duct and then into the small intestine, where it emulsifies fatty molecules so that fat and the fat absorbable vitamins A, D, E, and K can enter the blood stream through the intestinal lining.
About 3/4 of the gallstones found in the U.S. population are formed from cholesterol. Cholesterol makes up only 5% of bile; it is not very soluble, however, so in order to remain suspended in fluid, it must be properly balanced with bile salts. If the liver secretes too much cholesterol into the bile, if the bile becomes stagnant because of a defect in the mechanisms that cause the gallbladder to empty, or if other factors are present, supersaturation can occur. Cholesterol may then precipitate out of the bile solution to form gallstones, a condition known as cholelithiasis. The process is very slow and most often painless. Gallstones can range from a few millimeters to several centimeters in diameter.

The other 25% of gallstones are known as pigment gallstones. They are composed of calcium bilirubinate, or calcified bilirubin, the substance formed by the breakdown of hemoglobin in the blood. These black stones often form in the gallbladders of people with hemolytic anemia or cirrhosis.

At any point, stones may obstruct the cystic duct, which leads from the gallbladder to the common bile duct, and cause pain (biliary colic), infection and inflammation (cholecystitis), or all of these. About 15% of people with stones in the gallbladder also have stones in the common bile duct (choledocholithiasis), which sometimes pass into the small intestine but also may lodge in the duct and cause distention, infection, or pancreatitis.

Symptoms
About 80% of people with gallstones never experience any symptoms. Most others remain asymptomatic (without symptoms) for at least two years after stone formation begins. If symptoms do occur, the chance of developing pain is about 2% per year for the first ten years after stone formation, after which the chance for developing symptoms decrease. On average, symptoms take about eight years to develop. The reason for the decline in incidence after ten years is not known, although some physicians suggest that younger stones may cause more symptoms.

Biliary Pain
The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic, which occurs either in the mid or the upper right portion of the upper abdomen. Large or fatty meals can precipitate the pain, but it usually occurs several hours after eating, often at night. Biliary colic produces a steady pain, which can be quite severe and may be accompanied by nausea. Changes in position, OTC pain relievers, and passage of gas do not relieve the symptoms. Biliary colic usually disappears after several hours. Attacks of pain tend to be intermittent and infrequent; the chance of pain recurring within a year is less than 50%. In one study, 30% of people who had had one or two attacks experienced no further biliary pain over the next ten years.

Acute Cholecystitis
Acute gallbladder inflammation (acute cholecystitis) is a more serious problem than biliary colic. It begins abruptly and subsides gradually. Nausea, vomiting, and severe pain and tenderness in the upper right abdomen are the most common complaints; fever is usual but may be absent. The discomfort is intense and steady and lasts until the condition is treated with medicine or surgery. Patients with acute cholecystitis frequently complain of pain when drawing a breath. The pain can radiate from the abdomen to the back. Acute cholecystitis is usually caused by gallstones, but, in some cases, can occur without stones. Anyone who experiences an attack of acute cholecystitis should seek medical attention; it can progress to gangrene or perforation of the gallbladder if left untreated.

Chronic Cholecystitis
Chronic gallbladder disease (chronic cholecystitis) occurs because of the prolonged presence of gallstones and low grade inflammation. Scarring causes the gallbladder to become stiff and thick. Symptoms of this condition tend to be vague. Complaints of gas, nausea, and abdominal discomfort after meals are common, just as they often are in people without gallbladder disease.

Common Bile Duct Stones (Choledocholithiasis)
Stones lodged in the common bile duct (choledocholithiasis) can block the flow of bile and cause jaundice. Serious infection of the bile duct (cholangitis) may develop that causes fever, chills, nausea and vomiting, and severe pain in the upper right quadrant of the abdomen. If there is evidence for common bile duct stones, such as dark urine, jaundice, pancreatitis, or elevated liver function tests, then more extensive tests may be used.

Most gallstones provoke no symptoms at all. One study reported that the risk of developing symptoms was 10% at five years, 15% at ten years, and only 18% at fifteen years, with no deaths reported. Asymptomatic gallstones seldom lead to problems. Death from gallstones is very rare, accounting for only 0.2% of annual deaths in the United States. Serious effects from gallstones are usually from stones in the bile duct or surgical complications.

Influences

Age and Gender
Gallstones affect about 10% of adults over 40. They occur in nearly 25% of women in the U.S. by age 60 and in up to 50% by age 75. About 20% of men have gallstones by the time they reach 75 years of age. Because most cases are asymptomatic, however, these rates may underestimate the disease in elderly men. Gallstone disease is relatively rare in children. Women are probably at increased risk because the female hormone estrogen stimulates the liver to remove more cholesterol from blood and divert it into the bile. Women of childbearing age may want to select an oral contraceptive with a low estrogen level to reduce their risk.

Other Factors
Conditions that decrease the flow of bile and therefore increase the risk of gallstone formation include skipping meals, fasting, pregnancy, and intravenous feeding. Native Americans are especially prone to developing gallstones; women in this population have an 80% chance of developing gallstones during their lives.

Pigment Gallstones
Pigment gallstones are more likely to affect the elderly, people with cirrhosis, and those with chronic hemolytic anemia, including sickle cell anemia. People of Asian descent who develop gallstones are most likely to have the pigment type.

Diagnosis
Diagnosis is by physical exam and by diagnostic testing. A physical exam often reveals tenderness in the right upper area of the abdomen in acute cholecystitis and sometimes in biliary colic. There is usually no tenderness in chronic cholecystitis.

Blood tests are usually normal in people with simple biliary pain or chronic cholecystitis. In acute cholecystitis, and especially choledocholithiasis (stones in the bile duct), however, blood tests of the liver show elevations of the enzyme alkaline phosphatase and bilirubin. Bilirubin is the orange yellow pigment found in bile; high levels cause jaundice, which gives the skin a yellowish tone. A high white blood cell count (leukocytosis) is another common finding but should not be relied on to establish a diagnosis of acute cholecystitis.

The diagnostic challenge posed by gallstones is to be sure that abdominal pain is caused by stones and not by some other condition. Ultrasound or other imaging techniques easily find gallstones. Nevertheless, because gallstones are common and most cause no symptoms, simply finding stones does not necessarily explain a patientís pain, which may be caused by numerous other conditions.

Ultrasound, the diagnostic method most frequently used to detect gallstones, is a simple, rapid, and noninvasive imaging technique. Ultrasound detects gallstones as small as two millimeters in diameter with an accuracy of 90% to 95%. The patient must not eat for six or more hours before the test, which takes only about 15 minutes. During the same procedure, the physician can check the liver, bile ducts, and pancreas and quickly scan the gallbladder wall for thickening (characteristic of cholecystitis). There are many other, more sophisticated tests, that may be suggested for further evaluation of the problem.

Treatment
Gallstones almost never spontaneously disappear, except sometimes when they are formed under special circumstances, such as pregnancy or sudden weight loss. Many natural doctors claim that some stones can be encouraged to pass, and that there are treatments to reduce or eliminate symptoms. Apart from natural or other preventive treatments, the probability of eventually needing an operation for a 30 years old is about 30%; for a 50 year old it is 20%; and for a 70 year old it is 15%.

Although removal of the gallbladder has not been known to cause any long term effects aside from occasional diarrhea, some researchers have been concerned about its effects on the bodyís cholesterol levels. One study found that within three days of the operation, levels of total cholesterol and LDL returned to their preoperative levels. After three years, however, some types of cholesterol not ordinarily associated with coronary artery disease had risen significantly. These results did not necessarily indicate any increased risk for coronary artery disease, but they did show that the metabolism of cholesterol by the liver had been altered. People who have had their gallbladders removed should have their cholesterol levels checked periodically, as should every adult.

Irritable bowel syndrome (IBS) has some of the same symptoms as gallbladder disease, including difficulty digesting fatty foods. In IBS, however, pain usually occurs in the lower abdomen. Acute appendicitis, pneumonia, stomach ulcers, hiatal hernia, pancreatitis, hepatitis, kidney infections, and even a heart attack may mimic a gallbladder attack, so it is important to see a physician immediately if symptoms occur.

In chronic cases (non acute) there are many natural treatments that can enhance gallbladder functioning and gradually dissolve existing stones. This is accomplished by:

  • Avoiding foods that directly cause symptoms.
  • Increasing bile production in the liver.
  • Liquefy the bile to help flush any built-up sludge from the gallbladder.
  • Dissolve stones slowly so that they can be reduced to a size that is able to pass naturally.

 

 
 

Signs, symptoms & indicators of Gallbladder Disease:
 
 
Symptoms - Bowel Movements  Pale stools

Symptoms - Food - General

  Infrequent eating
 Conditions that decrease the flow of bile and therefore increase the risk of gallstone formation include skipping meals, fasting, pregnancy, and intravenous feeding.

Symptoms - Gas-Int - General

  Abdominal pain after fat consumption
 The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic, which occurs either in the mid- or upper-right portion of the upper abdomen. Large or fatty meals can precipitate the pain, but it usually occurs several hours after eating, often at night. Biliary colic produces a steady pain, which can be quite severe and may be accompanied by nausea. Changes in position, over-the-counter pain relievers, and passage of gas do not relieve the symptoms. Biliary colic usually disappears after several hours. Attacks of pain tend to be intermittent and infrequent; the chance of pain recurring within a year is less than 50%. In one study, 30% of people who had had one or two attacks experienced no further biliary pain over the next ten years.

Acute gallbladder inflammation (acute cholecystitis) begins abruptly and subsides gradually. Nausea, vomiting, and severe pain and tenderness in the upper right abdomen are the most common complaints; fever is usual but may be absent. The discomfort is intense and steady and lasts until the condition is treated with medicine or surgery. Patients with acute cholecystitis frequently complain of pain when drawing a breath. The pain can radiate from the abdomen to the back. Acute cholecystitis is usually caused by gallstones, but, in some cases, can occur without stones.

  Unexplained nausea
  Meal-related burping

Symptoms - Liver / Gall Bladder

  Right side/bilateral scapula pain
 This condition is characterized by severe pain that becomes localized in the upper right quadrant, radiating to right lower scapula.

  (Severe) pain under right side of ribs
  Liver/gallbladder cleanses help

Symptoms - Metabolic

  Moderate/mild unexplained fevers or unexplained fevers that hit hard or unexplained high fevers
  Having a high/having a moderate/having a slight fever

Symptoms - Skin - General

  Lighter/paler skin color

Symptoms - Urinary

  Dark urine color
 
 

Conditions that suggest Gallbladder Disease:
 
 
Digestion  Dyspepsia / Poor Digestion

Lab Values

  Elevated Triglycerides
 Gallstone formation does not correlate with blood cholesterol levels, but persons with low HDL cholesterol (the so-called good cholesterol) levels or high triglyceride levels are at increased risk.

Metabolic

  Jaundice

Symptoms - Liver / Gall Bladder

Counter-indicators:
  No history of gallbladder problems
  Confirmed absence of gallstones
 
 

Risk factors for Gallbladder Disease:
 
 
Allergy  Allergy / Intolerance to Foods (Hidden)
 A 1968 study revealed that 100% of a group of gallbladder patients were free from symptoms while they were on a basic elimination diet (beef, rye, soybean, rice, cherry, peach, apricot, beet, and spinach). Foods inducing symptoms in decreasing order of their occurrence were: egg, pork, onion, fowl, milk, coffee, citrus, corn, beans and nuts. Adding eggs to the diet, for example, caused gallbladder attacks in 93% of these patients. At a minimum, an egg-free trial period of several months could be worthwhile.

Several mechanisms have been proposed to explain the association of food allergy and gallstones. Dr. Breneman, who conducted this study, believes the ingestion of allergy-causing substances causes swelling of the bile ducts, resulting in the impairment of bile flow from the gallbladder. This reduced flow leads to an increase in stone formation.[Ann Allergy 26: pp.83-7, 1968)]

Hormones

  Low Progesterone or Estrogen Dominance

Lab Values

  Elevated LDL/HDL Ratio
 Gallstone formation does not correlate with blood cholesterol levels, but persons with low HDL cholesterol (the so-called good cholesterol) levels or high triglyceride levels are at increased risk.

Metabolic

  Problem Caused By Being Overweight
 Obesity in both men and women increases the risk for gallstones. This may be a result of lower levels of bile salts relative to cholesterol in the bile causing a higher risk for cholesterol supersaturation and the formation of stones.

Organ Health

  Cirrhosis of the Liver
 If cirrhosis prevents bile from reaching the gallbladder, a person may develop gallstones as a result.

Personal Background

  American indian descent
 Native Americans are especially prone to developing gallstones; women in this population have an 80% chance of developing gallstones during their lives.

  Caucasian ethnicity

Counter-indicators:
  Asian/African ethnicity

Supplements and Medications

  (Past) non-human estrogen use
 Taking non-human estrogens after menopause doubles the risk of gallbladder disease.

  Current birth control pill use
 Increased risk of gallstone formation has been observed in women who take oral contraceptives. Women of childbearing age using oral contraceptives may want to select one with a low estrogen level to reduce their risk, or use other methods of birth control.

  History of birth control pill use

Symptoms - Food - Intake

  (High) raw egg white consumption
 Egg consumption is a very frequent cause of gallbladder symptoms. It is uncertain whether the white of the egg is partially or totally responsible for this allergic reaction. Most studies have eliminated the entire egg when addressing this problem.

  (High) cooked egg white consumption
  (High) egg yolk consumption
 Eggs have been identified as a symptom causing food for many with gallbladder disease. A trial period of egg avoidance should reveal if this is true for you.

Symptoms - Glandular

  Reasonably controlled diabetes
 Gallstones may progress more rapidly in patients with diabetes, who tend to suffer worse infections.

  Poorly controlled diabetes

Symptoms - Liver / Gall Bladder

  History of gallbladder attacks

Counter-indicators:
  Having had gallbladder removed
 
 

Gallbladder Disease suggests the following may be present:
 
 
Metabolic  Problem Caused By Being Overweight
 Obesity in both men and women increases the risk for gallstones. This may be a result of lower levels of bile salts relative to cholesterol in the bile causing a higher risk for cholesterol supersaturation and the formation of stones.
 
 

Recommendations for Gallbladder Disease:
 
 
Botanical  Chanca Piedra (Break-Stone)
 This South American herb is developing a reputation as a potent treatment for both kidney stones and gallstones. Testimonies indicate they just break up and come out.

  Dandelion Root (Taraxicum officinale)
  Silymarin/Milk Thistle (Silybum marianum)
  Artichoke Extract (Cynarin scolymus)
  Turmeric Extract, Curcumin
  Coffee (Coffea genus)
 An intake of 2-3 cups per day of caffeinated coffee was associated with a reduced risk of developing symptomatic gallstone disease in a study of over 80,000 women with no history of gallstone disease at the beginning of a 20 year study. Caffeine from any source exerted this effect. [Gastroenterology 2002;123(6): pp.1823-30]


Not recommended:
  Ginger Root (Zingiber officinalis)
 Avoid medicinal amounts of ginger (e.g. large doses of dried ginger extract) if you have gallstones because it increases bile flow. Bottles of ginger root often contain the warning not to take if gallstones are present.

So if you are in a gallstone crisis, avoiding ginger, or anything that stimulates bile flow and/or gallbladder contraction would seem wise. If not in crisis, it may be well tolerated and act to improve bile flow and reduce sludge.

Detoxification

  Liver/Gall Bladder Flush
 Flushing the gallbladder can help pass stones that would likely have remained and enlarged over time. The regular use of this flush will help prevent the development of gallstones.

Diet

  Sugars Avoidance / Reduction
 In research published in 1983 from the University Department of Medicine, scientists stated, "Bile is significantly more saturated with cholesterol after 6 weeks on a refined carbohydrate diet (white flour and sugar) than after a similar period on an unrefined carbohydrate diet (whole wheat and grains)."

  Vegetarian/Vegan Diet
 In a study published in the British Medical Journal, it was shown that vegetarian women had a much lower incidence of gallstones than non-vegetarian women. Of the 632 vegetarians, overall occurrence of gallstones was 25%. Vegetarians had only half as many gallstone problems, with 12% being found to have gallstones.

  Coconut
 Coconut has been reported to help normalize gall bladder function over time.

  Low Fat Diet
 Fats stimulate bile flow and gallbladder contraction so should be reduced or eliminated during a crisis. A low fat diet is often recommended after gallbladder surgery. Also, before surgery, limiting fat intake can reduce gallbladder pain and attacks.

  Monounsaturated Oils
 Studies have shown oils high in monounsaturated fats such as olive, canola, peanut, avocado and almond oil to be beneficial for the prevention of gallstones.

  High/Increased Fiber Diet
 Dietary fiber from cellulose (soluble fiber) clearly reduces the risk of gallstone formation.

  Beets
 Consuming beets, or beet extracts, and taurine has been shown to thin bile and cause it to flow more freely. This should reduce the tendency toward stagnation which can contribute to gallstone formation.

Drug

  Conventional Drugs / Information
 Oral dissolution therapy with ursodiol (Actigall) and chenodiol (Chenix) works best for small, cholesterol gallstones. These medicines are made from the acid naturally found in bile. They most often are used in individuals who cannot tolerate surgery. Treatment may be required for months to years before gallstones are dissolved.

Mild diarrhea is a side effect of both drugs; chenodiol may also temporarily elevate the liver enzyme transaminase and mildly elevate blood cholesterol levels.

Habits

  Aerobic Exercise
 Studies have shown that the more physically active one is, the lower one's risk of gallstone formation. One study indicated that men who performed endurance-type exercise (such as jogging and running, racquet sports, and brisk walking) for thirty minutes five times per week reduced their risk for gallbladder disease by up to 34%. The benefit depended more on the intensity of activity than the type of exercise. Some researchers guess that in addition to controlling weight, exercise helps normalize blood sugar levels and insulin levels, which, if abnormal, may contribute to gallstones.

If you already have gallbladder disease, then gallbladder flushes may provide some relief. If symptoms then resolve, consider an aggressive aerobic exercise program to permanently improve gallbladder function.

Lab Tests/Rule-Outs

  Test for Food Allergies
 Frequently offending foods include eggs, pork, onions, poultry, milk, coffee, oranges, corn, beans, and nuts. Eliminating these from the diet may help. See relationship between Gallbladder Disease and Hidden Food Allergies for further information.

  Tests, General Diagnostic
 The ultrasound uses sound waves to visualize the bile ducts, liver, and pancreas. When gallstones are present, they are seen in either the gallbladder or bile ducts. Little risk is associated with the ultrasound test. The ultrasound may not see gallstones in obese patients, or in patients who have recently eaten.

Nutrient

  TMG (Tri-methyl-glycine) / SAMe

Surgery/Invasive

  Surgery
 There are medications designed to dissolve gallstones. However, when obstruction of the outflow of bile from the gallbladder occurs causing symptoms, the best option is removal of the gallbladder. Laparoscopic gallbladder surgery is appropriate for the vast majority of patients who need gallbladder surgery.

In emergency situations there is no natural treatment that will work quickly enough and the risk of complication is too great to wait for slower treatments.

Vitamins

  Vitamin C (Ascorbic Acid)
 Sixteen patients with gallstones who were scheduled for surgery received 500mg of Vitamin C four times per day for two weeks prior to surgery. Another sixteen patients who had their gallbladders removed did not receive Vitamin C (the control group). During surgery, bile was taken from the gallbladder of each patient. Vitamin C treatment resulted in a significant increase in the concentration of phospholipids in bile (phospholipids such as lecithin have been shown to prevent stone formation). More importantly, it took seven days for the bile from Vitamin C-treated patients to form cholesterol crystals (the first step in stone formation), compared with just two days in the control group. [Eur J Clin Invest 1997;27: pp.387-391]

Vitamin C also could help dissolve gallstones, although that probably would require several years of continuous treatment, combined with a strict diet. It is noteworthy that birth-control pills have been shown both to reduce blood levels of Vitamin C and to increase the risk of gallstones.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences







GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Alkaline:  A solution having a pH greater than seven.

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Anemia:  A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.

Asymptomatic:  Not showing symptoms.

Bile:  A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Cholangitis:  Bile duct inflammation.

Cholecystitis:  Gallbladder inflammation.

Cholelithiasis:  Presence of gallstones in the gallbladder or bile duct.

Cholesterol:  A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cirrhosis:  A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Diarrhea:  Excessive discharge of contents of bowel.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Estrogen:  One of the female sex hormones produced by the ovaries.

Gallbladder:  A small, digestive organ positioned under the liver, which concentrates and stores bile. Problems with the gallbladder often lead to "gallbladder attacks", which usually occur after a fatty meal and at night. The following are the most common symptoms: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.

Gallstone:  (Biliary Calculus): Stone-like objects in either the gallbladder or bile ducts, composed mainly of cholesterol and occasionally mixed with calcium. Most gallstones do not cause problems until they become larger or they begin obstructing bile ducts, at which point gallbladder "attacks" begin to occur. Symptoms usually occur after a fatty meal and at night. The following are the most common ones: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.

Hemoglobin:  The oxygen-carrying protein of the blood found in red blood cells.

Hemolytic Anemia:  Anemia caused by excessive destruction of red blood cells.

Hepatitis:  Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.

Hiatal Hernia:  Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (a diaphragmatic hiatus). This is a common problem and most people are not bothered by it. A hernia may allow stomach acid to flow back into the esophagus ("food pipe"), where it can cause problems. The most common symptom is burning in your chest (heartburn), especially at night when you are lying down. Other possible signs include burping and trouble swallowing.

High-Density Lipoprotein:  (HDL): Also known as "good" cholesterol, HDLs are large, dense, protein-fat particles that circulate in the blood picking up already used and unused cholesterol and taking them back to the liver as part of a recycling process. Higher levels of HDLs are associated with a lower risk of cardiovascular disease because the cholesterol is cleared more readily from the blood.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Irritable Bowel Syndrome:  (IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.

Jaundice:  Yellow discoloration of the skin, whites of the eyes and excreta as a result of an excess of the pigment bilirubin in the bloodstream.

Lecithin:  A mixture of phospholipids that is composed of fatty acids, glycerol, phosphorus, and choline or inositol. Lecithin can be manufactured in the body. All living cell membranes are largely composed of lecithin.

Low-Density Lipoprotein:  (LDL): Also known as "bad" cholesterol, LDLs are large, dense, protein-fat particles composed of a moderate proportion of protein and a high proportion of cholesterol. Higher levels of LDLs are associated with a greater risk of cardiovascular disease.

Menopause:  The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Millimeter:  (mm): A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.

Nausea:  Symptoms resulting from an inclination to vomit.

Over-The-Counter:  A drug or medication that can legally be bought without a doctor's prescription being required.

Pancreatitis:  Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomachís mucous lining must constantly regenerate itself.

Tablespoon:  (Tbsp) Equivalent to 15cc (15ml).

Triglyceride:  The main form of fat found in foods and the human body. Containing three fatty acids and one unit of glycerol, triglycerides are stored in adipose cells in the body, which, when broken down, release fatty acids into the blood. Triglycerides are fat storage molecules and are the major lipid component of the diet.

Ulcer:  Lesion on the skin or mucous membrane.

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.