Gallstones (cholelithiasis) and cholecystitis
Gallstones are hard deposits of bile in the gall bladder. Fat makes the gall bladder squeeze and hurt, so eat low fat, high fibre and lose weight slowly.
At a glance
Dietary principles
| Stage or nutrient | Recommendation | Why |
|---|---|---|
| Acute attack | Nil by mouth and IV fluids; then fat-free clear fluids; then low-fat soft diet | Rests the gall bladder |
| Fat | Low: about 20-25% of energy; books range from about 20 g a day just after an attack to 40-50 g in chronic disease | Fat releases the hormone CCK, which makes the gall bladder contract and cause pain |
| Energy | Reduce if overweight, but lose weight slowly (about 0.5-1 kg a week); no crash diets or long fasts | Rapid weight loss and fasting make bile richer in cholesterol and slow gall bladder emptying |
| Protein | Normal, from low-fat sources (toned milk, curd, egg white, dal, fish) | Supports health without adding much fat |
| Fibre | High: whole grains, pulses, vegetables, fruits | Binds bile acids and cholesterol; helps weight control |
| Meal pattern | Small, regular low-fat meals; avoid one large heavy meal | Regular gentle emptying, no sudden strong contraction |
| After gall bladder removal | Low fat for a few weeks, then slowly normal | Bile now drips continuously; large fatty meals may cause loose stools |
Foods to include and avoid
| Food group | Include | Avoid or limit |
|---|---|---|
| Cereals | Whole-wheat chapati (no ghee), brown or hand-pounded rice, oats, ragi, idli | Puri, paratha, bakery items, biscuits |
| Protein foods | Toned or skimmed milk, curd, egg white, dal, sprouts, grilled or steamed fish | Whole milk, cream, cheese, egg yolk in excess, mutton, organ meats |
| Vegetables and fruits | All vegetables and fruits; cook with little oil | Vegetables fried or in rich gravies |
| Fats and sweets | 2-3 teaspoons of oil a day | Ghee, butter, vanaspati, fried snacks, mithai, coconut-rich curries, nuts in large amounts |
Sample one-day menu (low-fat diet)
| Meal | Menu |
|---|---|
| Early morning | Tea with skimmed milk |
| Breakfast | Oats upma with vegetables (1 tsp oil) or idli with sambar |
| Mid-morning | Guava or orange |
| Lunch | Rice, dal, cabbage poriyal (little oil), cucumber salad, curd from toned milk |
| Evening | Sprouts chaat; buttermilk |
| Dinner | Chapati (2, no ghee), steamed fish or egg-white bhurji, mixed vegetable curry |
| Bedtime | Skimmed milk |
Before and after cholecystectomy, patients ask whether they can ever eat normally. Tell them yes: keep meals low-fat for a few weeks, then add fat back slowly, and avoid crash diets that cause new stones in the bile duct.
2 marks: “What is cholelithiasis?” The presence of stones in the gall bladder, usually made of cholesterol, bile pigment or both.
5 marks: “Explain the dietary management of gallstones.” Acute: NPO, then fat-free fluids. Chronic: low fat, high fibre, normal protein, slow weight loss, small regular meals, foods to avoid.
10 marks: “Discuss the causes, symptoms and dietary management of gallstones with a sample menu.” Define, types of stones, 5 Fs and other risk factors, symptoms and complications, principles table, foods, low-fat menu.
Gallstone risk = 5 Fs: Female, Fat, Forty, Fertile, Fair. Diet = low fat, high fibre, slow loss.