Chemical factors involved in cholesterol gallstone formation: possible prevention and medical management
Navarro, M.D.; Guevara, B.Q.
Acta Manilana 15(24): 25-33
1976
ISSN/ISBN: 0567-7688 PMID: 12308407 Document Number: 432456
Cholesterol supersaturated bile with the concomittant dimunition of bile acids and lecithin usually leads to precipitation and formation of gallstones. Since cholesterol is insoluble in water but soluble in bile, it is important that the proportion of bile to the cholesterol content be such that the latter is always at a lower level. Individuals with gallstones have higher molar percentage of cholesterol than those without; hence the rationale for the low cholesterol diet in people prone to gallstones. Of the 3 bile acids, cholic acid, chenodeoxycholic acid (CDCA), and deoxycholic acid, it is CDCA that is diminished in bile that has become lithogenic; a genetic factor is postulated because of ethnic group tendencies to lithogenecity. Tendency to produce lithogenic bile is not diminished by lessening the exogenous cholesterol and increasing the intake of essential unsaturated fatty acids. Instead, CDCA intake should be increased. Healthy women planning to take oral contraceptives (OCs) are cautioned that ingestion is accompanied by significant rise in the cholesterol saturation of gall baldder bile. 1 report showed that the mean level of cholesterol saturation was 92% in women off the OCs and 125% in women on OCs. Of the women off OCs, only 6/20 had supersaturated bile, whereas 16/20 women on OCs had supersaturated bile. Supersaturation is explained by 2 mechanisms: 1) secretion of cholesterol into bile by the liver; and 2) secretion of solubilizing lipids. Prevention of gallstone formation may be accomplished by administering CDCA from .75-4 gms daily or maintaining sufficient intake of vitamin C.