Gallstones (which can be detected easily radiologically, or by using ultrasonography to check whether they are harmless or not) are regarded as the most common, and at $5 billion each year, the most costly to treat, of the digestive diseases in the US. Around 10 per cent to 15 per cent of the adult population, or more than 20 million people there suffer from gallstone attacks, and have opted for surgery to remove the gall bladder which contains the stones.

In the elderly, 50 per cent of stones lie in the bile duct (Brit J of Clin Practice, 1993; 47 [3]: 164-165). It's thought that around a million new sufferers are diagnosed every year (JAMA, 1993; Vol 269, No 8: 1018; Ann Clin Lab Sci, 1984; 14: 243-251).

Women are more likely to suffer from gallstones, especially older women, and those who have had multiple pregnancies, who may be obese, or who may have been on crash diets (Ann Clin Lab Sci, 1984; 14: 243-251). In fact, anything that increases a woman's estrogen levels, greatly increases the incidence of gallstones, including HRT and the Pill.

Bile, made by the liver, is stored in the gallbladder. From there, it's eventually transferred into the intestines, so that it can assist in the process of digestion. Gallstones are actually chunks of cholesterol and other minerals which grow in size for a couple of years within the gallbladder and then stabilize.

Gallstones can block the route of bile from the liver to the intestines, and can irritate the gallbladder's lining, causing inflammation (cholecystitis).

Around 85 per cent of all gallstones measure less than 2 cm across. They're formed when bile in the gall bladder becomes saturated and the bile's substances that can't be absorbed, harden. Typically, symptoms occur eight years after the stones' formation (Scientific American Medicine, Rubenstein E and Federman DD, Scientific American, 1986; 4: VI-I-10).

Much of gallstone prevention has to do with diet and processing of food. According to Dr Melvyn Werbach (Healing Through Nutrition) gallstone formation appears to be associated with the backward movement of bile and pancreatic juices into the stomach. These juices can destroy the gastric acid producing cells, causing flatulent dyspepsia (gas and indigestion), as well as other symptoms of hydrochloric acid deficiency (HCl). About half of all people with gallstones are deficient in HCl.

Stomach acid is necessary, so that the body can properly utilize nutrients. A deficiency also increases both the susceptibility to, and severity of, bacterial infections of the intestines. Therefore, in addition to its possible value in reducing symptoms, Werbach suggests that an HCl, supplement would be appropriate for anyone who is found on testing to be deficient.

One silent villain in the gallstone saga is certain cholesterol lowering drugs. Clofibrate and some other cholesterol lowering drugs lower blood fats but greatly increases the development of gallstones by increasing the amount of cholesterol that is secreted into the bile. Octretide (Sandostatin), one of the new generation "statin" drugs, prevents the gall bladder from emptying after a fatty meal. It has been suggested that a reduction in gallbladder emptying may well play a role in stone formation (BMJ, 1992; 305: 313; Gut, 1996; 38 [5]: 775-83). Short term doses (for up to a month) of octreotide pose a minimal risk, but the risk increases with longer treatments (Am J of Gastroent, 1995; 90 [7]: 1042-52). In fact gall bladder stones have been found in up to 50 per cent of patients receiving octreotide (Metabolism: Clin & Experimental, 1992; 41 [9 Suppl 2]: 22-33). The manufacturer recommends that ultrasound examination of the gallbladder be conducted before and at six to 12 month intervals during long term therapy. And of course, in today's hysterical anti cholesterol climate, many patients with slightly elevated cholesterol are being placed on statin drugs for life.