SCIENCE: COMPOSITION? What are gallstones composed of?

What are Gallstones composed of?

Most gallstones and most stones formed inside bile ducts are mainly composed of cholesterol - "Cholesterol based" stones.

Cholesterol is a pearly-white, waxy substance. It is semi-solid.
Cholesterol can not be dissolved in water, but it can be easily dissolved in alcohol.

"Cholesterol based" doesn't mean 100% cholesterol.

All gallstones contain variable amounts of bile pigments!
Some stones contain proteins!


Even stone that contain 95% or 70% cholesterol is still "Cholesterol based"
Other 5% or 30% can be bile pigments & proteins.


No gallstone is 100% cholesterol.
There is no 100% clean substance in nature!

Stone may contain protein (mucoprotein), and those stones are usually very hard. Only protein stones and stones containing a lot of calcium carbonate are hard stones.
Be aware that hard stones are rather rare, less then one out of 100 stones is hard enough that it can't be crushed with fingers.
And, most of those "hard" stones are not calcified, instead, they contain a lot of protein that makes them very hard, just like our nails are very hard thanks to strong protein.

Why do many people think that gallstones are always calcified, hard stones?

Because, for hundreds of years it is those calcified, hard stones that were causing the most pain ... and these were the first people to choose gallbladder surgery.

As calcified stones tent to cause most discomfort and most pain, they are also the only stones easily detectable by X-ray.

During the last 60 years, X-ray and gallstones symptoms were the main way of diagnosing gallstones, while surgery was the main treatment.

As a result, majority of people who were referred to gallbladder surgery, have had calcified stones.

Those stones are also very clean and can be easily kept forever.

That is why word "gallstones" in many people and many doctors create an idea of hard calcified, stone ... while in reality, soft cholesterol stones are more frequent ... but are not causing as many symptoms ... and are also invisible on X-ray. Ultrasound may detect larger cholesterol stones... but Ultrasound is relatively new diagnostic method.










Mucoprotein DEFINITION:
A covalently linked conjugate of protein and polysaccharide, the latter containing many hexosamine residues and constituting approximately 4 to 30 percent of the weight of the compound; mucoproteins occur mainly in mucous secretions. (Mucoprotein is secreted by the inner lining of the gallbladder, also known as the epithelium)

Stones containing proteins are almost only formed inside gallbladder!

There is at least a little bit of bilirubin (yellow/red/brown) or Biliverdin (green/blue/black) inside of every stone. That is the reason why cholesterol stones are not white, but may be of any color.
The same is true for every other stone. Most stones are green, and that means that they contain some Biliverdin (blood pigment).

Those 7 colors: white, yellow/red/brown, green/blue/black can produce any other color.


Common Bile Pigments:

Bilirubin (linear tetrapyrrole)
color: yellow/red/brown.
Source: liver


Biliverdin (linear tetrapyrrole)
color: green/blue/black
Source: oxidation of bilirubin


References:
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http://www.medbroadcast.com/health_topics/health_conditions/gallstones/index.shtml


"Gallstones are classified as cholesterol stones, calcium bilirubinate stones (pigment stones) and calcium carbonate stones, which are extremely rare. Pure stones, however, are almost never found. All gallstones contain variable amounts of bile pigments, cholesterol, calcium carbonate, and apatite, and their core usually consists of bile pigments or mucoprotein, which is secreted by the inner lining of the gallbladder, also known as the epithelium. "


CHOLESTEROL STONES
http://www.medbroadcast.com/health_topics/health_conditions/gallstones/index.shtml
The basis of the common cholesterol stone appears to be a precipitation of cholesterol that cannot be absorbed into solution. Cholesterol, which is insoluble in water, is carried in solution in the bile. People with cholesterol stones sometimes secrete a bile that is saturated or supersaturated with cholesterol. The bile secreted in the liver is abnormal in patients with cholesterol stones. These patients have a reduced bile salt pool and it seems
that the defect is a lack of bile salts rather than excessive cholesterol. Gallstones are also a common accompaniment of cirrhosis, as there is often a reduction in the bile salt pool and a decrease in the bile salt content of the bile.


The gallbladder really plays a secondary part in allowing the cholesterol crystals to form a stone. Stones can form in the bile ducts in people who have had their gallbladders removed (cholecystectomy), which proves that the gallbladder is not essential for stone production, however, this situation is really quite rare. There may also be dietary and genetic factors in cholesterol stone formation, as cholesterol stones are far more common in European and Western cultures, than in Oriental groups.




PIGMENT STONES
Pigment stones seem to beget stones. For instance, a gallbladder that has a stone can become obstructed and cause inflammation, which in turn causes more gallstones. Pigment stones consist of variable quantities of cholesterol, calcium bilirubinate, and calcium carbonate and produce a predominantly brown colour. These mixed stones are typically found in groups multiple, and form around organisms and inflammatory debris.




AHA Scientific Position
http://www.americanheart.org/presenter.jhtml?identifier=4488
Cholesterol is a soft, waxy substance found among the lipids (fats) in the bloodstream and in all your body's cells.




What is cholesterol?
http://archives.obs-us.com/obs/english/books/pg/pg173.htm
Cholesterol is a pearly-white, waxy substance found in animal fats and oils. It is found throughout the body but is produced primarily by the liver. Cholesterol circulates in the blood, commonly in association with other saturated and unsaturated fats, and can be either beneficial or harmful. For instance, it is necessary for making cell membranes and many important hormones. However, cholesterol may also form gallstones and harmful deposits in blood vessels.



http://www.gicare.com/pated/edtot24.htm
Over the years, a hardened, waxy substance called cholesterol plaque builds up on the artery walls, and reduces or blocks blood flow. Organs supplied by these arteries then become damaged because they cannot get the oxygen and nutrients they need. For example, when blood flow to the brain is blocked, a stroke occurs. When plaque completely blocks a coronary artery, a heart attack takes
place.



http://www.prevention.com/cda/finder/1,1345,1198,00.html
"In addition to helping your bones, calcium has a good effect on bile acid metabolism," explains Dr. Hofmann. "What has been found is that large doses of oral calcium form calcium phosphate in the gut." This sets off a chain of chemical events that eventually lowers the amount of cholesterol in the gallbladder, thus reducing the possibility that gallstones will form, he explains.


It also seems to explain why a study of 872 Dutchmen between the ages of 40 and 59 found that the more calcium the men consumed over a 25-year period, the fewer gallstones they were likely to have.


In fact, one study in the Netherlands revealed that men who had more than 1,442 milligrams of calcium in their diets every day had a 50 percent lower prevalence of gallstones.


"Since most individuals have stopped drinking much milk by the time they're 45 years old, it makes good sense to take calcium supplements," says Dr. Hofmann. Nonetheless, the view that large doses of supplemental calcium can prevent gallstones has not yet been tested experimentally. Normal doses of calcium do not increase the risk of kidney stones, however, and are likely to be good for
both bones and bile. Studies are needed to prove this point as well as to prove that there are no important risks associated with long-term use of oral calcium supplements, says Dr. Hofman.


Experts who recommend calcium to help prevent gallstones suggest aiming for the Daily Value, which is 1,000 milligrams. But before you race out to the drugstore, Dr. Pitt suggests that you take a moment to check with your physician, especially if you're a woman.


"Calcium may have something to do with the origin of most of the gallstones in this country," says Dr. Pitt. "It's at the center of almost every stone we find. And in our animal studies, diets with high calcium seem to enhance the formation of pigment stones," the stones made of bilirubin.


And keep in mind all of the hormonal factors that affect women, says Dr. Pitt. It may turn out that calcium prevents gallstones in men but actually contributes to their formation in women.

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