Today while I was cooling my heels waiting to get my hair cut and highlighted at the salon, I picked up a copy of Oprah’s magazine. Sometimes, I come prepared with a stack of medical papers or a good book and invariably my stylist is running ahead of schedule and gets me right in. Today, I took nothing and had the usual choice of salon mags: recent issues of People, US, Oprah, Vogue and an ancient and dog-earred Travel and Leisure (which issue I’ve now read thrice). Although I do not subscribe to any of these periodicals, except T&L, I must confess that I do on occasion riffle through them at the salon…just to keep up on the latest breaking news, of course. Granted, the news in them is all about Brangelina or what my beloved Johnny Depp wore on the red carpet, but it’s something to pass the time while sniffing the hair spray.

Today, I happened to notice a short piece in O: The Oprah Magazine entitled “Cream Puffs, Anyone?” about the recently and widely reported results of the Women’s Health Initiative that showed that eating less fat doesn’t reduce the risk of breast cancer, colon cancer, or heart disease. The gist of the piece was a caution that despite the lack of connection of eating fat to any of these problems, we should all still eat a diet low in fat, particularly in saturated fat, and high in healthy whole grains.

The usual drivel.

What was interesting here, however, was the comment of Elizabeth Nabel, MD, director of the National Heart, Lung, and Blood Institute and of the WHI study, who was reported as having said:

…the investigators have yet to report on many other things–like the effect of a low-fat diet on gallbladder disease. And eating fatty foods may saturate the bile (stored in the gallbladder) with cholesterol, which could increase the risk of stones.

Cling onto that feeble hope, Lizzie, but don’t come whining to me when you get the results all analyzed and find that the people who ate the least fat had the most gallstones.

Mike and I saw exactly that result, albeit in a smaller group of patients, during the lead-in to a large weight maintenance drug trial we monitored in the late 1990s. During the trial, participants were asked to first lose weight on a low fat diet for 6 months, then were to be placed on one of three strenghths of the study drug or a placebo for a year to determine if the drug helped them maintain their meager low-fat weight loss. As a part of the study, before they began the weight loss phase, the participants underwent extensive testing, including having ultra-sound examinations of their gall bladders to look for stones. They then followed a low-fat, high-carb reduced calorie diet for 6 months with lots of nutritionist contact and regular visits and behavior mod.

At the end of the weight loss period those who had lost at least 4% of their starting weight in 6 months could go on to enter the drug trial. This cut off meant, of course, that a 200 pound woman would work for 6 months to lose 8 pounds and then be permitted to enter the maintenance trial to receive drug or placebo in a double-blinded set up, where neither the subjects nor the staff knew who got what. All this effort to see if taking a prescription drug, with not especially pleasant side effects, three times a day could help a 200 pound person maintain at 192 pounds, while continuing on a low-fat high carb maintenance number of calories.

Sheesh!

Before the subjects could enter the drug phase of the trial, however, each one had to again undergo the extensive battery of tests, including another gall bladder ultrasound. Although I don’t have the numbers at my fingertips, I can attest that an unusually large number of these moderately overweight to modestly obese people had developed gallstones during the 6 months of monitored low-fat dieting. We know they hadn’t had them before because we had pretty ultrasound pictures to prove it!

In all our many years (decades, actually) of helping patients lose weight on a low carb diet, which by its very nature is higher in fat, I cannot recall a single one (from among many thousands that we treated ourselves hands on) who developed symptomatic gall bladder disease.

This…there’s no other word for it…ignorant notion that eating fat will cause gallbladder disease is laughable.

What makes the gall bladder empty? As any basic human physiology text will you, it’s fat entering the first portion of the small intestine. When saturated, monounsaturated, or even polyunsaturated fat reaches this area, its entry triggers the release of cholecystokinin (CCK) which is the hormone that causes the gall bladder to squeeze and squirt bile into the intestine to emulsify the fat.

This is what the gall bladder is supposed to do, for crying out loud; it’s its raison d’etre.

Translated loosely from its medical Latin roots, it’s very name says it all: chole (gall) cysto (bladder) kinin (mover).

When little or no fat comes through, the bile in the gall bladder sits around turning to sludge. Absence of fat is the recipe for supersaturation of bile and gall stone formation, not eating fat!

You buy them their books and you send them to school and still they don’t get it.

When (and if) they finally do release the further results of the WHI trial pertaining to the effect of the low fat diet on gall stone formation get ready for Round 2 of head scratching, back peddling, and scrambling from the low fat camp.

If ever there were a hypothesis doomed to failure the theory that a low fat diet prevents gallbladder disease is it.

 

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