Could Gallstones Be Expelled?
It seems likely that gallstones might occasionally be expelled. Small stones are regularly expelled from the gallbladder. There is some risk that stones over about 5mm in diameter will lodge in the bile duct, but most pass on into the bowel and out of the body unnoticed. Gallbladders may spontaneously empty themselves of small stones, but this is rare .
Also, the large oily meal would stimulate strong gallbladder contraction. This could help expel small gallstones or even, very rarely, a whole crop of small gallstones or sludge. Whether the whole ritual is needed is another matter. A meal of fried fish and chips, or the “whole fat milk and a Mars bar” sometimes used to stimulate gallbladder contraction during x-ray examinations might serve as well.
The magnesium sulphate (Epsom Salts) could have an added effect, as it also stimulates gallbladder contraction and relaxes the muscles controlling the release of bile into the intestines. However, it acts in the same way as would fat or oil, causing the release of cholecystokinin from the upper small intestine . The availability of that hormone and the ability of the gallbladder to respond to it would be limiting factors. The chance of success is further diminished by the fact that patients with symptomatic gallstones often have impaired ability of the gallbladder to empty (a factor in gallstone formation), stones that are too big to pass, or a blocked gallbladder duct (the “non-functioning gallbladder” in contrast studies).
Moreover, it can be predicted that even if occasionally successful, most patients would go on to form more stones. After successful dissolution of gallstones with ursodeoxycholic acid, 30-50% of patients form new stones within five years . Despite much research, no simple, safe, or dietary measure has been found to prevent gallstone formation. The traditional fat-free diet has shown no consistent benefit , possibly because an occasional fatty meal helps expel small stones or sludge. This may be why patients on prolonged intravenous feeding are prone to develop gallstones.
In a popular variant, large quantities of apple juice are consumed in the days prior to the olive oil and lemon juice (or equivalent). Its supporters claim that apple juice is a stone solvent , usually offering in support a reference to the prestigious medical journal, The Lancet . The cited item, “Apple juice and the chemical-contact softening of gallstones,” is merely a brief letter to the editor stating that the writer’s wife had passed soft, brown, “fatty stones” after drinking a lot of apple juice and then a cupful of olive oil, apparently as part of a gallbladder flush. This source offers no evidence that apple juice can soften gallstones. Actually, there is no way for apple juice or any other agent taken by mouth to come into contact with stones in the gallbladder or bile ducts. A very effective sphincter muscle prevents intestinal contents from leaking back into the bile duct or gallbladder.
Thus there is no logical reason to believe that any of the materials consumed in the “flushes” (oils, fruit juices, magnesium sulfate) could soften or otherwise affect the characteristics of gallstones in the gallbladder or bile ducts. Bile salts such as ursodeoxycholic acid can do so, but they must be absorbed into the blood stream and processed by the liver before they can affect the ability of bile to dissolve cholesterol stones—and a minimum of nine months of treatment is usually required.
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