Causes of Gallstones

Cause details for Gallstones: Cholesterol Stones
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment Stones
The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia.

Other Factors
It is believed that the mere presence of gallstones may cause more gallstones to develop. However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.

Obesity. Obesity is a major risk factor for gallstones, especially in women. A large clinical study showed that being even moderately overweight increases one's risk for developing gallstones. The most likely reason is that obesity tends to reduce the amount of bile salts in bile, resulting in more cholesterol. Obesity also decreases gallbladder emptying.
Estrogen. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
Ethnicity. Native Americans have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rates of gallstones in the United States. A majority of Native American men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30. Mexican-American men and women of all ages also have high rates of gallstones.
Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
Age. People over age 60 are more likely to develop gallstones than younger people.
Cholesterol-lowering drugs. Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones.
Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids increase the risk of gallstones.
Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
Fasting.Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol, which can lead to gallstones.

Most researchers believe three conditions are necessary to form gallstones. First, the bile becomes supersaturated with cholesterol, which means the bile contains more cholesterol than the bile salts can dissolve. Second, an imbalance of proteins or other substances in the bile causes the cholesterol to start to crystallize. Third, the gallbladder does not contract enough to empty its bile regularly. ²

Underlying condition causes of Gallstones: The list of possible underlying conditions (see also Misdiagnosis of underlying causes of Gallstones) mentioned in various sources as possible causes of Gallstones includes:

Gallstones as a complication: Other conditions that might have Gallstones as a complication might be potential underlying causes of Gallstones. The list of conditions listing Gallstones as a complication in our database includes:

Gallstones as a symptom: Conditions listing Gallstones as a symptom may also be potential underlying causes of Gallstones. The list of conditions listing Gallstones as a symptom in our database includes:

Related information for causes of Gallstones: Further relevant information on causes of Gallstones may be found in the risk factors for Gallstones and underlying causes of Gallstones.

Footnotes:
1. excerpt from Gallstones: NIDDK
2. excerpt from Dieting and Gallstones: NIDDK

Last revision: May 27, 2003

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