Sufficient, sustained weight loss may cut the risk of fatal heart attacks and strokes in half.
The Effects of Obesity on Gallstones, Acid Reflux, and Cardiovascular Disease
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
In the ABCs of health consequences of obesity, it looks like we’re up to G, and G is for Gallstones.
The #1 digestive reason people are hospitalized is because of a gallbladder attack. Every year, more than a million Americans are diagnosed with gallstones, and about 700,000 have to get their gallbladders surgically removed. It’s a relatively safe procedure. Complication rates tend to be under 5 percent, and the mortality rate is only about 1 in 1,000, but 1 in 10 may develop a “post-cholecystectomy syndrome” of persistent gastro-intestinal symptoms long after their gallbladder is removed.
What are gallstones made of? In 80 to 90 percent of cases, the gallstones are mostly just crystalized cholesterol, forming like rock candy in your gallbladder when cholesterol gets too concentrated. This was used to explain why some small, early studies found non-vegetarians had a higher incidence of gallstones. But the results from more recent, larger studies are more equivocal, with one study suggesting protection from gallbladder disease, but another showing higher rates among vegetarians, independent of weight. The biggest purported cause-and-effect risk factor, though, may be obesity, increasing risk as much as seven-fold, with a doubling of risk even at the heavier side of normal.
Ironically, rapid weight loss may also be a trigger. A half-pound a day has been deemed the upper limit for medically safe weight loss, based on gallstone formation. Ultrasound studies found that above that the chance of new gallstones can go from less than 1 in 200 a week to closer to 1 in 40. To help prevent a gallstone attack, you can increase your fiber intake. Not only is dietary fiber intake associated with less gallbladder disease in the first place; those placed on high-fiber foods during a weight-loss regimen suffered significantly less gallbladder sludging than those losing the same weight without the extra fiber.
G is also for GERD: gastroesophageal reflux disease. Fiber-rich food consumption also decreases the risk of acid reflux. Previously, I explored how chronically straining at stool may push part of the stomach up into the chest cavity. Well, the excess abdominal pressure due to obesity may have the same effect, pushing acid up into the throat, causing heartburn and inflammation. The increased pressure on the abdominal organs associated with obesity may also explain why overweight women suffer from more vaginal prolapse, where organs such as the rectum push out into the vaginal cavity.
The deadliest letter in the alphabet of obesity consequences, however, is H. H is for Heart Disease. Of the 4 million deaths attributed to excess body weight every year around the world, nearly 70 percent of the deaths are due to cardiovascular disease. Is it just because they’re eating poorly? Mendelian randomization studies suggest that people randomized from conception to be heavier, just based on genetics, do indeed have higher rates of heart disease and stroke, regardless of what they eat. The question is: if you lose weight, does your risk drop?
Enter the SOS trial, the first long-term controlled trial to compare the outcomes of thousands of bariatric surgery patients to matched control subjects who started out at the same weight, but went the nonsurgical route. The control group maintained their weight, whereas the surgical group maintained about a 20 percent weight loss over the next 10 to 20 years. Over that time, the weight-loss group not only developed 80 percent less diabetes, but suffered significantly fewer heart attacks and strokes; so, not surprisingly, significantly reduced their total mortality overall. You can see how 10 years out, the weight-loss group appeared to cut their risk of fatal heart attacks and strokes in half.
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- Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet. 2006;368(9531):230-9.
- Alexander HC, Bartlett AS, Wells CI, et al. Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB (Oxford). 2018;20(9):786-94.
- Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175-83.
- Isherwood J, Oakland K, Khanna A. A systematic review of the aetiology and management of post cholecystectomy syndrome. Surgeon. 2019;17(1):33-42.
- Pradhan SB, Joshi MR, Vaidya A. Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal. Kathmandu Univ Med J (KUMJ). 2009;7(27):268-71.
- Chang CM, Chiu THT, Chang CC, Lin MN, Lin CL. Plant-based diet, cholesterol, and risk of gallstone disease: a prospective study. Nutrients. 2019;11(2):335.
- McConnell TJ, Appleby PN, Key TJ. Vegetarian diet as a risk factor for symptomatic gallstone disease. Eur J Clin Nutr. 2017;71(6):731-5.
- Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: a Mendelian randomization study. Hepatology. 2013;58(6):2133-41.
- Stampfer MJ, Maclure KM, Colditz GA, Manson JE, Willett WC. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr. 1992;55(3):652-8.
- Aune D, Norat T, Vatten LJ. Body mass index, abdominal fatness and the risk of gallbladder disease. Eur J Epidemiol. 2015;30(9):1009-19.
- Weinsier RL, Wilson LJ, Lee J. Medically safe rate of weight loss for the treatment of obesity: a guideline based on risk of gallstone formation. Am J Med. 1995;98(2):115-7.
- Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Long-term intake of dietary fiber and decreased risk of cholecystectomy in women. Am J Gastroenterol. 2004;99(7):1364-70.
- Sulaberidze G, Okujava M, Liluashvili K, Tughushi M, Bezarashvili S. Dietary fiber’s benefit for gallstone disease prevention during rapid weight loss in obese patients. Georgian Med News. 2014;(231):95-9.
- Hampel H, Abraham N, El-Serag H. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143(3):199-211.
- Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11-26.e3.
- Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13-27.
- Hägg S, Fall T, Ploner A, et al. Adiposity as a cause of cardiovascular disease: a Mendelian randomization study. Int J Epidemiol. 2015;44(2):578-86.
- Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial-a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219-34.
Video production by Glass Entertainment
Motion graphics by Avocado Video
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
In the ABCs of health consequences of obesity, it looks like we’re up to G, and G is for Gallstones.
The #1 digestive reason people are hospitalized is because of a gallbladder attack. Every year, more than a million Americans are diagnosed with gallstones, and about 700,000 have to get their gallbladders surgically removed. It’s a relatively safe procedure. Complication rates tend to be under 5 percent, and the mortality rate is only about 1 in 1,000, but 1 in 10 may develop a “post-cholecystectomy syndrome” of persistent gastro-intestinal symptoms long after their gallbladder is removed.
What are gallstones made of? In 80 to 90 percent of cases, the gallstones are mostly just crystalized cholesterol, forming like rock candy in your gallbladder when cholesterol gets too concentrated. This was used to explain why some small, early studies found non-vegetarians had a higher incidence of gallstones. But the results from more recent, larger studies are more equivocal, with one study suggesting protection from gallbladder disease, but another showing higher rates among vegetarians, independent of weight. The biggest purported cause-and-effect risk factor, though, may be obesity, increasing risk as much as seven-fold, with a doubling of risk even at the heavier side of normal.
Ironically, rapid weight loss may also be a trigger. A half-pound a day has been deemed the upper limit for medically safe weight loss, based on gallstone formation. Ultrasound studies found that above that the chance of new gallstones can go from less than 1 in 200 a week to closer to 1 in 40. To help prevent a gallstone attack, you can increase your fiber intake. Not only is dietary fiber intake associated with less gallbladder disease in the first place; those placed on high-fiber foods during a weight-loss regimen suffered significantly less gallbladder sludging than those losing the same weight without the extra fiber.
G is also for GERD: gastroesophageal reflux disease. Fiber-rich food consumption also decreases the risk of acid reflux. Previously, I explored how chronically straining at stool may push part of the stomach up into the chest cavity. Well, the excess abdominal pressure due to obesity may have the same effect, pushing acid up into the throat, causing heartburn and inflammation. The increased pressure on the abdominal organs associated with obesity may also explain why overweight women suffer from more vaginal prolapse, where organs such as the rectum push out into the vaginal cavity.
The deadliest letter in the alphabet of obesity consequences, however, is H. H is for Heart Disease. Of the 4 million deaths attributed to excess body weight every year around the world, nearly 70 percent of the deaths are due to cardiovascular disease. Is it just because they’re eating poorly? Mendelian randomization studies suggest that people randomized from conception to be heavier, just based on genetics, do indeed have higher rates of heart disease and stroke, regardless of what they eat. The question is: if you lose weight, does your risk drop?
Enter the SOS trial, the first long-term controlled trial to compare the outcomes of thousands of bariatric surgery patients to matched control subjects who started out at the same weight, but went the nonsurgical route. The control group maintained their weight, whereas the surgical group maintained about a 20 percent weight loss over the next 10 to 20 years. Over that time, the weight-loss group not only developed 80 percent less diabetes, but suffered significantly fewer heart attacks and strokes; so, not surprisingly, significantly reduced their total mortality overall. You can see how 10 years out, the weight-loss group appeared to cut their risk of fatal heart attacks and strokes in half.
Please consider volunteering to help out on the site.
- Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet. 2006;368(9531):230-9.
- Alexander HC, Bartlett AS, Wells CI, et al. Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB (Oxford). 2018;20(9):786-94.
- Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175-83.
- Isherwood J, Oakland K, Khanna A. A systematic review of the aetiology and management of post cholecystectomy syndrome. Surgeon. 2019;17(1):33-42.
- Pradhan SB, Joshi MR, Vaidya A. Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal. Kathmandu Univ Med J (KUMJ). 2009;7(27):268-71.
- Chang CM, Chiu THT, Chang CC, Lin MN, Lin CL. Plant-based diet, cholesterol, and risk of gallstone disease: a prospective study. Nutrients. 2019;11(2):335.
- McConnell TJ, Appleby PN, Key TJ. Vegetarian diet as a risk factor for symptomatic gallstone disease. Eur J Clin Nutr. 2017;71(6):731-5.
- Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: a Mendelian randomization study. Hepatology. 2013;58(6):2133-41.
- Stampfer MJ, Maclure KM, Colditz GA, Manson JE, Willett WC. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr. 1992;55(3):652-8.
- Aune D, Norat T, Vatten LJ. Body mass index, abdominal fatness and the risk of gallbladder disease. Eur J Epidemiol. 2015;30(9):1009-19.
- Weinsier RL, Wilson LJ, Lee J. Medically safe rate of weight loss for the treatment of obesity: a guideline based on risk of gallstone formation. Am J Med. 1995;98(2):115-7.
- Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Long-term intake of dietary fiber and decreased risk of cholecystectomy in women. Am J Gastroenterol. 2004;99(7):1364-70.
- Sulaberidze G, Okujava M, Liluashvili K, Tughushi M, Bezarashvili S. Dietary fiber’s benefit for gallstone disease prevention during rapid weight loss in obese patients. Georgian Med News. 2014;(231):95-9.
- Hampel H, Abraham N, El-Serag H. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143(3):199-211.
- Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11-26.e3.
- Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13-27.
- Hägg S, Fall T, Ploner A, et al. Adiposity as a cause of cardiovascular disease: a Mendelian randomization study. Int J Epidemiol. 2015;44(2):578-86.
- Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial-a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219-34.
Video production by Glass Entertainment
Motion graphics by Avocado Video
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Title
The Effects of Obesity on Gallstones, Acid Reflux, and Cardiovascular Disease
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
If you missed the previous videos in my series on the ABCs of obesity, see:
- The Best Knee Replacement Alternative for Osteoarthritis Treatment
- The Effects of Obesity on Back Pain, Blood Pressure, Cancer, and Diabetes
- The Effects of Obesity on Dementia, Brain Function, and Fertility
I continue the topic of obesity and weight with these videos:
- The Effects of Obesity on the Immune System and Kidney and Liver Disease
- What’s the Ideal BMI?
- What’s the Ideal Waist Size?
For more on the health conditions discussed in this video, see the gallstones, GERD, and heart disease topic pages.
The video I showed is Diet and Hiatal Hernia.
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