Factors Influencing Their Formation.—According to Friedenwald and Ruhräh[155] the two factors that in all probability exert the most influence on the formation of gallstones are the stasis of bile and the inflammation of the bile passages and gall bladder.
Dietary Rules.—There are certain dietary rules which should be observed by all persons who have had gallstone attacks. These are (1) to prevent stasis of bile, (2) to avoid fats. Everything should be done to prevent the formation of the stones, and this can only be accomplished by observing these rules. The flow of bile must be free; this is encouraged by keeping the intestinal tract in good condition.
Stimulating Peristalsis.—Peristalsis must not be allowed to become sluggish, for it is only during the process of digestion when the food mass passes along the intestinal canal that there is an ejection of bile into the intestines. When the passage is abnormally slow the bile is in a measure dammed back with a formation of gallstones as a result. The restriction of the fats has already been discussed in another part of the chapter. It has been demonstrated that these substances have a chemical influence upon the formation of gallstones as well as upon the intestinal stasis which leads to their formation.
Dietetic Treatment.—Hence the diet should be so directed as to (1) increase the flow of bile, and (2) to avoid all foods that are liable to cause indigestion which may bring about putrefaction in the intestinal tract and a consequent irritation and inflammation of the bile passages and gall bladder.
The meals should be regular and an abundant diet advised to increase the flow of bile and stimulate peristalsis in the intestines.
Exercise.—Exercise is especially recommended. Horseback riding, swimming, rowing, golf, and tennis are especially valuable in forcing the bile from the gall bladder and liver.
The Clothing.—The clothing should be loose enough to be perfectly comfortable. Certain cases of gallstone attacks in women have been said to have been traced to tight lacing, which interfered with the normal flow of the bile.
The Bowels.—Constipation should be avoided, and the diet should be directed with this point in view. The meals must be frequent, ranging from four to six a day. In this way only is the flow of bile encouraged. The breakfast should be ample in order to utilize the bile secreted in the night season. With all this, care must be observed not to give more food than can be adequately handled by the digestive apparatus, since food which is not digested becomes a prey to the actions of the putrefactive bacteria which infest it, and the toxic substance thus formed produces the very result which all of our efforts are directed to prevent.
Available Foods.—The following foods low in fats may be used in formulating the diet:
Soups: Meat broth (made from lean meat) from which all the fat has been removed.