Time to consider downsides of all those goodies

THE average recommended daily calorie intake is 2,500 for a man and 2,000 for a woman. An achievable goal, one might think, at least most of the time.

As we’re still hopefully enjoying the festive period and looking forward to some New Year celebrations, we can safely assume that the calorie goal has gone somewhat out of the window for many of us.

One study a few years back suggested that the average person puts away around 5,373 calories on Christmas Day alone. It’s no secret that the average Christmas Day menu is a bit on the naughty side.

Consider also the leftovers on Boxing Day and all the chocolates and mince pies that need eating in the ensuing run-up to some sort of New Year feast.

And let’s not forget the alcohol. One industry estimate suggested the nation gets through almost six billion units of alcohol between Christmas and New Year.

Of course, all food, including the stuff that is good for us, holds calories. It just so happens that we gravitate at Christmas towards all the foods that aren’t good for us.

For example, there are more than 200 calories in a glass of red wine or a pint of beer, roughly equivalent to four pigs in blankets, while a 100ml portion of Baileys is equal to 327 calories, as is a slice of Christmas pudding.

And while for a short period that’s absolutely fine (I don’t want to spoil the fun), the high fat diet causes more than just indigestion for some.

The gall bladder is a small pear-shaped pouch that sits just below the liver. It is connected to the liver by a duct through which bile travels on its way to the small intestine. The gall bladder acts as a sort of reservoir for bile. What is bile, you might ask? I regularly talk about the four humours cited in ancient medicine, an imbalance of which is supposed to have caused disease.

While wrong, we still use the names for these humours today — phlegm, blood, yellow bile and black bile.

In reality, there is only one type of bile and if we were to visualise it, we would see a yellow-brown hue.

This colour is from the pigment bilirubin, which is a breakdown product of red blood cells, broken down in the liver and passed out of it via the bile duct.

Bile also contains cholesterol, phospholipids and bile salts, the latter of which help to digest fats in our intestines.

And that is essentially its main function. As we ingest foods high in fat, the gallbladder is stirred into action and contracts, pushing out stored bile through the bile duct and into the intestines to break down the fats in our food and to help absorb them.

If the duct becomes blocked, that bile never gets to its intended site of action and this produces two visible results.

Firstly, the stools we produce become pale because the bilirubin is not getting through to create the brown colour that our stools normally display.

Secondly, our urine becomes darker because the bilirubin is diverted back into the blood where it builds up and seeps out via the kidneys into our urine. If that
build-up occurs to a significant degree, we become jaundiced.

If this pattern occurs without any other symptoms, such as pain, this is a matter requiring urgent investigation to ensure there are no masses pressing against the bile duct.

The pancreas is in the vicinity and sometimes pancreatic cancer can present with this painless jaundice.

However, more often than not, the blockage of the duct occurs from within and this most certainly does cause pain. It’s estimated that one in 10 of us has gallstones, though not all of those will have symptoms.

Gallstones occur within the gallbladder when the ratio of cholesterol and bile acids tip in favour of cholesterol, at which point solid cholesterol begins to form. (There is a pigment form of gallstones too but cholesterol gallstones form the majority.)

These can range from something as small as a grain of sand to being as large as a golf ball. The Guinness world record for the heaviest gallstone was 6.29kg, which was removed from an 80-year- old woman in 1952.

There is also a record for the most removed from a single patient — an unbelievable 23,530. Thankfully, it doesn’t become that extreme for most of us.

A high fat diet puts one at a much higher risk for developing gallstones and so it is no surprise that it is more prevalent in those who are overweight or obese.

It is also more common in women, particularly those who have had children.

With all of that in mind, picture the scenario.

A mother of four who is perhaps on the heavier side sits down for Christmas dinner and, because it has been a hard year, doesn’t hold back.

As well as feeling rather full, she begins to feel a gripping pain on the right side of her abdomen, just at the edge of her ribs. This comes in waves.

This lady has gallstones and, as the gallbladder contracts to secrete the bile needed to meet the fats being ingested, its walls are irritated by the gallstones within.

Picture then one of these gallstones slipping into the bile duct. As the contractions continue, the colic pain becomes severe. This is not pleasant and can last for as little as an hour or as long as five hours before the stone passes.

A yet further scenario occurs when the gallbladder becomes infected. This results in pain in the same region and is associated with fevers, vomiting and an extreme tenderness when pressing on a certain point, especially if one then takes a deep breath (a sign called Murphy’s sign).

This infection of the gall bladder is called cholecystitis and more often than not requires a trip to the hospital for intravenous antibiotics. (This is allegedly what Alexander the Great died from.)

Clearly if gallstones are causing problems in any of the ways just mentioned, something needs to be done.

Two hundred years ago, one might be bled or advised simply to rest. Surgeons might have opted to make cuts in the gallbladder to drain fluid and remove stones — a painful and high risk procedure in those days. However, there was a reluctance to remove it altogether for fear of killing the patient by depriving the patient of its function.

It was subsequently discovered that actually we can live quite normally without our gallbladders — in this case the bile simply drips continuously from the liver into the intestines.

The first removal (cholecystectomy) was carried out in 1882 and now it is one of the most common operations worldwide.

Since the Eighties, the laparoscopic technique (keyhole) has been used, which is preferable as it is a minimally invasive procedure.

In order to identify the existence of gallstones, an ultrasound scan of the liver and gall bladder is the mainstay diagnostic test.

Depending on the level of symptoms, a GP may recommend a referral to the surgeon or a gastroenterologist who has more sophisticated investigative procedures to employ.

If mild, then simple measures such as portion control, limiting alcohol and going easy on processed foods such as white bread, deep fried foods, whole milk, sausages, cakes, pies, snack foods and eggs is the way forward.

Weirdly, one study found that cases of gallstones seem to be more common in the summer months. Dehydration is one reason for this, something that will set off the formation of gallstones.

However, it is possible that the conception of the stones may have taken place six months prior as we indulged ourselves during the winter festive season.

A cautionary word therefore to enjoy all the goodies around us but not too much. Happy NewYear.