Only a quarter of people with gallstones typically require treatment. That's fortunate, because every year nearly 1 million Americans are diagnosed with these little pebbles, which are primarily made of cholesterol and bile salts. Getting rid of them typically requires removal of the gallbladder, one of the most common U.S. surgeries.
Gallstones can get blamed for symptoms caused by other, more elusive culprits, such as irritable bowel syndrome, says Robert Sandler, chief of the division of gastroenterology and hepatology with the University of North Carolina School of Medicine. An ultrasound test might pick them up while missing the real problem. If you're told you need to have gallstones out but they're not bothering you, get a second opinion, he advises.
Removal may be necessary if the stones instigate inflammation or infection of the gallbladder, pancreas, or liver. This can happen if a stone moving out of the gallbladder gets stuck—blocking the flow of bile—in the ducts between the liver and the small intestine.
The pain of a gallstone lodged in a duct usually comes on quickly—in the right upper abdomen, between the shoulder blades, or under the right shoulder—and means a trip to the ER is needed, as may fever, vomiting, nausea, or pain lasting more than five hours. Gallbladder removal can be performed laparoscopically and more recently has been done without an external incision by going through the mouth or vagina.
Obesity is a risk factor for gallstones, and it's theorized that they develop because of a shortage of fiber and an excess of fat in the western diet. Losing weight—then regaining it—also seems to set the stage for gallstones. In a 2006 study of men, the more frequent the weight cycling and the larger the number of pounds shed and regained, the greater the odds of gallstones. Women, especially those who are pregnant or taking birth control pills, face increases in gallstone likelihood as well.
Between 30 million and 50 million Americans are lactose intolerant, meaning they lack an enzyme needed to digest the main sugar in milk, and African-Americans, Asians, and American Indians are most likely to have the condition. Ranging in severity from person to person, symptoms include cramping, bloating, gas, nausea, and diarrhea. These usually occur 30 minutes to two hours after one drinks or eats a dairy product.
Doctors can test for lactose intolerance using a breath test, which detects heightened levels of hydrogen; a blood test, before which the patient drinks a lactose-containing beverage; or a test of stool acidity (which undigested lactose helps generate). There's also a cheaper, do-it-yourself approach to diagnosis, Bickston says. "Buy a tall container of milk, drink it, and call me the next day and tell me how the afternoon was," he says. If you experience bloating, abdominal pain, or diarrhea, he says, you're probably lactose intolerant.
If so, don't despair. Over-the-counter pills can replace the missing enzyme, called lactase, and some milk and milk substitutes are lactose-free. Avoiding all dairy products, in any case, may not be necessary. Many lactase-deficient people "can tolerate small amounts of lactose," Bickston says.