What causes cholesterol gallstones?

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Last updated: June 7, 2025View editorial policy

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From the Research

Cholesterol gallstones are primarily caused by an imbalance in the composition of bile, where the bile contains too much cholesterol and not enough bile salts or lecithin to dissolve it, leading to the crystallization of excess cholesterol and the formation of stones. This imbalance can be attributed to various factors, including obesity, which increases cholesterol secretion into bile 1. Rapid weight loss can also cause the liver to secrete extra cholesterol into bile, contributing to the formation of gallstones. Female hormones, particularly estrogen, play a significant role in increasing cholesterol saturation in bile, making women twice as likely to develop gallstones as men, especially during pregnancy or when taking hormone replacement therapy or birth control pills 2.

Some key factors that increase the risk of developing cholesterol gallstones include:

  • Obesity, which leads to increased cholesterol secretion into bile
  • Rapid weight loss, causing the liver to secrete extra cholesterol into bile
  • Female hormones, particularly estrogen, increasing cholesterol saturation in bile
  • Genetic factors, with certain ethnic groups like Native Americans having higher rates of gallstone formation
  • Age, with risk increasing after age 40
  • Diabetes and metabolic syndrome, associated with higher gallstone risk due to insulin resistance affecting cholesterol metabolism
  • Diet high in refined carbohydrates and low in fiber, contributing to gallstone formation
  • Lack of regular physical activity, which can help prevent gallstones by improving gallbladder emptying and reducing cholesterol saturation in bile 3.

The formation of cholesterol gallstones is a complex process, and while the exact mechanisms are not fully understood, it is clear that an imbalance in bile composition plays a crucial role. The most effective way to prevent or treat cholesterol gallstones is to address the underlying factors contributing to the imbalance in bile composition, such as maintaining a healthy weight, eating a balanced diet, and engaging in regular physical activity 4.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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