Can Caffeine Make Biliary Colic Worse?
No, caffeine does not make biliary colic worse and may actually be protective against gallstone disease. In fact, caffeine consumption has been associated with decreased risk of gallstone formation and promotes gallbladder emptying through physiological mechanisms 1, 2.
Physiological Effects of Caffeine on the Gallbladder
Caffeine has several beneficial effects on gallbladder function that argue against it worsening biliary colic:
Caffeine stimulates cholecystokinin (CCK) release, which is the principal hormone controlling gallbladder emptying. Both regular and decaffeinated coffee increase plasma CCK concentrations (2.8-3.3 pmol/L increases) and cause gallbladder contractions of 29-33%, compared to only 10% contraction with saline 3.
Caffeine enhances gallbladder motility through phosphodiesterase inhibition pathways. Laboratory studies demonstrate that caffeine decreases baseline gallbladder tone and actually increases CCK-induced gallbladder contractions, which promotes bile flow and may reduce stone formation 1.
Caffeine is excreted in bile in concentrations similar to blood plasma levels, allowing direct local effects on biliary epithelial cells 4.
Clinical Evidence on Caffeine and Gallstone Disease
The epidemiological data supports a protective rather than harmful role:
Coffee consumption decreases the risk of gallstone disease according to multiple studies 1, 2.
Dietary factors that may prevent gallstone development include caffeine, along with polyunsaturated fat, monounsaturated fat, and fiber 2.
One large epidemiological study found only heavy coffee drinkers showed a borderline increased prevalence (OR 1.083,95% CI 0.999-1.174, P=0.051), but this was not definitive and no clear relationship was established between caffeine consumption and increased gallstone disease 5.
Important Clinical Context
The American College of Physicians guidelines clearly state that biliary colic presents as severe, steady pain that is unaffected by household remedies, position change, or gas passage 6. The pain is not influenced by dietary triggers in the acute setting—it results from gallbladder distension and increased pressure from stone obstruction 6.
Belching, bloating, and intolerance of fatty foods are problems NOT attributable to gallstone disease according to established guidelines 6. This is a critical distinction, as many patients and clinicians mistakenly attribute these symptoms to gallbladder pathology.
Practical Recommendations
Do not advise patients to avoid caffeine for biliary colic or gallstone disease, as there is no evidence it worsens symptoms and may actually be beneficial 1, 2, 3.
Focus dietary counseling on proven risk factors: saturated fats, refined sugars, and processed foods should be limited, while emphasizing fruits, vegetables, whole grains, and lean proteins 7.
Recognize that true biliary colic is not triggered by specific foods or beverages—it occurs when stones obstruct the cystic duct or gallbladder outlet, causing distension 6.
Perioperative caffeine considerations: While caffeine increases blood pressure and heart rate and may interfere with diabetes control, these are anesthesia-related concerns, not reasons to avoid caffeine for gallbladder disease management 6.