Wednesday, February 02, 2011

Gallbladder Disease and Diabetes

Note: I refer to cholesterol gallstones exclusively in this post. Pigment gallstones have separate risk factors entirely.

One thing I've been saying, that I thought I was told by a doctor, was that my gallstones and diabetes were unrelated.
I mean, that makes sense. I've had these stomach aches since I was 10 years old, and we certainly didn't notice any diabetes symptoms at that time. If the gallstone symptoms predate the diabetes symptoms, they shouldn't be related, right?
And the four major gallbladder disease risk factors are: family history, female, fertile, over forty, and fat. Since female, over forty, and fat are risk factors for type 2 but not type 1 diabetes, I figured it would make sense for diabetes to be listed as a risk factor without type 1 diabetes actually being a risk factor, and I figured that my diabetes was not related to my gallstones.

So I asked the GI doctor, why did I get gallstones? I don't fit any of the risk factors. He said that type 1 diabetes was a major risk factor, and that many of the atypical cases he sees- cases in people who are non-obese young men- are type 1 diabetics.

I wasn't sure I believed him.

So I started looking on pubmed and now I believe him. 20% of people with diabetes who have their gallbladders removed are type 1s. Since less than 20% of all diabetics are type 1s (about 10% of people diagnosed with diabetes have type 1 diabetes), that means that type 1s are at a higher risk of having a gallbladder removed compared to type 2s, and since type 2s tend to be high risk because of having the same profile that is high risk for gallstones... type 1 diabetes must be a major risk factor for gallbladder disease.

The next question is, why would diabetes be a risk factor for gallbladder disease? I had already read two possible answers. Celiac disease is known to affect some of the muscles that are supposed to keep the gall moving and prevent gall stones, and celiac sprue is a risk for gallstones. Hypothyroidism, even subclinical hypothyroidism, is also a known risk factor for gallstones, for similar reasons.

Having celiac and/or hypothyroidism is very common among type 1 diabetics, particularly among diabetic girls and women. But myself, I have neither one (although admittedly it's not unlikely that I've been hypothyroid at some point and in fact I had active thyroid disease when my gallbladder was removed). And the higher risk of gallstones among people with diabetes is specifically seen more in men with diabetes, who are at a lower risk of celiac and hypothyroidism compared to women with diabetes.

So, I am still not clear on whether type 1 diabetes can play a role in CAUSING gallstones and whether it did in my case, or whether it is merely associated with other things that cause gallstones that may or may not have caused my gallstones.

Here is one study on diabetes and gallbladder disease:


htimm=) said...

great info Jonah, thanks!

Anonymous said...

I never thought that thryoid dysfunction can also affect diabetic patients too. I'm glad I am taking porcine thyroid . It brings my sugar back to normal.

Karol said...

Thanks for posting this. I am a Type 1 and have a family history of gall bladder disease. Really interesting reading.