03/06/2026
The "you ate too much fat" explanation for gallstones is one of the most persistently repeated medical myths — and it leads to harmful dietary advice.
Here's the physiology: bile is produced by the liver and stored in the gallbladder. Bile salts are the molecules that keep cholesterol dissolved in bile. When bile salt concentration drops relative to cholesterol, bile becomes supersaturated, cholesterol crystallizes, and stones form.
The irony: low-fat diets are a documented risk factor for gallstones. When dietary fat is absent, there's no stimulus for gallbladder contraction. Bile sits stagnant. Sludge forms first. Stones follow.
Birth control pills and synthetic estrogens increase biliary cholesterol excretion while reducing bile salt synthesis — a dual mechanism explaining the elevated gallstone risk in women on hormonal contraceptives.
Cortisol impairs bile acid synthesis directly. Chronic stress chronically suppresses bile flow. This is almost never discussed in standard gallbladder conversations.
Gut health matters significantly: intestinal bacteria in the terminal ileum recycle bile salts back to the liver. Dysbiosis and ileal dysfunction impair this recycling, reducing the total bile salt pool.
Supporting bile health: eat fat with meals to stimulate bile secretion, include bitter greens and beets, consider taurine and ox bile therapeutically if bile production is already compromised, and address gut dysbiosis.
Struggling with digestive issues, bloating, or hormonal imbalances? Get my Free Balance Toolkit — comment BALANCE.
Research: Portincasa P, et al. "Cholesterol gallstone disease." Lancet. 2006;368(9531):230-239. https://doi.org/10.1016/S0140-6736(06)69044-2