A 28-year-old patient came to see me with a sharp pain just beneath his breastbone, fever, chills and yellowing eyes. He was convinced he had jaundice but turned out he was suffering from gallstones, hardened deposits of a digestive fluid called bile that is crucial for digesting fats and absorbing fat-soluble vitamins. These form in the gallbladder, a small organ beneath the liver that stores all the bile the liver produces. If the gallbladder doesn’t empty the bile often enough, the latter concentrates and causes stone formations.
I wondered why this fit young man had developed gallstones rather early in life. Then I found that he had been on an aggressive keto diet to lose weight quickly. The ketogenic diet is characterised by a high intake of fats and is low on carbs, which can lead to increased cholesterol levels in the bile and decreased gallbladder contractions, solidifying the bile. The keto diet also results in significant weight loss, particularly in the initial stages. As the body breaks down fat for faster weight loss, it can cause the liver to secrete extra cholesterol into the bile, which can lead to gallstones.
Gallstones are becoming increasingly common in the younger population, being diagnosed more frequently in the 20-30 age group, and even teenagers. What’s driving this condition?
Watch your diet
The modern diet, characterised by high energy intake, refined sugars, saturated fats and low fibre, has been strongly associated with an increased risk of gallstones. Fast foods, sugary beverages and processed snacks —staples of many young people’s diets — contribute to obesity and disturbances that favour the formation of gallstones.
High Fat and Cholesterol: Diets rich in fried and fatty foods increase the risk of gallstones by oversaturating bile with cholesterol, making it more likely to crystallise and form stones.
Refined Sugars and Carbohydrates: High consumption of simple sugars and refined carbohydrates is linked to higher gallstone risks, likely due to their impact on insulin resistance and lipid metabolism.
Low Fibre Intake: Diets low in fibre slow digestion, prolonging the time bile spends in the gallbladder, which can promote stone formation. Fibre from fruits, vegetables and whole grains supports healthy digestion and reduces risk.
Conversely, Mediterranean or DASH diets, which emphasise whole foods, good fats, lean proteins and plenty of fruits and vegetables, are associated with a lower risk of gallstone disease.
A risk factor called obesity
Obesity is a well-established risk factor for gallstones, particularly among young people. Excess body weight increases cholesterol secretion into bile, promoting supersaturation and stone formation.
Other Contributing Factors in the Young
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Diabetes and insulin resistance are increasingly prevalent in younger populations and are linked to higher triglyceride levels, which promote gallstone formation.
Use of hormonal contraceptives and pregnancy, both common in young women, can increase cholesterol levels in bile and reduce gallbladder contractions, raising risk.
Some populations have a genetic predisposition to gallstones but environmental and lifestyle factors often act as triggers. The shift towards sedentary lifestyles and increased consumption of processed foods has compounded the problem. Lifestyle correction is not just an option, it is required in the earliest years of your life.
(Dr Chatterjee is internal medicine specialist, Indraprastha Apollo Hospitals, Delhi)
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