Hi Friends,
Dr. Tabibian here.
A few weeks ago, I posted a short TikTok answering a patient’s question: “If you had gallstones, what would you do?”
I received numerous comments and DMs from people who just discovered they have gallstones and don’t know what to do next.
Some said their gallstones were found by accident on an ultrasound. Others were told they “must” have surgery, even though they have no symptoms.
And a few were recovering from painful gallstone attacks that sent them to the ER.
So in this week’s newsletter, I’m expanding on that video.
(link below, follow me on TikTok for more health tips I don’t always cover here).
If you or someone you know has been told they have gallstones, here’s how I’d think about it as both a doctor and a patient.
WHY YOU SHOULD READ THIS NOW
Over 15 million Americans have gallstones, and many don’t even know it.
Some people discover them by accident on a scan done for another reason. Others end up doubled over in pain, heading to the ER, and finding them that way.
Gallbladder removal (cholecystectomy) is one of the most common operations in the U.S.. but it isn’t always the right first step.
Here’s what I’d personally do if I found out I had gallstones, and what your options actually look like.
Today’s Opponent:
Gallstones (Cholelithiasis)
Gallstones are pebble-like deposits that form in your gallbladder, usually from cholesterol or pigment imbalances.
They can sit there quietly for years, or they can suddenly cause severe pain, nausea, or even infection.
If you were recently told you have gallstones, take a breath.
Here’s how I’d think it through: doctor to patient, human to human.
5 Things I’d Do If I Had Gallstones (Source: I’m a GI Doctor)
1. Don’t Panic
Gallstones are extremely common. Roughly 1 in 7 U.S. adults has them. Most never cause symptoms, and many never require surgery.
2. Ask Myself, “Are They Causing Symptoms?”
If you’re feeling:
Dull pain under the right ribs or shoulder after eating (especially fatty meals)
Bloating, nausea, or discomfort that comes in waves
…then the stones may be causing inflammation in the gallbladder or obstructing bile flow . You can often watch and wait in these scenarios, but each patient is different.
One commenter on my TikTok video wrote:
“I had an ultrasound in May, no stones. Started Zepbound in June and lost 40 lbs and as of a repeat ultrasound today, I now have stones. I have NO symptoms. No idea if I should agree to surgery or not, I really don’t want it!”
My take: If you’re symptom-free, there’s no rush. Rapid weight loss can trigger gallstones, but that alone isn’t a reason for surgery.
Monitor, adjust your diet, and re-image down the road.
3. If I Had Gallstones, But No Symptoms
I’d meet with a registered dietitian to review eating patterns that support healthy bile composition:
→ Limit saturated fat and crash diets.
→ Add fiber and stay hydrated.
→ Keep weight changes gradual.
Ursodiol (a dissolving medication) exists, but it’s only modestly effective and must be taken long-term. Personally, I wouldn’t rely on it.
Prevention through nutrition beats pills or scalpels.
4. If I Did Have Pain
Before saying yes to surgery, I’d confirm that the pain is truly coming from my gallbladder.
An upper endoscopy or MRI (MRCP) can rule out ulcers, reflux, or bile-duct issues.
I’ve seen too many people remove their gallbladder only to find their pain persisted because something else—like an ulcer—was the real culprit.
And having your gallbladder removed is not without risk.
Another commenter on my video wrote:
“My mom still had stones in her bile duct even after gallbladder removal.”
Exactly why proper testing matters first.
Stones in the bile duct, before or after gallbladder removal, require a special procedure, known as “ERCP” (which I happen to specialize in).
5. If Surgery Becomes Necessary
Cholecystectomy is safe and common, but it’s still surgery.
You may consider asking your doctor:
How many of these procedures do you perform each month?
What’s your complication rate?
What does recovery look like?
If you don’t feel comfortable asking certain questions, at least try to around, and ask yourself, “Do I get the sense that this surgeon will take good care of me?”
Listen to your gut on this (sage wisdom from a gastroenterologist 😅).
When gallstones are truly symptomatic and obstructive, surgery can be life-changing.
“Gallstones are one of those conditions that sound scarier than they are.
If you’re not having symptoms, don’t let anyone rush you into surgery.
If you are, get the right tests first. Sometimes it’s the gallbladder, sometimes it’s not.
The key is accurate diagnosis, not knee-jerk treatment.”
“I see a lot of women panic after being told they have gallstones.
For many, it’s an incidental finding. Focus on diet, hydration, and stable weight before assuming you need surgery.
And if you do need it, go in informed. Ask questions, get a second opinion.”
What’s On Your Mind?
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As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
