Understanding Your Risk for Gallbladder Stones: Beyond the “Five F’s” Myth

Since the 1950s, doctors have relied on a catchy phrase—the “Five F’s”—to remember who’s most at risk for gallstones: Fair, Fat, Female, Forty, and Fertile. This classic mnemonic paints a picture of older, overweight white women with several children as the typical gallstone patients. But medicine evolves, and today, we know the story is much more complex.

Are You Really at Risk? Let’s Find Out

Gallstones mainly come in two types: cholesterol stones and pigment stones. Most gallstones are cholesterol-based, formed when cholesterol in bile becomes too concentrated and starts crystallizing.

Who Is Most Vulnerable to Cholesterol Stones?

Ethnicity

• Native American tribes have the highest risk, with nearly 50% affected.

• White Americans and Europeans have about a 20% risk.

• In India, 3–6% of people have gallstones, with higher rates in North India.

Age

Cholesterol gallstones are rare in kids and teens but become more common with age as the liver secretes more cholesterol into bile.

Sex and Hormones

Women are twice as likely to develop stones due to estrogen, which increases cholesterol secretion into bile.

Genetics

Family history matters—if a close relative has gallstones, your risk triples.

Lifestyle and Medical Factors

• Diet: Western diets rich in saturated fats, cholesterol, and refined carbs promote cholesterol stones.

• Pregnancy: Hormonal changes slow gallbladder emptying, increasing bile saturation.

• Rapid Weight Loss: Crash diets and weight-loss surgery cause bile stasis and cholesterol oversaturation, leading to stones rapidly.

• Total Parenteral Nutrition (TPN): IV feeding bypassing the gut causes gallbladder inactivity, with half of such patients developing gallstones within months.

Medications That Raise Risk

• Estrogen therapies (birth control, hormone replacement) double the risk.

• Octreotide, used for some tumors, slows gallbladder emptying.

• GLP-1 agonists for weight loss may contribute to gallstones by causing rapid weight loss and sluggish gallbladder movement.

Ceftriaxone antibiotic can cause temporary bile sludge and stones, especially in children, which usually clear after stopping the drug.

Other Important Risk Factors

• Obesity: Increases cholesterol secretion and slows gallbladder emptying.

• Diabetes: No direct proven link to gallstones, despite earlier beliefs.

• Small Intestine Diseases: Damage or removal of the lower small intestine reduces bile acid absorption, shrinking the bile pool and raising stone risk.

• Fatty Liver: Often related to metabolic syndrome/obesity, it may raise gallstone risk but isn’t a sole cause.

• Celiac Disease: Damaged intestines reduce gallbladder contraction, allowing bile stagnation and stone formation.

What About Protective Factors?

Some studies suggest statin medicines, vitamin C, and coffee might mildly protect against gallstones. However, the evidence is inconclusive—be cautious of health claims promising easy gallstone prevention with trendy diets or drinks.

Pigment Stones Are Different

Pigment stones, made mainly of bilirubin and calcium, come in two types:

• Black pigment stones: Linked to high red blood cell breakdown (hemolytic anemia), liver cirrhosis, or gut diseases.

• Brown pigment stones: Result from bile duct infections or blockages, often after liver surgeries or procedures, especially prevalent in Asia.

Unlike cholesterol stones, pigment stones stem from waste buildup or infection rather than cholesterol imbalance.

Busting the “Drink More Water” Myth

Drinking excessive water doesn’t prevent or flush out gallstones. Unlike kidney stones, gallstones form due to bile chemistry, not hydration levels. Advising high water intake to “flush” gallstones is misleading and might only lead to frequent trips to the bathroom.

Wisdom for Patients and Providers

Croatian author Eraldo Banovac said, "Superficial knowledge is potentially more dangerous than ignorance." This reminds us all—patients and doctors alike—that honest, well-informed understanding is key, especially in complex medical issues like gallstones.

If a doctor admits uncertainty but commits to finding the right answer, that honesty deserves respect. Similarly, know that no quick fixes or universal solutions exist for many health conditions, including gallstones.

Thomas Sowell, an acclaimed economist, wisely noted, "It takes considerable knowledge just to realize the extent of your own ignorance." Embrace learning and question myths.

Final Thoughts

Hopefully, this overview makes gallstone risks clearer and busts some old myths. For a deeper dive into gallstones and how to manage them, watch the other videos in our Gallstone Series.