Daily peanut and peanut butter consumption reduces risk of gallstones

Anonymous. Nutrition and Food Science. Bradford: 2004. Vol. 34, Iss. 6; pg. 285

Abstract (Summary)
New research has found that consuming peanuts or peanut butter more than five times a week is
associated with a significantly reduced risk of gallbladder disease. Nuts offer a bevy of benefits.

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New research has found that consuming peanuts or peanut butter more than five times a week is
associated with a significantly reduced risk of gallbladder disease.

Reporting in the American Journal of Clinical Nutrition this month, researchers from the Harvard
School of Public Health found that, compared with those who rarely ate peanuts or peanut butter,
women consuming one serving of peanuts (28 g, 1 oz) almost daily had a significant, 20 per cent
reduced risk of cholecystectomy (removal of a diseased gallbladder). Similarly, eating half a
serving of peanut butter (about one good teaspoon) five or more days per week reduced the risk
by 15 per cent.

Gallbladder disease is common in Western countries and is a major cause of abdominal ill health,
due to the formation of gallstones in the gallbladder. A staggering 50,000 operations to remove
the gallbladder are carried out each year in the UK. It effects mainly women, although it can
occur in men. In Western countries, some 80 per cent of gallstones are cholesterol stones and
their development is linked to high blood triglyceride levels and low levels of the protective
HDL cholesterol. Peanuts are rich in the beneficial cholesterol-lowering fatty acids and animal
studies have confirmed that unsaturated fats, such as those in peanuts may reduce the
development of gallstones.

The Harvard study suggests a threshold effect, with protection against gallbladder disease
occurring in those women who consumed peanuts or peanut butter as a regular, almost daily, part
of their diet. This study adds to the growing list of research reports that highlight the significant
protective effect of small daily servings of peanuts and peanut butter against coronary heart
disease, type 2 diabetes, obesity, and now gallbladder disease.

Nuts have traditionally been seen as foods to avoid, due to their high fat content and the
perception that this will cause weight gain. Several studies have now shown, however, that
including peanuts and peanut butter in calorie-controlled diets can help reduce weight and keep it
off long term.

These latest results support this since the women who consumed more nuts tended to weigh less.
The researchers suggest that the monounsaturated and polyunsaturated fats in nuts, peanuts and
peanut butter may act as inhibitors to gallstone formation. In addition, their results show that
even after controlling for the intake of specific fatty acids, the protective effect of nuts persists.
This suggests that other nutrients in nuts may also be contributing to the reduction in risk for
gallbladder disease. Peanuts are high in dietary fibre, one serving providing some 1.4 g (one-
twelfth of the daily recommended level). It is well known that dietary fibre offers protection
against cholesterol gallstone formation by removing some of the constituents of gallstones and
by improving insulin sensitivity. Peanuts also contain many other bioactive compounds, such as
phytosterols that may lower cholesterol levels by inhibiting its absorption. Nuts, peanuts and
peanut butter are a good source of magnesium, which may play a role in improving insulin
sensitivity and hence may reduce the development of gallstones.

This valuable piece of research, from the now famous Nurses Health Study, shows yet again that
peanuts and peanut butter are beneficial foods to include in a healthy, balanced diet. Not only are
they a tasty and nutritious snack, but it is reassuring to note their protective health benefits.

This research, was supported by grants from the US National Institutes of Health.

The Nurses Health Study: established in 1976 by researchers at the prestigious Harvard School
of Public Health, Boston, USA, the Nurses Health Study includes detailed medical and lifestyle
information on 121,700 registered female nurses aged 30-5 5yrs, in the USA over nearly 30
years. Follow-up questionnaires are sent to all participants every two years to collect data on
potential risk factors for diseases and identify newly diagnosed diseases, such as CHD and
diabetes.

Food frequency questionnaires show how many women were eating nuts five or more times per
week. Of the 83,000 female nurses who were followed for an average of 16 years in the Nurses
Health Study, 749 women ate peanut butter almost daily compared to 82 for peanuts and 32 for
other nuts.

One serving peanuts = 1 oz or 28.6 g. One serving peanut butter or 1 tablespoon.

Gallstones are the commonest cause for emergency hospital admission with abdominal pain in
developed countries and account for an important proportion of healthcare expenditure. Around
5.5 million people have gallstones in the UK, and over 50,000 cholecystectomies are performed
each year.

Laparoscopic cholecystectomy was introduced in 1987 and 80 per cent of cholecystectomies in

the UK are now carried out using this technique, which reduces the risk associated with surgery
in morbidly obese patients.

Published references cited in this release:

* Chung-Jyi Tsai, Michael F. Leitzmann, Frank B. Hu, Walter C. Willett.

* Giovannucci, E.L. (2004), "Frequent nut consumption and decreased risk of cholecystectomy
in women", American Journal of Clinical Nutrition, Vol. 80 No. 1, pp. 76-81.

* Beckingham, I.J. (2001), "ABC of diseases of liver, pancreas, and biliary system: gallstone
disease," British Medical Journal, Vol. 13, January.

* Kris-Etherton, P.M. (2001), "The effects of nuts on coronary heart disease risk", Nutrition
Reviews, Vol. 59 No. 4, pp. 103-11.

* Hu, F.B., Manson, J.E. and Willett, W.C. (2001), "Types of dietary fat and risk of coronary
heart disease: a critical review", Journal of the American College of Nutrition, Vol. 20 No. 1, pp.
5-19.

* McManus, K., Antinoro, L. and Sacks, F. (2001), "A randomised controlled trial of a moderate
fat, low-energy diet with a low fat, low-energy diet for weight loss in overweight adults",
International Journal of Obesity, Vol. 7 No. 5, pp. 1503-11.

* Jiang, R., Manson, J.E., Stampfer, M.J., Liu, S., Willett, W.C. and Hu, F.B. (2002), "A
prospective study of nut consumption and risk of type II diabetes in women", Journal of the
American Medical Association, Vol. 288 No. 20, pp. 2554-60.

For further information on the nutritional benefits of peanuts and peanut butter, visit Web site:
www.peanutsusa.org.uk/su4, or please contact: Jennette Higgs, Consultant Nutritionist/ Dietitian
and Media Specialist for the American Peanut Council. E-mail: jennette@foodtofit.co.uk; Tel:
01327 354632.

Indexing (document details)

Subjects: Peanuts, Diet, Health risk assessment, Gallbladder, Gallstones
Author(s): Anonymous
Document types: Feature
Document references
features:
Section: Food facts
Publication title: Nutrition and Food Science. Bradford: 2004. Vol. 34, Iss. 6; pg. 285
Source type: Periodical
ISSN: 00346659
ProQuest 774563311
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Gallstones are the most common and costly digestive disease in the United States,
causing more than 800,000 hospitalizations annually at estimated cost of over five
billion dollars. More than 20 million Americans have gallstones and approximately
one million new cases are diagnosed each year. Women are twice as likely as men
to develop gallstones; the higher prevalence of gallstones in women is thought to
be caused by multiple pregnancies, obesity, and rapid weight loss. Well over half a
million people undergo cholecystectomy (surgical removal of the gallbladder) each
year.

The normal function of the gallbladder is to store bile produced by the liver, and to aid in the
digestion and absorption of fats in the duodenum (the first portion of the small intestine).
Gallstones compose a solid formation of cholesterol and bile salts. However, research shows that
approximately 80 to 90 percent of all gallstones are cholesterol gallstones which form when the
liver begins secreting bile that is abnormally saturated with cholesterol. The excess cholesterol
crystallizes and then forms stones which are stored in the gallbladder or the cystic duct.
Gallstones can also form due to low levels of bile acids and bile lecithin.

Who Is At Risk For Gallstones?

When I was diagnosed with gallstones at 26, I was told that the typical gallstone
patient was fair, fat, and forty. Today gallstones are seen in younger patients,
perhaps due to the large amount of fast foods being consumed. My daughter went
through five years of vomiting beginning at age 15, leading me to almost believe
that she was bulimic, before she was diagnosed with gallstones at age 20. Risk
factors which can lead to increased incidence of gallstones include the "Four Fs:"
fat, female, fertile, and flatulent, as well as sickle cell disease (bilirubin), cirrhosis,
Crohn's disease, diabetes, pancreatic disease, and hyperparathyroidism. When the
symptoms of gallstones occur they are often called an "attack" because they occur suddenly. The
typical gallstone attack includes:

• Steady, severe pain in the upper abdomen that increases rapidly and lasts from 30
minutes to several hours.
• Pain in the back between the shoulder blades.
• Pain under the right shoulder.
• Nausea or vomiting.

Gallstone attacks often follow fatty meals, and they may occur during the night. Although I was
lucky not to have too much nausea and vomiting with my gallstones, one of my most vivid
childhood memories is of my mother up at night, in the bathroom, vomiting.

Other symptoms of gallstones include:

• Abdominal bloating.
 • Recurring intolerance of fatty foods.
• Colic.
• Belching.
• Gas.
• Indigestion.

The following symptoms are indication that you should seek immediate medical attention:

• Sweating.
• Chills.
• Low-grade fever.
• Yellowish color of the skin or whites of the eyes.
• Clay-colored stools.

Many people have gallstones with no symptoms, these people are called asymptomatic.
Gallstones that cause no symptoms are called "silent stones." Silent stones do not interfere in
gallbladder, liver, or pancreas function and do not require treatment.

Until just a few years ago, the most common treatment for symptomatic gallstones was a surgical
procedure called cholecystectomy which required a large abdominal incision to remove the
gallbladder. This was an extremely painful (based on my personal experience) and difficult to
recover from operation that required at least five days in the hospital, and approximately six
weeks for recovery.

Today laparoscopic cholecystectomy is most commonly performed. Laparoscopic

cholecystectomy is usually performed in a day-surgery unit and requires only a tiny incision. My
daughter's gallstones were treated laparoscopically, leaving her feeling well enough to continue
her normal activities later that day. However, it should be noted that not all patients will recover
almost instantaneously as my daughter did--the typical patient may need up to a week to recover
before returning to normal activities.

Alternative treatments for gallstones include:

• Oral bile acid dissolution therapy.

• Contact solvent dissolution.
• Mechanical extraction through a catheter placed into the gallbladder either through the
skin or through and endoscope.
• Fragmentation through shock-wave lithotripsy combined with bile acid dissolution.

Each of these alternative treatments leave the gallbladder in place. Because the gallbladder is not
removed during these treatments many patients face a significant risk of recurrence.

People who may be at risk for developing gallstones may want to try modifying their diet to
decrease their risk. The amount of dietary fiber consumed is an important therapy for gallstones
that is often overlooked. Gallstones may be prevented by increasing consumption of both soluble
and insoluble fiber which reduces the absorption of deoxycholic acid by producing a favorable
shift in the triad of factors that control cholesterol's solubility in bile. Soluble fibers which are
effective include guar gum and pectin, as well as other types of fiber (including oat bran, wheat
bran, and soy fiber) which are found in many fruits and vegetables. The benefit of fiber is seen in
the low incidence of gallstones in vegetarians.

Coffee drinking has been associated with a decreased risk of symptomatic gallstones, according
to research conducted by the Harvard School of Public Health and published in the June 9, 1999
issue of the "Journal of the American Medical Association". The study found that men (over
46,000 men were studied) who drank two or three cups of coffee a day had a 40 percent lower
risk of developing gallstones, while men who drank 4 or more cups of coffee a day decreased
their risk by 45 percent. The study found no relation between gallstone prevention and tea,
decaffeinated coffee, or caffeinated soft drinks.

Regular, vigorous, exercise may decrease the risk of gallstones. One study, reported by WebMD,
found that men who performed endurance activities such as jogging, running, racquet sports, and
brisk walking for 30 minutes five times a week, experienced a 34 percent reduction in risk for
gallbladder disease. The amount of benefit derived from exercise was more dependent on
intensity than type of exercise. Researchers theorize that exercise helps to normalize blood sugar
and insulin levels which may contribute to gallstones, if abnormal.

There is also some research which suggests that taking nonsteroidal anti-inflammatory drugs
(NSAIDS) such as aspirin or ibuprofen offers some protection against the formation of
gallstones. However, one study found no difference in the risk of gallstones in over 400 chronic
arthritis patients who regularly took NSAIDS.

Another option, approved by the FDA for obese patients, is a drug called Actigall®. This is the
first drug approved for the prevention of gallstones; it has been used in carefully selected patients
since 1988.

• Gallstones affect approximately one in ten Americans, and are associated with
approximately 3,000 deaths annually.
• More than 800,000 hospitalizations each year are caused by gallstones that are large
enough to cause significant pain.
• Over 500,000 people undergo surgery for gallstones annually.
• Obesity is one of the strongest risk factors for gallstones.
• Rapid weight loss diets significantly increase the risk for gallstones.