Gallstones in the Antarctic

 The effect of the isolated Antarctic environment on biliary disease has not been reported previously

Ok, so there could potentially be something about going on an artic expedition that predisposes you to gallstone disease.  What on earth could that ever be??????

Indigenous inhabitants of the Arctic polar regions have been reported to have higher prevalence of obesity and gallstone disease

Dietary factors, physical activity and energy expenditure, obesity and dyslipidemia affect the hepatic secretion of cholesterol and saturation of bile leading to a lithogenic state. Thus, residence in the Antarctic environment and the consequent lifestyle changes predispose susceptible individuals to cholesterol GD. 

Now, here is the first line of the text about changes in dietary habits....

Total caloric and fat intake was found to be higher and dietary fiber lower when compared with the regular diet in India

 And then, a few lines later, we see this.....

 the high energy intake can be explained by consumption of calorie-dense precooked meals, instant noodles, biscuits and canned foods 

omg look at those high-fat foods, instant noodles and biscuits!!

Now here comes the graph of the macro-nutrient intake of the diet, lets see if anyone can spot the invisible elephant in the room, as the writers of this report clearly could not....

Anyone see it?????? Calories are high, especially in winter. Fat is also high in winter! Calories and fat. Everything else looks fine doesnt it?  Fiber could be higher. That might be it, gallstones = low fiber?!

 As a consequence of changed dietary habit and lifestyle, the subjects in this study developed a positive energy balance, weight gain and obesity, hypertriglyceridemia, low HDL cholesterol and a lithogenic biliary profile

We are into the discussion section now, but still no sign of the proverbial elephant in the room.  Next! they highlight the risk factors for gallstone disease, these include ,   obesity, dyslipidemia, and .......

Diet:  The dietary assessment revealed calorie consumption and total fat intake far in excess of energy expenditure during summer. Increased consumption of energy-dense and processed foods was noted in summer when outdoor work was performed. During the lower activity period of winter, food intake including consumption of total fat and calories reduced significantly in many individuals as a result of a decreased requirement and increased awareness after diet counselling.

lol, the elephant is still invisible. Lets have a look at the conclusion.....

Obesity, dyslipidemia, impaired glucose tolerance ( hold breath in anticipation.... ) and high fat and caloric intake were found to increase the risk of developing cholesterol GD during the course of the year-long 30th Indian Antarctic expedition.

and.......breath out. No. no elephant is seen in the room according to these reporters. Better luck next time!

But me, yes ME, I think I see it ,     heres what I see........

OK look, im not gonna pretend I know exactly what causes gallstones. Does ANYONE have a definite answer? But what I do think is that there are some suspicious associations between gallstones, hepatic insulin resistance and high carbohydrate diets. First we have to remember that, yes, high CHO intake causes hepatic insulin resistance. And yes, 417 +/- 72g per day counts as "high" in my books.

Second, insulin regulates the enzyme that controls cholesterol to bile acid conversion.

And lastly, ( not a great example but what the hell ) the LIRKO mouse has a very high susceptibility to gallstone formation. Not a great example because LIRKO doesnt have "hepatic insulin resistance" per se, but rather it has complete hepatic insulin deficiency.

But the bottom line remains, dysregulated insulin signalling pathology in the liver allows the cholesterol->bile acid synthesis enzymes to go out of whack, the result of which seems to be gallstones.