Do GLP-1 Agonists Cause Gallstones?

What Are Gallstones?

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Gallstones are small, hardened deposits that form in the gallbladder, a small pear-shaped organ located just below the liver. The gallbladder stores bile, a digestive fluid produced by the liver, and helps break down fats in the small intestine. 

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Gallstones can develop when there is an imbalance in the substances that make up bile, such as cholesterol and bilirubin, or when the gallbladder does not empty properly. They can range in size from a grain of sand to a golf ball and can cause symptoms such as abdominal pain, nausea, and vomiting. In some cases, gallstones may need to be removed surgically if they are causing significant discomfort or complications.

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How Can GLP-1 Medications Cause Gallstones?

While GLP-1 medications are generally considered safe and effective, some evidence suggests that they may increase the risk of gallstones in some individuals. A systematic review of 76 different clinical trials looking at the risk of gallbladder disease for people taking GLP-1 agonists showed that there was an increase in risk for the development of gallbladder disease when taken at higher doses for long periods of time. This is because GLP-1 medications can slow down the emptying of the gallbladder, which can lead to the formation of gallstones. However, the study also found that the risk of gallbladder varied between different types of GLP-1 agonists and depended on the therapy duration and dosage. Also, substantial weight loss can cause the formation of gallstones, which is another mechanism. 

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Normally, the gallbladder contracts and releases bile into the small intestine after a meal. However, GLP-1 medications can delay the emptying of the gallbladder, which can cause the bile to become concentrated and lead to the formation of gallstones.

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Not everyone taking GLP-1 medications will develop gallstones, and the risk is generally considered to be very low (0.8%) (1). However, if you are taking a GLP-1 medication and experience symptoms such as abdominal pain or discomfort, it's important to speak to your doctor.

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What If I Have Gallstones?

If you have gallstones or a history of gallbladder inflammation (cholecystitis), you should be cautious when using GLP-1 medications. You should notify your provider if you have a history of gallbladder disease or if you start to experience sudden right upper quadrant abdominal pain after meals while taking a GLP-1 medication. 

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What If I Had My Gall Bladder Removed?

Some of you may have had your gallbladder removed already. If that is the case, then the risk of gallstones and gallbladder disease is even lower than it already is. There is a minimal chance a gallstone is left behind after the surgery to get stuck in the bile ducts. Ultimately, this should not prevent you from considering GLP-1 medications if you have had your gallbladder removed. 

Where Can I Learn More?

If you would like to learn more about GLP-1 medications or want to see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!

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References

1. He L, Wang J, Ping F, et al. Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary Diseases: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. 2022;182(5):513–519. doi:10.1001/jamainternmed.2022.0338

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