Category: Family Health

If your doctor says your bloodwork reveals prediabetes, you’re bound to have questions about what’s best to eat. Tara Seymour, an advanced practice clinical dietitian and diabetes educator at Johns Hopkins, provides guidance on how a healthy diet and lifestyle can control — and even help reverse — prediabetes.

Diet for Prediabetes — What foods should I eat?

People with prediabetes have fasting blood sugar levels that are elevated, but not to the point that they meet the criteria of type 2 diabetes.

The key to warding off progression of prediabetes is a balanced approach to diet, says Seymour.

“People with prediabetes do not have to eliminate entire food groups,” she explains. “All foods can fit in the meal plan, and patients should steer clear of fad diets and other strategies that promise quick fixes, since their claims are not supported. We encourage making gradual behavior changes. Small changes can lead to big results.”

With that in mind, she regards the Mediterranean diet as the gold standard for people with prediabetes, with its emphasis on whole grains, lean protein and healthy fats.

She also refers patients to diabetes meal planning recommendations from the Centers for Disease Control and Prevention and a version of the MyPlate guidelines issued by the U.S. Department of Agriculture and adapted by the American Diabetes Association (ADA).

“Though these resources are not specifically for prediabetes, they can serve as a guide to incorporating healthy choices, especially when you’re eating away from home,” Seymour says.

The ADA’s version of the recommendations suggests these proportions for meals:

• 50% of the plate filled with nonstarchy vegetables, such as leafy greens
• 25% with healthy carbohydrates, such as whole grains like brown rice, farro or quinoa
• 25% with lean protein, such as chicken, turkey, fish or tofu, not fried

Water or another zero-calorie beverage is preferred.

Seymour also recommends:

• Avoiding excessive intake of added sugars by limiting sugary beverages, cakes, cookies, candy and snacks
• Limiting portion sizes of refined carbohydrate foods such as white bread, white rice and white pasta
• Incorporating fiber to reach a goal of 25 to 30 grams per day by eating a variety of fruits, vegetables and whole grains
• Limiting saturated and trans fats by choosing lean protein and low-fat dairy

Foods to Avoid If You Have Prediabetes

“Grapefruit and pomegranate juice can interact with some medications, since they are processed by the same liver enzyme that metabolizes medication. That enzyme is cytochrome P450, which accounts for about 75% of the total drug metabolism performed by the body.”

In addition, Seymour advises care with some nutritional supplements. Ginseng, gingko and garlic are OK in moderation, but high doses of these, as you get in over-the-counter supplements, can cause low blood sugar. “When it comes to supplements,” she says, “it is always important to know your risks and follow the proper dietary protocol by consulting your doctor or dietitian.”

“What should I eat for breakfast if I have prediabetes?”

“Opt for balanced meals that incorporate lean protein, low fat dairy and plenty of fiber,” Seymour advises. “Try cereals with at least five grams of fiber per serving, whole fruits, vegetables and whole grains.

“If you’re tempted to skip breakfast, try a low carbohydrate meal replacement bar or shake to start your day off right.”

“What fruits should I avoid with prediabetes?”

Seymour stresses that all types of fruit are OK and unlikely to be a problem for people who have prediabetes (with the exception of pomegranate juice and grapefruit for people taking certain medications).

“Fruit is a carbohydrate that provides both sugar and fiber,” she says. “You will get more fiber eating whole, fresh fruit than you will by drinking fruit juice.”

“All foods can fit,” she adds. “The key is to watch your portion sizes and read labels of prepared items. Fruit juice and canned fruit may have more sugar.”

A professional can help customize a prediabetic meal plan

Because everyone is different and many people with prediabetes have other health issues, Seymour says it is important to tailor prediabetes food plans to the individual. For instance, patients with high cholesterol may do better with a lower-fat approach, while those with high A1C may benefit from a meal plan that’s lower in carbohydrates.

Working with a doctor or dietitian can be helpful. “People diagnosed with prediabetes can ask their primary care practitioner for a referral to a local registered dietitian,” Seymour says. “That way, they can get individual counseling to achieve their health goals.”

Prediabetes and sugar — How much is too much?

Blood sugar levels are important indications of prediabetes, and it’s no secret that most Americans eat more sugar than they should. Sugar can hide in less obvious places, including processed foods such as breakfast cereals, frozen meals, snacks, sauces and dressings.

Though some sugar is necessary for your body to function, too much can worsen prediabetes. Seymour explains: “Carbohydrates are an important source of energy since glucose [blood sugar] is the preferred molecule to fuel the brain. However, excessive intake of refined carbohydrates from added sugar can cause adverse health effects.

Recommendations for Limiting Sugar

“The World Health Organization advises limiting added sugars to less than 10% of your total energy intake. For added health benefits, you would limit sugar calories to 5% or less of your total.

“For example, for someone on a 2,000-calorie daily diet, if they are following the 10% guideline, they would limit sugar calories to about 50 grams, which is about 12 teaspoons. For the 5%, they would stick to 25 grams, or about six teaspoons.

“The American Heart Association is a little more stringent, and for people at risk for heart disease, including those with prediabetes, it recommends less than six teaspoons of sugar a day for women (about 25 grams) and less than nine teaspoons (about 36 grams) a day for men.”

That’s not a lot. Seymour points out that one can of soda contains about 32 grams of sugar, which is about eight teaspoons.

“We urge our patients to watch what they drink,” Seymour says, noting that sweetened beverages such as sodas, sports drinks, juices and gourmet coffee shop creations account for some of the biggest concentrated sources of added sugar. “Just one of these beverages can take up your entire recommended allotment of sugar for the day ― or even several days.”

The 5-20 Rule

Another way to assess whether a product is overly high in sugar is to read the nutrition label. “The general rule for sugar content is choose products with a sugar content of 5% or less of the daily requirement and avoid items in which the amount of sugar is 20% or more of the daily requirement,” Seymour says.

How to Reverse Prediabetes — Lifestyle

Seymour says switching to well-balanced meals high in healthy, fiber-rich foods, along with incorporating more physical activity, can help people with prediabetes take charge of their health.

“It has been well cited in research studies such as the National Institutes of Health’s Diabetes Prevention Program Outcome Study that incorporating healthy eating habits, weight reduction and increased physical activity can lower your risk of developing type 2 diabetes.

“Additionally, lifestyle changes resulting in modest weight loss have shown to delay the onset of type 2 diabetes by 34% for four years compared to placebo, which was an outcome of the Johns Hopkins’ diabetes prevention program.”

Stay active

Physical activity can help prevent diabetes while boosting heart health. Seymour recommends that people with prediabetes try to get at least 150 minutes per week of moderate to vigorous exercise or aim for 10,000 daily steps. Be sure to check with your doctor before starting exercise or leveling up your current physical activity.

Lose some weight

To steer away from type 2 diabetes, Seymour says men and women should try to achieve and maintain a body mass index of 25 or lower. Waist circumference should be under 35 inches for women and under 40 inches for men.

Even small amounts of weight loss can have a benefit. “The ADA states that moderate rate reduction of 5% to 10% of your body weight can significantly lower your A1C level,” says Seymour. “So, for instance, for a person weighing 200 pounds, a weight loss of 10 to 20 pounds could make a difference.”

Get enough sleep

The relationship among sleep, diabetes and weight gain is important to understand. “Sleep deprivation has been shown to increase people’s cravings for sugary foods,” Seymour says. “People with prediabetes should make sure they’re getting seven to eight hours of sleep a night.”

Avoid excessive alcohol and all tobacco

“These are modifiable lifestyle factors that can significantly lower your risk of several chronic diseases, including type 2 diabetes, heart disease, vascular problems and metabolic syndrome,” Seymour explains.

Stay on top of your numbers

Seymour says people with prediabetes should be vigilant about their laboratory test results. “Know your ABCs,” she advises. “That’s A1C, blood pressure and cholesterol. And if you’re at risk or have prediabetes, make sure you follow up with your A1C level with a blood test at least yearly.”

Reversing Prediabetes — Is it possible?

Yes! “If you’ve been diagnosed with prediabetes, progressing to diabetes is not a given,” Seymour emphasizes.

In addition to taking medications, she says there are other ways to take control.

“Adopting a well-balanced diet, staying active, controlling your weight can put you in control, enabling you to arrest or even reverse the process,” she says.

“I like this quote from the CDC: ‘Life doesn’t always give you the time to change the outcome. Prediabetes does.’”

Protecting your neck from injuries and pain involves practicing good posture and body mechanics. This may mean correcting bad habits you have related to the way you hold and move your body. The tips below can help you improve your posture and body mechanics.

What is posture and why does it matter?

Posture is the way you hold your body. For many people, this means hunching over, thrusting the chin forward, and slouching the shoulders. But this kind of poor posture keeps muscles from correctly supporting the neck and puts stress on muscles, disks, ligaments, and joints in your neck. As a result, injury and pain can happen.

How is your posture?

Use a full-length mirror to check your posture. To begin, stand normally. Then slowly back up against a wall. Is there space between your head and the wall? Do you slouch your shoulders? Is your chin pointing up or down? All these can lead to neck tension and pain.

Improving your posture

Follow these steps to improve your posture:

• Pull your shoulders back.

• Think of the ears, shoulders, and hips as a series of dots. Now, adjust your body to connect the dots in a straight line.

• Keep your chin level.

What are body mechanics and why do they matter?

The way you move and position your body during daily activities is called body mechanics. Good body mechanics help protect the neck. This means learning the right ways to stand, sit, and even sleep. So, do what’s best for your neck and practice good body mechanics.

Standing 

To protect your neck while standing:

• Carry objects close to your body.

• Keep your ears and shoulders in a line while standing or walking.

• To lower yourself, bend at the knees with a straight back. Do this instead of looking down and reaching for objects.

• Work at eye level. Don’t reach above your head or tilt your head back.

Sitting 

To protect your neck while sitting:

• Set up your workstation so your monitor is at eye level. Also use a document holder when viewing papers or books.

• Keep your knees at or slightly below the level of your hips.

• Sit up straight, with feet flat on the floor. If your feet don’t touch the floor, use a footrest.

• Don’t sit or drive for long periods. Take breaks often.

Sleeping 

To protect your neck while sleeping:

• Sleep on your back with a pillow under your knees or on your side with a pillow between bent knees. This helps align the spine.

• Don’t use pillows that are too high or too low. Instead, use a neck roll or pillow under your neck while you sleep to keep the neck straight.

• Sleep on a mattress that supports you.

Using mobile devices 

To protect your neck while using mobile devices:

Author: StayWell Custom Communications



Last Annual Review Date:
3/1/2025

More than six million people in the United States have Alzheimer’s disease, and researchers from the University of Pittsburgh and Vanderbilt University Medical Center (VUMC) are discovering how lifestyle habits are linked to the likelihood of developing the disease.  

According to a new study published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, researchers found that increased sedentary behavior in aging adults was associated with worse cognition and brain shrinkage in areas related to risk for developing Alzheimer’s disease. 

Marissa Gogniat, assistant professor of neurology at Pitt and former postdoctoral fellow at the Vanderbilt Memory and Alzheimer’s Center at VUMC, led the study, coauthored by Angela Jefferson, professor of neurology at Vanderbilt and founding director of the center.  

“Reducing your risk for Alzheimer’s disease is not just about working out once a day,” said Gogniat. “Minimizing the time spent sitting, even if you exercise daily, reduces the likelihood of developing Alzheimer’s disease.” 

The team of researchers examined the relationship between sedentary behavior, or time spent sitting or lying down, and neurodegeneration among 404 adults aged 50 and older. Study participants wore a watch that measured their activity continuously over the span of a week. Their sedentary time was then compared with their cognitive performance and brain scans captured over a seven-year follow-up period.  

Participants who spent more time being sedentary were more likely to experience cognitive decline and neurodegenerative changes, regardless of how much they exercised. These conclusions were stronger in participants who carried the APOE-e4 allele, a genetic risk factor for Alzheimer’s disease, suggesting that reducing sedentary time may be especially important for older adults who are at increased genetic risk for Alzheimer’s disease. 

“It is critical to study lifestyle choices and the impact they have on brain health as we age,” said Jefferson. “Our study showed that reducing sitting time could be a promising strategy for preventing neurodegeneration and subsequent cognitive decline, particularly among aging adults at increased genetic risk for Alzheimer’s disease. It is critical to our brain health to take breaks from sitting throughout the day and move around to increase our active time.” 

 This study was supported by the Alzheimer’s Association and the National Institute on Aging. 

Get Up, Stand Up: Combatting “Sitting Disease”

Posted on January 26, 2022 by Ava Sharifi.
This entry was posted in Staying Healthy and tagged sitting disease, Staying Healthy. Bookmark the permalink.

Over the last few years of working from home, staying at home orders, and social distancing, many people are sitting even more than before the COVID-19 pandemic. Sitting is something so commonplace we often don’t realize just how much of our day is truly spent sedentary. However, sitting for too long can have many negative impacts on health and longevity.

A 2011 study in the American Journal of Preventative Medicine found that prolonged sitting was associated with an increased risk of 34 chronic diseases including obesity, diabetes, cancer, and cardiovascular disease. Yikes!

A typical American is sedentary for 21 hours out of the day. Including exercise and physical activity, people across the U.S. only spend approximately 3 hours out of the day simply standing.

This phenomenon has been coined as “Sitting Disease,” which, broadly speaking, is defined as a condition of increased sedentary behavior associated with adverse health effects. Sedentary behavior can be defined by two things: the position you are in, which is generally reclining or sitting, and the amount of energy expenditure that your body is experiencing.

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You may be asking yourself, “But I work out every day, does this still apply to me?”

Unfortunately, according to The Journal of Medicine and Science in Sports and Exercise, the “Active Couch Potato” phenomenon states that even an active person who works out five times a week still faces the risks associated with “Sitting Disease” if they are living a sedentary lifestyle outside of the gym. Unfortunately, you can’t undo eight plus hours of sitting with a workout!

Although participating in moderate to vigorous exercise 3-5 times a week is recommended, it’s important to start with the first step: standing. Dr. Brian Liem, MD, FAAPMR, from UW Sports Medicine, says that a “lifestyle of prolonged sitting is distinctly different even from a lifestyle absent of routine exercise.”

A study at Mayo Clinic found that for every 2 hours spent sitting 352 calories are conserved as compared to someone standing. Dr. Liem emphasizes that “standing can help get some of that metabolic activity back up because standing causes contractions in your postural muscles in your back, hips, and knees to keep you upright.”

The majority of Americans stare at a computer screen during the day, whether it be at an office desk or at home. If not, we are looking at the computer in our pockets – our smartphones. An average office worker sits for 15 hours every day, which calculates to about 80,000 hours spent sitting over a lifetime.

Technology has become an accepted part of our everyday lives, but that doesn’t mean we shouldn’t be cognizant of what our bodies are doing while we are using technology.

Staring at your computer with poor posture causes the development of a hump at the top of your back, the shortening of your hip flexors, shortened abdominal muscles, a caving chest, weakened shoulders, arm pain, numbness and tingling in your extremities, and worst of all, traumatic pressure on the disks in your back. All of these symptoms are not uncommon.

Good posture is also important when using a smartphone because a human head weighs about 10–12 lbs. Studies show that bending your head down to the 60-degree typical texting position can make your head weigh about 60 lbs. We spend about 700 – 1,400 hours on our smartphones every year, so putting that much stress on our necks and spines just by bending our heads for that long can start to develop problems.

So, what are some solutions?

We know that it is difficult to be removed from technology and that many common solutions can be expensive or difficult to find on the market. Instead, we emphasize the importance of awareness in terms of your posture, bodily movement, and the amount of sitting/reclining per day.

For every hour of sitting, try to get about ten minutes of standing in. For every 30 minutes that you are doing work, there should be 20 minutes of actual computer work, and then a 10-minute break. That 10-minute break should be 8 minutes of standing and 2 minutes of stretching. This alone is a pretty big change from sitting for hours on end, and should over time give back to your body exponentially.

Incorporate movement breaks into your day

Check out the Whole U’s Flex at your Desk and Stretch at your Desk handouts to learn a few movements that you could try at work. We also encourage you to join The Whole U’s daily movement class at 11 a.m. 15-minutes of stretching and light movement to give your body a much needed sitting break.

When you are sitting, think of an ergonomic posture – bringing your keyboard and mouse closer to your body, keeping your shoulder blades pulled back, relaxing your elbows by your side, and maintaining a neutral spine. The Whole U’s Working with Better Posture handout is a great place to start.

Learn more by watching 2 recorded webinars

Working Ergonomics with Dr. Peter Johnson

Join Dr. Peter Johnson, Professor Emeritus, Environmental and Occupational Health Sciences, and Adjunct Professor of Industrial and Systems Engineering to learn everything you need to know about creating an ergonomic workspace—wherever you’re working! Click here to download Dr. Johnson’s updated slides. 

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Sitting Disease Deep Dive with UW Sports Medicine

Elliot O’Connor, DPT, and Dr. Brian Liem from UW Sports Medicine share information about what sitting disease is, how it can lead to chronic back and neck pain, and provide some simple exercises that you can do to prevent and beat the sitting disease.

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Small steps can make a big difference – literally!

You can also combat “Sitting Disease” through small things. Try parking farther away, standing while you eat lunch, and doing one-leg balance stances while you watch television or brush your teeth. Every little step you take is one less moment spent sitting.

Alongside standing, aerobic exercise is extremely important. As recommended by the HSS, you should be performing a minimum of 30 minutes of moderate intensity aerobic activity about 5 days a week or 20 minutes of vigorous intensity aerobic activity about 3 days a week.

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Fight against the avoidable effects of “Sitting Disease” by standing up and moving away from a sedentary lifestyle!

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Vacations are a time to relax, recharge, and escape from the responsibilities and routines of everyday life. If you’re a fitness fan, a vacation can present a challenge: how to balance rest and fun while maintaining the consistent fitness routine that is important to you. Whether you’re an avid gym-goer or just starting on your fitness journey, taking your fitness routine on vacation is not only possible but can also be an enjoyable way to make your trip memorable.

In this article, we’ll explore why staying active during a vacation is beneficial, the challenges of maintaining a fitness routine while vacationing, and strategies to overcome these challenges. We’ll also consider that even elite athletes take breaks. And that you might want to as well.

Vacation Fitness: Finding Benefits and Finding Balance

Maintaining your fitness routine on vacation has real benefits; you continue to progress toward your goals while supporting related health benefits (like feeling good and sleeping better). At the same time, there is value in taking some time off to rest and recover. And know it takes longer than a week or two away from scheduled fitness to see a significant drop in cardiovascular health and muscle strength.

Maintaining your fitness routine on vacation comes with its own set of challenges you may have to balance like a packed schedule, the lack of familiar fitness equipment, and how offset your fitness needs with the preferences of your travel companions. Maintaining a fitness routine while on vacation requires flexibility, creativity, and a shift in mindset.

Here are some strategies to help you stay active while enjoying a fun, relaxing and balanced vacation:

1. Set Realistic Goals

While it’s important to stay active, make enjoying your time away your primary focus. Setting achievable fitness goals, like 20 minutes of movement each day or incorporating one active activity into your plans, can help you stay accountable without feeling pressured.

A vacation might not be the best time to launch a new fitness program, especially if you are beginning to build fitness into your life. Capitalize on the physical activity that is part of your vacation and that makes it fun, like walking through museums or climbing stairs to historic sites. Take that momentum home with you and see if your vacation fitness work builds enthusiasm for fitness at home.

2. Make Your Workouts Short and Efficient

Instead of spending an hour at the gym, aim for a 20-30 minute high-intensity interval training (HIIT) session. Or try a bodyweight circuit including exercises like squats, push-ups and jumping jacks for a full-body workout in a short amount of time.

3. Try Supplemental Fitness Work

If you think about fitness options like stretching or pliability work, but don’t make time for them at home, your vacation may be a good time to try this supplemental work. Rest and recovery are components of peak athletic performance, and a vacation might be an ideal time to add these valuable yet less demanding elements to your program.

4. Pack Portable Fitness Equipment

Pack lightweight, portable fitness equipment like resistance bands, a jump rope, or a yoga mat. Resistance bands, for example, are versatile tools that can provide strength training without the need for weights. A jump rope is an excellent tool for cardio work that can be used virtually anywhere.

5. Use Your Surroundings to Stay Active

Where you vacation can offer unique opportunities for physical activity that doesn’t feel like exercise. If you’re by the beach, go for a swim or try paddleboarding. In a city? Take a walk or rent a bike. Live like a local by sampling fitness classes that interest you.

6. Bite Sized Options Count

Walk instead of taking public transportation or an Uber when possible. If you’re staying in a multi-story hotel, take the stairs instead of the elevator. Add a walk along the shoreline to a day at the beach. These small efforts add up over the course of your trip, helping you stay active without feeling like you’re taking time away from your vacation.

7. Use Fitness Apps and Online Workouts

If you’re staying somewhere without a gym and you want guidance for your workouts, fitness apps and online workouts can be great resources. If you work with a personal trainer, ask your coach for three to six simple bodyweight exercises you can do on your own. You might even record these programs on your phone in real-time, so you stay on track and maintain proper form.

Balancing Fitness and Relaxation

Ultimately, the goal of taking your fitness routine on vacation is to strike a balance between staying active and enjoying the relaxation and rejuvenation that comes with time away. It’s important to remember that fitness is not just about the time spent in the gym but about staying healthy and active in a way that complements your life. Vacations offer the perfect opportunity to try new activities, explore different ways of moving, and offset fitness with some recovery time.

Staying active on vacation doesn’t have to be a burden—it can enhance your experience, improve your mood, and help you return home feeling both refreshed and fit.

What is a bile duct disease?

Your gallbladder stores bile until you eat, then releases bile into your small intestine to help digest food. Bile is made in the liver. It contains a mix of products such as bilirubin, cholesterol, and bile acids and salts. Bile ducts are drainage “pipes” that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine.

A variety of diseases can affect your bile ducts. All impede the normal flow through bile ducts in some way, which is why the various diseases tend to cause similar symptoms.

Gallstones are the most common cause of blocked bile ducts. Stones typically form inside the gallbladder and can block the common bile duct, the drainpipe at the base of the liver. If the duct remains blocked, bilirubin backs up and enters the bloodstream. If bacteria accumulate above the blockage and back up into the liver, it may cause a severe infection called ascending cholangitis. If a gallstone stops in between the gallbladder and the common bile duct, an infection called cholecystitis may occur.

Less common causes of blockages include cancer of the bile duct (cholangiocarcinoma) and strictures (scars that narrow the ducts after infection, surgery, or inflammation).

Other bile duct diseases are uncommon, and include primary sclerosing cholangitis and primary biliary cholangitis (formerly called primary biliary cirrhosis). Typically diagnosed in mid-adulthood, these conditions create ongoing inflammation in the bile duct walls, which can narrow and scar the walls. Primary sclerosing cholangitis is more common in people with inflammatory bowel disease (ulcerative colitis or Crohn’s disease). Primary biliary cholangitis is more common in women. It is sometimes associated with autoimmune diseases such as Sjögren’s syndrome, thyroiditis, scleroderma, or rheumatoid arthritis.

Biliary atresia is a rare form of bile duct blockage that occurs in some infants two weeks to six weeks after birth, a time when the bile ducts have not completed their development normally.

The chronic conditions of primary sclerosing cholangitis, primary biliary cholangitis, and biliary atresia can result in inflammation and scarring of the liver, a condition known as cirrhosis.

Symptoms of a bile duct disease

Symptoms of a blocked bile duct may be abrupt and severe (for example, when a gallstone blocks the whole drainage system all at once), or they may appear slowly many years after bile duct inflammation started. Bile duct diseases often cause symptoms related to liver products backing up and leaking into the bloodstream. Other symptoms result from the bile ducts’ failure to deliver certain digestive juices (bile salts) to the intestines, preventing the absorption of some fats and vitamins. Symptoms of a blocked bile duct include

• yellowing of the skin (jaundice) or eyes (icterus), from the buildup of a waste product called bilirubin
• itching (not limited to one area; may be worse at night or in warm weather)
• light brown urine
• fatigue
• weight loss
• fever or night sweats
• abdominal pain, especially common on the right side under the rib cage
• greasy or clay-colored stools
• diminished appetite.

Diagnosing a bile duct disease

Your doctor may suspect that you have a bile duct problem if you have any of the classic symptoms or if a blood test shows that you have a high level of bilirubin. Your doctor will take your medical history and examine you to look for clues that could explain damage to the bile ducts and liver. Because liver inflammation (hepatitis) and liver scarring (cirrhosis) can cause similar symptoms, your doctor will ask about your alcohol use, drug use, and sexual practices, all of which can result in liver disease.

If you have gallstones, have had pancreatitis or abdominal surgery, or have symptoms of an autoimmune condition (such as arthritis pain, dry mouth or eyes, skin rashes, or bloody diarrhea), tell your doctor. Because some medicines can slow drainage through the bile ducts, your medicines should be reviewed.

You will need blood tests to measure your levels of alkaline phosphatase, bilirubin, and/or gamma-glutamyl transferase (GGT). These are markers of bile duct obstruction. Other blood tests may suggest liver inflammation or cirrhosis. Occasionally, specialized blood tests may be helpful, such as antibody tests to diagnose primary biliary cholangitis or primary sclerosing cholangitis. A blood test with a high level of CA 19-9 may suggest a diagnosis of cholangiocarcinoma.

If your doctor suspects a bile duct problem, additional tests will depend on the suspected cause of the disease. Commonly used tests include:

• Right upper quadrant ultrasound. This provides pictures of the liver, gallbladder, and common bile duct. For example, it can show enlargement of the ducts above a blockage.
• Computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the liver.
• Endoscopic retrograde cholangiopancreatography (ERCP), an examination in which a small camera on a flexible cord is inserted through your mouth and down past your stomach to the opening where the common bile duct empties into your stomach. A dye can be injected into the common bile duct that will appear on x-rays. How the bile ducts look on the x-rays can provide clues to the problem. Sample cells from the bile duct walls can be examined under a microscope for evidence of cancer. Treatments to relieve blockages can be performed during this examination.
• Magnetic resonance cholangiopancreatography, an examination similar to the endoscopic exam above. The advantage: MRI images can be obtained without passing an endoscope into the stomach. The disadvantage of this test is that tissue for a biopsy (laboratory examination) cannot be obtained.
• Cholangiography (x-rays of the bile ducts), which can also be done after dye is injected into the liver. This enables doctors to watch the flow of bile as it drains from the liver. Tissue for biopsy can be obtained during this procedure, and any blockages or narrowing can be relieved.
• A liver biopsy sample, obtained using a needle through the skin. The tissue is examined for evidence of inflammation or cancer.

If you have a chronic form of bile duct disease, your doctor may check you for cholesterol abnormalities or osteoporosis. Both of these conditions are more common in someone with longstanding bile duct drainage abnormalities.

Expected duration of a bile duct disease

To treat a gallstone blockage and infection (cholecystitis), doctors first prescribe antibiotics. After the infection subsides, a surgeon removes the gallbladder.

Symptoms caused by a scar (stricture) may improve rapidly after treatment restores the duct’s drainage.

Symptoms of primary biliary cholangitis and primary sclerosing cholangitis are long-lasting diseases. They may steadily get worse and lead to cirrhosis and liver failure after years of damage. When liver failure develops, a liver transplant can improve survival. However, primary sclerosing cholangitis and primary biliary cirrhosis can return after transplant.

Preventing a bile duct disease

If you are overweight or have high cholesterol, you are at higher risk of developing gallstones. To avoid trouble, work toward a healthy weight through diet and exercise. Also, a near-starvation diet aimed at rapid weight loss can also result in gallstone formation.

Although cholangiocarcinoma is uncommon, smoking appears to increase the risk.

Certain parasite infections (Clonorchis sinensis and Opisthorchis viverrini, also known as Chinese liver fluke) are associated with a higher risk of bile duct diseases. If you travel to Southeast Asia, eat fish only if it is well cooked. If you do eat undercooked fish while traveling in this area, ask your doctor for a stool parasite test, especially if you have symptoms of weight loss or diarrhea.

Treating a bile duct disease

To treat a gallstone blockage accompanied by signs of persistent pain or infection, a gastroenterologist or surgeon can remove stones in the bile duct using endoscopic retrograde cholangiopancreatography (ERCP). The endoscope cuts through the base of the common bile duct, allowing a stone to pass through. In some cases the endoscopist may insert various devices into the bile duct to extract the stone. This same procedure can widen an area of scarred bile duct (a stricture) by inserting and expanding a wire coil (called a stent) within the duct. Doctors generally recommend that anyone with a persistent or recurrent bile duct blockage from a gallstone have his or her gallbladder removed.

Ascending cholangitis caused by a bacterial infection requires hospitalization and intensive intravenous antibiotic therapy. If there is any blockage in the common bile duct, it needs to be cleared promptly by ERCP or other surgical procedure.

It’s rare to find bile duct cancer early, but if it is found early, it can be treated with surgery. When cancer is more advanced, surgery cannot totally remove the tumor. Surgical procedures can help cancer patients feel better, even if they cannot provide a cure. Surgery can reroute the bile duct to allow better drainage. Radiation treatments can help to shrink, but not cure, a bile duct tumor.

Biliary atresia, the failure to develop normal bile ducts in infants, can be treated by surgery. One method uses a portion of the baby’s intestines to substitute for missing segments of the bile duct. Another method requires rerouting the bile drainage and additional intestinal surgery. However, most babies with this condition continue to have inflammation due to poor drainage, and eventually develop scarring (cirrhosis) and require a liver transplant.

Because both primary biliary cholangitis and primary sclerosing cholangitis can cause severe liver failure, a liver transplant may be needed for long-term survival. Treatment may reduce symptoms or delay the progression of the disease. In primary biliary cholangitis, the medicine used most often is ursodiol (Actigall).

The most bothersome symptom in chronic bile duct disease, itching, can be reduced with medicine — cholestyramine (Questran) or colestipol (Colestid) — that prevents irritants in the gut from being absorbed. Another medicine, naloxone, might neutralize irritants that cause itching. If greasy stools are a problem, a low-fat diet may be helpful. Doctors recommend multivitamin supplements to improve nutrition.

When to call a professional

If you develop yellowing of the skin or eyes, contact your doctor. If you also have fever or abdominal pain, call for professional advice immediately.

Prognosis

Infections related to gallstone blockage have excellent results when treated. Even the most severe infection, ascending cholangitis, has a low death rate if treated promptly.

The prognosis for primary sclerosing cholangitis and primary biliary cirrhosis has improved with better medical treatment and the potential for liver transplantation.

The prognosis for people with cholangiocarcinoma is better if the cancer is discovered while it is still confined to the duct. It can then be treated surgically. Once the cancer has spread, the survival rate is much lower.

Additional info

American Liver Foundation

https:/liverfoundation.org/

National Digestive Diseases Information Clearinghouse (NDDIC)

https://digestive.niddk.nih.gov/

American Gastroenterological Association

https://www.gastro.org/

American College of Gastroenterology (ACG)

https://gi.org/

Biliary interventions treat blockages, narrowing and/or injury of the passages between the liver, gallbladder and small intestine. These passages are called bile ducts. The liver produces a fluid called bile and stores it in the gallbladder. The gallbladder releases bile into the small intestine to help digest your food. If the bile ducts become blocked, it may lead to inflammation or infection of the entire biliary system. This is known as cholangitis. Biliary interventions are used to open narrowed bile ducts, drain excess bile outside of the body, and restore the flow of bile within the biliary system.

Your doctor will tell you how to prepare for your specific procedure and may prescribe an antibiotic. Tell your doctor about any recent illnesses or medical conditions and whether you have any allergies, especially to anesthesia or iodinated contrast material. List all medications you’re taking, including herbal supplements and aspirin. Your doctor may tell you not to eat or drink for several hours before your procedure. They may also tell you to stop taking aspirin or blood thinners. Leave jewelry at home and wear loose, comfortable clothing. You may need to change into a gown for the procedure. Ask your doctor if you will stay overnight at the hospital. If not, plan to have someone drive you home.

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This page was reviewed on May 30, 2024