4 ms·

What the heck? This is completely bizarre. Gallstones don't develop overnight from eating one weird food, and I'm not aware of any other reason gallbladder remo

What the heck? This is completely bizarre. Gallstones don't develop overnight from eating one weird food, and I'm not aware of any other reason gallbladder removal surgery would be performed..

decebalus1 4y ago
Cholecystectomies can also be performed in cases of cholecystitis (inflammation of the gallbladder) which can of course be caused by gallstones but also by infections of the bile tract, reduced blood flow to the gallbladder and other nasty things like tumors. Not sure how exactly this product caused the inflammation though..
- _benedict 4y ago
  Also anything that affects gut motility, so anything that messes with the nervous system in the gut. If the signalling controlling eg the sphincter is messed up, the bile won’t escape to the intestines, and if the bile stops flowing you’ll get liver and pancreatic inflammation. It might be that some toxin in the food could cause such an effect? I’m not sure how easy it would be to tell if this was the case in an acute setting though. It isn’t exactly common, and is usually chronic and intermittent. Gall bladder removal would seem to be the wrong treatment in this case, but it might be hard to establish? My amateur medical knowledge is insufficient to know, just hypothesising other potential mechanisms.
  - decebalus1 4y ago
    You're spot on about bile not flowing. I'm very interested in the final verdict on this. I'm also not an expert, just someone who parted with their gallbladder a while back and became a major consumer of information on gallbladder pathology.
- Engineering-MD 4y ago
  Acalculi cholecystitis (cholecystitis not caused by gallstones) is rarely treated with surgery, it is usually just antibiotics. Cholecystectomies are indicated in cholecystitis, gallbladder tumours and gallbladder perforations (rare).
  - decebalus1 4y ago
    Is it possible that these people already had asymptomatic gallstones and whatever was in this food triggered a gallbladder attack?
    - Engineering-MD 4y ago
      While certain foods (high fat content) can trigger biliary colic, I’m not aware of any specific foods that would trigger this more than any other with a similar fat content
bsder 4y ago
> Gallstones don't develop overnight Yeah, the fact that this even made it to the legal system says everything. Gallstones are normally a gooey crystal. It's cholesterol that has "crystallized" slowly over time. It's one of the reasons why they don't have very good drugs to treat gallstones--any drug would have to "ungrow" that crystal which would take just as long.
- elliekelly 4y ago
  > Yeah, the fact that this even made it to the legal system says everything. A lawsuit was filed. That’s it. Just about anyone can file a law suit alleging just about anything. Now Daily Harvest will have the opportunity to get it tossed. That’s how the system works. That’s how the system is supposed to work.
- sveiss 4y ago
  The argument isn't “Daily Harvest's product caused gallstones”, it's “Daily Harvest's product caused liver damage with symptoms strongly resembling gallstones, and as a result plaintiffs received irreversible surgery with a risk of life-long side effects”. There are several questions here, and the legal system is the right place to unpick them. From the top of my head: - did DH's lentils cause liver injury? - is that injury permanent or temporary? - were gallstones misdiagnosed because of the injury inflicted by DH's lentils? - was unnecessary surgery performed due to misdiagnosis? - did the doctors misdiagnosing gallstones/performing unnecessary surgery meet the standard of care? - did the unnecessary surgery cause permanent/temporary harm? - was the direct harm (temporary liver injury) caused by DH's lentils reasonably foreseeable? - was the indirect harm (surgery, surgical complications, lifelong side effects) caused by DH's lentils reasonably foreseeable? A lawsuit is the right way to get answers to these and determine who, if any is liable for damages and in what amount.
sveiss 4y ago
Medical diagnosis isn't a perfectly exact process, and is strongly driven by prior probabilities. If you present to the ER with pain in the upper right abdomen, with blood test results showing raised liver enzymes, meeting some or most of the "fair/fat/female/fertile/forty" risk factor mnemonic criteria, and have imaging that doesn't completely rule out gallstones, then the overwhelming probability is that you're suffering from gallstones, and that's the diagnosis you'll be given. Since the gold standard treatment for symptomatic gallstones is gallbladder removal, that's likely what will happen. Under normal circumstances, far more aggregate patient harm would be caused by trying to make the diagnosis more certain than is caused to the few patients who undergo surgery but don't actually have gallbladder disease. Unfortunately, these aren't normal circumstances: it appears that the liver damage produced by this lentil product produces similar pain and blood test results to gallstones, the risk factors for gallstones are very common in the US population, and it's actually quite hard to completely rule out gallstones by imaging. So more patients than expected are currently being harmed with unnecessary surgery. It's important that this be publicized, so that doctors making these diagnoses know that asking "did you eat anything from Daily Harvest" is now a diagnostically relevant question when considering upper abdomen pain, and the answer may change those prior probabilities drastically.
- Engineering-MD 4y ago
  At least in the UK, this if not the case. The number of people presenting with RUQ which is not caused by gallstones (even in the presence of deranged liver function tests in an obstructive pattern and with risk factors) is significant. This means USS +/- MRCP is used to diagnose the gallstones before considering surgery. Indeed, in most trusts (hospital areas) funding for surgery can only be acquired with imaging evidence for gallstones due to this issue. Furthermore, approximately 30% of cases of assumed biliary colic do not improve with cholecystectomy, as the pain has been falsely attributed to the stones or gallbladder. Sometimes it’s actually sphincter of Oddi Dysfunction, which is difficult to prove and treat.
  - Calavar 4y ago
    I am an internist in the US. It's the same here. I would never call the surgeon without an image. They would (rightly) refuse to operate without visual confirmation of gallbladder inflammation and/or a stone. Usually I wouldn't get an MRCP unless there was specific reason to suspect cholangitis. My first test would be ultrasound for right upper quadrant pain or CT for poorly localized pain.
superbaconman 4y ago
Had mine removed and I didn't have any stones, just lots of pain. Sometimes they just stop working.

What the heck? This is completely bizarre. Gallstones don't develop overnight from eating one weird food, and I'm not aware of any other reason gallbladder removal surgery would be performed..

decebalus1 4y ago

Cholecystectomies can also be performed in cases of cholecystitis (inflammation of the gallbladder) which can of course be caused by gallstones but also by infections of the bile tract, reduced blood flow to the gallbladder and other nasty things like tumors. Not sure how exactly this product caused the inflammation though..

_benedict 4y ago
Also anything that affects gut motility, so anything that messes with the nervous system in the gut. If the signalling controlling eg the sphincter is messed up, the bile won’t escape to the intestines, and if the bile stops flowing you’ll get liver and pancreatic inflammation. It might be that some toxin in the food could cause such an effect? I’m not sure how easy it would be to tell if this was the case in an acute setting though. It isn’t exactly common, and is usually chronic and intermittent. Gall bladder removal would seem to be the wrong treatment in this case, but it might be hard to establish? My amateur medical knowledge is insufficient to know, just hypothesising other potential mechanisms.
- decebalus1 4y ago
  You're spot on about bile not flowing. I'm very interested in the final verdict on this. I'm also not an expert, just someone who parted with their gallbladder a while back and became a major consumer of information on gallbladder pathology.
Engineering-MD 4y ago
Acalculi cholecystitis (cholecystitis not caused by gallstones) is rarely treated with surgery, it is usually just antibiotics. Cholecystectomies are indicated in cholecystitis, gallbladder tumours and gallbladder perforations (rare).
- decebalus1 4y ago
  Is it possible that these people already had asymptomatic gallstones and whatever was in this food triggered a gallbladder attack?
  - Engineering-MD 4y ago
    While certain foods (high fat content) can trigger biliary colic, I’m not aware of any specific foods that would trigger this more than any other with a similar fat content

bsder 4y ago

> Gallstones don't develop overnight Yeah, the fact that this even made it to the legal system says everything. Gallstones are normally a gooey crystal. It's cholesterol that has "crystallized" slowly over time. It's one of the reasons why they don't have very good drugs to treat gallstones--any drug would have to "ungrow" that crystal which would take just as long.

elliekelly 4y ago
> Yeah, the fact that this even made it to the legal system says everything. A lawsuit was filed. That’s it. Just about anyone can file a law suit alleging just about anything. Now Daily Harvest will have the opportunity to get it tossed. That’s how the system works. That’s how the system is supposed to work.
sveiss 4y ago
The argument isn't “Daily Harvest's product caused gallstones”, it's “Daily Harvest's product caused liver damage with symptoms strongly resembling gallstones, and as a result plaintiffs received irreversible surgery with a risk of life-long side effects”. There are several questions here, and the legal system is the right place to unpick them. From the top of my head: - did DH's lentils cause liver injury? - is that injury permanent or temporary? - were gallstones misdiagnosed because of the injury inflicted by DH's lentils? - was unnecessary surgery performed due to misdiagnosis? - did the doctors misdiagnosing gallstones/performing unnecessary surgery meet the standard of care? - did the unnecessary surgery cause permanent/temporary harm? - was the direct harm (temporary liver injury) caused by DH's lentils reasonably foreseeable? - was the indirect harm (surgery, surgical complications, lifelong side effects) caused by DH's lentils reasonably foreseeable? A lawsuit is the right way to get answers to these and determine who, if any is liable for damages and in what amount.

sveiss 4y ago

Medical diagnosis isn't a perfectly exact process, and is strongly driven by prior probabilities. If you present to the ER with pain in the upper right abdomen, with blood test results showing raised liver enzymes, meeting some or most of the "fair/fat/female/fertile/forty" risk factor mnemonic criteria, and have imaging that doesn't completely rule out gallstones, then the overwhelming probability is that you're suffering from gallstones, and that's the diagnosis you'll be given. Since the gold standard treatment for symptomatic gallstones is gallbladder removal, that's likely what will happen. Under normal circumstances, far more aggregate patient harm would be caused by trying to make the diagnosis more certain than is caused to the few patients who undergo surgery but don't actually have gallbladder disease. Unfortunately, these aren't normal circumstances: it appears that the liver damage produced by this lentil product produces similar pain and blood test results to gallstones, the risk factors for gallstones are very common in the US population, and it's actually quite hard to completely rule out gallstones by imaging. So more patients than expected are currently being harmed with unnecessary surgery. It's important that this be publicized, so that doctors making these diagnoses know that asking "did you eat anything from Daily Harvest" is now a diagnostically relevant question when considering upper abdomen pain, and the answer may change those prior probabilities drastically.

Engineering-MD 4y ago
At least in the UK, this if not the case. The number of people presenting with RUQ which is not caused by gallstones (even in the presence of deranged liver function tests in an obstructive pattern and with risk factors) is significant. This means USS +/- MRCP is used to diagnose the gallstones before considering surgery. Indeed, in most trusts (hospital areas) funding for surgery can only be acquired with imaging evidence for gallstones due to this issue. Furthermore, approximately 30% of cases of assumed biliary colic do not improve with cholecystectomy, as the pain has been falsely attributed to the stones or gallbladder. Sometimes it’s actually sphincter of Oddi Dysfunction, which is difficult to prove and treat.
- Calavar 4y ago
  I am an internist in the US. It's the same here. I would never call the surgeon without an image. They would (rightly) refuse to operate without visual confirmation of gallbladder inflammation and/or a stone. Usually I wouldn't get an MRCP unless there was specific reason to suspect cholangitis. My first test would be ultrasound for right upper quadrant pain or CT for poorly localized pain.

superbaconman 4y ago

Had mine removed and I didn't have any stones, just lots of pain. Sometimes they just stop working.