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Q: I didn’t realize I have gallstones in my gallbladder until they were seen when I had an abdominal CT scan. I don’t have any symptoms. Do I need to change my diet or take any medication to dissolve them?

A: The gallbladder is a small organ that sits under the liver in the right upper portion of our abdomen. It plays an important role in helping us digest food. But we often don’t acknowledge it unless something goes wrong — which happens in about 15% of American adults.

The gallbladder essentially serves as a storage room for bile, squeezing the fluid into the small intestine to help break down dietary fats we consume.

Gallstones develop when bile or related fluids form hardened stonelike lumps that can grow and multiply. Most gallstones are made of cholesterol. Much less often, the primary component of the stones is bilirubin.

Risk factors for cholesterol gallstones include extra weight or obesity, a family history of gallbladder issues, Native American or Latino heritage, and being 40 or older. Women are twice as likely as men to develop gallstones, which top the list of gallbladder problems.

Gallstones that are not causing any symptoms usually do not require specific treatment. When gallstones do cause symptoms, most often the reason is a blockage from a stone that has moved out of the gallbladder and gets stuck in the bile duct.

Typically, this leads to pain in the right upper belly, often radiating to the back, along with nausea. The stone may pass on its own after minutes to hours.

However, a stone that remains lodged can lead to more serious problems from pressure backing up, including cholecystitis (an inflamed gallbladder), cholangitis (infection in the bile duct), and pancreatitis (inflammation of the pancreas). These conditions need to be treated in the hospital and almost always require cholecystectomy to surgically remove the gallbladder.

While dietary changes alone usually cannot dissolve established gallstones, preventing weight gain, avoiding simple sugars and limiting unhealthy fats may help prevent new gallstones from forming and current stones from enlarging.

So, the recommendation is to follow a “heart-healthy” diet and consume just enough calories to meet your daily needs. This means focus on plenty of fruits and vegetables; choose fish or plant-based proteins such as beans and nuts; and use unsaturated fats like olive or avocado oil.

Body size is one part of the equation. Another risk factor is rapid change in body weight. Gallstones often form when someone gains or loses a large amount of weight over a relatively short period of time. If you need to lose weight, do it slowly. Don’t go on a crash diet.

Q: I get attacks of dizziness that cause me to feel off-balance. The episodes usually last a few minutes. I can stop them if I stay very still. Is this a type of vertigo?

A: Recurring vertigo usually is caused by a disorder involving the vestibular (balance) system, which includes several tiny, fluid-filled canals — called the semicircular canals — inside your ears.

The most common reason for recurring vertigo is benign paroxysmal positional vertigo (BPPV). In this condition, tiny crystals in the inner ear can become dislodged when you do a particular movement, such as putting your head back to use eye drops. The loose crystals then bump around inside the semicircular canals, which normally help the brain sense the position and movement of the head.

The loose crystals send confusing signals to the balance center in the brain. Typically, the first time an episode hits, you may be woozy and dizzy most of the day. After that, vertigo happens only when you change your position — lie down, sit up, roll over, or move your head up or down. Once you stay in a new position, the crystals land in one place, and the vertigo stops.

Meniere’s disease can also cause recurring vertigo. In this condition, a small canal inside the ear becomes swollen for uncertain reasons. It causes not only attacks of vertigo but also nausea, a sensation of fullness or ringing in the ear and hearing loss. The attacks typically last longer than the recurring episodes of vertigo due to BPPV.

You should make an appointment with your primary care provider or an ear, nose and throat specialist to help diagnose the cause of your vertigo.

For BPPV, a simple maneuver to reposition loose crystals in the ear can reduce or eliminate symptoms. There are a number of different types of maneuvers, and each one includes a series of positions done while sitting or lying down.

The Epley maneuver is the gold standard. Your doctor may give you a diagram to try it at home. But be careful: If you don’t do it correctly, the loose crystals may wind up in the wrong place and worsen vertigo. It’s best to have a clinician or physical therapist guide you through it the first time.

Once you’re comfortable with the maneuver, you can try it at home at the first sign of vertigo. It might be helpful to watch a video about it for guidance (there are many on YouTube). Just make sure the expert in the video has the proper credentials.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, visit health.harvard.edu.

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