Are you on a low-fat diet after gallbladder removal? Or have trouble digesting fats even if you still have your gallbladder? Read on for some explanation of the gallbladder, liver, and bile, as well as my top ten ways to improve fat digestion.
Is Gallbladder Surgery Helping?
According to a study in the Journal of American Medicine (JAMA), out of the 700,000 gallbladder-removal surgeries each year, more than 10% are still left with pain in the area that once was the gallbladder.1
Current treatment involves inspecting the common bile and pancreatic ducts for a small stone or a surgery that cuts the sphincter muscle in order to relax it enough to allow bile to flow. The risks of pancreatitis from this procedure are high and, according to the JAMA study, surgery is not a viable option.1
Logically, removing a bile or pancreatic duct stone or relaxing the sphincter muscle makes sense, but these procedures have not proven to be very effective, and many folks end up with chronic post-surgical gallbladder pain—even when there isn’t a gallbladder.
In this article, I want to explore some other possibilities that could cause lingering digestive problems after gallbladder removal. These are very often the same reasons behind indigestion in folks who do have a gallbladder.
The number of gallbladder surgeries is rising each year, leading some to suggest that perhaps we don’t need a gallbladder. I probably get more questions about how to navigate around a cholecystectomy (gallbladder removal) than any other condition, and the good news is that we can safely navigate around it. However, I do not think it means that we have somehow evolved away from needing a gallbladder.
No Gallbladder Does Not Mean No Bile
The gallbladder does not produce bile, it just stores it in a super 15-20x concentrated form.2 Without a gallbladder, the liver simply makes bile on demand when you ingest a fatty meal. So, as long as you are not eating the brains and fatty intestines of a woolly mammoth, you will likely be okay without a gallbladder.
The concentrated nature of gallbladder bile sheds light on how the gallbladder evolved. While anthropologists agree our ancestors did not have meat for breakfast, lunch, and dinner, when they did catch a rabbit, they ate all of it. The fatty parts, like the brains, eye balls, and intestines spoil quickly, so that was eaten first and all at once. So, in times of feasting on the innards of a freshly killed animal, we needed a source of unmitigated bile. Such a bile surge would require some time for the bile to be replenished, suggesting that these fatty feasts were not a daily occurrence.
Few people in this day and age ingest enough fat in one sitting to demand a Paleo dose of bile. Today, meals tend to be more balanced with proteins, fats, and starches that allow the liver to make needed on-demand bile to emulsify dietary fats after gallbladder surgery.
What is the Real Cause of Gallbladder Pain?
The gallbladder and liver get the signal to secrete bile into the small intestine from the stomach and the lining, or what I like to call the skin, of the intestinal tract. If either of these feedback loops are disturbed, the bile flow from either the gallbladder or liver can be disturbed.
For folks without a gallbladder, this kind of disturbance can cause either too much or too little bile in the small intestine at any given time. The gallbladder is not only a storage site of bile, but a regulator of its flow. When the gallbladder is removed, the liver makes bile as needed. If signals from the stomach or small intestine are out of balance, a host of digestive symptoms can ensue.
The same exact symptoms can arise if you have a gallbladder that is getting disturbed signals from the stomach or small intestine. So, in most cases, the therapies are the same for both, with the caveat that provoking bile flow with large amounts fats in folks without a gallbladder is not advised. A more kind and gentle approach is used.
I have numerous free articles and videos on the importance of the integrity of the intestinal skin, and the critical nature of the digestive coordination between the acid production in the stomach, the production of the pancreatic and duodenal digestive enzymes, the bile flow from the liver and gallbladder, and the microbes that weave it all together. This, in great detail, is the topic of my book, Eat Wheat: A Scientific and Clinically Proven Approach To Safely Reintroducing Wheat and Dairy Back Into Your Diet.
We RecommendThe Most Important 1/2 Inch of Your Body
Low Cholesterol Linked to Indigestion + Blood Sugar Epidemic
The other primary reason for gallbladder concerns and lingering indigestion after a gallbladder removal is the American diet. In 1961, the FDA put cholesterol on the nutrient concern list and, in short order, fats became highly processed and indigestible. Fat was a major source of energy for the body and, without good fats, demand and cravings for sugar soared.
The result of more than 60 years of a low-cholesterol, highly processed fatty and sugary diet is the blood sugar epidemic we face today. The first response in the regulation of healthy blood sugar is more related to liver function than pancreatic function. Metformin, the prediabetic drug, blocks production of sugar in the liver and has no effect on the pancreas.
A low-quality, highly processed fatty diet will gunk up bile ducts, causing thick and viscous bile that cannot flow easily through very small bile ducts. When these ducts become congested, bile will build up in both liver and gallbladder. The result is a host of digestive symptoms related to a congested gallbladder or inability for the liver to produce adequate amounts of bile. The latter is a critical cause of indigestion and pain after gallbladder removal.
Simply taking the gallbladder out does not fix the underlying problem of viscous bile and congested liver and bile ducts. For most folks, getting the gallbladder removed takes away the log jam of bile flow, but if the digestive problems persist after surgery, the problem is likely in the liver.
Common Symptoms Related to Gallbladder Concerns
- Gas + bloating
- Occasional heartburn
- Occasional constipation
- Looser stools
- Gray stools
- Yellow stools
- Blood sugar concerns
- Stomach discomfort
- Abdominal discomfort
- Chest discomfort
- Breathing concerns
Top 10 Ways to Improve Bile Flow + Production
TurmericPerhaps the most well-studied herb for increased production and delivery of bile is turmeric. In one study, just 40mg of turmeric extract increased gallbladder contraction by 50%.3
Note: Turmeric is high in oxalic acid, which, in excess, can precipitate gallstones. If you are sensitive to oxalate, you may want to avoid turmeric, although the science is not totally clear here. In one study, curcumin was found to significantly reduce oxalic acid levels when study participants were fed a high oxalate, gallstone-promoting diet.4
Fish OilsFish oils were evaluated in a controlled study on their ability to reduce oxalic acid levels in the urine. Supplementation with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) was compared with a standardized control diet. Fish oils significantly lowered oxalic acid levels in the blood.5,6
BeetsEat one red beet per day. Beets have natural nitrates that open up bile ducts and increase flow. Studies suggest beets can increase liver production of detox enzymes like glutathione and decongest an ischemic liver.7
Don’t like beets? Check out our Beet Cleanse capsules.
We RecommendThe Health Benefits of Beets
RehydrationHot Sips: Take 2-3 sips plain hot water every 15-20 mins for 2 weeks. Also, drink half your ideal body weight in oz purified room temperature water each day.
ApplesEat one to two apples a day. Apples are high in malic acid, which naturally opens bile ducts and allows bile to flow. Apples are also shown to increase elimination of bile acids into the toilet, more effectively detoxifying the body and forcing the liver to manufacture new bile.8
FiberSoluble fiber attaches to toxic bile and takes it to the toilet, forcing the liver to manufacture fresh bile. Eat more:
- Slippery elm, marshmallow root, and licorice
- Roughage like leafy greens
- Root veggies
- Apple pectin and celery contain insoluble fiber, which sweeps the intestines of toxins8
LemonsLemons reduce uric acid levels and increase bile flow. Try to consume the juice of one lemon per day.9
Lemon Juice + Olive OilTake 1-2 tsp lemon juice and 1-2 tbsp extra-virgin organic small farm olive oil together before bed for a month.
GheeAdding 1-2 tsp ghee per day is a great way encourage bile flow, better intestinal health, and gallbladder contraction. When doing one of our LifeSpa kitchari cleanses, start with just 2 tsp ghee each day and only increase if the previous dose was comfortable. This is for those without a gallbladder or those who are having gallbladder issues. Ghee has been shown in numerous studies to support effective liver detox.10
Protect Intestinal SkinWhole, unprocessed foods are key. Amalaki, brahmi (Centella asiatica), and neem are my favorite Ayurvedic herbs to support intestinal skin. Colonizing probiotics are also an important component of protecting intestinal skin and sending balancing signals to the liver and gallbladder to produce and deliver bile.