Improving Digestion after Gallbladder Removal
A cholecystectomy, or gallbladder removal, is the second most common surgery in the United States. The removal is a safe, conventional treatment for the diseased organ, but it can often result in various complications on a daily basis.
A cholecystectomy does relieve pain, but 50 percent of patients still have digestive symptoms afterwards1 and most patients are not counseled on how to deal with these symptoms. Technically we can live without it; yet, the gallbladder has significant purpose and multiple functions in the body; understanding these functions is key to addressing side effects and risks.
The gallbladder is part of our biliary system which includes the liver, gallbladder, and bile ducts. This system works together to make, store, and secrete bile which contains bile acids. These acids break down dietary fats for absorption. Bile also has the job of assisting in removal of both cholesterol and toxins processed through the liver.
During consumption of a fat-containing meal, the gallbladder contracts and releases an appropriate amount of stored bile into the small intestine where important fat-soluble vitamins such as A, D, E, and K, and essential fatty acids like omega-3 and omega-6 fats are absorbed. Without a gallbladder to release the right amount of bile at the right time, there is high risk of vitamin deficiency and inflammation.
In the absence of the gallbladder, the liver continues to produce bile which then trickles into the small intestine commonly allowing too much or too little bile at meal times which can cause gastrointestinal issues such as diarrhea, nausea, cramping, heartburn, and an intolerance of higher-fat foods (even the healthy ones).
The good news is that there are actions you can take to improve these symptoms and avoid further digestive issues.
The first step is to adjust your diet. Initially after removal, fat intake should be limited and spread throughout meals for several months and then introduced gradually to allow the liver to compensate for the absence of your gallbladder. Spreading out fats into smaller, more frequent meals can help avoid developing discomfort and improve absorption rates.2 Slowly increasing fiber from fruits and vegetables can help normalize bowel movements if that is an issue. Some people may require following a lower fat diet long-term, while others can return to a normal diet within months.
Without a gallbladder, it can be challenging but imperative to consume adequate amounts of high-quality fats from a variety of sources such as wild, fatty fish; organic, pasture-raised meats; nuts and seeds; avocados, olives, coconut and oils derived from these. To avoid adverse reactions after increasing fats, you may try supplementing with digestive enzymes and/or bile salts. A easy recommended brand is Super Enzymes from Now which contain supportive substances for both the liver and gallbladder such as ox bile, protease to manage pH, pancreatin, bromelain and ginger to support digestion and nausea. Bile salts, which exist in your bile naturally, are useful when the liver makes thick bile, the condition of biliary sludge; it acts like soap to thin and dissolve the bile. Supplementing may be a lifetime necessity to achieve optimal health after losing a piece of your digestive system.
A helpful oil to cook with and consume is MCT oil (medium chain triglycerides). MCT is a great option for those missing a gallbladder due to its unique digestive and metabolic properties which bypass the dependence of bile while processing. MCT can provide energy and fullness, help manage blood sugar and cravings, and can support weight loss. It was recently popularized by the “Bulletproof Coffee” fad, which adds butter and MCT oil to coffee as a breakfast replacement for the aforementioned benefits. Make note that you should increase MCT oil usage slowly as it can cause stomach discomfort in higher doses.
Having gallbladder problems in the first place may be a sign that there are dietary concerns that need to be better managed. A diet high in sugar and processed carbohydrates, combined with poor quality fats and oils, is the gateway to gallbladder disease. The abnormal bile secretion into the small intestine has been shown to affect gut microbes and gut function;3 therefore, to support gut health it’s important to maintain a low inflammatory diet, including plenty of vegetables with the daily addition of probiotics or fermented foods. Additionally, research has linked gluten intolerance to increased prevalence of gallstones,4 so a gluten-free diet may also be explored if you do not resolve digestive health.
With some diligence and guidance from a knowledgeable practitioner, you can develop an individualized plan that supports your health, and live comfortably with or without your gallbladder.
Tiffany is a certified nutrition consultant and functional diagnostic nutrition practitioner and can be reached at (760) 285.1221. For more information visit tiffanydalton.com.
1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116086/, 2) Escott-Stump S. Nutrition and DiagnosisRelated Care. 7th ed. Baltimore,
MD: Lippincott Williams & Wilkins; 2012:516-518, 3) https://onlinelibrary.wiley.com/doi/full/10.1111/1758-2229.12319, 4) https://www.
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