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.

Without a gallbladder it is important to consume high quality fats from a variety of sources.

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.sciencedirect.com/science/article/pii/S0002927097001147

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Comments (12)

  • My 20yr old son just had his gallbladder removed after months of continual nausea/vomiting after meals. HIDA scan showed it was functioning at 35%. He had 2 great week after it was removed and then nausea/vomiting started again. Started on digestive enzymes which were a lifesaver but is still having episodes of nausea/vomiting that can last a long time. Have tried essential oils, prescription antiemetics etc without any success at all. Have you seen people struggle like this? It’s been almost 2 months since surgery and he is still struggling, losing weight etc. Any help would be greatly appreciated. Thanks so much.

    • Hi Ami,
      I’m so sorry about your son! Yes, this is common and often is related to the body just trying to figure out what to do with bile now that it doesn’t have a “storage compartment” anymore! Dietary changes for quite a few months are important, and there are specific enzymes he could try taking to minimize the GI distress. Feel free to schedule a consult with me and see if I can help, or if I need to refer you to a specialist. Link to my schedule is here: https://schedule.10to8.com/
      -Tiffany Dalton

  • Hello
    I am vegetarian so can not take ox bile.
    I have tried quite a few digestive enzymes and end up with burning pain and feeling worse.
    I have tried eating pineapple for thier enzymes but get simpler affects.
    Why does this keep happening.
    I really want to get healthily oils in my diet as I have very dry eyes.
    Thank you

    • Hi Fiona,
      I am curious as to what type of digestive enzymes you have tried. Some enzymes are combined with HCL (Hydrochloric acid), which may be causing that burning feeling. I would maybe start with Digestive Enzymes Ultra by Pure Encapsulations (easy to find online or in a health food store). You take WITH meals (after the first two bites or so).
      The best way to add in healthy oils is by slowly increasing them 1/2 tbsp at a time until you feel like it is digesting well- may it takes a full week to increase, but that’s ok! If it continues to worsen, I definitely recommend discussing it with your general care practitioner.

  • Good day!Tiffany,I do not have gallblader.,can I drink MCT Oil for my bulletproof coffee? Thank you.

    • Hello Shalini,

      You can definitely try MCT oil in coffee or even in cooking (great for high heat), but I would advise you to start with small amounts and work your way up to the desired amount. The great news is that unlike most fatty acids, MCTs do not rely on the production of bile to be metabolized and begin breaking down immediately from contact with enzymes found in your saliva, so adding MCT oil to your diet is one of the best ways to increase the medium-chain triglycerides that support ketosis without a gallbladder. BUT- if you have been avoiding added fats in general, there is still a period of adjustment you will go through; so again, take it slow and listen to your body! It does adapt well, but on its own schedule.
      -Tiffany Dalton

  • Thank you for replying
    I have dried a few digestive enzyme but I can’t not remember there names lastly I tried one that was only for fat digestion lipase.

  • Ghanshyam Shrestha

    Got my gall bladder removed 2 weeks ago, can I take fish oil casules and eat fish? Am not facing any problems so far.

    • Hello Ghanshyam,
      As always, it’s a good idea to speak with your doctor, but generally speaking yes- you should be able to eat fish and take supplements- every body responds differently to gallbladder removal so just be aware of how you feel and start slowly on increasing your fats. Fats, especially from fish, are so good for you so I’d recommend getting it from food first and see how your disgetive system responds.
      Best of luck! -Tiffany

  • Hi miss Tifanny..My gallbladder removed almost 3yrs from now but i feel like my right side of my abdomen is always in pain.i always go to check ups here in Saudi Arabia where iam working as home caretaker..The doctor said its alright no problem about my operation..what is the possible cause of my flank is always in pain?Is there possible of my liver?thanks..

  • I absolutely love taking Cod Liver Oil. The EPA in it is my mood enhancer. I love it for brain health. It makes me feel good. I’m so afraid that I will no longer receive the benefits of CLO without a gallbladder.

    • Tiffany Dalton-Capobianco

      Hi Adriana,
      Good news, you can still absorb fatty acids without your gallbladder! Your liver will still produce bile, you just have to slowly increase your fat intake and disburse your fat grams fairly evenly throughout the day (equal amounts per meal). Here are a few tips:
      -Every *body* (aka- liver) will react differently, so give yourself time to find out how much fat you can handle per meal in a slow manner, by increasing the fat you consume in small amounts (5 to 10 grams-ish).
      -Consume and account for your Cod Liver Oil in fat grams with a meal- track the grams of fat and try to keep the fat similar at each meal- so add a different fat at the meal you are not consuming cod liver oil at, to meet your total fat gram per-meal amount.
      – Avoid snacking for a while and try to keep a fairly strict meal schedule (the body likes a schedule) for optimal digestion.
      Good luck!


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