Low-carb diets and gall bladder health

Have you ever wondered about your gall bladder, and whether or not it's true that fats hurt or helps? What's more, could you live without yours and continue to consume saturated fats, or are you destined for a low fat diet? 
Jeremy Bernal is the author (and artist) of the just-released book and e-book The Gall Bladder Survival Guide: How to live a normal life with a missing or dysfunctional gall bladder. Keep reading for the poop (erm) on Jeremy's personal journey, and how he feels a healthy paleo/low carb lifestyle can affect your gall bladder, and life beyond.

Lots of people ask me how I can offer advice on gall bladder health when I no longer have a gall bladder. Well, that's kind of the point. Been there, done that, killed it. Literally. And the search for solid poop afterwards occupied years. I know how to kill a gall bladder, trust me. And following a low-carb diet is definitely not something that will endanger your gall bladder; I don't need a health science degree or a gall bladder to prove it.  In fact, minimizing carbs is what finally ended the Age of Soft-Serve Poop for me. And, had I known better and not followed a low-fat diet for untold years (doctor's recommendations due to hereditary high blood pressure), I might very well still have a gall bladder today.

If you have gall stones, whenever you eat fatty foods you may experience discomfort or fits of incapacitating pain. This is because the gall bladder is triggered to squeeze when your intestine signals the intake of fatty foods. This does not mean that low-carb eating is incompatible with gall stone sufferers or gall bladder amputees. Understanding which fats rebel and which ones comply with your system is key.  In fact, educated, controlled gall bladder activity can actually help eliminate existing stones.

The gall bladder is probably one of the body's most, if not themost, poorly designed organs (think of it as the Yugo parked next to the Rolls Royce of your liver). It is designed to both store and squeeze out a portion of liver-manufactured goo down the biliary tree where it exits into the duodenum by the same pipe the pancreas uses to release digestive enzymes.

Not only does the gall bladder have an absurd curly valve mechanism (perfect for trapping granular material) to control its output, but it is also oriented with its exit near the top, which allows any particulate trash to settle to its bottom and eventually form stones. And trash it receives. Basically the garbage your liver can't use or doesn't want gets tossed down the bile chutes. Worn-out or surplus cholesterol, bilirubin, salts, etc. all combine into bile. This “fresh” bile is then further concentrated into a thick sludge within the gall bladder, by up to five times, increasing the odds of crystallization of whatever crud happens to be present.

Bile is used for two things: to emulsify fats and to increase the pH (reduce acidity) of the stomach acid. The pancreatic enzyme Lipase is used to break those emulsified fats into fatty acids your intestine can absorb, but it can't work efficiently unless the bile has emulsified the fats and increased their surface-area-to-volume ratio. The two chemicals work as a team. Once the bile has done its job it is reabsorbed at the end of the small intestine and sent back to the liver, which usually cycles it straight back into the gall bladder. The same bile molecules can be re-used some 3 times in a single meal.

In a normal human diet, the gall bladder is able to cycle properly. What goes in, goes out, in a regular pattern. However, in a low-fat diet (or, in the case of celiac disease sufferers), the gall bladder is not called to action enough and bile stasis can occur. If you put garbage into a can, concentrate it, and empty only 80% of it every time, you will eventually end up with some really nasty junk stuck in the bottom of the can. This is the case with underactive gall bladders.

To further exacerbate the situation, diets high in sugars and trans fats will have the body working harder cycling its cholesterol in order to control cellular inflammation, in addition to having surpluses of chylomicrons, VLDL, and their resulting LDL blood cholesterol to get rid of, which means more trash tossed down the bile chute. Which means higher odds of gall stones.

Once you have gall stones, you will have a couple of growing problems. You will tend to shy away from fatty foods as they cause you digestive discomfort. This comes from the stone causing you pain when the bladder contracts, and also from the fact that the bladder cannot hold as much bile as it once did (especially if you have large or multiple stones), so it cannot issue enough bile to emulsify the volume of fat in hearty meals. This under-treated fat will cause havoc later down the tract; your pancreatic lipase will not be able to break it down as efficiently, so you will not be absorbing the fats you need, and what is left unprocessed will become food for gas-forming bacteria. And what they don't eat, will come out in the form of soft-serve nastiness.

Less fat processing by bile and lipase means you absorb fewer fatty acids and fewer fat-soluble vitamins. You will have less energy and feel cravings to eat fatty foods. But you don't want the discomfort or the diarrhea... until your body is so needy of fat that it screams for that bucket of wings you can no longer deny, and leaves you hugging the toilet all night with the pained sweats and dry-heaves of a gall stone attack.

Gall stones, long story short, are the result of over-concentrated chemical solutions in your bile. They can dissolve, given the right environment. Proper diet (paleo or low-carb) will bring the biliary, lymph, and cholesterol cycles to where they should naturally be and will have your liver pushing less-nasty junk out the exit. When your liver no longer needs to throw so much of its weight around your system taking care of sugar damage and oxidation, it no longer has the need to pour so much toxic waste down the garbage chute. The proper balance of bile chemicals will return in time.

Chemistry nerd joke: If you are not part of the solution, you are part of the precipitate. Joking aside, it's absolutely correct. The right concentration of chemicals in your bile can and will shrink, break down, or dissolve those stones eventually and bring them back into solution, whereupon they can be flushed out with the rest of the trash. Taking dietary bile acid supplements has also proven fairly effective (85%) in getting rid of stones as they help return your bile to a healthy and balanced “formula” which will dissolve existing stones. I am not a doctor, but I would definitely recommend a paleo or low-carb diet with bile acid supplements to someone suffering from gall stones.

What if you have no gall bladder and want to do a low-carb diet, but you are afraid of uncontrollable grease-poop? Try it, you might find that it better suits you than whatever you were doing before. It worked for me. I am not strict about avoiding all carbs at all costs but I cut out almost all bread and wheat from my diet completely; despite the fact that I do not have celiac disease, my system returned to some semblance of normal and the unrelenting butt-volcano went dormant within a couple of weeks.

And you don't have to eat grease to eat low-carb. A body without a gall bladder will tolerate animal fats better than vegetable fats, because their chain structures break down more easily, and because phytosterols (plant cholesterols) will slow and block absorption of animal cholesterol. Furthermore, phytosterols contain estrogen and progesterone precursors which, interestingly, contribute to gall bladder laziness and/or inactivity.

Even lean meat should contain enough fats to keep you healthy. What you want to avoid is heavy doses of vegetable oils (like salad dressing) and hydrogenated fats, which I can assure you a gall-bladder-less body does not tolerate. Pork fat, I am happy to say, is the most tolerable fat I experience without my gall bladder. I can now eat eggs fried in bacon fat, with the bacon, and not have to run to the bathroom in 15 minutes. Without a gall bladder, and without dietary supplements.

Milk from cows and goats (and horses, if you are into that) contain short and medium chain fatty acids that do not require lipase to break them down before absorption, meaning that the presence of bile is not required to digest and absorb them. These go nicely with low-carb and paleo, though ultimate low-carb nazis may take issue with the lactose content.

Here is a list of things to avoid while eating low-carb with gallstones or without a gall bladder:
·        Olive oil in excessive amounts; for cooking it's ok, but do not use it for salad dressing.
·        Any other vegetable oil that is liquid at room temperature
·        Hydrogenated oils of any kind
·        Soybeans or derivative products
·        Margarine or fake-butter products
Things to encourage while eating low-carb with gallstones or without a gall bladder:
·        Cook your food in real butter, clarified butter (ghee), coconut oil, palm kernel oil, or pork fat.
·        Eggs from happy chickens (contains lots more Omega-3/6)
·        Grass-fed beef (contains 4x more Omega-3/6 than unhappy cows)
·        Pork from happy pigs (yes, surprise surprise it also contains higher levels of Omega-3/6)
·        Whole (not skim) milk from cows or goats
·        Cheese and yogurt (especially yogurt with active cultures)
·        Omega-3/6 Fish oil supplements, essental fatty acids
·        Plenty of dark leafy greens like cale, spinach, etc.
·        Avocados but don't go overboard
·        Vitamin supplements of A, D, E, and K optional, don't go overboard on them especially if you are eating plenty of dark greens
·        Do eat your greens in the presence of fats, otherwise their vitamin enrichment is wasted.

What do you think, Lighter Siders? Do you have your own galling gall bladder story to share? Do you agree or disagree that a lower carb/paleo lifestyle can help heal the body from the inside out? Share your thoughts below! 


Print Friendly, PDF & Email


  1. I live without my gall bladder for several years now and have never had problems with digesting fat after the surgery.

    For 18 month I've been eating a low carb high fat diet and am doing extremely well with it. My emphasis is clearly on animal fats and coconut/red palm oil.

  2. I am having a horrible time with eating a LCHF diet (been doing it for 4 months now)…..I am losing weight but my bathroom trips are much more, and more urgent than when I was eating crap….I don’t understand why….I had my gallbladder removed a few years ago and had to go on a medication to stop my issue of bile dumping (which was the worst year of my life before I found this medication) and now even with the medication I won’t eat unless I am in the safety of my home because I never know what is going to happen…..I don’t want to go back to my old ways but I can’t live like this…..any ideas?

  3. clairekrobertson says

    I’m the exact same way. When I just eat what ever I want I’m fine but with a LCHF diet I’m running! I don’t know what to do because I have gained 40 pounds in 2 years. What medication are you on for the bile dumping?

    • I am taking cholestyramine ……there is another name for it but I can’t remember it…it is a packet of powder that I sprinkle over water/juice first thing in the morning and let it sit for a couple of minutes….then stir and drink…..it completely stopped my bile dumping and I got my life back….I will be on it for the rest of my life…..but when I try to do LCHF it changes everything…and I don’t know why…I have to assume it is to much fat and/or protein for my liver to process without my gallbladder…..I am going to try LCHF again but try adding 1 bread product a day and see if I can still lose weight and stop the bathroom trips….seems we are the minority with this problem so it has been hard finding information to help…..but I am not giving up yet because it was working so well…except for the bathroom trips :)…..

    • I’ve also experienced the same issue. For me taking a teaspoon of psyllium husk powder morning and night did the trick. It bulks up your stool and give your body time to absorb the bile like it’s supposed to. I’ve been using the vitamin shoppe brand because it’s cheap and has no added carbs. I also found it works better if you mix with a hot glass of water and let it sit for 5 to 10 min before drinking. Sometime it’s really difficult to drink because of the texture but it’s worth it because it stopped my emergency bathroom trips. Hope this helps.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.