No Gallbladder?

Q: I would like to know how this high fat diet can work for those patients that do not have a gallbladder. Because they no longer have the concentrated enzymes needed to breakdown a high fat meal dose this change how they are or are not absorbing the fat. regardless of good or bad.

A: I address this question in my book, Primal Fat Burner at some length.

The fact that you don’t have a gallbladder can certainly be a bit of an issue, but is not an insurmountable problem when it comes to adopting this way of eating.  You do have to take an extra step or two, however, to prepare for this dietary transition (which I still highly recommend).  The first key consideration is that whatever the issues were that caused you to lose your gallbladder in the first place may very well still be problematic for you and didn’t go away simply because your gallbladder did.  You need really to look at this closely.

Common reasons for gallbladder problems include thyroid issues, excessively low fat/vegetarian/vegan diets, diets overly high in processed fats/trans fats, and certain nutrient deficiencies. Also, I would recommend finding a quality source of bile salts you can used to supplement with fat-containing meals from now on to help enhance digestion and proper assimilation of quality fats, essential fatty acids, critical fat-soluble nutrients and dietary minerals. Whether you adopt my dietary approach or not (and I hope for your sake that you do), you absolutely have to find a way to better digest and absorb dietary fats. The minute trickle of bile directly into your small intestine from your liver (sans gallbladder) is simply not sufficient to prevent critical fat-soluble nutrient deficiencies down the road.

Bile salts, sometimes marketed as “ox bile” in health food stores, are composed of numerous substances typically produced by the liver and accumulated in the gallbladder for the express purpose of properly digesting fats and fat soluble nutrients. With no gallbladder, it becomes difficult to produce sufficient concentrations of bile salts on your own in order to meet the demand of a healthy diet (i.e., one that includes critical fats, essential fatty acids and fat-soluble nutrients– all of which are absolutely required for optimal brain, neurological and physiological health).

Most healthcare providers are able to get a hold of these through quality companies. With no gallbladder, I would be buying this stuff by the caseload, just to have it on hand.  You might also want to consider a quality source of pancreatic enzymes rich in the enzyme, lipase to help a bit more with digestion and assimilation of critical fat-soluble nutrients. But if you had to pick one over the other (even though both would be nice)— for sure go for the bile salts. You will need to take these with every single fat-containing meal for the rest of your life in order to optimize your digestion of fats and fat-soluble nutrients going forward in the absence of a gallbladder. (Biotics Beta Plus is a good one but there are lots out there these days…look for a high quality and/or practitioner brand)



PS. For those of you who still have a gallbladder: If you have gallbladder attacks or gallstones you should exercise extreme caution where increasing dietary fat is concerned and you may first need to resolve this issue with your trusted, licensed health care provider before embarking on any major dietary change. See my Disclaimer

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  1. Syd says

    My mother very much wants to start this protocol, but not only does she not have a gallbladder, but she got what’s called Bile Salt Diarrhea as a result. She can’t take bile salts as that would make things worse!

    Is there no work around for someone with her issues?

    Thanks much.

  2. Nora says

    So much depends on what the source of this condition is for your mom. Has she been diagnosed (or screened for) Crohn’s disease? Bile salt diarrhea is commonly associated with this condition. Also, small intestinal bacterial overgrowth (SIBO) can deconjugate bile acids and also lead to this difficulty she has. There are also certain genetic markers also associated with the problem. In short, it’s important to get to the source of this issue as much as possible. That supplies a more solid basis for treatment. I am quite surprised that she still has this condition with no gallbladder.

    That said, there’s no getting around needing to be able to digest the fats that you consume. And we all have significant requirements for essential fatty acids and a number of critical fat-soluble nutrients. IF she supplements with ox bile/bile salts during her fat-containing meals and titrates the dosage very carefully it might be worth a try. Obviously, if it generates discomfort then she would need to back off until she figured out what the source of her bile acid malabsorption problem was.

    There is a probiotic— and only one— that might be worth a try to help improve the possibility of SIBO and other potential dysbiotic influences over this condition. Here is a link to the product I think might be worth a try (and certainly couldn’t hurt, but could also really help). By way of disclosure, I do make an extremely small commission on this product, but that is absolutely not the reason I am recommending it. This is quite literally the only commercial probiotic I am comfortable widely recommending anymore, and it can truly have some miraculous effects (which is why I am associating with them in the first place):

    I hope this helps! I do sincerely wish your mom well.



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