Gallstones and Low Carb

Gallbladder in pink

Do gallstones improve or worsen on a low carb / high fat diet? It’s a common question with an interesting answer.

The gallbladder stores bile, a yellow-green fluid manufactured in the liver. The bile is used to digest the fat you eat. The question is: Is it good or bad for the gall bladder to eat fat?

The conventional fat phobic answer

The usual medical belief today is that fatty food can result in gall stones. This is because what happens if you already have gallstones in the gallbladder and eat fat: A gallstone can get stuck on the way to the intestines and give you a gallstone attack (pain in the top right part of your stomach).

The conventional advice is thus to eat low fat – and take pain killers if you get a gallstone attack. If the attacks continue the gallbladder is removed by routine surgery and the problem usually goes away. Probably with the side effect of slightly decreased ability to absorb fat and nutrients from what you eat (there is a reason we have gallbladders).

The conventional low fat advice rarely makes gallstone disease go away. Instead it often gets worse with time, until surgery is necessary. That is hardly a coincidence.

How to get gallstones

If you eat low fat less bile is needed to digest your food. More bile thus stays in the gallbladder. Long enough, perhaps, for stones to form. It’s been shown that people who (instead of fat) eat more carbohydrates are at increased risk of gallstones.

It all sounds logical. And there is even better evidence. The risk of low fat diets have been tested at least three times:

Studies of extreme low fat diets

  • In a study of 51 obese people using an extremely low fat low calorie diet (just one gram of fat a day!) the gallbladder was examined by ultrasound before the diet and after one and two months. After one month four of the 51 participants had developed new gallstones. After two months more than one in four (13 people) had new gallstones! This on an almost fat free diet. Three participants needed to have their gallbladder removed during the study.
  • A similar study examined 19 people eating an extremely low fat low calorie diet over 16 weeks. At the ultrasound examination at the end of the study five people (again about one in four) had new gallstones.
  • A third study compared an extremely low fat diet with a diet slightly higher in fat during 3 months. More than one in two (6 of 11 people) in the group eating extremely low fat developed new gallstones. Nobody in the group eating more fat did.

Conclusion: Do you want gallstones? Avoid fat.

What happens if you do the opposite?

What if you were to do the opposite of the usual advice? Regularly eat food with fat in it? Then more bile will be used to digest the food. The bile ducts and the gallbladder will be flushed through regularly. Probably no stones will have time to form, and pre-existing stones might (if you are lucky) be flushed out into the small intestine.

The risk is that you will get gallstone pain in the short term – if you already have gallstones.

The question is: Do you want to think short-term (low fat) or long-term (higher fat)?

Does high fat food work?

It’s logical to think that food higher in fat can result in a gall bladder free from gallstones. But as far as I know no study has tested high fat food to people with gallstones.

On the other hand I know quite a few people who have experienced that their gallstone disease disappeared on a LCHF diet. Sometimes at the expense of initial gallstone attacks though.

A Swedish low carb site conducted a survey of its members. 145 people who used to have gallstones answered what happened since they started eating LCHF. Take the result with a huge pinch of salt as this kind of survey gives very unreliable answers:

This survey gives some support to the theory that high fat food can cure gallstone disease.

Gallstones and kidney stones

Patients with kidney stones get better advice. They are told to drink a lot of fluid, increasing the production of urine, so that stones do not have time to develop. If you already have kidney stones this advice could give you a painful kidney stone attack initially – but you are still advised to drink a lot.

The reason why we give the opposite advice when it comes to gallstones might be the obsolete fear of fat. If we were afraid of water instead patients with kidney stones might have been advised to avoid drinking to avoid kidney stone attacks. If they did not improve their kidneys would be surgically removed.

What do you say?

Have you had gallbladder problems? Have you tested a LCHF diet? What happened?

Mer

Other health problems

LCHF for beginners

PS

Another common question is if you can eat LCHF if your gallbladder is already removed. The answer is that this seems to work fine.

Some people without a gallbladder might have to increase their intake of fat gradually to allow their body time to adapt. Otherwise the body might not have time to digest the fat which could result in loose fatty stools initially. However this rarely seems to be a problem.

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158 Comments

  1. Fran
    Hi Sten

    I think your post has a lot of sense to it as bile can become sludgy! I will try this once I get my acid balance correct. It really is quite a pain.

    Thanks you for your help, it is rely much appreciated. I have often challenged the doctors about leaving stones sit in sludge which we keep off the fats.

  2. Trish
    Yep, after one year on a low fat diet my gallbladder rebelled and had to be removed. Total surprise for me....I thought only very high fat diets caused gallbladder problems.
  3. Ana
    I've been experiencing gallbladder pain that started around the time I was first pregnant. After that, everything was kind of different. I've been on a lchf lifestyle for a while, now, and never once have I had another gallbladder attack while eating this way. I notice that when I do incorporate the carbs back in, that is what seems to bring on the pain! The 2013 holidays were painful... I tread a lot more carefully knowing this. Ahhh - the price I pay for certain deliciousness!!! Not going to lie, I still go back every now and then and suffer the consequences, but now that I know what causes it... it kinds of make it somewhat tolerable, if that makes sense?
  4. Sarah
    Wonder if anyone knowledgeable is still reading this article…? I know I've got stones. I got the usual BS advice (gotta love the NHS - NOT! But I won't get started on THAT because I'll just get ranting…) and chose to ignore it (I now want nothing further to do with the NHS - it is NOT a 'health service', it is nothing more than the sales arm of Big Pharma - and your GP is nothing more than a sales rep.

    Eating HF now DOES NOT cause pain - it wipes me out. Not in the sense of needing to sleep, but I simply can't function. My diet is now crap. I'm eating all the grainy crud I'd eliminated (I lost 23 stone eating LCHF palaeo). It's a little like the 'low-carb/keto flu' but, I was fully fat-adapted before I started having stone trouble (I was IFing and following Mark Sisson's Primal Fitness fasting moderate cardio regime very successfully). This is ALWAYS worse round TOTM (I should mention I also have PCOS which was probably WHY I was obese - and type 2) like now.

    I'm becoming scared of food - ANY food; scared of ODing on the carbs - for obvious reasons - and scared of fat (again, for obvious reasons). I'm in my 40s, I shouldn't be like this (the other problem is that I'm severely autistic, and I'm beginning to feel out-of-control and panicky the whole time; I knew where I was when I was able to eat LCHF - EVCO, grass-fed goats' butter, MCT oil, goats' cream, high-fat non-cow cheese, goats/buffalo milk, fatty cuts of GF meat (not often because I simply can't afford it, I was buying 100% grass-fed beef burgers though (no fillers of any kind, just beef, onion, herbs (thyme, oregano, sage, and basil) and they did one with tomato & mozzarella in the middle (PROPER mozzarella - you'd not BELIEVE the number of times I've bought what I thought was mozzarella only to get it home and read 'contains cows' milk' on the pack! THATS *NOT* MOZZARELLA! Sorry, but there needs to be some kind of a regulation preventing a 'mozzarella-like' cheese being called 'mozzarella'. I've yet to find feta, for example, made with cows' milk. It's deceitful.

    I'm wanting to take control of my diet again - because I've been stuck in bed 3 years and, frankly I'm sick and tired of being sick and tired!

    Obviously now I'm no longer FA, but I know that, SOMEHOW, I must get my body 'reset' - but HOW…? The only thing I CAN'T tolerate anymore (in the sense that it DOES cause pain and makes me throw up) is MCT oil. When I was palaeo, I was able to tolerate 2tblspns (around 40ml) in a standard sized mug of strong black coffee (LOVE my coffee, I can't seem to tolerate that now, either). Got that tip from a dude on Mark's forum - he said it helped him IF and train fasted for longer and - sure enough - he was right. I've tried starting small (1 x 2.5ml scoop) but I can't even tolerate that small amount now… :*o(

    So, what to do…? Although I'm still small (though EXTREMELY bloated - I look permanently 6 months pregnant) I have zero muscle tone now, unsurprisingly and I'm living in baggy PJ bums because of my swollen and distended belly. I'm also suffering from what I term a 'hyper-spasmodic' colon (it's like having my IBS back again - but this time it's satanically evil! Without being too graphic (I hope - I'm autistic, so I find it impossible to judge whether I am or not) I'm either having up to 12 BMs a day (and, yes, if I'm trying to increase fat, they ARE orangey) or I'm lying on my bed with my guts constantly cramping (and erm, I honestly don't know how to put this delicately, passing copious amounts of 'gunk' - I'm having to wear large Always, otherwise I'd be changing my knickers every 5 minutes!). This is another reason I'm having 'food issues'. I eat, and it sets it off again!

    I'm taking high-strength B vits (as separate tabs, NOT as an all-in-one; for a start they're too large for me to swallow, and secondly, I've always doubted the efficaciousness of multis (I don't take multivitamins for the same reason), CoQ10, Fe, Mg, K, Se, Z, vitamin D3, choline, taurine, ALCAR, tyrosine, tryptophan, TMG, theanine (as needed). I'm NOT good at taking O3, because the gels are really too Big for me to swallow (I've always had issues swallowing large caps and tabs) and the liquid makes me gag (and it's not very high-strength). I KNOW supplements are no substitute for a healthy diet but, when food now seems to be your mortal enemy, what can you do…?

    Sorry this is so long but, if there's anyone out there still following this article and reads this - HELP!

  5. Thad
    My experience has been interesting. When going on a very low carb diet, while overweight, the rapid weight loss caused my gallstones to grow and multiply. Though, after losing the weight and remaining at a stable weight for some time, all while remaining on the low carb diet, my gallstones shrank. The doctors advice to me was, if I ever become obese again and then return to the low carb diet to lose weight, I should take ursodiol tablets (to prevent gallstones) until the bulk of the weight is off. It's the same thing that doctors recommend for people with gastric bypass, because the weight loss is often just as fast on the low carb diet. If you are not overweight, it seems that the low carb diet will help gallstones, if you are overweight, it seems that the low carb diet will make them worse, until you stop losing weight. Ursodiol is supposed to prevent this from happening during rapid weight loss though.
  6. Judith Batchelor
    THIS REQUIRES AN ASAP RESPONSE . I have a friend who has been told by the doctor that he has to have his gallbladder removed as one of his stones is as big as a Australian .50c. Is there any way of him avoiding surgery- what can I say to him? His surgery is set for the 14th July! PLEASE RESPOND SOON! Thanks
    Replies: #109, #110, #111
  7. Fran Davies
    Hi folks, I'm back after a long period of no computer! Just thought I'd pop in and say that recently I ate a salad to which my husband had added quite a lot of oil. There was also goats cheese mixed in. The next day I experienced really bad joint pain with itching beneath the skin, almost like along the bones in my right arm. It drove me nuts all day. This has happened before when I have had high fat by mistake.
    I also have go say that having chronic diverticulosis I need to eat carbs to keep me from having extremely loose motions.
    I am afraid of putting too high fat in my diet as the pain in my joints is so bad. Does anyone else have this.
    My single gallstone is about 13 mm.
    I apologise for not replying to the previous poster regarding her friend's gallstone, I can't really give any advice.
  8. Fran Davies
    Oh gosh I think I have 'reported' Judith Batchelors post. Please forgive me it was done in error and reinstate if necessary. many many apologies.
  9. erdoke
    Judith,
    We are not specialists here, but that size of a firm stone surely needs removal. There are stages being not reversible. I still advise to consult another specialist if in doubt.
  10. Zepp
    As alredy told.. if stones are to big to pass out by it self.. surgery is necessary.. its only a question about time.

    If not removed it could lead to worse conditions, like damage to the liver in the end.

    And.. many have done that.. whithout complications.. complications is very rare.

    I read that about 5% have some complications the first half year.. and its about gall/bile leaking out in guts.. then one need to eat faty food often in small portions for a time.

  11. sten
    One untested possible option could be to spread out small portions of fat from early morning till late night. I would use butter and coconut oil, for instance "bullet coffee" or some real olive oil or mix cream with water to make a low sugar high fat "milk".
    But no fat portion must be large enough to cause pain, or bad pain. The purpose is to increase bile flow slowly, the ONLY natural way I can see to thin the bile in this situation.
    When the small portions work without pain, increase them carefully and slowly, best just below pain limit. When the bile is thinned enough all stones will slowly dissolve due to this simple physical balance: A saturated or more concentrated liquid form crystals and when the same liquid is diluted below saturation, same crystals dissolve.

    For the rest of us, never eat foods too low in fats, not only to avoid gallstones. The liver is our most important cleansing organ and it must also itself be cleanses. The unwanted stuff goes out through the bile.... , which must be allowed to flow in good streams, starting off with the naturally fatty mothers milk. "Liver flushes" is something untested and unproven to me.

    Also consider the French that at least had the lowest heart disease in Europe despite high fat and lots of wine: The lowest heart disease in France is found in the Perigaux district (Bergerac to Sarlat, West to East) where the fat consumption is highest as it is the home of fatty Fois Gras etc.
    The next hypotesis is that plenty of wine needs plenty of fat to keep the liver clean from all bi-products alcohol break down causes, so the wine without the fat may not be as good as many think.

    If gallstones are merely operated and no fundamental change not is taking place, another nail in the coffin isn't avoided. Gallstones are a warning that the liver is becoming unable to do what it must do.
    Good Luck and let us know more later!

  12. Judith Batchelor
    My friend doesn't think he has any option but to go thru with the gallbladder surgery. I have put them onto this site.
    But I have my own questions. I decided to read thru all the replies and came across one by Zepp on the 5th of May 2012 saying that the Gallbladder flush is a hoax. Welllll I have been using the flush for quite a few years on and off! I use grapefruit juice instead of lemon. I have produced green like stones. Please don't tell me that these can be made in a matter of hours? I feel so much better after using this cleanse, it feels like I can consume more fat. Zapp could you give me more info on the reason why you call the Gallbladder Flush a hoax? I have not been fully converted to the LCHF diet. But I'm willing to give it a go. The continual movement of the bile from the liver thru the gallbadder and out into the intestines makes sense.
    It was as I was awake one night with gallbladder pain that I came a cross this site looking for answers to my predicament - I have been diagnosed with gallstones since after the birth of my daughter in 1991. I went thru that no fat stage and lost a lot of weight, but new that God had given me a gallbladder for a reason. Since then I have struggled on and off with the food issue, my weight didn't stay off by the way! Any thoughts and comment s would be helpful!
    Replies: #113, #114
  13. erdoke
    If you are not seriously overweight, a low carb, high fat Mediterranean type diet would suit you well. Regular consumption of fat is needed for smooth gallbladder operations, so give it a go. No refined carbs, limited amount of pasta, lot of good fats through the day and a glass of red wine in the evenings.
    Coming back to your friend's cholecystectomy. Although I'm not a surgeon, after working with a laparoscopy training center for years, I'm confident to say that it is technically possible to remove only the big stone and not the gallbladder. However, I believe it mainly depends on two things: the inflammatory state of the gallbladder and the surgical protocols covering this type of procedure in the country in question. I'm skeptic about the chances that you are able to find a surgeon who is ready to go against the national surgical protocols in place, i.e. the removal of the gallbladder as the "official" solution in such cases. Also, this might be financially not viable for the hospital depending on local reimbursement for these procedures. They have probably offered options if such have existed...
  14. sten
    Only liver flush I know that works is daily intake of fat, best saturated fats. A "study" done in the 1930's that I found on the net showed that the highest bile volume trigger was an egg yolk mixed into thick cream. A half a glass of this produced higher bile flow than anything else they tried at the time.
    But the drink would surely mean an instant attack for a gall stone patient, so please be careful!
    Use instead my recommendations in previous post and go very slow but regular to gradually dissolve the stones by diluting the bile slowly as described.
    I agree with Zepp that those green "stones" were probably not at all gall stones, but I am also awaiting proof from Zepp!
    .
    I also take some chlorella tablets or even charcoal tablets before I take cream with eggyolks to prevent reabsorbtion or recirculation of some difficult toxins that the bile well can contain. I do this once or twice a month to keep my liver in top condition, at least I believe so.
    Some animals eat a lot of none-foods when they are sick, or in prevention. That is the function I try to imitate with chlorella and Charcoal above, before the bile triggering fat.
  15. Judith Batchelor
    Thank you guys - I have a few things to sort thru. There are health professionals out there who encourage us who have gallbladder stones to do the liver cleanse/ flush, one who I highly respect!
    In Australia if you have gall stones the protocol is to remove the whole gallbladder. There's really no other choice!
    Reply: #116
  16. Zepp
    Well, liver cleans is one thing its like @113 says for all I know!

    The hoax is that those lumps origin is from your gall blader.. its a way to use your own body to produce.. soaplumps!

    Thats the way soap is made in industry too.. fat, acids and ensyms reacting!

    On the other hand.. and like @113 says.. letting the bile flow is a way flush out gravel and to let stones get reduced!

    Soo, Im not saying that those healt professionals have it wrong.. its good to let the bile flow!

    But I think they give wrong explanations!

    Moste stones/gravels comes frome bile that are stored.. the gall bladers purpose is to store/concentrate bile/gall.. and if its newer used it gets to concentrated and starts crystalise.. and falls out as gravel!

    There are several sorts of gravel/stones.. but if one let the bile/gall flow regulary.. they never have the time to be stones.

    http://en.wikipedia.org/wiki/Gallstone

  17. Judith Batchelore
    You'll have to excuse my ignorance but what is @113?
    Reply: #118
  18. Zepp
    Its erdokes answer in nr 113.
  19. LowFatWorks
    I had been eating out exclusively, mainly fast food, since I was young. After I turned 30 I would experience random attacks of horrible upper abdominal / back / chest pain. First monthly, then later weekly or biweekly. Finally, at 31, after a particularly severe and crippling attack that was excruciating and lasted over 15 hours causing me to go a day without sleep, I went to the ER and sure enough got diagnosed with gallstones. I was told to eliminate fat from my diet, that's what I did. It's been two months, and I've never suffered an attack since then. I've been eating mainly carbs, white rice, with occasional fruits and salad with balsamic vinigrette (I don't eat bread / pasta as it contains fat). When I was eating a high fat diet of fast foods, I would have severe debilitating attacks every week or other week, but eliminating fat has kept me pain free. Urging people with gallstones to eat high fat when that's what caused lots of us to get gallstones in the first place is pure madness. I was eating hamburgers / cheese steaks / fried chicken / greasy Chinese food /Mexican food / pizza / etc. as main staples and I got gallstones, so it was not because of a "lack of fat".
    Replies: #120, #121, #122
  20. erdoke
    I don't see that high fat was proposed for gall stones. What I recommended in fact was to consume fat regularly (i.e. several times a day) to ensure continuous flow of the bile from the liver through the gallbladder to the small intestine. This is the natural way of operation and building up of stones is not. The latter is a consequence of jumping back and forth between low and high fat in the diet over a longer period of time. Of course there are other factors playing a role as well.
  21. sten
    Low fat = > stagnated bile flow => gall stones build up. Small amount of fats easy cause gall stone attack after longer time on low fat diet.

    Agree totally with what Erdoke just said.

    Moreover the fat you described is not good. Heated omega 6 oils go rancid quickly inside our bodies! Also transfats and glycation products are formed when these oils used to fry food. Very bad fat and wrong cooking methods. A recipe for heart disease, for instance.

    Good fats are olive oil not heated, coconut oil, butter and other animal fats. All are high in saturated fats and therefore long lasting as the most difficult oils to oxidize or go rancid. With these fats and low carbs at same time very little Reactive Oxidising Species (ROS) are formed which prolong the useful life of all fats in the body and hence make us healthier. Less lipid peroxidation.
    Read what Diet doctor is saying about saturated fats here: http://www.dietdoctor.com/science

  22. sten
    If you read this diet doctor article from the top you would not miss the science that says no good things about low fat diet. It is crystal clear: avoid fat and your gallstones increase in size and numbers, measured with ultra sound. Hence I recommend you to find a doctor to do just that, then measure again 6 months later, unless you have to be operated before of course.

    Copied from start of this article.
    "In a study of 51 obese people using an extremely low fat low calorie diet (just one gram of fat a day!) the gallbladder was examined by ultrasound before the diet and after one and two months. After one month four of the 51 participants had developed new gallstones. After two months more one in four (13 people) had new gallstones! This on an almost fat free diet. Three participants needed to have their gallbladder removed during the study.
    A similar study examined 19 people eating an extremely low fat low calorie diet over 16 weeks. At the ultrasound examination at the end of the study five people (again about one in four) had new gallstones.
    A third study compared an extremely low fat diet with a diet slightly higher in fat during 3 months. More than one in two (6 of 11 people) in the group eating extremely low fat developed new gallstones. Nobody in the group eating more fat did.
    Conclusion: Do you want gallstones? Avoid fat."

  23. AussieKate
    Sorry I'm late to the discussion but thought I put my oar in. I'm a 58 yr old female and had my gallbladder removed when I was 19! (low fat diet). Since then have suffered from very poor immune system, I now think this is linked.

    If you have your gallbladder removed, you must take digestive enzymes. I have only just discovered this - and it seems to work. It means that you will be able to emulsify fats properly and absorb the nutrition from your food. I live the LCHF life. If you are having huge pain, get the thing out and take enzymes. Anyone else discovered this???

    Reply: #124
  24. erdoke
    In principal lack of normal volumes of bile does not mean lack of enzymes, just that the enzymes (mainly pancreatic lipase) have no good access to the fat. Adding more enzymes can help though due to simple statistical reasons. I suggest that you check out this article:
    http://www.liverdoctor.com/what-to-do-if-you-dont-have-a-gallbladder/
  25. TRJ
    Excellent empirical discussion. I had my first attack in the summer of 2012, followed by an ultrasound which clearly showed stones. Doctor was adamant I have gall bladder removed. But resisting because of side effects of removal, I suffered through perhaps 10 more attacks over the next year, each subsequent attack getting easier to deal with. In the summer of 2013 I cut out gluten (wheat, barley, and rye) to try to deal with other issues. I have not had an attack since, but can feel subtle discomfort at times, recognizing this as passage of a small stone or 'gravel'. I have not had an ultrasound since, but feel my gallbladder is better, and am glad I still have it. I believe fat has nothing to do with gallstone creation and that refined carbs are the problem in causing my liver to create too much stone creating cholesterol as it tries to deal with the refined carb poisoning.

    LowFatWorks post seems to mirror what I hear a lot, that cutting out fast food lowers fat intake and thus results in better health. The bulk of fast food's problem is not fat but refined carb's. Pop and white bread and even fries are dominated by carbs, relative to fat. Reducing pasta and and bread reduces carbs much more than fat, so I would urge LowFatWorks to review his empirical findings. Correlating reduced fat intake to a reduction of attacks in the short term may only mean the stones are piling up in your gallbladder just waiting for that fatty meal.

    Funny; doctors seem to be now reversing. I just saw a CNN piece where the doctor says eat the butter and cut out the bread. I dont think the medical profession is even close to understanding what is good and what is bad. Empirical results for each of us independently seems a far more accurate solution if you have the time and analytical ability.

    Reply: #128
  26. BostonGal
    This nutritionist helped me avoid surgery using just foods. (Mostly beans pre LCHF diet.) From very sick to feeling great in just a few weeks.The info is worth a read. And a phone consult with her if you can (her rates are very reasonable.)

    In any case, now instead of beans for soluble fiber, I mix some Psyllium Husk Powder in water and drink it. It tastes horrible but anyone that has had gallstone pain knows that you'd do just about anything to keep it at bay. Added bonus is that it helps with constipation.

    http://www.karenhurd.com/pages/healthtopics/specifichealthconcerns/ht...

  27. Terry
    Such an interesting article.

    I wondered if there is more information about kidney stones in relation to LCHF as the article only briefly touches on it and most of the comments I have read so far are about gallstones.

    I think I get some bouts of colic left instead of right since moving to full LCHF and wondered how that might get addressed.

    Can anybody direct me please. Thanks :)

    Replies: #129, #130
  28. sten
    You write: " I believe fat has nothing to do with gallstone creation and that refined carbs are the problem in causing my liver to create too much stone creating cholesterol as it tries to deal with the refined carb poisoning."
    I agree that fat is not the problem but please also see Erdoke's short comment just above yours.
    He believes that "enzymes with no access to fat" is the problem. resulting in low bile production.
    To dissolve and transport out just the bilirubin from recycled red blood cells a minimum bile flow is required and the only well proven substance to stimulate bile flow is FAT!

    And too low fat intake means that the produced bile will be near saturation, a condition that forms stones through well known physics.
    Raise the fat quickly once stones have formed and a gall stone attack is highly likely.
    But increase daily fat intake carefully=slowly and bile volume increases slowly from a thick stone-forming liquid and thin out. And when thinned enough old stones slowly dissolve instead of increase and no new ones form. Just because the bile then is thinner or far from saturation.

    How much more fat to add ? For starters add 25% to a very low fat diet, simplest through butter or cream i sauces. After a few days without any pain increase further, else reduce to fat and try again.., and so on.

    Finally the liver is a key organ and all the non-usables it collects must be disposed through the bile into the intestine where food like vegetables, charcoal and psyllium is good as it binds to the bile and ensures minimum re-circulation of what should go out.
    But with too little fat this daily clean out reduces and poor looks and bad skin and all kind of sicknesses may follow, and if allowed to go to far the clogged up liver mast be replaced.

    Don't know if any low fat eater has had two successful liver transplants., but I believe it is possible to destroy it quickly over and over with too little fat.

  29. Zepp
    About gallstones and LCHF there are some articels!

    First.. there seems to be a slightly incres in gallstone.. at least for those on a very harsch ketogenic diet against Epilepsy.

    Its probably caused by altered PH in the kidney.. for those how is cald "stone Builders"!

    They prescripe potasium citrate for those!

    And on the other hand.. there are studies on kidneys and low carb diets.. both english and Swedish!

    here is one.. in english!

    "This study provides preliminary evidence that long-term weight loss with a very-low-carbohydrate diet does not adversely affect renal function compared with a high-carbohydrate diet in obese individuals with normal renal function."

    http://www.ncbi.nlm.nih.gov/pubmed/20338292

    And here is a case report on a swedish type2 patient with kidney damage!

    "A low-carbohydrate diet may prevent end-stage renal failure in type 2 diabetes. A case report"

    http://www.nutritionandmetabolism.com/content/3/1/23

    Replies: #132, #133
  30. Zepp
    Sorry.. I did write gallstones when I meant kidneystones!
  31. sten
    TRJ, you wrote: " I believe fat has nothing to do with gallstone creation and that refined carbs are the problem in causing my liver to create too much stone creating cholesterol as it tries to deal with the refined carb poisoning."
    I agree that fat is not the problem and please also see Erdoke's short comment just above yours.
    He believes that "enzymes with no access to fat" is the problem. resulting in low bile production.
    And I believe fat has a lot to do with gall stone creation: Too little of it keeps them growing.
    And carbs becomes sugar and sugar coated LDL must become useless and sticky like HbA1C, so much at all refined carbs are definitely bad I agree!
    To dissolve and transport out of the liver just the bilirubin from recycled red blood cells a minimum bile flow is required and the only well proven substance to stimulate bile flow is dietary FAT!

    A too low fat intake however means that the produced bile can be near saturation, a condition that forms stones through well known physics.
    But raise the fat quickly once stones have formed and a gall stone attack is highly likely.
    If daily fat intake however is increased slowly over weeks so that volumes of bile grow likewise, the bile can change from thicker stone-forming liquid to thinner unsaturated liquid not forming stones. And when thinned enough old stones can slowly dissolve and no new ones form. Just because the bile then is thinner or further away from crystal building saturation.

    How much fat to add ? For starters maybe 25% to a very low fat diet, simplest through butter or cream, maybe ni sauces. After several days without or with less pain increase further, else reduce the fat and try again.., and so on.

    Finally the liver is a/the key cleansing organ and all the non-usables it collects must be disposed of, which goes just through the bile into the intestine where food like vegetables, charcoal and psyllium is good as it binds to the bile and ensures minimum re-circulation of stuff that should go out.

    But with too little fat this daily clean out is not enough and poor looks, bad skin and all kind of sicknesses may follow and if allowed to go to far the clogged up liver mast be replaced.

    Don't know if any low fat eater has had two successful liver transplants., but I believe it is possible to destroy it quickly over and over with too little fat.

  32. Terry
    Thanks Zepp, exactly the info I needed!
  33. Terry
    Would it be fair to say based on your comments about the epilepsy diet that a diet with moderate carbs - say around 100g per day is less likely to induce kidney stones than one much lower in carbs, lets say below 50g?

    I also wondered about the harsh keto diet for epilepsy - can you explain what the parameters were for that, what did you mean by 'harsh'?

    Is there a report about it please? Thanks.

    Reply: #134
  34. Zepp
    Its not that easy.. becuse the ketogenic diet for Epilepsy differ from a normal LCHF/Atkins diet!

    Its calorie low, its very high on fat.. its very low on carbs and minimum of protein!

    For those on LCHF/Atkins for weightloss and/or diabetes they say that optimum is betwen 1,5-3 as blood ketones.. but for those on seisure control they try to have at least 4!

    Its semistarving and very high fat.. usaly they prescripe coconut oil or rather pure MCT oil!

    If one eat about 50 grams of carbs.. one often get other nutrients from veggies.. like pottasium!

  35. Anna
    heyhey, just wanted to leave the advice that people with gall stones maybe should increase the amount of fat they eat slowly. I started lchf yesterday and ate the usual amount people seem to eat on that diet and i got a major attack during the night. Just something some people maybe should take into considereation.

    cheerio
    A

    Reply: #136
  36. sten
    Anna, you are dead right!
    See comments 111, 114,128 or do crtl-F and put in slow.
    You then find most here relating to protect against gall bladder pain through slow increase of dietary fats.
  37. Michael F.
    How does the body digest saturated fat without a gallbladder providing bile?
    Replies: #138, #139
  38. Zepp
    Its your liver that provide bile!

    And the bladder is only for storage and concentration.

    And if one eat low fat, the bile can get that concentrated that it form stones or gravel by crystalisation.

  39. sten
    Zepp is right, and add this:
    Digestion will suffer as the "inline bile production" or "liver storage" of bile becomes insufficient when we digest a lot of fat in one go. (The same that before would have caused gall pain).
    Hence low fat eating that eventually resulted in too thick bile and stines causing gall pains and was "solved" with gall bladder removal will probably give some undigested fat all the way down into the escape end of the alimentary channel.
    What problems, if any, that causes is unknown or at least unresearched to me. A lack of good saturated fats makes it hard to build good brains, which would apply to young people. Fat cells also needs to be exchanged sometimes.
    If there is a correlation between gall bladder removal and dementia and/or Alzheimer's , I don't know.
  40. Michael F.
    Thanks for your answers!

    I am a person lacking the gallbladder and I'm experiencing some troubles digesting butter and whole milk, although I have yet to try coconut fat.
    Somebody has recommended taking "ox bile" supplement _before_ eating saturated fat. Would that help me with my low-carb dieting?

    In particular, I've been recommended Solgar's Digestive Enzymes: http://amzn.to/1xsGZsb

    Replies: #141, #142
  41. sten
    Michael, interesting! Maybe "ox bile" will help, but isn't it aimed primarily for grass digestion?
    Main purpose of bile is to emulsify fat being digested. So maybe you should try to find emulsified fats to eat instead ?
    The purpose of the gall bladder now becomes clearer. It is needed when our intestines dissolve food with fats in. Later in time the liver contiunes the processing also separating out the bile for reuse during the hours following a meal, refilling it (and wastes) into the gall bladder, ready for next meal to come down from the stomach. Very hard to recycle some of the bile without gall bladder, hence a vital organ for good digestion! Something the skilled surgeon was never taught? So emuslisified fats (must be better stuff there than soap !) could become a staple for the gall bladder removed. I suggest something basic, not E-number! Run the fats with water and emulsifier in a turmix and, bingo! Because of the emulsifier in the mixture the fat droplets remain in solution for a long time, enough to be digested ?
    The first natural emulsifier must be eggyolk. Hence home made Majo would be a nice way for you to digest the fats . With your liking for butter, make the majo on clarified butter. Really nice taste, nicer than on olive oil for me at least. Question is if enough water can be mixed in. Good Luck!
    I did not check the enzymes.
  42. Zepp
    Probably Bile acid/salt malabsobation?

    "Bile acid sequestrants are the main agents used to treat bile acid malabsorption.[16] Cholestyramine and colestipol, both in powder form, have been used for many years. Unfortunately many patients find them difficult to tolerate; although the diarrhea may improve, other symptoms such as pain and bloating may worsen. Colesevelam is a tablet and some patients tolerate this more easily."

    http://en.wikipedia.org/wiki/Bile_acid_malabsorption

    One side effect of Bile acid malabsorbation is gallstones how leads to gall bladder surgery in the end!

    Discuss it whit your doctor!

  43. Soleil
    Hello, I have read the comments above and would like to share my experience. I had my gallbladder removed August 2013 and had 2 stones (5mm each) removed along with the gallbladder. I initially had a stone stuck in one of my bile ducts and caused a lot of pain, I was jaundiced for about a month and somehow I was able to pass the stone that got stuck (or maybe it went back to the gallbladder I'm not so sure). I didn't want to get surgery at the time so I endured the pain from gallstone attacks (which I can describe as similar to getting punched in the stomach real hard with the pain staying for about 6 hours each time) and the jaundice - I was prescribed hydromorphone for the pain.

    Surgery was the only option since I am already at risk for getting another stone stuck in my bile duct. My surgeon said that if I wait longer and a stone gets stuck again and tears one of the bile ducts I would have to have an open cholecystectomy (which meant 5 - 8 inch cut in my abdomen and longer recovery time). So, I opted to have it removed via laparoscopic cholecystectomy which meant smaller incisions and faster recovery time. I got my surgery and when I was finally allowed to eat I was only given liquids and Jell-O. That is what I ate for a few meals until my surgeon told me to start eating soft food that is low in fat.

    After about three weeks, I decided to try to eat normally - meaning meat, fat, vegetables etc. I even had coffee for the first time in weeks. Now, my surgeon told me that each person adjusts differently to certain food and drink after gallbladder removal so I decided to see what works for me and what doesn't.

    I am able to drink coffee, milk, soda, and eat everything without any major problems, I guess I am one of the lucky people who doesn't have issues with not having a gallbladder. The only change is having to go to the bathroom a few minutes after drinking my first cup of coffee (not having a gallstone made me regular - sorry if that is TMI). The rest of the day I do not worry about my food and running to the bathroom.

    I just recently started LCHF and I am now on my 3rd day, so far so good. I have not experienced anything weird. However, I would like to say the LCHF diet has been great for me, since I have ankylosing spondylitis (AS), too (http://www.spondylitis.org/about/diet_lowstarch.aspx). I started doing LCHF so I can lose some weight and avoid the pain in my joints which I get whenever I eat starchy food.

    Overall, I would say my experience living without a gallbladder has been a good one. I do not miss my gallbladder at all especially gallstone attacks that came along with it. Each person is different and you should find out what works for you after having your gallbladder removed.

    I have been able to avoid AS joint pain since I started on LCHF. Losing weight will be an added bonus.

    Thanks for reading. :)

  44. alexpeikary
    Thank you,you have given so much information and time into your site us.It is very appreciated.
  45. Christie
    I went on an extremely low fat diet a few years ago. About 5 months in, I started having severe pain in my upper center abdomen. After many tests, it turned out that I did have gall stones, however that was not causing the problem. I had a build up of biliary sludge stuck in my main bile duct. I had an MRCP to remove the sludge. They recommended that my gall bladder be removed. I did not listen. I want to keep what I was given, if possible. I slowly added fat back into my diet. Three years later, I am pain free and still have my gall bladder. About 50% of my calories are fat today!
  46. sten
    Wow Chistie! Great practical proof for what we have said above: Too little fat and the bile flow slows and sludges up also with direct problems and making it easier to make stones. Great that you dared and suceeded!

    When more people read this blog gallstone problems will belong to the past with fad low fat diets.

    Regarding Dietdoctor: Only objection I have is the page linking system. Only use the "Permalink" in the link to the blog, below the new comment, else some old state of the blog page is shown.

    Otherwise these pages are truly life giving and giving our livers a new change to cleanse everyday through avoidung low fat diets.

  47. Julia
    I sure hope the writer is still viewing comments on this post, because I have some questions...

    1) I had gallstones 10 years ago. It was explained to me at the time that when a stone is pushed out of the gall bladder, it can get stuck somewhere and this causes the pain. I was also told that if it gets stuck in the wrong place it can be an immediate danger. Was I misinformed (or perhaps just misunderstood)? If this is correct, than it puts a new spin on the short term/long term dilemma in that, if you choose the long term, you're not just suffering short term pain, but taking a real risk.

    2) I started low-carb dieting a couple years ago. In general, I think it's been good for me. But it just occurred to me that I don't know what happens when I eat high fat (~60% of my calories) and don't have a gall bladder. Will you please explain what's happening now, how I'm digesting fat without a gall bladder?

    Replies: #148, #149
  48. Zepp
    Its your liver that produce gall/bile, the bladder is for storage and concentration.

    Mayby some cant eat to much fat in one sitting, but that you soon gonna knew.

    Yes if stones get stuck one can get an inflamation that spreads to the liver.

    But one altso can have pain by gravel that passes right thru.

  49. sten
    One solution I can see when the bladder is gone is to simulate a little what the bile is doing, since you can no longer produce a large dose when needed, without the bladder that is made for just this.
    Bile is emulsifying fat, and only natural emulsifier I found was eggyolk. (Would not try E-numbers!) So if at least part of the fat is mixed (high speed I guess) with a raw eggyolk, that fat becomes emulsified. Home made majo made on eggyolks hence fine.
    It will probably be many decades before the medical proffession stops regarding several of our organs as "unnecessary" just because teachings going back long time just did not know.
    In this sense the earth is still flat in many branches of medicine. Many more need to, like me, be helped out of "uncurable" disease (angina pectoris inmy case), maybe by (strict in my case) low carb with lots of saturated animal fats, before the medical proffession even opens their eyes.
    Good luck and please tell what, if anything, worked well for you!
  50. Phil
    If people had regular ultrasound of the gall bladder, then they would know in good time if stones were forming. Simple.

    Then, they can do things to prevent further stone formation, and repeat the ultrasound. There's nothing special about an ultrasound. It's simple, non-invasive, and usually not at all painful unless they press too hard in the affected area.

    Ursodeoxycholic acid is proven to dissolve cholesterol stones. In many cases the stones don't come back. But once again, you need screening - not guessing.

  51. Catherine
    Glad to find this article. My fiancé, male, white, 43 years old, 1m85 and 83kg with slightly high LDL Cholesterol had a very bad pain attack 2 weeks ago with vomiting. He went to hospital and they found one gallstone (2.8cm). The gallbladder is in good condition, his liver has a small amount of cholesterol on it. The Dr recommended to remove the gallbladder, briefly mentioning dissolving stone medication but said they usually only give that to older people as it takes a long time.

    He generally eats a varied diet, small amount half fat milk with cereal or porridge oats in morning or toast with nutella. Lunch a sandwich with wholewheat bread, meat and salad and then dinner meat (generally chicken) with either potatoes, pasta or rice and veg. With fruit in between. Then in the evening he has full fat ice cream sometimes and yoghurts or cookies as a treat. So he was not really on a low fat diet, but I guess high in carbs. Why do you reckon he could have developed a gallstone?

    He gets a lot of headaches and has a fairly stressful job but keeps on top of it. The Dr has said to remove the gallbladder. Since the attack 2 weeks ago I cut out fats from his diet to try and avoid an attack, lots more veg and fruits with vit c and green apples. Meals with wholewheat pasta, brown rice or brown bread for the increased fibre... he has had no pain with this so far. I have made some salad dressings with extra virgin oil and cooked sugar free cookies with coconut oil (shredded coconut, coconut oil, oats, flax seed, maple syrup). I do not want more stones to appear without adding enough fat but I also do not want to cause any pain.

    My question is am I doing the right thing with his diet and what more should I do with his diet?
    Would you recommend asking the DR for Ursodil medication to dissolve the stone as we do not want to have his gallbladder removed? Have you any experience if it is possible to dissolve a large stone with just diet or how long it can take to dissolve if taking Ursodil?

    He is also taking milk thistle tablets and dandelion tablets. We also want to reduce his cholesterol levels, I read that low bile production increases cholesterol levels in blood, is this the case? I totally understand you can not give medical advice but I would really appreciate your thoughts as I can not find a Dr that is open minded yet. Thank you very much.

    Reply: #152
  52. sten
    By cutting out fat the gall bladder removal will eventually become inevitable. The "full fat icecrem" is a mere sugar bomb what I understand, not much fat today! The side effect of a low fat diet is stagnated bile flow resulting in thick bile and more stones. Cut out sugar and increase fat SLOWLY to increase the bile flow that will clean up the liver, the "most important" organ in the body. Full fat Cream is good fat, Coconut oil and real butter too.
    Sugar makes things to stick in our bodies, just like in the pan Glycation is the name for it. Google it and see why sugar or high blood sugar is bad.
    Read the comments above in the thread. All the needed advise is already there. Good Luck!
  53. Phil
    1. Has the Chinese gallstone removal technique published in 2012, wherein the gall bladder is not removed but simply opened using special laparoscopic instruments and methods, been given much press?
    2. If a "high" fat diet is now seen as desirable, should one consider the toxic residues in animal fat, and choose, for example, organic butter? Certainly, the advice to eat fish has caused problems with mercury residues in large species fish, so there is "fish" and then there is fish.
    3. If the medically endorsed low fat diet is "wrong" and even harmful, then why are we not taking a class action against those in authority who encouraged it?
    4. How are our arteries doing on our now higher fat diet - it was our clogged arteries, not our gall bladders, which caused the low fat era. I want to keep my gall bladder, but will sacrifice it for my arteries, if need be. Arteries too can be easily easily scanned.
    Reply: #156
  54. sten
    1 ??
    2 -Absolutely yes. Especially since conventional animal feed also in EU is sold as "rations", with unknown percentages of GMO grains, including Bt toxins. Bt toxins weakens intestional walls and insects eating such grains die from burst intestines. GMO is allowed as animal feed in the EU and is here not sold directly for human consumtion except in some unchecked(?) US made packaged products.
    But the buck stops att the top of the food chain. Toxin concentrations also tend to increase higher up in the food chain, as we know well. GMO feed applies at least to beef, pork and eggs and poultry sold in all EU standard food stores, so most of us are accumulating it (and glyphosate residues ) by the day.

    3- It is only a matter of time for a class action the way I see it. When less people stop beiieve they had the bad genes or bad luck things will change. The focus on genetics seem to have a hidden agenda protecting the food industry as our genes haven't, but our foods have changed as the new diseases exploded.

    4- It seems that apart from industrial transfats (made from vegetable oils) , high blood sugar is one proven agent to cause heart disease. High LDL cholesterol may have a role, but only for small LDL-particles. If it is due to easier oxidation or glycation (high blood sugar again), it is not known, but large LDL particles have never been implicated. High blood sugars cause the liver to produce triglycerides and also small LDL particles and palmitic acid (saturated fat). The last one is the only saturated fat implicated in heart disease, What happens is not clarified 100% but it seems to me that as oon as high bloodsugar is taken out of the equation calcification stops and can even reverse!
    And high blood sugar is known to cause inflammation in the artey wall, reason it is dangeous and a necessity for diabetics to get it down to avoid to die earlier than otherwise, in just heart disease; Lifespans up to 10 years shorter than average is typical for diabetics type 2.

  55. Phil
    Re: 1.??
    Here is the reference:
    Rev Sci Instrum. 2012 Jan;83(1):015115. doi: 10.1063/1.3673472.
    Design and application of a new series of gallbladder endoscopes that facilitate gallstone removal without gallbladder excision.
    Qiao T1, Huang WC, Luo XB, Zhang YD.
    Reply: #157
  56. Zepp
    Its nothing new.. they can do it on any western hospital with sugery clinic.. but they think that one surgery is better then many.

    And if one got one stone one get others becuse people dont change there lifestyle.

    And a few is geneticaly predominante to be stone builders.

  57. sten
    There is one single problem:
    one must do it time after time on a low fat diet as too little fat in the diet
    creates sludgy concentrated bile which eventually forms gall stones.
    It is a bit like smoking and get some kind of a lungwash once in a while, if it was available.
  58. Phil
    1.Recurrence of gallstones after any measure to prevent them reforming, is always a possibility. 2.Not all gallstones are associated with low fat diet I'm pretty sure. Weight loss regimes, for eg.,which more or less involve the individual using their fat reserves for energy are strongly associated with gallstones for example. That, is not what one might call a "low-fat" diet. Rather, the reverse. Although, the fat being consumed in that case is not arriving via the usual route of the mouth.
    3.Agree with Sten that repetative stone removal while preserving the gall bladder, would be "extreme". But with ultrasound monitoring, corrections to prevent recurrence would seem a better way. Radiologists seem to be in the box seat.
    4.Ultrasound monitoring seems the only sensible approach, as it takes little time or resources, is virtually harmless and painless, is non-invasive, and respects the individual.
    5.Zepp says "they can do it now in any Western hospital" - I'm not sure that's right. The Chinese designed their own instruments for the technique, and have published a further paper more recently.
    6.In Australia, you can get your gall-bladder removed without any symptoms, so keen are doctors to do laparoscopic cholecystectomies(LCs). But you cannot get Ursodeoxycholic Acid dissolution for less than about 40 dollars a week(the capsules), because the government only subsidies UDCA if being used for primary biliary sclerosis - despite people on waiting lists for LCs having taken UDCA and dissolved their stones completely.
    7. Are LCs the "training exercise" for intending surgeons? What a notch in the belt for a beginner to be able to say....."I've done a lap-chole!"
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