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?

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Other health problems

LCHF för nybörjare

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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124 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/
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