Gallstones and low carb

Gallbladder

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 eating fatty foods 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 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

galla

  • 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: Avoiding fat increases your gallstone risk!

Could it be the carbs?

Instead of looking at fat as the primary cause of gallstones, perhaps we should look at carbs.

One observational study reported that eating more carbs correlated with an increased risk of gallstones. The authors reported the same trend for glycemic index and glycemic load.1

Based on this study, reducing the total amount of carbs and focusing on lower glycemic carbs appears to be a reasonable approach to lower the risk of future gallstones.

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 regularly. Theoretically, stones will not have time to form, and pre-existing stones might (if you are lucky) be flushed out into the small intestine.

The risk is that if you already have gallstones, you may get discomfort as you flush them out.

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

Does high fat food work?

It’s logical to think that food higher in fat can result in a gall bladder free from gallstones, and the science supports it. One randomized controlled trial compared a higher fat to a lower fat diet in obese subjects over the course of 6 months. 2 The Higher fat group had better gallbladder emptying and no stones developed, whereas over 50% of the low-fat group developed gallstones. This was despite weight loss in both groups.

This fits with clinical experience and anecdotal reports from those who have experienced their gallstone disease disappear on a LCHF diet. Sometimes at the expense of initial gallstone attacks though.

Gallstones and kidney stones

Let’s compare the advice we give patients with kidney stones to the advice for gallstones. We tell patients with kidney stones 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 attack initially as you pass the stone. But doctors still advise this despite the short-term discomfort as it is the better longer term solution.

The reason we give the opposite advice when it comes to gallstones might be the misguided 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, would we surgically remove their kidneys?

What do you say?

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

More

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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374 comments

  1. Debra
    I am wanting to try LCHF , and am seeing all of the gall bladder comments. I had my gall bladder out in 1998 ......so what is the verdict on high fat without a gall bladder? I am tired all of the time, need to lose 35 lbs, and have a high stress sales job( lot of time in the car and with people) I am 68 years old....and have been pre diabetic for years. Really want relief!
    Reply: #352
  2. Kristin Parker Team Diet Doctor

    I am wanting to try LCHF , and am seeing all of the gall bladder comments. I had my gall bladder out in 1998 ......so what is the verdict on high fat without a gall bladder? I am tired all of the time, need to lose 35 lbs, and have a high stress sales job( lot of time in the car and with people) I am 68 years old....and have been pre diabetic for years. Really want relief!

    You may find this PS at the bottom of the article helpful!
    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.

  3. Amy
    To anyone who is suffering from gallbladder problems... three supplements that you can use to not only stop the gallbladder pain, but also to dissolve the gallstones.

    The first one is known in the United States as a prescription medication, and it is called ursodiol. In the United States, ursodiol is very expensive. I have heard that a one month supply is upward of $400 per month in the United States. However, you can get the same medication for about 30 to $40 per month from Japan in a product called Liverurso. This medication has 50 mg of ursodiol per tablet, so, you would take six at a time in order to get the full 300 mg dose of the prescription version in the United States.

    The next product is called Like Dan Pian. This is a Chinese medicine herbal concoction that is meant to reduce what they call damp heat. It is also very cheap. One bottle usually runs about $6 on eBay. It has a number of different herbal and natural ingredients, such as different flowers and roots.

    The third product that you should look into is called chancha
    piedra. This word means stone-breaker in Spanish. It is well known to not only reduce pain caused by the gallbladder but also to help dissolve gallstones.

    Finally, another product you can use is called Rowachol. This is a German manufactured product that is also intended for gallbladder health and liver function and can help to dissolve gallstones. The price for this is about $45 for a one month supply.

    All of these items can be found on eBay. Likewise all of them work by increasing the bile flow, increasing liver health, increasing gallbladder function, and thinning out the bile. In all of these ways the gallstones are encouraged to dissolve naturally

    I am a person that has suffered terribly from gallbladder pain and gallstones. I have been to the emergency room more often than I want to admit.I have been told repeatedly to have my gallbladder removed. However, I would not accept that as the gospel truth. So, I decided to go on a quest and discover for myself what was available in the way of natural remedies for alternative 70s. And that is how I came across these four items that I have told you about here.

    I do not know if these items have in fact reduced or dissolved my gallstones. I have not been back to the doctor as I do not have any medical insurance, so I don't know for sure. However, I do know that I'm able to eat basically anything I want. I don't take advantage of that fact. I know that I need to eat better regardless of the condition of my gallbladder. but thanks to these supplements I no longer have to live in fear of eating the smallest amount of fat and knowing that it's going to send me to the emergency room later on that night. And one day just to test it I decided to have an extra-long cheese Coney with extra cheese at Sonic. yes I ate every bit, and it did not bother me at all.

    Also, the lemon juice in the water and apple cider vinegar does in fact help a lot. I do that as well along with the supplements that I mentioned above.

  4. Dee
    Just want to throw it out there that there is also another gallstone removing product called "Dissolve GS." Acupuncturists may have this or Chiropractors. You can search them online too. Wish I found this product years ago when my gallstones were really small.
  5. 1 comment removed
  6. Dee
    Did you remove your gallbladder, or do you still have it?
  7. Jennifer
    Dawn, B: I noted your entry from 2019, addressed to Amy (May 23 2019:
    "Hi Amy. I read through your post and I am wondering if the issue is not gallstones, but a low ejection rate of your gallbladder...HIDA Scan...").
    I don't know if you'll check this post but, if you do, I would love to know more. I think maybe I have what you are describing and I was hoping I might be able to dialogue on this. My GP is beginning to think I'm a hypochondriac because I keep returning to her with the very complaint you are describing. And I have gone for a few ultrasounds without any sign of gallstones. Hoping we could sidebar chat: j.fo@me.com.
    Thanks kindly! Even if we don't connect, your input here is immensely helpful and appreciated.
  8. Barbara Roberts
    Hi everyone, I suffered for years with what eventually my doctors thought was gall bladder. Got so poorly and so many hospital admissions they took it out. Result..............was not my gall bladder! I ended up 3 years later being rushed into hospital and after a scan something showed in my bowel, the ilium (small bowel), the symptoms are so similar to having gall bladder problems. As my bowel had collapsed it showed on a scan. i had 17cm removed and fortunately it could be connected again. the result this time it turned out to be Crohn's disease. is suffer from massive tiredness and a whole host of other symptoms but am trying Keto for a whole myriad of reasons. I hate keto bread, cauli rice so I just work out how many grams for carb I am allowed and just have small and rare portions of bread or rice.It is the only way I can do this. My biggest worry was the fat but this is healthy and I think you have to find your own way with this but following the rules.
    Barbara UK
  9. 1 comment removed
  10. Claude
    Hello Richard, can you possibly mention the studies you are referring too. Interested.
  11. 1 comment removed
  12. K S
    What does someone WITH kidney stones or gallstones do ?? What has been the experience?
    Reply: #363
  13. Kristin Parker Team Diet Doctor

    What does someone WITH kidney stones or gallstones do ?? What has been the experience?

    While keto can't reverse existing kidney stones or gallstones, it will be important to work with your doctor to determine the course of treatment. For kidney stones, diet advice would depend on the type of kidney stone as different varieties have different dietary triggers.

  14. Doug
    What are the implications of fasting to development of gallstones? It seems they should/would be e same as LFHC due to the fat restrictions over extended periods of time.
    Reply: #365
  15. Dr. Bret Scher, MD Team Diet Doctor
    Great question Doug. Studies show that fasting can increase the cholesterol concentration in bile, and increase the amount of bile in the gallbladder. Some observational studies suggest longer fasts are associated with increased risk of hospitalization from gallstones, and it makes sense that if low-fat diets predispose to gallstones, longer fasting should as well. However, studies that look at TRE and clinical experience from those who follow hundreds of patients using IF have not show gallstones to be a meaningful issue. Why is that? Is the risk so small that we need much larger sample sizes? Are they just not reporting them? Or does the combination of LCHF and fasting somehow protect against gallstones? Is there a certain time frame needed before we run into trouble, i.e. even a 5 day fast isnt enough, but issues arise after weeks or months of low-fat, so the same timeframe is required with fasting? All of these are potential explanations for why we don't see it as a big problem with TRE and IF, despite theory and some science to suggest we should. I hope that helps!
    Bret Scher MD FACC Medical Director DietDoctor.com
  16. Tina M
    I have spent most of my life eating low cal/carb to stay thin. I ended up getting a foot condition that caused me to put on a significant amount of weight in a short period of time (I had been pretty active and suddenly became a couch potato). I eventually found my way to the keto craze and enjoyed it because I felt full all the time without eating much. When I lost about 30+pounds I suddenly had a VERY severe gallbladder attack. I didn't know what it was at the time. Once I figured out what it was, I stopped keto, terrified, and discovered the apple juice and 1 tbsp of ACV w/mother trick to stop the attack. Eventually, I went back on it and had another attack so again I stopped. I had given up until recently I watched a video with a doctor basically saying what you did, to stick it out.

    So, I went back on keto at a time when I was having gallbladder pain daily. I've been on it a week now, eating a lot of fat even with the occasional pains and I am almost totally pain-free now a week later (w/o apple juice or ACV!)!!!

    I was scared to go to the hospital after that really bad 1st attack because from what I read, nearly all of them will tell you that you need surgery ASAP and it seemed from reading so many testimonials, you can STILL have attacks/pain even w/o a gallbladder, so I figured, what's the point? I think you're right. I think that now that it's getting a good workout, it's working better so not causing me any pain.

    Thank you!

  17. Mahesh
    Thank you for the wonderful comments and responses. Makes a lot of sense now on the subject. Cheers
  18. Brenda
    I had been experiencing what felt like a lump under my right rib cage and when I would bend over in a certain position it would bother me. I had an ultrasound which showed that I have gulls tones. Since that diagnosis I have started keto , I have been on keto for 6 months now and in the last 2 weeks I have had discomfort from the middle of my stomach to the middle of my back on the right side. Most of the time it feels swollen and bruised but sometimes I do have some pain although it doesn’t last long. Is this common or should I be concerned?
    Reply: #369
  19. Kristin Parker Team Diet Doctor

    I had been experiencing what felt like a lump under my right rib cage and when I would bend over in a certain position it would bother me. I had an ultrasound which showed that I have gulls tones. Since that diagnosis I have started keto , I have been on keto for 6 months now and in the last 2 weeks I have had discomfort from the middle of my stomach to the middle of my back on the right side. Most of the time it feels swollen and bruised but sometimes I do have some pain although it doesn’t last long. Is this common or should I be concerned?

    Please check in with your doctor for the appropriate diagnosis and treatment options.

  20. Mike
    I was also very committed to a lchf diet but the last 2 times I wen5 hardcore ended up in the ER with pain and other heart attack like symptoms which were almost definitely gallbladder related. Much as it mentally pained me to go the other direction I feel much better eating hclf but very natural diet. Breakfast is oatmeal with blueberries, some apple, and almond milk. Most other meals are chicken breast with veg and brown rice. If I’m having any digestive issues the first thing I do is to stop all supplements and keep it really simple. I suggest that for starters. Then gradually add in some fish and avocados and olive oil.
  21. Clare Spendelow
    I'm stuck in limbo waiting for gallbladder removal which has been postponed due to covid for almost a year now. I lost 4 stone 12 lbs in six months with keto and kept it off but was 24lbs from my goal when I was struck down with biliary colic and a whopping 18mm gallstone. I had suffered gut pain for years prior to this but that settled down immediately when i initially started the keto diet. Every time I try to resume keto within a week I suffer repeat attacks of biliary colic, get inflamed gallbladder and have been hospitalised twice.
    As I'm now physically incapable of eating hflc but I'm insulin resistant type 2 diabetic I literally have to starve myself to slow down wright gain. In 1 year I've put on 2 and 1/2 stone. Is there anything or anyway of tweeking my diet to suit my predicament while I wait for surgery. ( ps the consultant surgeon suggested urgent removal when I explained my dietary needs and how diet doctors keto diet had helped me as the gallbladderdiet was gonna make me put all my weightback on)
    Reply: #372
  22. Crystal Pullen Team Diet Doctor

    I'm stuck in limbo waiting for gallbladder removal which has been postponed due to covid for almost a year now. I lost 4 stone 12 lbs in six months with keto and kept it off but was 24lbs from my goal when I was struck down with biliary colic and a whopping 18mm gallstone. I had suffered gut pain for years prior to this but that settled down immediately when i initially started the keto diet. Every time I try to resume keto within a week I suffer repeat attacks of biliary colic, get inflamed gallbladder and have been hospitalised twice.
    As I'm now physically incapable of eating hflc but I'm insulin resistant type 2 diabetic I literally have to starve myself to slow down wright gain. In 1 year I've put on 2 and 1/2 stone. Is there anything or anyway of tweeking my diet to suit my predicament while I wait for surgery. ( ps the consultant surgeon suggested urgent removal when I explained my dietary needs and how diet doctors keto diet had helped me as the gallbladderdiet was gonna make me put all my weightback on)

    You may have success with a more liberal low carb diet or a modified Mediterranean diet where you aren't consuming as much fat with each meal. I hope this issue is resolved for you soon!! https://www.dietdoctor.com/low-carb/how-low-carb-is-low-carb

  23. George Legge
    I am here as I have just restarted LCHF and have felt a few twinges in the gallbladder area which is why I am reading this article. I have had gallstone issues for many years with threats of cutting it out etc. I have managed to hold on to it as I have done a couple of gallbladder flushes which gets rid of the gallstones. The first one I did I took many suppliments and a strict low fat diet (horror) but my gallbladder was then very healthy and I then drank a pint of olive oil, one teaspoon at a time. This did the flush and out popped many gallstones. I did a less intense one a few years back with the same results with less gallstones. I am going to look into doing another one. My point is this may be an option for those who are experiencing gallbladder pain. The flush is painless. Perhaps someone might know of the latest info on a GB flush ?
    Reply: #374
  24. Kristin Parker Team Diet Doctor

    I am here as I have just restarted LCHF and have felt a few twinges in the gallbladder area which is why I am reading this article. I have had gallstone issues for many years with threats of cutting it out etc. I have managed to hold on to it as I have done a couple of gallbladder flushes which gets rid of the gallstones. The first one I did I took many suppliments and a strict low fat diet (horror) but my gallbladder was then very healthy and I then drank a pint of olive oil, one teaspoon at a time. This did the flush and out popped many gallstones. I did a less intense one a few years back with the same results with less gallstones. I am going to look into doing another one. My point is this may be an option for those who are experiencing gallbladder pain. The flush is painless. Perhaps someone might know of the latest info on a GB flush ?

    Please check with your doctor for appropriate diagnosis and treatment options.

  25. Jeff Spiteri
    Regardless of whether you're high fat diet will flush the gallstones out of your system some of the gallstones may be too big to pass through your biliary ducts. Your bile is returned and recycled through your system and never expelled through a process called Intero hepatic reuptake this causes the same old bile to digest fats over and over again if the process of reuptake is not disrupted which can only happen through soluble fiber consumption the bile grows thicker and sludge year and overtime will into gallstones. Your bile is what helps break down fat and so it is extremely important to your health that you maintain and take care of your gallbladder. The process of breaking down fats through the concentrated bile in your gallbladder mitigates the absorption of cholesterol into your bloodstream when your gallbladder is not functioning 100% cholesterol and fats are not broken down properly and are absorbed into your bloodstream creating higher potential for heart issues. Beans are our highest source of soluble fiber in the human diet psyllium husk is the runner-up how far behind are oats and several other Foods soluble fiber captures bile and transfers it into the: allowing it to be expelled through your stool. Soluble fiber is an important in often neglected part of our diet for this reason. There are several other solutions to consider before resigning yourself to the surgeon's knife if your having gallbladder issues afternoon. Check out Andrea's Moritz is book The Amazing liver flush. Then it is detailed a cleanse through which you consume hey steady certain amount of malic acid for about a week either through apple cider vinegar or apple juice does help soften the gallstones then a colonic or enema is suggested before taking several doses of Epsom salt solution water in an olive oil lemon juice concoction that will trigger the gallbladder to contract pushing the gallstones into the biliary ducts that would be lubricated by the Epsom salt solution pushing them into the colon to be expelled in the morning followed by another colonic or enema to ensure all the stones have evacuated the digestive tract.
  26. Cynthia
    The third study you cited is not comparing low fat to higher fat diets. Rather, it was examining the effects of introduction of bile acids for obese people who lose weight rapidly. I am fully on the low-carb bandwagon, but I think that poor use of research findings to back up your point does not serve people well, particularly when most people do not know how to read or interpret research findings. They are depending on you—and there is plenty of good research out there to support the wisdom of a LC diet without resorting to these sorts of strategy. The evidence is growing stronger and stronger as more mainstream research test important hypotheses. I would rather have you be more tentative, if that’s what’s need right now—I’m willing to wait. But it’s misleading to cite studies that don’t really support your point.
  27. J Davis
    I am glad you addressed this. I think that stocky (fat) people are adapted to cold climates and in cold climates there is mostly fat to eat. Fat people have slow emptying gall bladders and need a lot of fat to keep gallstones from happening. They are adapted to eating fat not carbs. German naturopaths, were being fat is common, especially in the north, recommend a high fat diet to keep gallstones at bay.
  28. Lucie
    I have been doing LCHF for 6 months and very recently I had a gallbladder attack.

    I was a bit surprised as I allready am doing LCHF (very clean-whole food) and about 60 gr of fat daily (I have about 60 lbs still to loose)

    I did a dive in the science and I have 4 genomes snips which impact how I process choline.

    I added some egg wokes and choline supplements and I feel much better.

    I was wondering if there was any scientific study linking choline deficiency to gallstones formation.

    Thanks!

  29. Mikel
    Type one diabetes and have incredible results with Keto. My only drawback is mastering the exercise. My thing is long cycle rides, 80k a day for two weeks or training 80k. Low impact endurance results in hypo, then sugar then too much carbs for the day.
  30. Michelle Young
    I suffered from gallstone pain anytime I would eat solid fat from bacon, ham, steak, charcuterie etc from 2010 to 2017. I would refrain from eating it to avoid the attacks and the inevitable surgery. In 2017 I started keto and was worried about what would happen with the return of these solid fats to my diet. Well apparently the gallbladder doesn’t get involved if you remove carbs from your digestion of solid fats because I haven’t had an attack in the last 4 years I have been keto faithful. Last week I had a CT scan of my abdomen. They found…Gallbladder and biliary system: There is a stone measuring 2.5 cm, in the gallbladder. No biliary ductal dilatation present. They need to teach this in med school. There is a cure for gallstones besides surgery.
  31. Dawne
    I have no gallbladder now removed 6/7 weeks ago now.

    I was already on a low carb lifestyle to help with the pain and gallstone attacks which helped a lot because I didn’t get much pain with this lifestyle and my pain meds I took, which I reduced from what the docs prescribed as it was to much for my body.

    Now I’m still low carbing and eat about 75g per day sometimes less. I also don’t poo every day either.

    The cause of my gallstones was rapid weight loss caused by keto and low carb in the past. So be aware of this folks as it’s one of the reasons for it.

  32. Dawne
    Anyone thinking that they can get rid of gallstones through certain things like oils or supplements is a myth only surgery will help get rid of them and doing these things can make you very ill or worse.
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