Gallstones and low carb
, medical review by Dr. Bret Scher, MD
in Gallbladder disease, Potential LCHF problems 
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
- 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
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.
Gut 2005: Dietary carbohydrates and glycaemic load and the incidence of symptomatic gall stone disease in men [nutritional epidemiology study with HR<2; very weak evidence] ↩
International Journal of Obesity Realted Metabolic Disorders 1998: Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well).[randomized trial; moderate evidence] ↩
375 comments
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.
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.
"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.
Barbara UK
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.
Bret Scher MD FACC Medical Director DietDoctor.com
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!
Please check in with your doctor for the appropriate diagnosis and treatment options.
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
Please check with your doctor for appropriate diagnosis and treatment options.
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!
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.