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 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

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: 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:

Gallstone survey

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?

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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309 comments

  1. Sara
    I had my gall bladder removed at 21 yrs of age following sever years of pain flareups which Drs seemed unable to diagnose, after having my daughter I saw a consultant to diagnosed gall stones and whipped my gall bladder out! A few days after surgery I had the pains again and they continued to flare up in times of stress. I saw a naturopath who said it was criminal that my gall bladder had been removed - that I should now spend a life time of being dairy free and low fat unless I wanted to die of a heart attack! Great stuff to hear in your early 20s. Fast forward 25 yrs. Ive struggled all my life with weight - more bad eating habits than from not having a gallbladder. I was scared into a low-fat diet for a while but sustaining that type of diet around children and family life was unachievable. over the years I got many flareups which seemed to be more stress related than food type - even tho I believe tomato might have been my trigger food; a change of lifestyle and life partner has seen no flareups in the past 10-15 yrs however our love of good food and a relatively sedate lifestyle has resulted in the lbs piling on, however I seem to get to a point in my weight where my body tells me its hurting - generally my colon just under the ribcage seems to hurt - maybe related to the lack of gallbladder? Ive never had it checked out as it subsides if I lay off the high calorie or high processed food. I started the Keto diet yesterday and then laid awake for some time in the night worry and reliving the advice of that naturopath telling me to avoid fat like the plague! Or else! Hoping my liver can deal with the extra fat content in the diet and that im not gonna keel over with a heart attack from clogged up arteries over time like she seemed to think I would!!! SO far so good So good, Im enjoying the food and have no desire to reach for anything sweet or carby at this point. Would love to hear from other gallbladderless folks on the LCHF to see how they are managing and if the initial purpose of the diet is to loose weight and body fat should I actually consume as much fat as the diet recommends initially? Like don't sauté in the fat from the bacon perhaps to not add unnecessary fat - id really like to burn the fat off my body 1st! Haha.
  2. Marsha Duregger
    Both of my parents are diabetics and several of my siblings. I'm a nurse and have always tried to keep low carbs but by body still acts like it wants be to be diabetic. I went Keto and so did my diabetic sister and this IS the BEST way to eat for diabetics. It rests your pancreas and stops the constant output of insulin and puts you in nutritional ketosis! This is not the same as Keto acidosis. Check out Dr Fung on YouTube. He's a diabetic specialist and kidney doc!
  3. Richard
    Thanks so much for this wonderful collection of information.

    Gallbladder ultrasound should be a standard part of health checkups. It's cheap, easy and non-invasive.
    It makes perfect sense. But it would mean less income for surgeons and hospitals. So they don't do it.

    People need to start asking for it.

    Also, another related diet that doesn't get talked about much is Keto Vegan. Considering the terrible decline in quality of various foods Keto Vegan makes more and more sense.

    Close to half of us will get cancer or heart disease in our lives. That's a terrible statistic!

    Current research shows that most of that risk can be reduced by removing meat and dairy from our diets.

    "Oh I could never stop eating meat and cheese and dairy! I don't care how much better it makes me feel or how many more disease-free years I'll live."

    Hmm.

  4. Lewis
    I suffered through a couple years of gallbladder disease eating low fat which I started when I retired. The internist wanted to remove my gallbladder immediately. I guess I can understand since the attacks were extremely severe (lasting about two weeks on average and causing debilitating abdominal and back pain along with severe nausea and explosive diarrhea). The frequency was also about once every two to three months which with the two months ones giving just about enough time for me to feel almost normal. Anyway I started reading up on natural, holistic treatments and settled on a high protein, average fat, low carb, high fiber diet supplemented by ACV-lemon juice cocktails with olive oil chasers twice daily and adding lemon juice to just about everything I drank. After about a month I cut back on the ACV, kept using olive oil exclusively for cooking and occasional gulps, kept using the lemon juice (6-8 quarts/month), and stopped using white sugar completely along with using almond milk as opposed to cow milk. I also increased my liquid intake to 6-8 liters/day and stopped eating "trigger" foods (for me) like raw cabbage, broccoli, cauliflower. I lost 25 pounds in six weeks and have been gallbladder problem free for almost five years now. I still drink a LOT of lemon juice-about four quarts/month, only use sugar for baking (raw honey for all other sweetening) use only butter instead of margarine, have gone back to whole milk, and still eat lots of high protein foods like eggs, lean meat, cheese, and fish. Unfortunately I went back to eating too many carbs and have gained back the weight but have zero gallbladder problems. I was 63 when this all started so yes a lifetime of food abuse can sometimes be reversed by a focused changing of one's ways and diet. I did this in consultation with my doctor and likely would have agreed to surgery had the symptoms not gone away in a reasonable amount of time. I just feel that any surgery should be avoided if being contemplated solely for the purpose of symptom relief as opposed to getting better by acheiving and maintaing a state of being that brings balance to the systems that make our bodies work properly.
  5. Kelley
    I'm just starting to have gall bladder issues. Ive been keto for a few years with a week here or there off. Just went off for a week over Christmas and felt so bad that Ive decided it was certainly not worth it. I also had a gall bladder attack yesterday. It only lasted about an hour but I was nauseous and in pain. From reading here, I'm guessing that full on keto will help. I know I have gall stones from an mri I had last summer. I've had 3 gall bladder attacks so far, two lasting an hour or so and one that ended me up in the ER where they put me on Pepcid IV. Actually yesterday I took a Pepcid OTC and felt better although I dont know if the pain ran it's course or the pepcid helped.

    Im interested in adding ACV and lemon juice but what is the cocktail recipe?

  6. Elaine Wilson
    Hi There,

    I have been on the keto eating plan for a month now and have only lost 1 1/2 kilos. It is very dispiriting. I really advocate for the problems associated with metabolic syndrome as I have a couple of those offshoots namely: diabetes type 11, arthritis, hypertension. I am on medication for the last two. I haven't been hungry at all which makes for my 500 calorie days really easy. (twice weekly).I have had my gall bladder removed and just after the Tex Mex meal the other night I had indigestion, thinking there was a lot of fat in that meal. I am female aged 66, and live in Australia. The G.P who put me onto this diet recommended your web site. I always have black coffee with dollop cream (twice a day). I have to have Physillium husks in Greek yogurt for breakfast as I have been constipated all along. I am on Januven (Diabetes medication) as Metformin gives me diarrhea. The G.P who put me on this Keto says if it tastes sweet spit it out. Good one huh! I don't have a sweet tooth at all anyway. I exercise (fast walking) half an hour a day. Or get on my exercise bike. Just don't know what I am doing wrong!! HELP!! I am overweight by 10 kilos. Once I reach that will be in the normal weight category.
    Thanking you.

    Reply: #307
  7. Kristin Parker Team Diet Doctor
    Elaine, you can check out our weight loss troubleshooting tips here - https://www.dietdoctor.com/how-to-lose-weight
  8. Jennifer
    I am confused with the above tips on kidney stones. TIn general, to avoid formation of kidney stones, should we drink more water?? Thank you for your comments
    Reply: #309
  9. Kristin Parker Team Diet Doctor
    Just to clarify, this article is about gallstones, not kidney stones. There are different types of kidney stones with different causes.
  10. Sarah
    No essential carbs? I think you may be confused as to what a carbohydrate is. Not all carbs are from bread and dairy. Carbs are a macro nutrient found in almost all food. Balancing carbs with proper fiber is essential, but you cannot cut ALL carbs from your diet. They are found in leafy greens, fruits, and almost every other food that exist. Processed carbs have minerals, fiber and fatty acids removed, turning them into empty calories fro the most part. You can force your body to run on fat and not carbs but you still have to have a carb intake. Real foods, straight from the ground - not a factory, have carbs. Some more than others, and while gluconeogenesis will keep your body running without carbs, with no fruits and veggies in your diet you open yourself up to slower digestion and inflammation. Don’t give up on those greens just because they have carbs, just balance them.
  11. Iwona
    I have kidney stones - how it will be working with Keto diet?
    Reply: #312
  12. Kristin Parker Team Diet Doctor

    I have kidney stones - how it will be working with Keto diet?

    Generally speaking, there are several different types of kidney stones and they have different causes. Keto is moderate protein, not high protein so it generally won't cause problems. Sodas and diet sodas are one of the main causes of the most common kind of kidney stones. If you have specific concerns about the type and cause of your kidney stones, you may want to give your doctor a call.

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