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?

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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287 Comments

  1. drae0879
    The drinking more water will help flush OUT the kidney stones that are already present. Hence the kidney pain. Read it again, slowly until it makes sense.
  2. drae0879
    I found out I had gallbladder issue from eating fresh avocado. I'm super sad about it! I now have random attacks depending on the type of fat I ingest. I'm starting Keto today so I am not sure which to do, gradual carb decrease and higher fat intake or just suck it up and go right into it head on. I personally do well bull in China shop style. I take 1/4 cup ACV with organic lemonade and ice for my gallbladder attacks.
  3. Maggie
    To my shock, my primary physician diagnosed me today with gallstones, after requesting an ultrasound on a nearby organ. (Tech forgot to include number and sizes with report, I cannot provide for you.) Absolutely symptomless. I looked up alternative remedies (none) and the (FRIGHTENING!) options (my favorite: "after removal of gall bladder, there were no recurrences of gallstones.") Terrific logic there!--Then I looked you up. (I have been on Keto for three weeks now--yay!)

    Thanks for including the studies with your hopeful reports and anecdotes. WHAT a comfort to me! Will print out and take to specialist when I go see on my first appt.

    And I will keep up Keto, and let you all know the outcome as this goes along!

  4. Delores
    Hi Tammy, Have you found the ox bile to help? I also had my gall bladder removed several years ago and would love to know if this works. Which brand did you use? Do you take it at the beginning of the meal? During the meal? At the end? Thanks!
  5. Hector
    So you say you were raised that way, because you're parents were diabetic. It sounds a bit weird. What country was this? I ask because I'm almost 50, and since my earliest memories from childhood I can remember relatives struggle with diabetes, including my mother went I was a teenager. I NEVER saw or heard of them receiving advise for a really low carb diet, just to avoid the "unhealthy" carbs and to limit total calorie intake (a calorie is a calorie), plus avoiding fat like the plague. In fact, the advice went progressively more permissive in terms or carbs and more restrictive of fats! Didn't help much. She only got some 2 years of "remission" to then come back with a vengeance, pills, more pills, and then insulin, and yes, my mother had terrible attacks of gallbladder stones after several years of such wonderful advice. And to loose weight while on insulin she had to almost starve herself, and the cravings were painful to even watch, like a heroin addict trying to stop "cold turkey" (well, not THAT bad, but still.) There is no such thing as "essential carbs", that's a fact. That there's a significant number of people maintaining such diets consistently and successfully for DECADES is also a fact. I don't believe in on one size fits all approach to nutrition. Some people are obviously able to metabolize carbs better than others. Live and let live!
  6. AngieBernard
    Hi my name is Angie
    I was diagnosed with gallstones back in march but before that in February I had some very nasty pains that made me go on a struck diet of not eating any fried food at all, I would make me a lot of soups with mainly salary carrots onions and some chicken, drink lots of water no soda, no dairy, a lot of plain oatmeal and I lost 10 pounds in a month. The pain decreased but I was still having some discomfort. I did drink diluted apple cyder vinegar and that helped for the pain and for the weight loss as well. I decided to go see another doctor and he sent me for the ultrasound which showed the stones. Ok so my pain has been lingering I have not had a very painful attack since February but th pain was still there like on background mode. I work in the ER ion a hospital and you can imagine how many patients present with pain and get diagnosed and have their gallbladders removed. It's like sigs all over the place for me to decide to get my surgery. I finally decided to do it. I have it scheduled for the end of the month. I am not 100 % sure I want to do it after reading about so many stories about what appens after you. O longer have a gallbladder and I am so scared!! Over the past month I have not been watching what I eat anymore and have gone back to eating high fats good ones and bad ones ( less of these of course) and I even incorporated the spicy Mexican foods that I love. I did start cooking with olive oil and I am pain free I am almost terrified. Could it be that now that I am eating more fat my bile is flowing better but I'm the back of my mind I know the pain can come back any time. I don't know what to do? Should I cancel my surgery? I've been arguing with people in the er over the fact that you do need your gallbladder? On top of that I work graveyard and the heart problems are more prevalent?? I don't know!!!
    Replies: #283, #285
  7. Carmen Prince
    I came into LCHF with gallbladder pain. I increased the intake of fat. Every time I experienced pain I would eat a handful of cooked legumes (at the advice of my nutritionist). Within minutes the pain was gone. Within days I no longer have gallbladder pain. Try this before considering surgery.
  8. Amber
    Bill...you're a real pill.
  9. Chris
    I started the LCHF diet in April and have had some great success with it.
    Fortunately and unfortunately in July I ended up in the hospital and was diagnosed with gallstones. Surgeon suggested surgery and out came Ms. Unhappy Gallbladder.
    I'm not going to blame the LCHF for the gallstones though, I'm actually going to thank it.
    I've had "attacks" for almost 20 years, and every time I went in to my Dr. or Urgent Care, I was turned away with the advice to pick up some Antacid pills and take them regularly. Heartburn/acid reflux is always what I assumed the pain was.
    Thankfully at the ER visit they did more than just poke at my stomach and had an ultra-sound done to see what was going on in there.
    So, after years of misdiagnosis, I can go attack free.
    Post-surgery I have returned to the LCHF diet with minimal issues. Mostly an unhappy stomach when I eat the wrong thing (bacon) and occasional sudden trips to the bathroom so far.
    But I'm optimistic about being able to stay on this diet for a while longer. :)
    Reply: #268
  10. Kathryn
    About 5 years ago, I lost 10 kilos on a low carb / high fat diet, but suffered with pain, which on one occasion in particular was so excruciating that I could hardly bear it. I also suffered vomiting on two occasions after eating. I had no idea what was causing this at the time. Eventually I returned to a high carb diet, mostly because of a lack of willpower, not because of the pain and vomiting.
    A week ago I began the LCHF diet again and have again felt similar symptoms but much milder this time, maybe because it is early in the diet and may get worse as I lose more weight?
    Anyway, the point is, after reading many sources, I have realised that it is most likely Gallstones, which I most likely already had due to my high carb diet for many years, and that the pain I experience while on a LCHG diet is the stones being flushed out. Therefore I am determined to persevere with the LCHG diet now I know that the diet is not the cause of it, but could be the remedy. Am I right in my conclusions? I do not wish to have my Gallbladder removed.
  11. Darlene
    For people who have been diagnosed with gallstones and are contemplating having it removed, they might change their minds when they realize that having the gallbladder removed is not a guarantee that they will have no more problems. One of the side effects of removal of the gallbladder is on going diarrhea for a percentage of people. In fact 40% of people have some issues after removal of their gallbladder. Another treatment for getting rid of gallstones is to do a gallbladder flush using apple juice to soften the stones or a low carb alternative is malic acid in powdered form and Epsom salts and a EVO oil and pink grapefruit mixture to open the ducts and flush the stones out. I have done it three times after being told I needed to have mine removed and I still have it today. It is not a very pleasant thing,but better than losing my gallbladder. You can find the procedure online and need to do it the way they say to prevent gallstones getting stuck. The malic acid prep is essential. That is a 6 day preparation period.
    Replies: #269, #276
  12. peter
    "a few people who have experienced that their gallstone disease disappeared on a LCHF diet. Sometimes at the expense of initial gallstone attacks though."

    after went to high fat, i had my first gallstone attack, does that mean if i hang on the pain for awhile, the stone will shrink or disappear?

    i know these stone developed over many years, if high fat can cure it i dont mind some pain

  13. peter
    i think some people make a mistake, high fat = high potent, and they ate too much animal potent, and this is why it make the gallstone worse

    i think that high fat can mean anything, you can put some butter on vegatable or baked potato, and it can call high fat

  14. Lara
    I had a few twinges of pain in gallbladder area and also between my shoulder blades when I first began a keto-paleo type diet last year. This was just at the start however, and then the symptoms subsided. I'm guessing that my gallbladder was just flushing itself out as my fat intake increased. I'm also prone to kidney stones and so avoid such as almond flour, brazil nuts, spinach etc which have a high oxalate content. I drink loads of sparkling spring water with lemon juice in daily also to prevent stones from forming (lemon apparently boosts citrate levels in the blood which keeps minerals in urine from crystalizing.)
  15. nat
    I am 8 weeks post op, never ate low fat, been healthy fats for many years, still got gallstones, likely genetic...
    Back on paleo/low carb and fat back up to 80+g thanks to Ox bile and enymes and removing the blocked gallbladder has removed most of the symptoms/issues.
  16. di
    I was doing the LCHF diet and in one month had 2 bouts of constantly running to the bathroom over a period of 3-4 days that left me dehydrated and in the hospital with them wanting to take out my gall bladder, I felt so great while on that diet, I have autoimmune and going back to normal lower fat diet even with just following paleo I am feeling horrible with joint pain, swelling and trouble sleeping again....I'm going to give this another try
  17. Nelly

    And does anyone else without a GB have sudden needs to "go"? I hope there is something to take to do the work of bile

    And does anyone else without a GB have sudden needs to "go"? I hope there is something to take to do the work of bile

    Richard, I had gallstones and my primary doctor prescribed Ursodiol 300mg I took for a year twice a day and also my naturophatic doctor gave me digestive enzymes, probiotics and liver support supplements and I don't have any gallstones now in my last ultrasound. Ask your doctor for this Ursodiol capsules there are salts that helps dissolve the gallstones with prescriptions. I am free now of stones and follow an anti-inflammatory diet because I have arthritis, but with this diet I eat more salmon, fish, turkey and chicken and the good fats.

  18. Claire
    Hello Chris,

    It's funny you should mention bacon, because that seems to set me off. I don't know if it's connected but I have had some unpleasant stomach upsets in the way of vomiting since July when I started LCHF. It was very acidic and mainly bile. I couldn't understand it as I was expecting to have less acid. No pain to speak of. This has happened a number of times and now I'm writing everything down to monitor it. The most recent vomiting was bacon related five hours after eating, it does seem to be an excess of bile upsetting the stomach. Heartburn followed by immediate vomiting. Heartburn symptoms are very few now. Out of interest has this ever been a symptom of yours? Was wondering whether to get it checked out, but afraid the GP would say go back to LFHC! That ain't gonna happen!

    Reply: #275
  19. Sue
    I did that years ago and was amazed at all the little green fatty blobs that I passed. The book I read suggested those where gallstones.
  20. Kevin O'Keefe
    Maggie, my mom had her gallbladder removed for gallstones in the 1950's. In the 1970's and 1980's, she had to have bile duct surgery every 4 years or so to remove stones and sludge from her blocked bile duct. Sure, no gallbladder to collect gallstones. But that is no guarantee that they don't happen or get stuck in the bile duct!
  21. Kerry Clayton
    I know I have gallstones they have been inactive for years. This past month I have been having problems with my gut and both my doctor and naturopath have told me to continue LCHF and that's what I've been doing. Last night I had to have my old (I'm 68) appendix removed. I've really been suffering for a month now and believed also it was my gall bladder. I'm on the firm belief now that it was appendix all this time. Only time will tell.
  22. John Wort
    Hi, My brother recently had his gallbladder removed because of gallstones. I tried talking him around having followed LCHF for a number of years but to no avail. The problem is I sent him articles like this and his response was there is no way his diet was low fat !Very true. How does a diet high in carbs, sugar and fat from processed foods affect the gallbladder? Do the carbs/sugar affect the secretion from the gallbladder?
    Thanks.
  23. Kim
    Gall stones run in my family. My grandfather, mother, aunt and sister have all had their gallbladder removed by age 45. all of them followed the guidelines, lots of bread and pasta, no butter. I'm the odd one out 50yrs with a happy gallbladder. I grew up watching Julia child, the galloping gourmet & yan can cook. Butter is basic and healthy. Olive oil runs in my veins.
  24. J. Lance De Foa, MD
    Laying prone on one's stomach after a fatty meal will allow any gall stones to fall away from the opening of the gall bladder where it drains into the common bile duct. That way the stones won't act as a ball valve preventing the bike from being ejected. When fresh bile is produced by the liver and stored in the gall bladder the stones may begin to slowly dissolve. Each time the bile in the gall bladder us emptied then refreshed the stones can shrink.
  25. EM
    Pork, amongst a few other foods, are not recommended for those with gallstones. There is one old study out there claims this and it’s often cited in books and articles like, Sandra Cabot’s book on maintaining health of the gallbladder. Check it out, iif you want to keep your gallbladder. Hope that helps!
  26. Rhonda
    Darlene,
    Please tell us where you found the protocol for the gallbladder flush. Thank you.
  27. Elkiara
    I was diagnosed with gallstones after a year of thinking that I had acid reflux/heartburn problems (diagnosed by a doctor who didn't want to look into the issues) and limiting my intake of citrus foods that actually help digestion otherwise...
    I had 3 attacks that happened 2 weeks apart each time because I was stressed out after a break up and had bad eating habits. I met a first surgeon who stressed me out by wanting to cut the gallbladder out. That afternoon, I had a super short gallstone attack after just having a peanut butter sandwich and banana. He wanted to have it cut out the next week!
    Since I wasn't sure for this surgeon's way of going about it, my doctor recommended me to another one. She said he'll probably want to cut out the whole thing too. Fast-forward 4 months and he's harassed my mom and I to make me meet him to schedule a surgery date. I said no thanks and he said he'll see me in the ER. Very rude unfortunately.
    In these last 4 months, I cut out heavy carbs and limited my unhealthy carb intake. I didn't go high fat, but I kept eating fatty foods in good doses and with hot tea (chamomile/green tea) to help melt the fat. No attacks so far and I'm planning to continue this way for as long as I can. So far, I've lost a lot of weight, haven't gotten a cold and feel amazing. I will accept the challenge set by this last surgeon. I'll do anything to heal my body without cutting it out. Thank you for this page, I don't know how the future will be, but I'm a very happy person now and I hope to keep all my organs intact like this. :)
  28. Sanna
    Hello!

    After initial good beginning on LCHF (keto), I started to feel lousy on week 5. Sharp pains on lower-right, acid, nausea and bloating suggested gallstones.

    This makes great sense, because I started to get more hungry (54kg woman, 2700kcal intake on worst days), no satiety with more fat (75-80%). Low bile means low utility of fat aka less energy (and by that time I should have been steady fat-burner). Also have struggled with constipation since day one even with 30-40g fiber and lots of water. Low bile is also to blame.

    This is week 6 of LCHF, have started to soften stones with lemon and apple vinegar, feeling better and energetic. Aiming to do the flush in a weeks time.

  29. karen
    I had been using the Dukan Diet somewhat successfully for the last few years. That is a very high protein/lowfat diet. Within months of completing my first 4 month session of this diet, I had to have a 15mm kidney stone removed and have had stone attacks about every 3-4 months. About a year after the second session of the diet, I had a gall stone attack and had to have the gall bladder removed. It certainly seems that the above is true based on my anecdotal evidence.
  30. Jean
    After being keto for 6 months I had a gallbladder attack. Funny thing was it came and went. Never heard about it again. It's been 12 months. I suspect it was just an adjustment. If I'd raced off to the surgeon no doubt I'd be minus a gallbladder.
  31. Mickey
    Hi..just started 2nd week of diet challenge. I had my gallbladder removed when I was 30 (..Runs in the family). I am now 77 and having no problems with this diet so far. Finally a diet where I finally have no hunger pangs. Love the recipes. I don't have a lot of weight to lose( maybe 15 lbs. max) but want this for the health advantages. I do have diverticulosis and so far no flare ups at all. My husband has joined me on this and he does need to lose a significant amount of weight so I will keep both of us on it and see how we do.BTW..no gallbladder issues at all ..ever..after surgery. I was so thankful to be rid of the pain.
  32. Cindy
    This was written in 2012, have there been any studies since then that do a comparison between LFHC and LCHF and the number of stones?
  33. Dara M'chelle Ragan Mosher
    Have you had any success in keeping your gallbladder?
  34. Ian
    The article mentioned that those with kidney stones get better advice, though there doesn't appear to be many articles, if any on this site?

    I had a kindey stone 3 months after starting low carb which I understand could have been there already.

    From scans at time I was told i had 2 more stones which decided to both come out together needing surgery to remove.

    If that's the last of the stones, it will be an interesting test to see if I ever develop any more in the future now that I'm low carb.

    In the past 2 years i was consuming a lot of lemon water and a bit of apple vinegar which had apparently reduced the size of the stone, down to an uncomfortably large 8mm.

  35. Dorine Garcia
    Hi Angie,
    my name is Dorine. I know exactly how you feel. I had my first gallstone attack 4 days ago and ended up in the ER. Naturally the Dr. said I needed to get it removed. I can't bare the thought of having surgery! I'm still not sure what foods I can or can't eat. So many web sites and doctors say different things. I'm following a low fat/low cholesterol diet now and so far so good. But now I hear I need to eat more fatty foods!? I don't know what to do. I pray every night that God will heal me from this. I hope your doing well. God Bless You
  36. Jane Brown
    I found Questran fixed the urgency and loose stools following removal of my gall bladder. Took it for a few months and things settled down. That was 25 years ago
    Now I'm eating LCHF and have lost 10 kilos. I feel great and have loads of energy.
  37. Sarah
    I'm 67, I was told I had gallstones about 10 years ago no symptoms, they found them by accident. No surgery. Fast forward. I have now been Keto for 4 1/2 years had my first acute gallbladder attack last week. 12 hours of 9-10 pain! I have been using ACV and lemons for months. Did my gallstones shrink due to LCHF and one was small enough to fit in the bile duct? I want to keep my gallbladder I already have problems with diarrhea, thank you.
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