Of the questions I am asked often, how to follow the ketogenic diet without a gallbladder is one of the most popular.
Since the gallbladder is known for secreting bile so we can digest fats properly, many people are concerned that you cannot follow a high-fat diet (like keto) without a gallbladder. However, this is not true. You may need to make some adjustments to your keto diet and take some digestive health supplements at first, but you can still get all of the benefits of keto after you have your gallbladder removed.
In this article, we will take a deeper look at what happens to your digestion after gallbladder removal and exactly what you need to do to follow the keto diet and get the results you want.
The Purpose of the Gallbladder — It’s Not Just A Sack of Liquid
The gallbladder is a thin-walled sac usually that is usually found between the lobes of your liver. It is essentially a bladder (storage organ) for your gall (bile).
Throughout the day, your liver will produce 400 to 800 ml of bile, which will travel down the bile ducts. If you are fasting, most of the bile your liver produces will be directed to the gallbladder where the bile is concentrated five-fold.
Once you consume a meal with fat in it and it enters your small intestine, hormones are secreted that trigger the gallbladder to release bile into the small intestine and tell the liver to increase bile production.
Once it reaches the small intestine, the bile serves many purposes including:
- Emulsifying dietary fats in a way that allows for their absorption.
- Eliminating excess cholesterol, potentially harmful substances, and other heavy particles that cannot be filtered through the kidneys.
- Protecting us from intestinal infections.
- Improving blood sugar control indirectly.
- Delivering many hormones and pheromones that contribute to the growth and development of the intestine.
After the bile makes it to the end of the small intestine, approximately 95% of it is absorbed back into the blood and recycled in the liver so that we can reuse it to digest the next meal.
Now that we have a basic understanding of gallbladder and bile physiology, a clear evolutionary purpose emerges. Although it is typically viewed as a simple storage organ, the gallbladder plays a crucial role in the making the bile more concentrated, which in turn makes the bile much more effective at the many things that this versatile substance does for us.
Unfortunately, the gallbladder isn’t always the most efficient organ — especially in the presence of a high carb and high-calorie diet — and this can lead to some serious issues.
Why Did They Remove My Gallbladder?
Occasionally, the bile will thicken up too much and gallstones and/or blockages along the pathway where it typically empties.
Gallstones can also lead to acute or chronic gallbladder inflammation, sometimes with an associated infection, which can cause:
- bloating
- nausea
- vomiting
- more pain
However, these symptoms may clear up on their own or after the patient adopts a healthier diet and lifestyle.
The gallbladder will typically only be removed when these symptoms persist:
- sharp pain in the right upper portion of your abdomen that can radiate to the middle of your abdomen, right shoulder, or back
- fever
- nausea
- bloating
- jaundice, or yellowing of your skin, which typically indicates a bile duct blockage when due to biliary disease
Other conditions that may require gallbladder removal are:
- Biliary dyskinesia. This occurs when the gallbladder doesn’t empty bile correctly due to a defect in its contractions.
- This happens when gallstones have moved to the common bile duct where they may be stuck, causing a blockage that doesn’t allow the gallbladder to drain properly.
- Inflammation of the gallbladder.
- Inflammation of the pancreas.
What Happens When You Don’t Have a Gallbladder?
When you don’t have a gallbladder, the bile that is made by the liver can no longer be stored between meals. Instead, the bile will flow directly into the intestine anytime it is produced. Thus, there still is bile in the intestine to mix with food and aid in fat digestion.
There will not be as much bile as before, and it will not be as concentrated, but there is enough to allow the digestion of fat. However, this doesn’t mean that your body will immediately adapt to digesting food without a gallbladder.
In fact, around 50% of patients will have digestive symptoms after surgery. The most common side effect is diarrhea and loose stools. This will happen because of the more continuous release of bile into their intestines, which seems to control the speed at which food flows through the intestine. Also, if you have a high-fat meal during the first few weeks to a month after surgery, some of the fat may go partially digested which can cause fatty diarrhea.
With that being said, normal digestion is possible without a gallbladder once the body is able to make the necessary adaptations. Bile will continue to reach your small intestine, but it just won’t be stored along the way in the gallbladder.
In other words, it is possible to follow your original diet after gallbladder surgery. However, you may have to make adjustments before your body can adapt to fat digestion.
Gallbladder Removal Diet — How Should You Eat When You Don’t Have A Gallbladder?
In general, most sources suggest avoiding very high-fat and low-fiber meals after surgery. If you ingest a lot of fat with a small amount of fiber in one sitting, then you are much more likely to experience diarrhea or indigestion.
For these reasons, it is best to follow these recommendations after surgery:
- For the first few days, stick with clear liquids and easy to digest foods. After that, gradually add more solid foods back into your diet.
- Eat smaller meals on a more frequent basis until your body adapts to higher fat meals.
- Make sure you have foods that are high in soluble fiber like low carb vegetables or keto bread with your meals.
- Take an ox bile supplement with your meals if you are struggling to digest higher fat meals.
By following these suggestions, you’ll give your body a chance to adapt to digesting fats without a gallbladder. Most people will be able to return to a regular diet within a month after surgery. However, make sure you talk to your doctor if you experience these symptoms:
- Persistent, worsening or severe abdominal pain
- Severe nausea or vomiting
- Jaundice
- No bowel movements for more than three days post-surgery
- Inability to pass gas more than three days post-surgery
- Diarrhea that lasts more than three days post-surgery
It is also important to follow a diet that will help optimize various blood markers like cholesterol, triglycerides, and blood sugar because people without a gallbladder may have an increased risk of developing nonalcoholic fatty liver disease (NAFLD) and other metabolic conditions. (you can read more about NAFLD and how diet and lifestyle can help reverse it by clicking this link.)
One of the best ways to improve your cholesterol, triglyceride, and blood sugar levels is by following a keto diet. And despite the fact that it’s a high-fat diet, you can still follow it if you have no gallbladder (or if you struggle with gallbladder issues).
How to Follow The Ketogenic Diet Without a Gallbladder
To adapt to the keto diet after gallbladder removal surgery, it is best to follow the suggestions from the previous section at first. Having smaller and more frequent meals, slowly introducing keto foods back into your diet, and consuming soluble fiber from a supplement, low carb vegetables, and/or keto bread will be essential strategies for your success.
If you find that your body is struggling to digest fatty foods at first, try implementing some of these suggestions:
- Follow a moderate fat diet for the first couple of weeks after surgery and slowly increase your fat intake until you are following the keto diet by the end of the month.
- Supplement with an ox bile supplement to assist your body with fat digestion.
- Take MCTs (i.e., caproic acid, caprylic acid, capric acid, and lauric acids) to supplement your fat intake. These fatty acids are much easier to digest, boost ketone levels, and don’t require bile for proper absorption.
- Consume ginger or ginger tea with your meals to help improve fat digestion.
- Make sure you are hydrated and consuming plenty of potassium, sodium, and magnesium (check out this article for specific recommendations).
Once your body adjusts to digesting fat without a gallbladder, you will most likely be able to follow the keto diet without any issues. For most people, this will take about a month.
If issues ever come up in the future, you may have to decrease the fat content of your meals, eat smaller and more frequent meals, and/or assist your body by taking an ox bile supplement.
On the other hand, is there anything we can do to keep our gallbladders?
For those of you who still have your gallbladder, you may be able to prevent the need for surgery altogether. By changing your diet and lifestyle, for example, you may be able to prevent gallbladder disease and keep future gallstones from forming.
How to Save Your Gallbladder Before It’s Too Late
The current research suggests that obesity disturbs gallbladder motility and increases the risk of gallstones. A research review from 1999 even states that:
“There is general agreement that obesity causes stones.”
What is the most well-known contributor to obesity? Excess calorie consumption.
This means that it is possible to improve and protect your gallbladder’s health by restricting your calories and losing weight. One of the most effective ways to do this is by following a ketogenic diet.
By eating keto foods and cutting out the carbs and sugar, most people spontaneously reduce their calorie intake and start losing weight without having to battle against persistent cravings and hunger pangs. This can help reduce your risk of having gallbladder issues and potentially save you from having to undergo gallbladder removal surgery in the future.
If you’d like to learn more about how to lose weight by using the keto diet, check out our most recent article on weight loss.
Putting It All Together — Following The Keto Diet Without a Gallbladder
The gallbladder is an essential part of our digestive system and metabolic health. Although it isn’t part of the gastrointestinal tract, it does secrete highly concentrated bile that allows us to digest the fat we eat.
Fortunately for those who have had their gallbladder removed, our bodies can still digest food without the help of our gallbladder. In fact, most people will be able to follow their normal diet within a month after surgery.
During that first month, however, it is important to follow these recommendations:
- For the first few days, stick with clear liquids and easy to digest foods. After that, gradually add more solid foods back into your diet.
- Eat smaller meals on a more frequent basis until your body adapts to higher fat meals.
- Make sure you have foods that are high in soluble fiber like low carb vegetables or keto bread with your meals.
- Take an ox bile supplement with your meals if you are struggling to digest higher fat meals.
If you want to follow the ketogenic diet after your gallbladder is removed, then simply follow these recommendations.
However, if you find that your body is struggling to adjust to keto dieting, try implementing some of these suggestions as well:
- Follow a moderate fat diet and slowly increase your fat intake until you are following the keto diet by the end of the month.
- Take MCTs (i.e., caproic acid, caprylic acid, capric acid, and lauric acids) to supplement your fat intake.
- Consume ginger or ginger tea with your meals to help improve fat digestion.
- Make sure you are hydrated and consuming plenty of potassium, sodium, and magnesium (check out this article for specific recommendations).
On the other hand, if you’d like to keep your gallbladder health, then adopting a healthy diet and lifestyle should be your go-to strategy. From a dietary perspective, the ketogenic diet is a healthy and highly effective way to lose weight, which means that it may be able to help prevent gallbladder disease and gallbladder removal surgery.
Whether you still have your gallbladder or had it taken out, you may find that the ketogenic diet is exactly what you need to achieve your health and weight loss goals. If you’d like to get started as soon as possible, I recommend reading through our comprehensive beginner’s guide to the ketogenic diet.
Or if you’d like to have exclusive access to meal plans, shopping lists, and expert guidance, consider signing up for our Keto Academy.
Sources:
- Gallbladder disease — NCBI
- How does the liver work? — PubMed Health
- Functions of the Gallbladder. — NCBI
- Secretion of Bile and the Role of Bile Acids In Digestion — VIVO Pathophysiology
- 5 Ways to Avoid Discomfort After Your Gallbladder Removal — Cleveland Clinic
- Bile Formation and Secretion — NCBI
- Physiology and Pathophysiology of the Biliary Tract: The Gallbladder and Sphincter of Oddi—A Review — Hindawi
- Editorial: Cholecystectomy and NAFLD: Does Gallbladder Removal Have Metabolic Consequences? — Nature
- What Is Open Gallbladder Removal? — Healthline
- Fat digestion and absorption in spice-pretreated rats. — NCBI
- How bile acids could fight diabetes — Science Daily
Thank you for posting this. I’m having my gallbladder out in May (stones) and have been a bit worried about being on a high fat diet. This gives me some strategies to get back into it after the surgery.
Just my experience — I had my gallbladder out last December, after having started keto over a year before. The doctor doesn’t believe that keto caused any of the gallstones, but rather, made an existing issue more prominent. As it turns out, my gallbladder was completely blocked and not taking in any bile — for how long they don’t know. I was determined to continue my keto diet in spite of the surgery, and it’s been surprisingly uneventful. In the first month or two, I had a few bouts of GI issues, but it’s been a non-issue ever since. My advice would simply be to give it a chance and not think that your keto diet is doomed 🙂
Great article! I had my gall bladder removed (and my husband did, too) before we started keto dieting. We have not had any issues – haven’t missed the thing (other than the pain it caused) before or after going keto. Great advice in the article though if we ever have issues! 🙂
I had my gallbladder removed 4 years ago and have had no problems with digestion. But I started the Keto diet about 6 weeks ago, and never thought about too much fat (without my gallbladder), until I ran across this website and others. I’m not fat, and I’ve been a pescatarian for 20 years, and Keto sounds like the perfect way to eat, but I still want to lose some weight, and it is NOT coming off! Too much cream in my coffee? Not enough protein? I don’t drink enough water??? Anyone else experience this frustration?
Hey Jenny,
I think this article will give you the info and strategies you need to lose weight:
https://www.ruled.me/how-to-lose-weight-ketogenic-diet/
If you have any questions after reading it through, please let me know.
Hey Jenny,
I think this article will give you the info and strategies you need to lose weight:
https://www.ruled.me/how-to…
If you have any questions after reading it through, please let me know.
> The gallbladder is an essential part of our digestive system and metabolic health. [snip] Fortunately for those who have had their gallbladder removed, our bodies can still digest food without the help of our gallbladder. In fact, most people will be able to follow their normal diet within a month after surgery.
I suggest an edit here because the gallbladder cannot be essential if the body can adapt to live without one.
I write that it is essential because, although we can digest food relatively normally a month after gallbladder removal, there are still some things that the gallbladder does that are vital for maintaining optimal health. These functions may not be essential in the short term, but in the long term, not having a gallbladder is associated with health issues (like non-alcoholic fatty liver disease and increased weight gain). So, in other words, I believe the gallbladder is essential for maintaining ideal digestive and metabolic health, but not essential for survival.
Does that make sense?
So, I had my gallbladder removed 11 years ago after having my son and have since developed NALF, diagnoses 8 years ago. I tried low carb a few years ago but didn’t find much success. I tried again, started a month ago, and have been enjoying great success, lost weigh, my knees felt great, my body shape was changing, felt good all over…til two days ago.
My body is one of the few that still develops common bile stones without a GB. I had three attacks within 2 days, so more like 2 preemptive strikes and then a full blown attack. Took morphine, went to the hospital. Two days later diagnosed with pancreatitis. I didn’t tell them I was on Keto as I didn’t want a lecture. I will say that my fibre intake probably wasn’t what it should be, just the day before it all happened I started on fibre supplements. To make a short story long, have you heard of complications such as pancreatitis with Keto and no GB and or NALF? I felt great eating Keto, lost 13 lbs and was convinced this was a a great lifestyle change and not a diet that you would lose on and then go back to “regular” eating. I also have a gluten intolerance (again can be related to no GB and NALF so I’ve been told) so it wasn’t too difficult to fully commit. (I miss apples though) any thoughts on the Pancreatitis? I’m lying in bed on T3’s, only thing that brings relief. I’d love to continue with the lifestyle, I will look into ox bile (where would one get that in Canada?) , I just want to know if this is a good plan for someone who now has issues with her pancreas, liver and no GB. Thanks for listening, patiently awaiting your learned response (absolutely love the website, by far the best Keto resource I have seen)
Hey Tannis,
I haven’t come across any recommendations for your specific condition, but I do know that pancreatitis can be caused by the gallstones, and having no gallbladder can increase your likelihood of having a fatty liver.
Supplementing with ox bile shouldn’t cause any harm (you’ll probably be able to get it at any supplement store in Canada), and make sure you are eating plenty of low carb veggies:
https://www.ruled.me/best-low-carb-vegetables-ketogenic-diet/
If the problems persist while you are on the keto diet and following the suggestions in this article, then a lower fat diet like a paleo diet or Mediterranean diet may be helpful for you.
I hope this helps. Wishing you a speedy recovery! If you have any other questions, please let me know.
I recently read that if you have no gallbladder, it is best to avoid drinking liquids a half hour before/after meals. Thoughts?
I had my GB removed in 1989. I haven’t had any noticeable issues but always wonder about maximizing nutrient absorption
There is no research to back this up, but I can see how it may have some impact. At this point, I think that self-experimentation is probably the best way to find out if it actually makes a difference for you.
Well I had to have gallbladder surgery last Sunday when it all just came out of the blue. I’ve been on low carb since February (roughly 6 months) and lost about 25 lbs but I guess it was enough to prevent gallstones from causing inflammation and that intense pain. So now I need to think about the future. I have IBS already so losing my gallbladder will certainly increase the possibility of diarrhea so I’ll have to be careful not to create new triggers. My sister had hers removed a year ago and recently was diagnosed with NAFLD so something to keep an eye on.
Wishing you the best! If you need help with anything, please let us know.
Thanks and here’s an update. I got off low carb for awhile and of course gained the weight back so last September I went on Keto and IF. Yes there is the diarrhea but I also lost 27 lbs and have stayed in the mid 160s. But my doctor wants me to get off of it because he checked my lipids and total cholesterol was at 221 (was 161 July 2020) and LDL jumped to 157 (from 92 July 2020). Triglycerides dropped to 62 and HDL stayed at 52. Would not having a gall bladder affect the numbers? If so, what can I do to drop them?
Thanks for the update, and congrats on the weight loss!
I’m thinking the best bet for improving your cholesterol levels is to replace some of your saturated fat intake with minimally processed sources of monounsaturated and polyunsaturated fats. Increasing your soluble fiber intake may be helpful as well.
For more information, I recommend checking out the “What to Eat If Your Cholesterol is Rising on the Keto Diet” section of our keto and cholesterol article:
https://www.ruled.me/the-ke…
Another good resource is our keto Mediterranean diet guide, which will give you a better idea of what a lower saturated fat keto lifestyle looks like:
https://www.ruled.me/ketoge…
I had my gall bladder out 7 years ago. I’m doing keto again and overall love it, it is the most successful I have ever been with a diet as I can manage to be low calorie when I have high fat content that makes me feel full.
However, I am having recurrent issues with bile reflux attacks. It always starts with subtle radiating pain the night before that isn’t bad enough to notice except in hindsight, and then I wake in the middle of the night with horrible pain, and bile reflux in my throat.
My first 3 month period doing keto, the attacks only occurred if I got too strict doing keto, like if my ketosis meter read 1.9 mmol/L or higher and I had been doing 15-20 grams of net carbs. But now, I am barely even a week into doing keto, my ketosis meter only said 0.5 mmol/L in middle of the attack and wasn’t in ketosis at all the morning before, and I ate 30 grams of carbs.
Eating white (high carb) bread helps prevent an attack when I notice the pain signals in time, and helps stop a bile reflux attack although I still feel pain for hours.
I’m beginning to think I need at least 50 grams of carbs to avoid bile reflux and pain, which isn’t really keto anymore.
I have a biology degree and found your article very well researched. My personal opinion is that maybe I am eating too late, my liver is being stimulated to produce larger amounts of bile due to my high fat diet, and while I’m sleeping that bile is able to travel up through the esophageal sphincter and cause me reflux. But the fact is that even if I didn’t have reflux, I would still have the pain symptoms. So I am worried I’m going to have to give up the keto diet in order to be safe. Any advice is welcome. Thank you.
Based on what you said, my thoughts as to what is happening align with yours.
However, these are some changes that might help without having to stop keto:
-eating a smaller meal at dinner and biasing most of the daily macros to earlier meals
-eating more smaller meals throughout the day rather than 1 or 2 big meals
-increasing fiber intake with each meal (while keeping net carbs low)
As with the other articles on this website, keep in mind that this is intended for general informational purposes only. For all matters relating to your health, it is best to consult with the appropriate professional. 🙂
If you have any further questions, let me know.
A question about “approximately 95% of it is absorbed back into the blood and recycled in the liver”… It is common to read that if the bile is reabsorbed, then the “harmful substances, and other heavy particles” will be reabsorbed too. Thus the advise to eat soluble fibers (that you also give).
Is it indeed the role of soluble fibers: binding to the bile so that it can be eliminated instead of recycled?
When soluble fibers are eaten at the same time as fat, does the soluble fiber binds to the fats and prevent the assimilation of part of it?
Sorry for the delayed reply, Xisca.
From the research I’ve read, some of the harmful substances may not be reabsorbed or they are rendered relatively inert by the bacteria in the small intestine before being reabsorbed.
Regarding soluble fibers, the answer to both of your questions is yes. However, the soluble fiber will only prevent the absorption of some of the bile, fat, and cholesterol.
If you have any further questions, let me know!