About Doing Keto Without a Gallbladder

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Written by Vanessa Roberts, Keto Expert and medically reviewed by Abby Courtenay

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The ketogenic diet is high fat and low carb. It attempts to match the body’s response to starvation by eliminating carbohydrates. There is no doubt that going keto is an effective weight loss strategy. Those who have tried this way of eating and seen results will agree with me.

However, is it safe to go for a keto diet if you don’t have a gallbladder? Read on to find out more about doing a keto diet without this organ.

 

What is the gallbladder?

The gallbladder is a small organ whose function is to store the bile produced by the liver. Then, when the body needs this bile to digest food, the bile is released into the intestine. As such, the gallbladder is part of our digestive system, and it's situated below the liver, on the right-hand part of the abdomen. The gallbladder resembles a pear in shape.

Gallstones, inflammation of the gallbladder, and polyps are common problems that can occur in this organ.

 

Can you do the keto diet with gallbladder problems?

The possible problems of the gallbladder include blockage, stones, infection, or inflammation.1 The gallbladder may also suffer from congenital defects which cause it to function incorrectly.  Some of these problems may lead to surgical removal. But, some of you may live with these gallbladder problems. 

Doing keto with gallbladder problems is possible, just like doing keto after the organ has been removed. The key is to introduce the diet slowly or start it once the problem is solved.

For example, let’s say you have gallstones. Pain can occur while you eat fatty foods. Some doctors do not recommend high fats as they can give you severe pain when consumed while having gallstones. If you wish to go keto, it is best to go slow and gradually reduce carbs while increasing the fats slowly. If you find it difficult to bear the pain, avoid high fats. The best is to get your gallstones removed or dissolved before starting your keto diet.

 

About keto and gallstones

Gallstones are hard, stone-like bits of bile that can form in your gallbladder, the organ that stores bile. Bile, an effective fat emulsifying fluid, is made from cholesterol by the liver.

A healthy gallbladder releases bile when it is needed to help digest fat. Proper fat digestion is essential for fat absorption and utilization by the body for energy.

“Eating fat leads to gallstones.” True or false? 

This is a myth. So going keto will definitely not increase your risk of developing gallstones. In fact, it may help to reduce your risk.

Research indicates that eating too little fat and too many carbs can actually lead to gallstones. If you do not consume enough fat, bile sits in your gallbladder losing water and thickening. As bile stagnates and thickens, this can lead to gallstones.

The formation of gallstones can block your bile ducts. This can lead to abdominal pain, vomiting, nausea, inflammation, and indigestion. 

 

Does keto cause gallstones?

If you are following a healthy keto diet by limiting saturated fat, processed foods, and refined sugars, then you are not at an increased risk of getting gallstones. 

The following can have a protective effect against the development of gallstones on keto:

  • High intake of monounsaturated fats like olive oil and fish
  • Fiber in the form of some vegetable proteins
  • Plenty of fruits and vegetables
  • Moderate intake of coffee and alcohol 

Consuming healthy fats while avoiding sugar and other refined carbs promotes gallbladder contraction and prevents gallstones from forming.

 

Can keto mess up your gallbladder?

Keto is a low-carb, high-fat diet. Consuming fats will promote the normal function of the gallbladder, i.e., releasing bile into the intestines when you eat fat. This will help in digestion and absorption of nutrients. Therefore, going keto will not mess up your gallbladder. 

 

How to prevent gallstones on the keto diet

Choosing the right kind of fats is an important step in preventing gallstones, together with the following:

  • Ensure healthy calorie consumption to prevent gallstones. Since obesity is a risk factor for developing gallstones, watch your weight. 
  • If you are a diabetic, keep your blood sugar level in check. Avoiding empty calories like refined sugars can keep you protected from gallstones. 
  • Eating a balanced mix of plant-based keto foods like nuts, veggies, fruits, and fiber along with healthy fats with little or no red meat can lower your risk of developing gallstones.
  • Don’t lose weight too quickly. Losing weight rapidly can increase your risk for gallstones. Research suggests that ursodeoxycholic acid and diets higher in fat can prevent gallstones during weight loss.2 Ursodeoxycholic acid is a capsule used to dissolve gallstones in patients whose gallbladder is working, as well as in treating primary biliary cirrhosis.

 

Can you do keto without a gallbladder?

The ketogenic diet is demonstrated to be an effective way to lose weight. However, keto is not without side effects, particularly if you don't have a gallbladder. This is because the gallbladder is involved in the digestion of fat, your primary food source on a keto diet.

Let's take a look at how the gallbladder works.

The gallbladder's job is to store bile, a liquid made up chiefly of bilirubin, bile salts, and cholesterol. Bile aids the work of the digestive system by breaking down fats.

Prior to eating, your gallbladder will be full of bile. When you start eating, however, the gallbladder begins to contract and squeeze its accumulated bile out through the biliary tract, until the gallbladder is empty.

Next, the bile travels to the duodenum, the first part of the intenstine, where the bile mixes with food. This helps to digest the food you've eaten, particular the fats.

Going keto right after gallbladder removal can be a little tricky, as your body has to adjust to life without a gallbladder first. 

So, what happens when it is removed? 

As there will be no organ to store and release bile when we eat fats, our digestive system has to adjust to the bile being secreted whenever the liver produces bile. Until your body adapts, you may experience loose stools or diarrhea at this time. 

The good news is that keto is possible even without a gallbladder. However, you have to start your diet plan gradually. 

Minor adjustments will be needed to help you digest food and absorb the nutrients. The gallbladder is not an essential organ. Your body will gradually adjust and compensate to digest food even without secretion of bile at the right time. 

The ketogenic lifestyle is not a good option immediately after gallbladder removal. However, with time you can gradually introduce a high-fat, low-carb diet. My advice is to speak to your doctor first, before going for major dietary changes. 

What are the side effects of keto without a gallbladder?

Starting keto in order to lose weight is a modern trend. Once you enter ketosis, your body will start to use fat instead of carbohydrates as fuel to give you energy. 

You may not have a gallbladder due to many reasons. For instance, if your gallbladder has been surgically removed (an operation called a Cholecystectomy), this may be because of:3

  • Large polyps in the gallbladder
  • Cholelithiasis (gallstones in the gallbladder)
  • Choledocholithiasis (gallstones in the bile duct)
  • Pancreatitis (pancreas inflammation due to gallstones)
  • Cholecystitis (gallbladder inflammation)

If you are without a gallbladder, do you ever wonder whether a keto diet is a good choice for you? 

Probably, soon after your gallbladder was removed you were advised to consume a low-fat diet by your doctor. After your body adapts to digesting without this organ, you can consult with your doctor about beginning a slow transition with keto. 

Initially, your body may struggle with digesting fat and you may experience loose stools or diarrhea, which should resolve after a few days or weeks. This is important to keep in mind because the keto diet is high in fat. 

You do have some flexibility regarding the amount of fat you eat. If you were eating a standard American diet prior to the removal of this organ, the amount of fat you eat during keto will likely be more. 

Most people with no gallbladder can do quite well on keto. Nevertheless, some do struggle with it and experience unwanted side effects. 

Once you follow keto, you will feel some discomfort as you start lowering your carbs to the levels that are required to reach ketosis. You may get keto flu and experience symptoms like headache, mild fatigue, insomnia (having trouble falling or staying asleep), and bad breath. If you follow keto, these are to be expected at the beginning but should fade away as your body adapts.

Here are some common side effects of keto without a gallbladder:

  • Bloating sensation
  • Gas
  • Diarrhea

The above side effects occur due to malabsorption, because sometimes your liver may fail to send the right amount of bile for digestion of food. 

How do you ensure that you don't experience any unwanted side effects and complications? 

Surely you want your new diet to go smoothly. So, here are some factors to consider if you want to go keto without a gallbladder:

  • The transition must be done slowly while being attentive to the signs your body gives you. 

Go slow and ease your way into the new way of eating. You can lower your carbs and progressively increase your fats over a course of 2-3 weeks. During this transition be mindful of how you feel. If you feel miserable after a diet higher in fat, go slower. 

  • Hydrate well and keep your electrolytes in check.

It is very important to stay hydrated and maintain a balance of electrolytes. Ketosis makes your body flush water faster than the usual rate.

If you are dehydrated, you may form additional gallstones in your bile duct, even if you no longer have a gallbladder.  

This doesn’t mean that you should drink excessive amounts of water, because it can dilute your electrolytes. For the proper functioning of your body, you must replenish its water supply by consuming water and other beverages. 

So, how much fluid does an average healthy adult living in a temperate climate need? According to the US National Academies of Sciences, Engineering and Medicine, an adequate daily fluid intake (from food and drinks) is:

  • About 3.7 liters (15.5 cups) of fluids a day for men
  • About 2.7 liters (11.5 cups) of fluids a day for women

Therefore, stay well-hydrated and be aware of your electrolyte balance. 

  • Adjust the amount of fat you consume and distribute it throughout the day.

The ketogenic diet is not a “one size fits all” approach. So the amount of fat you choose entirely depends on your goals. If your goal is to lose weight, some fats need to come from your body’s stores and not from your plate. 

To start, don’t go straight to very high-fat, low-carb meals. Adjust your diet slowly. Follow a moderate-fat diet for the first 1 - 2 weeks following surgery. Then slowly increase your fat intake and reduce your carbs until you are following the keto diet.

Once your body adjusts to digesting fat without a gallbladder, you will be able to follow the diet without any issues. Remember to consume adequate proteins to sustain your muscle mass throughout this time, choosing lean meats, poultry, and fish. 

  • Eat frequent small meals rather than 1 - 2 big ones.    

The liver continuously produces bile which gets stored in the gallbladder. However, when there is no gallbladder, the liver continuously secretes bile directly into the small intestine. 

If you eat small meals at least for the first few months, (while your body adapts to not having a gallbladder), the greater the chances are that your meals will be well digested by the small, continuous amounts of bile produced by the liver. 

If you eat a big meal, some of the fat will remain undigested. It will travel, in its undigested state, to your large intestine where it can cause bloating, gas, and even diarrhea. 

Try to have 5-6 small meals a day, rather than 1-2 big ones. Therefore, it will make sure that your body digests what you eat without any problem.            

  • Medium-chain fatty acids are better than long-chain fatty acids.

Long-chain fatty acids are commonly found in foods like meat, olive oil, egg yolk, and avocados. They require bile to be digested. When there is no gallbladder to store, the bile is continuously released straight into the small intestine. As mentioned before, if there is too much fat to be digested, the remaining fat will end up in the large intestine, causing gastrointestinal problems.

By comparison, medium-chain fatty acids (MCTs) are different. They go straight to your liver where they can be used as an instant energy source. MCTs are found in coconut oil, grass-fed butter, cow’s milk, and MCT oil. So if you are struggling with discomfort after eating your usual fats, try to switch to MCT fats to help you meet your fat quota for the day until your body has adapted. 

  • Consume soluble fiber with your food.

Soluble fiber slows down digestion and allows better absorption of nutrients, like fat. The slower the digestion, the more chance the liver has to make enough bile to help properly digest the fats in your meal.  

Examples of keto-friendly foods rich in soluble fiber are broccoli, hazelnuts, seeds (chia, flax seeds, sunflower, pumpkin), Brussels sprouts, cabbage, artichoke, and avocado.

 

What is ox bile on a keto diet?

There are claims that ox bile supplements may help to eliminate gallstones in the gallbladder, along with other potential benefits. These claims have not been supported by published scientific studies, so it is important that you speak with your doctor before you consider taking ox bile on keto.


Summary

The idea of going keto might put you off if you've had your gallbladder removed. But it is certainly possible, with the approval of your doctor, if you follow the simple measures described in this article. 

The key is to go slow with frequent small meals and not jump headfirst into the diet: lower your carbs and increase your fats little by little. This approach will give your body adequate time to adjust to the low-carb higher fat intake. Then you will be able to run on ketosis safely and experience weight loss. 

Going keto is not a risk factor for developing gallstones. In fact, consuming healthy fats protects you from gallstones provided you do not lower your carbs too much and avoid refined sugars with empty calories. However, do not forget to consult your doctor before starting keto.
 

References:

1. John Hopkins Medicine. Gallbladder Disease

2. Stokes CS, Gluud LL, Casper M, Lammert F. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2014 Jul;12(7):1090-1100.e2; quiz e61. doi: 10.1016/j.cgh.2013.11.031. Epub 2013 Dec 7. PMID: 24321208. https://pubmed.ncbi.nlm.nih.gov/24321208/ 

3. Mayo Clinic. Cholecystectomy (gallbladder removal). https://www.mayoclinic.org/tests-procedures/cholecystectomy/about/pac-20384818