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Your body is a fantastic machine. Every organ works in harmony to keep your body functioning correctly. Groups of organs form systems which add to the complexity of human anatomy and physiology. It’s all rather wonderous!
Despite this, there are several organs that you can do without. Some, like your appendix, are no longer necessary because of evolutionary changes. Other organs, such as your tonsils, can go wrong and need to be removed for medical reasons. One such organ you can easily live without is your gallbladder.
Can you do keto without a gallbladder? You bet! But you’ll need to pay attention to your diet to make sure it is as safe and compatible with your condition.
If you no longer have a gallbladder, make sure you speak to your doctor before starting the keto diet. Also, make sure you are familiar with all the intricacies of low-carb dieting before you begin so that you understand how and why to modify your diet to reflect your missing gallbladder.
The role of the gallbladder
About the size of a pear, your gallbladder is (or was!) located in the upper right section of your abdomen. It is part of two systems – the digestive system and the biliary system. This means it’s involved in the digestion of food and also the production and storage of bile. Your body uses bile to break down and emulsify fats so that they dissolve in water. Without bile, fat would remain separate to the fluids in your body – and that’s not a nice image.
Bile is synthesized by your liver and then stored in your gallbladder. Bile in your gallbladder is then released into your small intestines to aid fat digestion. Bile, a gooey substance, then moves through your small intestines, working its magic on the fat you have eaten. At the end of its journey, 95% of your bile is reabsorbed, recycled back to your liver, and reused.
In addition to emulsifying fats, bile is also involved in:
- The elimination of excess cholesterol and other potentially harmful substances that cannot be filtered through the kidneys
- Providing protection from intestinal infections
- Controlling blood glucose levels
- Transporting the hormones that contribute to the health and development of the intestines
Not having a gallbladder does not mean you are unable to produce bile. It just means you are unable to store it. Your liver is your main biliary organ. The principal role of your gallbladder is bile storage and concentration. It essentially “saves” bile and releases it on demand – when you consume fats.
Why are gallbladders removed?
The gallbladder sounds like a vital organ, and yet a lot of people have it removed. There are several reasons that it may be necessary to remove your gallbladder. Symptoms that are commonly associated with gallbladder disease include:
- Sharp pain in the right upper portion of your abdomen that radiates out to the middle of your stomach, right shoulder, or lower back
- Fever – a common sign of infection
- Nausea with or without vomiting
- Bloating and distension of the abdomen
- Jaundice, or yellowing of your skin
These symptoms may indicate one of the following diseases, the treatment of which is often removal of the gallbladder.
Cholelithiasis – also known as gallstones, this is the most common reason for gallbladder removal. The stones can be as small as a grain of sand or as large as golf balls.
Cholecystitis – a type of gallbladder infection, this condition is often caused by gallstones and results in swelling and inflammation.
Choledocholithiasis – this condition occurs when gallstones block the common bile duct preventing the movement of bile from the liver to the gallbladder.
Pancreatitis – the inflammation of the pancreas which is often caused by gallstones. The pancreas is another digestive organ and is responsible for the production of several vital hormones including insulin. Removing the gallbladder restores function to the pancreas.
Biliary dyskinesia – this occurs when the gallbladder doesn’t empty correctly due to a functional defect. Backed-up bile can become infected and causes inflammation.
What happens if your gallbladder has been removed?
If your symptoms persist, your doctor may decide that you need to have your gallbladder removed. This is called a cholecystectomy. A cholecystectomy is commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the errant organ. This is called a laparoscopic cholecystectomy. In some cases, one large incision is made to remove the gallbladder. This is called an open cholecystectomy.
Recovery after laparoscopic cholecystectomy is usually quite fast, and many people are allowed to leave hospital just a few hours after their surgery. However, if you have an open cholecystectomy, you may need to stay in hospital longer as the incision will need time to heal.
The good news about having your gallbladder removed is that you’ll soon start to feel better and the symptoms of gallbladder disease will vanish. However, because of the role your gallbladder played in the emulsification and digestion of fats, things are going to change.
With no gallbladder, your body now has nowhere to store bile. When you had a gallbladder, your liver produced bile between meals – not just when you ate fats. As a result, you always had an instant supply of bile available. With no gallbladder, there is nowhere for your body to store bile and it now has to be produced on demand.
Your liver soon realizes that your gallbladder is missing, and it adjusts its bile production schedule accordingly. Instead of producing bile between meals for storage, it now produces much smaller amounts of bile and deposits it directly into your small intestines – so called because they are small in diameter. They are actually 20 feet long, and much longer than the five-foot-long large intestines.
Initially at least, your liver may struggle to produce the right amount of bile. This can cause some dietary issues that are directly linked to improper fat digestion. 50% of gallbladder removal patients experience things like bloating, gas, loose stools, and diarrhea, as well as problems absorbing fat-soluble nutrients such as vitamins E, D, E, and K.
In time, your liver will become more adept at regulating bile production, and these issues should sort themselves out. This may take some time and may also need some dietary changes too. If you are still suffering from the initial side effects of having your gallbladder removed, you should postpone starting a ketogenic diet until everything settles down and returns to normal.
Is it possible to follow a keto diet without a gallbladder?
The keto diet is a high fat, moderate protein, low carb diet designed to speed up weight and fat loss. Because the gallbladder is an important organ for fat digestion, you’d be forgiven for thinking that keto and gallbladder removal are incompatible and even unsafe, but that’s not the case. You can still follow the keto diet with no gallbladder.
However, when you have no gallbladder, your body deals with fats differently so you’ll need to make some changes to the standard keto diet, particularly during the first few weeks.
For most regular folk, the best way to start the keto diet is to eliminate carbs all-but overnight and get into fat-burning ketosis as quickly as possible. This is a lot like ripping off a Band-Aid in that you’ll power through the side effects of eliminating carbs from your diet in a matter of days. This often makes for a shorter (but more uncomfortable) transition.
If you don’t have a gallbladder, this is not the way to go. A big increase in fat consumption could lead to a lot of unwanted complications.
Instead, if you have had your gallbladder removed, ease yourself into the ketogenic diet by gradually decreasing your carb intake as you increase your fat intake. Take it one meal at a time and monitor how your body responds. If you feel okay, try another meal. If you feel unwell, dial back your fat intake and increase carbs slightly. Only increase your fat intake if you continue to feel okay.
For example, instead of having high-carb cereal for breakfast, have some eggs and spinach. If you feel okay, try having a grilled chicken salad for lunch instead of a sandwich. Still feeling good? Try a low carb dinner. But if you start to experience any stomach upsets, bloating, or loose stools, have a regular meal to take some strain off your digestive system.
Remember that transitioning into the ketogenic diet comes with a range of symptoms and side effects – known as the keto flu. This is unavoidable. However, you should not confuse things like headaches and fatigue with issues associated with not having a gallbladder.
How to follow the keto diet if you have had your gallbladder removed
Once you have transitioned into ketosis, you should have no problem following a standard ketogenic diet. However, there are several things you can do to make your no gallbladder diet even better. Here are five ways to make following the keto diet without a gallbladder much easier.
1. Pair your fats with soluble fiber – if your stools are oily, you may not be digesting and absorbing fats properly. This is a common problem when you increase your fat intake too fast or too soon. You can make fats more digestible by eating plenty of soluble fiber when you eat fats.
Soluble fiber and fats combine to make a slow-moving gel. This gives your body the time it needs to digest the fats more effectively. Fiber is also good for your digestive system and your health in general. It’s calorie-free so don’t worry about bulking out your meals with soluble fiber. It won’t derail your diet.
Good sources of soluble fiber include:
- Brussels sprouts
- Chia seeds
- Pumpkin seeds
- Sunflower seeds
2. Eat foods that boost bile production – Some foods are known to signal your liver to increase bile production. Adding these foods to your meals will enhance fat digestion, allowing your body to deal with fat more efficiently.
Add the following foods to your meals:
- Lemons and lemon juice
- Limes and lime juice
- Apple cider vinegar
- Dandelion greens
- Milk thistle
- Green tea
3. Avoid drinking too much water at mealtimes – while it’s a good idea to drink plenty of water to stay hydrated, you should avoid drinking too much at meal times. Drinking water at meal times can dilute the digestive enzymes responsible for breaking your food down. This can make your meals harder to digest.
By all means, have a few sips of water with your meal, but to maximize digestion, avoid drinking a lot of fluids 30 minutes before and after your meal.
4. Eat more medium chain fatty acids, and less long chain fatty acids – you’ve probably heard of saturated and unsaturated fats, but you may not know that fats can also be classified by the length of their fatty acid chain. Saturation refers to the amount of carbon in the fatty acid chain but does not have much to do with how digestible these fats are.
In contrast, fatty acid chain length has a significant effect on digestibility. Long-chain fatty acids, such as those found in olives and olive oil, avocados, beef, and egg yolks, are much harder to digest and require more bile to process. Medium-chain fats are easier to digest and require less bile to do so.
Because of this, if you have no gallbladder, you may find that medium chain fatty acids, known as MCTs for short, are easier to digest. Good choices include:
- Coconut oil
- Palm oil
- Full fat milk
- Full fat cheese
- Full fat yogurt
You can also get MCTs from specially formulated MCT oil, which is much more concentrated as it’s made almost entirely from MCTs.
5. Fast to enter ketosis easier with less dietary fat – while eating more dietary fat will get you into ketosis sooner, so too will fasting. When you skip meals, your body has no choice but to start releasing and using stored fat for energy.
Your brain and muscles cannot use this fat for fuel, and so your body must convert it into ketones. In simple terms, fasting is the keto diet minus the high-fat menu. Alternate low carb, high-fat keto meals with periods of fasting to get into ketosis more quickly and easily.
It’s relatively easy to adapt the keto diet for no gallbladder. In fact, in all but a few cases, you should have no problem losing weight with keto. You will need to take it slowly at first, transitioning gradually into eating more fat and less carbohydrate, but the keto diet can still work for you.
This is a necessary step to avoid overloading your liver and digestive system and will give your body the time it needs to adjust to what is a radically different weight loss diet.
Once you are in ketosis, you should be able to adopt a standard keto diet. However, because of your missing gallbladder, you should continue to monitor yourself for any untoward side-effects and be prepared to seek advice if anything seems out of the ordinary. Decreasing your fat intake, eating a few more carbs, and supplementing your diet with MCTs often helps.
Finally, don’t forget to consult your doctor before starting the keto diet. That’s good advice for any new diet or exercise program.