Gallbladder removal surgery is a fairly common occurrence in the modern-day, and the associated dietary recommendations can be detrimental to your long term health. Today, we explore how you can still reap a ketogenic diet’s benefits, even if you have had your gallbladder removed.
The Myths of Gallbladder Removal and Its Implications
The gallbladder is a small organ that resembles a pear-shaped pouch located in the upper right quadrant of your stomach area just under the liver. The gallbladder stores the bile fabricated in your liver, which is released to help digest fats.
Various conditions related to the gallbladder’s pain and infections (including gallstones, cancer, cholecystitis, and pancreatitis) generally lead to removing the gallbladder through an operation called a cholecystectomy. Since the gallbladder stores bile to help the body digest and assimilate dietary fat, a low-fat diet is commonly prescribed following gallbladder removal surgery. 
The problem here is that healthy fats are a crucial part of the human diet. Fat-soluble vitamins A, D, E, and K are cognitive health, mental and physical development, supporting natural detoxification pathways, and even their ability to help you lose those unwanted extra pounds. [2-5]
The Benefits of A Ketogenic Diet
After years of being demonized by faulty science, high-fat, low-carb “ketogenic” diets are finally seeing the praise they deserve. The benefits of consuming a keto diet are far-reaching, and include:
- Improved Satiety: Eating low-carb can reduce hunger, which may lead to a reduction in caloric intake. 
- Improved Insulin Sensitivity: Minimum carbohydrate intake improves insulin sensitivity by promoting balanced blood sugar throughout the day. 
- Fat Loss: Improved insulin sensitivity and natural caloric reduction prove to be a significant catalyst for rapid loss of body fat (especially visceral fat), with little to no muscle sparing. 
- Drop in Triglycerides: Sugar (carbohydrates), especially fructose, can elevate triglycerides, particularly in sedentary people. Cutting carbs generally creates a dramatic reduction in triglyceride blood levels. [9, 10]
- Improved HDL (‘good’) Cholesterol: Consuming healthy fats has been shown to promote good cholesterol known and HDL, which reduces the likelihood of heart disease. 
- Promotes Brain Health: The keto diet is linked to brain health thanks to the production of ketones. It has shown remarkable results in various disorders, including drug-resistant epilepsy in children and in neurodegenerative diseases like Alzheimer’s and Parkinson’s. [12, 13]
Eating Keto Without A Gallbladder
Despite the mainstream narrative that removing the gallbladder should mean a low carb diet, there are many ways to continue consuming fats, even without the extra bile storage. The key is twofold: first, stick to healthy fats. “Bad” fats just promote chronic inflammation and are extremely toxic. Secondly, introduce the habits and supplements mentioned below to increase digestion and absorption of nutrients (especially fats!).
Good Fat vs. Bad Fat
A few key things you need to know about fat quality to understand if fat is healthy or not:
- Oxidization: One of the leading causes of ‘bad fats’ is oxidation, meaning the fat has gone rancid. Fats are heat sensitive, so too much heat or too much processing can render a healthy fat into highly toxic food. Saturated fat is one of the most heat-stable fats, making it less prone to oxidation.Saturated fat sources include red meat (beef, lamb, pork), chicken skin, whole-fat dairy, butter, lard, and coconut oil.
- Omega 3 to 6 ratio: A balanced ratio is optimal, but modern diets contain a very unbalanced ratio in favor of omega 6 fats, promoting serious inflammation in the body. Opt for omega 3 fatty acids to balance the ratio by consuming more: mackerel, salmon, herring, oysters, sardines, anchovies, caviar. Note: Avoid fish oil supplements, as they are often oxidized and rancid.
- Quality: Quality matters with fats, since toxins are also stored in fat cells. So a fatty cut of beef could be healthy if the animal grazed on pasture it’s entire life, free from hormones or antibiotics. In contrast, a grain-fed factory-farmed fatty steak would store highly inflammatory properties. Quality is pasture-raised or wild animals, organically fed if applicable.
Tips to Optimize Digestion
Slow Down and Relax
Some of the best ways to increase digestive fire are so simple that they are often ignored. Being present and mindful while you eat has been shown to boost digestion significantly. This is due to the ‘rest and digest’ parasympathetic system that is dominant during relaxed periods. When people eat multitasking, in front of the TV, in the car, or in a rush: our minds are busy. With too much input, the body has too many tasks to focus solely on digestion, and so it takes a back seat.
Chew Your Food
While being present with your food during mealtime, another way to optimize digestion is to chew your food properly. Chewing is the first step in the digestion process. Your teeth begin to break down your food, and your saliva is loaded with enzymes that continue the breakdown process. Eating slowly and chewing your food correctly is fantastic to promote easier digestion and assimilate more nutrients.
Consuming bitter leafy greens with your meals is a great way to stimulate bile production in the body. Although there is no gallbladder to store said bile, it will go straight away to help break down the fats consumed alongside the bitter greens.
Digestion boosting bitter greens include:
- Dandelion greens
- Mustard greens
- Collard greens
Go For A Walk
A post-meal walk has been shown to reduce blood sugar levels and promote digestion. A short stroll around the block, as short as 10 minutes, has proven to be highly beneficial. Avoid strenuous exercise or running directly after a meal, which will turn your sympathetic nervous system on and take you out of ‘rest and digest’ mode.
Supplements to Digest Fat
There are a handful of supplements that someone without a gallbladder or anyone with poor digestion can use to increase stomach acid and boost the breakdown and absorption of their food. For anyone without a gallbladder, consuming one of these supplements (especially ox bile and lipase) should be done 15-30 minutes before every meal containing fat.
- Ox bile supplement: you can directly consume an ox bile supplement, which helps replace the bile lost, which was previously being stored in the gallbladder.
- Digestive enzymes (containing lipase): Lipase is the specific enzyme that helps break down fats, so although enzymes generally come as a combination, make sure you get one that contains lipase.
- Betaine HCL supplement: to support stomach acid production. These capsules warn your stomach that food is on the way and promotes the endogenous production of enzymes in your stomach. Since your stomach is the leading player in digesting food, ensuring there are enough enzymes to break it down is key.
- Digestive bitters: bitter foods stimulate bile production, so consuming some digestive bitters before a meal can prepare the body for immediate fat digestion.
Gallbladder removal surgery is a fairly common procedure that comes with some very unfavorable diet recommendations. Although the body can no longer store fat-digesting bile in the liver, simply removing fat from the diet is not a viable solution for long term health. There are many ways to continue to consume a high fat ketogenic diet, thanks to lifestyle habits and mindful supplementation. Slow down, chew your food, consume bitter greens, and consume some digestion boosting supplements like ox bile and enzymes.
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