Updated: Jul 23, 2019
Cholecystectomy. That's the medical term for removing your gallbladder. About 500,000 cholecystectomies are performed each year in the U.S. That ranks as one of the Top 10 surgeries performed.
Cholecystitis is the term used when the gallbladder gets damaged and inflamed. This is usually by a mechanical disturbance like gallstones or an infection of the bladder itself. So without a gallbladder you're wondering "Can I do keto without a gallbladder?" First the good news is YES. But it comes with a "But...".
Before we get into the "How", let's take a quick look at how the gallbladder and liver function together and then look at how the liver functions solely without its friend the gallbladder.
The Role Of The Gallbladder
Your liver and your gallbladder work together, but have completely different functions. Your liver produces bile, a thick fluid that helps your body digest food and eliminate waste. Bile is especially useful for breaking down fats in your diet so they become a form of energy your body can absorb and use.
Your gallbladder is where that excess bile is stored. This is very efficient when food enters the upper part of the small intestine called the duodenum. Also if you are fasting (or intermittent fasting), most of the bile your liver produces will be directed to the gallbladder where the bile is concentrated five-fold.
So, under normal conditions, your liver produces bile when food reaches your small intestine to help break down what you eat and drink.
If your liver produces more bile than your small intestine needs, it sends the excess straight to your gallbladder.
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.
Where Did Things Go Wrong?
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.
Possibly due to a high carb diet, occasionally, the bile will thicken up too much and gallstones and/or blockages can form. When the gallbladder cannot empty properly this can lead acute or chronic gallbladder inflammation. Infection of the gallbladder can also lead to inflammation. In either case this can lead to:
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.
The following factors are known to increase your risk for gallstones:
Age: The risk of developing gallstones increases with age, especially after you reach the age of 40.
Genes: If someone in your family has had gallstones.
Sex: Women are more likely to get gallstones than men. The female sex hormone estrogen is believed to increase the risk of gallstones.
Using the contraceptive pill or estrogen tablets during menopause (hormone therapy).
Functional problems of the gallbladder: The organ cannot contract (squeeze bile out) properly.
Short bowel syndrome: A disorder that can develop after surgical removal of a large segment of the small bowel.
Cirrhosis: A severe liver disease caused by metabolic disorders or excessive consumption of alcohol.
Being very overweight.
Losing a lot of weight in a short time: This happens a lot in very obese people who have surgery to make their stomach smaller.
Special high-calorie liquid food.
Hemolysis: A disease that causes increased breakdown of red blood cells.
What Happens When You Don't Have A Gallbladder?
Once your gallbladder is removed from the equation, the digestion process looks a little different towards the end.
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.
If there isn't a place to dispense bile appropriately, and the liver is having to "guess" and "react" to the demand, the right amount of bile may be incorrect to complete the job. When this happens, your body may not have enough bile to properly digest meals that contain a higher amount of fat, which is pretty much every day on a ketogenic diet.
If fats aren’t properly digested, your body won’t take in all the essential nutrients found in them.
You could end up deficient in critical fat soluble vitamins — such as vitamins A, D, E and K — since your body will be unable to absorb them from the foods you eat.
Since the keto lifestyle is all about substituting fats for carbs, many people who have lost this organ (and that's as many as half a million Americans each year), we wonder if they’ll be able to conform to this regimen.
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.
If you are experiencing diarrhea, you aren't going to be absorbing essential nutrients and you're going to be losing water. So this is a good time to consider a multi-vitamin and to bring in some electrolytes to help restore fluid balance.
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.
The good news is that doing keto even without a gallbladder is possible. The bad news (and it's not all that bad) is that the "not having a gallbladder" equation means you’ll likely need to make some adjustments to the standard keto process and you may have to take some supplements to aid in digestion.
Strategies To Follow When You Don't Have A Gallbladder
Take It Easy
If you are trying to go keto and you have had your gallbladder removed, you will need to "ease" into a high fat diet. It doesn’t matter if you’ve recently removed your gallbladder or it’s been gone for over a decade, it’s still critical you take a much slower approach to the ketogenic transition than most people would.
I know you've heard about all the benefits keto offers and you want to get there fast but trust me, your body isn't ready or trained YET for a high fat diet. You want to give it time to adapt. The body is amazing at being able to adapt and compensate. This will be no different.
So instead of completely transitioning to keto overnight, you should start one meal at a time, per day and see how you do. How did your digestive tract respond?
Add Soluble Fiber To Your Diet
When you add more fats to your meals and you notice your stools becoming greasy or oily, there’s a good chance your body is unable to digest all the fats you’re eating.
But before you decide to jump off the keto train, you may need to try eating your fats with soluble fiber instead.
Here's a list of keto-friendly foods to get you started:
Apples (for the transition period only)
Digestive Enzymes with Ox Bile
Part of being able to absorb and utilize essential nutrients is first breaking them down. This requires different enzymes to help us with the digestive process. An easy option is to take a supplement that contains several essential enzymes for not only breaking down fats, but for also helping us break down carbs and proteins.
These supplements both trigger your body’s own stomach enzymes and bile to get to work on the foods you eat. This means they’re effectively digested and all the nutrients from your meals are absorbed.
In addition to taking a supplement, look for foods that help the body increase its production of bile. The following foods can signal the liver to secrete more bile:
Grab Some MCT Oil
MCT oil is loaded with healthy saturated fats like capric acid, caprylic acid, and lauric acid (all three of which are found in coconut oil). These fatty acids are much easier to digest, boost ketone levels, and don’t require bile for proper absorption.
On the flip side, long-chain fatty acids, such as those found in milk, beef and egg yolks, for example, are much harder to digest and require more bile to process.
For someone without a gallbladder, this is a lot of work and it may not be properly completed, leading to fat malabsorption.
At least early on in your keto journey, you should avoid the long chain fatty acids found in nuts, seeds, avocados, olives and meats until your body adjusts.
Reach for foods packed with medium-chain fatty acids such as the ones found in grass-fed butter and MCT oil instead.
The Wrap Up
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.
Obviously the best option is prevention.
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 ever forming.
And lastly, consider working with a Functional Medicine Doctor who is familiar with the ketogenic diet or is currently keto (like myself) who can help steer you in the right direction with your specific situation. References: