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Can I Do a Ketogenic Diet without a Gallbladder?

author avatar Dr. Eric Berg 08/31/2023

Your gallbladder plays a vital role in digesting dietary fats. Considering that keto is a high-fat diet, it’s only natural to worry if a keto diet is possible without a gallbladder. 

The short answer is yes, it’s possible to do keto without a gallbladder! But you must understand some critical steps and listen to your body. Learn here how to ensure a healthy keto lifestyle after gallbladder removal.

Keto diet foods

What is ketosis?

The keto diet is a high-fat, moderate-protein, and low-carb diet that puts your body into fat-burning mode. As you break down fat, your liver creates large quantities of ketones, a type of acid and very efficient fuel for your body. 

Ketones enter your circulation to fuel your body—this state is known as ketosis. In fact, your heart, brain, and muscles prefer ketones as a source of energy compared to relying on sugars and carbohydrates. To maintain ketosis, consume no more than 20 to 50 grams of carbs daily.

The benefits of keto

The ketogenic diet has become increasingly popular, and for a good reason. Priming your metabolism to utilize fats, not sugars, as the primary energy source has numerous health benefits. 

Here are some examples of why the keto diet is an excellent choice for your health:    

  • As you burn fat, you lose weight easier and maintain a healthy weight long-term.

  • You have more energy and improved cognitive function as a result of the increase in your metabolic rate.

  • Ketosis aids in balancing blood sugar and lowers cravings.

  • Ketones support healthy levels of insulin, your chief metabolic hormone responsible for fat storage.

  • Your body can fight inflammation and infections more effectively.

This study explains keto's several health benefits, including its role in weight loss, supporting heart health, and metabolic function. 

Gallbladder and liver

What is the gallbladder?

Your gallbladder is a small, pear-shaped organ that sits right beneath your liver. As your liver produces bile for fat digestion, it trickles into the gallbladder via bile ducts, where it’s stored and concentrated. Without bile, your small intestines can't digest fat properly.

Fatty foods in the stomach trigger your gallbladder to contract, causing the release of stored bile into the small intestines. The salts in your bile act like a detergent or soap and emulsify fats into soluble fatty-acids. As you consume more fat, your liver produces more bile.

In addition to digesting fat, your gallbladder has several other metabolic functions: 

  • Breaks down fat-soluble vitamins (vitamins A, D, E, and K) and omega-3 fatty acids

  • Removes cholesterol and toxins from the liver

  • Lubricates the colon and supports healthy digestion

  • Supports healthy thyroid function

  • Inhibits bacterial overgrowth in your digestive tract

  • Balances blood sugar levels

Consequences of gallbladder removal

Even if your gallbladder has been removed, bile production in the liver continues. But, because bile can no longer be stored and concentrated in the gallbladder, thin bile trickles slowly into your intestines. 

Sometimes your liver may produce too much bile and sometimes too little. Excess bile or lack of concentrated bile can cause fat malabsorption, fat-soluble vitamin deficiencies, excess cholesterol, weight gain, and a fatty liver. 

Common reasons for gallbladder removal surgery are:

  • Gallstones in either the common bile duct or the gallbladder

  • Inflammation of the gallbladder or the pancreas 

  • Polyps or other obstructions of the gallbladder or bile ducts 

  • Gallbladder disease

Can you do keto without a gallbladder?

The great news is gallbladder surgery doesn’t have to stop you from keto! Follow a smart strategy and be patient until your body adjusts to life after gallbladder removal surgery. Watch the video above to learn how to do keto without a gallbladder. 

How to do keto without a gallbladder

Rushing into keto without a gallbladder can cause you to experience symptoms related to fat malabsorption. The high-fat content of a keto diet, combined with thin bile, requires some simple but necessary tweaks to your keto lifestyle.

Make slow changes 

After a gallbladder removal, slowly increase your intake of fatty foods. At the same time, reduce your carb intake to no more than 50 grams daily, and maintain moderate protein intake. 

If you experience any symptoms or adverse effects, adjust your fat, protein, and carb ratio. A food diary helps you track your diet and any changes in your body. 

Compensate with supplements 

You can compensate for the lack of concentrated bile by taking an ox bile supplement. You don’t need to take ox bile with every meal, but digesting higher fat meals will be easier for your body if you supplement with bile salts. 

You can also supplement with digestive enzymes to improve the digestion of fats, protein, and carbs.

Choose the right fats

Foods high in long-chain fatty acids need bile to be absorbed. Medium-chain triglycerides (MCTs), however, don’t require bile. 

Coconut oil, grass-fed butter, and full-fat yogurt contain MCTs and are excellent choices for keto after gallbladder surgery. 

Intermittent fasting 

Combine your keto diet with intermittent fasting. During fasting, your intestines don’t need to digest, which lowers stress on the digestive system and reduces bile demands. 

But do be careful and don’t break your fast with a large meal to not overwhelm your digestion. 

Upset stomach

Potential issues on keto without a gallbladder

Symptoms of fat malabsorption are potential issues you need to be aware of after having your gallbladder removed. 

Until you find your optimal fat, protein, and carb ratio, watch out for the following symptoms:

  • Diarrhea and floating stool indicate fat isn’t being digested properly

  • Deficiencies in fat-soluble vitamins (A, D, K, and E) lead to depression, vision problems, fertility issues, increased inflammation, osteoporosis, and hair loss 

  • Omega-3 fatty acids deficiency can lead to skin issues, eczema, and dry eyes   

  • Acid reflux and gastritis are often a result of sluggish fat digestion 

  • Abdominal pain and gas indicate you consume too much fat too soon after surgery

Six tips for getting the most out of keto after a cholecystectomy

You may have heard that you must follow a low-fat diet after gallbladder surgery, but this isn’t true. Many people thrive on a high-fat diet after surgery. 

Listen to your body, make slow and steady changes and adjust your keto diet accordingly. Here are some tips to help you adjust to keto after gallbladder removal.

1. Avoid high amounts of long-chain fatty acids 

These fats require bile for breakdown. You don’t need to avoid foods high in long-chain fatty acids altogether, but do watch your quantities and supplement with digestive enzymes and bile supplements. 

Avoid these foods in large amounts:

2. Choose medium-chain triglyceride (MCT) oils

MCTs are easier to digest without a gallbladder. These foods are rich in MCTs and a good option for your keto plan after gallbladder removal:

You can also include an MCT oil supplement to add healthy, easily digestible fats to your ketogenic recipes.

3. Stay hydrated

Liver function and bile production require good hydration. Drinking plenty of water supports your digestive system and reduces symptoms of constipation. 

There’s no set amount of water a person should drink each day. The best way to stay hydrated is to drink when you feel thirsty.

4. Supplement 

MCT oil, ox bile supplements, and digestive enzymes are good choices to improve fat digestion and boost fat-soluble nutrient absorption. 

5. Bile supporting tea

Ginger, dandelion, and lemon tea stimulate your liver to produce bile, naturally supporting digestion and fat absorption. Drinking these teas shortly before or with your meals provides maximum digestive support. 

6. Soluble fiber 

Soluble fiber attracts water and forms a gel, slowing your digestive process. This will give your liver more time to produce bile, helping your digestive system to break down and absorb fats. 

Soluble fiber has other health benefits. It helps prevent constipation, increases the excretion of toxins and waste from your body, and promotes healthy gut bacteria.  

All vegetables are high in soluble fiber, particularly Brussels sprouts, turnips, broccoli, and asparagus. Try to incorporate soluble fiber with every meal—especially in the early stages after surgery—to help your body adjust. 

Eating keto

Key takeaways

Gallbladder removal may be a necessary step for you. However, this doesn't mean that keto is off the table. Take time to understand the role of bile salts in fat digestion and take the proper steps to help your body adjust to a ketogenic diet after surgery.

Watch out for possible symptoms of fat malabsorption and tweak your keto diet accordingly. Be guided by your body and how you feel, and take it slow and steady, rather than rushing into a full keto protocol. 

Many people without a gallbladder thrive on keto. After a gallbladder removal, these simple but essential steps boost your body's ability to digest fats and let you enjoy the health-promoting benefits of a keto diet.  

FAQ

1. Can I do keto after gallbladder removal?

Yes, you can do keto after gallbladder removal. Take your time to ease into keto after surgery, listen to your body, and modify your fat, protein, and carb ratios as necessary.    

2. Is it safe to do keto after a cholecystectomy?

It’s perfectly safe to do keto after a cholecystectomy. Focus on fats that don’t require bile for absorption and use digestive enzymes and bile supplements when needed to maintain your fat intake and stay in ketosis.

3. Can I do a low-carb diet with no gallbladder?

Yes! A low-carb diet is possible. Many people adapt very well to a low-carb diet with no gallbladder. Slowly increase your fat intake as you restrict carbs. Watch out for symptoms or changes in your digestion and tweak your diet until your body adjusts.  

4. Is diarrhea common with no gallbladder?

Diarrhea is a common symptom. Research shows that up to 35% of patients experience diarrhea, particularly during the early weeks after surgery. To ease loose stools, increase your soluble fiber intake.

Ideally, add fiber-rich foods to every meal until your body adapts. Don’t take bile salt supplements, as they retain fluid in the colon and potentially worsen your diarrhea. 

5. What is the best weight loss diet for someone without a gallbladder?

A ketogenic diet is a well-known tool for losing weight, with or without a gallbladder. Ketosis shifts your metabolism to burn your stored fat, not dietary carbs, making the keto diet an excellent tool to achieve weight loss and maintain long-term weight. 

6. Why did I gain weight after having my gallbladder removed?

Bile is responsible for fat digestion and supports healthy blood sugar balance and insulin levels. After surgery, the altered bile flow and weaker bile concentration can impact your metabolism, causing weight gain. A keto diet naturally counteracts these effects by stabilizing blood sugar and insulin levels.

7. Can I digest protein without a gallbladder?

Yes, you can digest protein without a gallbladder. Your pancreas produces digestive enzymes which break down and digest protein.

8. Can I digest fat without a gallbladder?

Yes! Digestion of fat is possible without a gallbladder. Your liver continues bile production, allowing the breakdown and absorption of some fat. Boost your fat digestion by choosing fats that don’t require bile and supplement with bile salts to help digest high-fat meals.

9. How can I boost my metabolism without a gallbladder?

Ketosis naturally boosts your metabolism. Combining keto with intermittent fasting is an excellent approach to getting the best out of your keto diet. Fasting augments the effects of keto, priming your metabolism to use fat as the primary fuel.

For peak functioning, your metabolism requires balanced nutrients. Follow a Healthy Keto® diet to get optimal nutrition to support your metabolism.  

10. Can I take bile salts if I don’t have a gallbladder on keto?

Yes, you can take bile salts or an ox bile supplement if you have your gallbladder removed. Bile salts compensate for the lack of concentrated bile by emulsifying fats. You don’t have to take bile salts with every meal, but digesting a large, high-fat meal is made easier with the help of a bile salt supplement.

11. Can I take digestive enzymes on keto?

Yes! Bile triggers the release of digestive enzymes, and the lack of concentrated bile after surgery can result in sluggish digestion and malabsorption. Digestive enzymes support the digestion of fat, protein, and carbs. Adding a digestive enzyme supplement is a great idea to compensate for a missing gallbladder.

12. How can I improve digestion on keto without a gallbladder?

Choose fats high in MCTs. These fats don’t require bile, making it easier to digest meals. Take digestive enzymes and bile salt supplements with larger meals and boost your liver’s bile production with ginger, dandelion, and lemon tea.

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