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Gallbladder Problems and Prolonged Fasting

author avatar Dr. Eric Berg 02/29/2024

Fasting may increase the risk of gallbladder issues. However, you can take plenty of steps to promote healthy gallbladder function while benefiting from the profound metabolic advantages of prolonged fasting.

Learn about various gallbladder symptoms associated with fasting and how dietary practices such as intermittent fasting and a ketogenic diet can help reduce them. Explore what it means to have gastritis during fasting, right shoulder pain connected to gallstones, and tightness underneath the right rib cage.

Furthermore, let's delve into preexisting conditions affecting gallstone development, including liver problems contributing to gallstone development, the importance of gut microbiome balance for preventing complications, and factors increasing susceptibility for those with preexisting conditions. See how a nutritious, low-fat diet like Healthy Keto®, in combination with intermittent fasting, supports liver health and gallbladder function.  

Gallbladder Symptoms During Prolonged Fasting

Some individuals experience gallbladder symptoms during prolonged fasting, such as gastritis, pain in the right shoulder area, and tightness under the right rib cage.

These issues can be attributed to an imbalance between cholesterol and bile concentrations within the gallbladder.

Intermittent fasting and keto foods

Gastritis during fasting

Some people may develop gastritis, which is stomach lining inflammation, during extended fasting periods. It’s thought that increased acidity levels in the stomach could trigger gastritis due to reduced food intake.

Gastritis may present as abdominal discomfort or pain similar to gallstone pain.

Right shoulder pain and its connection to gallstones

Pain in the right shoulder is often associated with gallstones.

When stones form inside your gallbladder or bile ducts, they can block normal bile flow, leading to inflammation and irritation.

The nerves responsible for transmitting this pain signal are connected to your diaphragm and right shoulder muscles, which explains why gallbladder issues can trigger pain in the right shoulder. 

Tightness underneath the right rib cage

A sensation of tightness or pressure beneath your lower-right ribs could indicate a problem with your liver or gallbladder. These symptoms might arise from bile sludge, gallstones, or an inflamed gallbladder, 

Gallbladder symptoms can manifest during fasting due to the interplay between cholesterol and bile. 

The Role of Cholesterol and Bile in Gallbladder Problems

When fasting or following a ketogenic diet, your body releases triglycerides and cholesterol, which may cause an increase in the concentration of cholesterol within your gallbladder, potentially increasing the risk of bile sludge formation and gallstones.

Impact of Increased Cholesterol on Bile Production

Bile is produced by the liver and stored in the gallbladder until it's needed for digestion. It aids in the breakdown of fats, enabling better fat digestion within the small intestines. 

Too much cholesterol within the gallbladder can crystalize, making it difficult for bile salts to dissolve excess waste products. Consequently, this increases the risk of developing bile sludge, the leading cause of gallstones.

Formation of Bile Sludge

Bile sludge, also known as biliary sludge or micro-lithiasis, occurs when tiny particles form within the gallbladder due to an imbalance between cholesterol and bile salts. Over time, these particles can clump together and lead to more significant problems like gallstones.

Fasting and ketogenic diets can sometimes increase cholesterol concentration within the gallbladder, which may contribute to forming bile sludge and gallstones. 

Therefore, it's essential for individuals who practice prolonged fasting to monitor their health status closely, adopt dietary strategies to mitigate these risks and seek professional guidance when necessary.

Health Issues Affecting Gallstone Development

When practicing prolonged fasting, certain pre-existing conditions can increase the risk of developing gallstones. 

It is essential to understand how liver problems and an imbalance of intestinal microflora can impair gallbladder health, making individuals with preexisting conditions more susceptible to gallstones.

How Liver Problems Contribute to Gallstone Development

Liver function is crucial in maintaining healthy bile production and preventing gallstones.

When the liver is not functioning optimally due to diseases like fatty liver or cirrhosis, it may produce fewer bile acids, causing an imbalance between cholesterol and bile concentrations within the gallbladder, which increases the likelihood of gallstone formation.

Gut bacteria, gut flora, microbiome. Bacteria inside the small intestine

The Importance of the Gut Microbiome 

A balanced gut microbiome plays a significant role in overall digestive health by breaking down food components and promoting nutrient absorption. 

An imbalanced gut flora can lead to improper digestion of fats, which may worsen existing gallbladder symptoms during fasting periods. 

Ensuring optimal gut health through probiotics supplementation or consuming fermented foods can help lower the risks of gallbladder issues associated with prolonged fasting.

Factors That Increase the Risk of Gallbladder Issues During Prolonged Fasting 

  • Age: Older individuals are more likely to have preexisting gallbladder or liver conditions, making them more susceptible to developing symptoms during fasting.

  • Gender: Women are at a higher risk of developing gallstones due to hormonal fluctuations and the use of oral contraceptives. This makes them more prone to experiencing gallbladder issues while fasting.

  • Dietary habits: A low-fat diet high in refined carbs and sugars can contribute to poor liver function and an imbalanced gut microbiome, increasing the likelihood of gallbladder issues during prolonged fasting periods.

In conclusion, understanding how preexisting conditions affect gallstone development is crucial for those practicing prolonged fasting.

Addressing underlying liver problems, maintaining a balanced gut microbiome, and being aware of factors that increase susceptibility can help prevent complications associated with prolonged periods without food intake.

Intermittent Fasting and Keto can support Gallbladder Health 

Many people who experience gallbladder symptoms after starting intermittent fasting or keto report that their issues improved after their bodies adapted to utilizing fat as the primary energy source. 

Most people who combine intermittent fasting with keto found improved digestive health and better fat digestion. 

Adaptation Process When Starting Intermittent Fasting

Your body undergoes an adaptation process when you first begin intermittent fasting. It learns how to use stored fat for energy instead of relying on glucose from carbohydrates.

This gradual change also improves fat digestion, which helps reduce the risk of developing gallstones or worsening conditions.

Positive Effects on Liver Function from Ketogenic Diets

Limiting carbohydrate intake and increasing healthy fats pushes the body into ketosis - a metabolic state where fat is burned for energy instead of glucose. 

Ketosis has been shown to positively affect liver function, including reduced inflammation and improved bile production. Consequently, these benefits contribute to better digestion, preventing gallstone formation, and may help alleviate existing gallbladder symptoms.

Here are the long-term benefits of combining a nutritious low-carb diet like Healthy Keto® with intermittent fasting for digestive health:

Better bile production: Consistently practicing intermittent fasting and following a ketogenic diet may lead to increased bile production by the liver due to improved liver function. This helps maintain a healthy balance between cholesterol and bile in the gallbladder, reducing the risk of sludge or stone formation.

Reduced inflammation: Both intermittent fasting and keto have been linked to reduced inflammation levels within the body. Lower inflammation can help alleviate symptoms related to gallbladder issues, such as pain and discomfort.

Gut microbiome balance: Fasting has also been shown to promote a healthier gut microbiome by increasing beneficial bacteria that aid digestion. A balanced gut microbiome may reduce susceptibility to developing gallstones or experiencing other digestive complications during prolonged periods without food intake.

In conclusion, combining intermittent fasting with a low-carb keto diet plan can lead to natural improvements in liver function over time, resulting in better overall health outcomes concerning your digestive system organs like the gallbladder itself.

Purified Bile Salts as a Remedy for Gallbladder Symptoms

When experiencing gallbladder symptoms during fasting, purified bile salts can alleviate discomfort and prevent complications.

Purified bile salts are derived from ox or bovine sources and function similarly to the bile produced in your liver. They help emulsify fats, making them easier for your body to digest and absorb.

Supplementing with purified bile salts during fasting periods or while following a ketogenic diet helps to ensure that excess cholesterol is broken down more efficiently within the gallbladder. This prevents sludge formation and reduces the risk of developing gallstones.

What are Purified Bile Salts?

Bile salts are produced by the liver and stored in the gallbladder until they're needed for digestion. They help break down fats into smaller particles your body can absorb easily. Purified bile salts can aid digestion and improve overall gut health when taken as a supplement.

In addition to aiding digestion, purified bile salts have been shown to:

  • Improve nutrient absorption

  • Support healthy cholesterol levels

  • Promote healthy bowel movements

The Benefits of Ox Bile

There are numerous benefits to ox bile. Ox bile is derived from cattle and contains high concentrations of cholic acid - one of the primary components found in human bile.

It's commonly used as a digestive aid because it helps emulsify fat-soluble vitamins A, D, E, and K, which makes them more readily available for absorption.

The benefits of ox bile include:

  • Aiding fat digestion: Ox bile aids fat breakdown, making it easier for your body to absorb essential fatty acids that support brain function and hormone production.

  • Symptom relief: Taking an ox-bile supplement may alleviate symptoms like bloating and indigestion after meals for those who've had their gallbladders removed.

  • Digestive support: Since some people don't produce enough bile, supplementing with ox bile can support the digestive process and prevent nutrient deficiencies.

If you're considering taking purified bile salts or ox bile supplements, speaking with your healthcare provider first is essential. They can help determine if these supplements are the right choice based on your medical history and current health status.


Gastric inflammation, tenderness in the right shoulder area, and strain beneath the lower right rib cage are signs of gallbladder issues and an increased risk of gallstone formation.

Combining intermittent fasting with a nutritious, low-fat diet like Healthy Keto can significantly benefit gallbladder health. 

While fasting and a ketogenic diet may trigger some transient gallbladder discomfort during the early phases of keto-adaptation, these symptoms typically improve once your body gets used to burning fat as the primary fuel source.  


1. Is Fasting Good for Gallbladder Problems?

Fasting can benefit gallbladder health as it promotes liver function and reduces inflammation.

However, prolonged fasting may cause temporary discomfort due to increased cholesterol levels and bile sludge formation. Combining intermittent fasting with a ketogenic diet can provide long-term benefits in improving digestion.

2. Can Fasting Trigger Gallbladder Pain?

Fasting may temporarily trigger gallbladder pain in some individuals, especially those with preexisting conditions or susceptibilities.

This is usually caused by the release of triglycerides during fasting and subsequent increases in cholesterol levels, which can lead to bile sludge formation.

3. Does Fasting Cause Gallbladder Sludge?

Fasting might contribute to the formation of bile sludge due to increased cholesterol production resulting from triglyceride release.

Maintaining a balanced gut microbiome and supporting liver function through dietary choices like the ketogenic diet can help prevent complications related to bile sludge.

4. Does Not Eating Make the Gallbladder Worse?

Not eating for an extended period could worsen existing gallbladder issues by increasing cholesterol levels and causing bile stasis.

It's essential to maintain a healthy balance between periods of eating and fasting while ensuring proper nutrition intake when following any dietary plan involving calorie restriction or time-restricted feeding patterns.

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