Should You Take Bile Salts After Gallbladder Removal?

The gallbladder plays an essential role in concentrating bile, which is crucial to enable the breakdown and absorption of fats and fat-soluble nutrients such as vitamins A, D, E, and K. 

However, if you’ve had your gallbladder removed, you may not have enough concentrated bile to support efficient digestion.

Discover how taking bile salts after gallbladder removal may help support digestive processes and learn how to promote bile salt production naturally.

The role of bile in breaking down fats

Bile is a vital digestive fluid produced by the liver and stored in the gallbladder. It contains bile acids, bile salts, cholesterol, phospholipids, and various amino acids.

Eating foods, especially meals rich in saturated fats, triggers the release of the hormone cholecystokinin (CCK), which signals the gallbladder to contract and release bile into the digestive tract.

“Bile acts as a detergent that emulsifies dietary fat into smaller particles,” explains Dr. Berg. “This allows digestive enzymes from the pancreas to further process the fats into fatty acids, monoglycerides, and glycerol that the small intestine can absorb.”

After aiding in digestion, around 95 percent of bile salts are reabsorbed in the small intestine and recycled back into the liver. 

This process, called enterohepatic circulation, helps conserve bile salts and enables the body to maintain efficient digestion while producing only small amounts of new bile acids each day.

In addition to supporting normal fat digestion, bile supports digestive wellness in several other ways.

Bile acids are synthesized from cholesterol, and their release into the intestine facilitates cholesterol elimination through stool, helping maintain cholesterol balance and supporting liver function.

Bile also supports the absorption of fat-soluble vitamins A, D, E, and K, which are crucial for maintaining healthy vision, immune health, antioxidant activity, and normal blood clotting. 

In addition, bile also helps maintain a balanced community of intestinal bacteria, thereby promoting overall digestive health.

Watch the video below to discover 12 potential complications of gallbladder removal.

Signs of low bile

After gallbladder removal surgery, the body no longer has the capacity to store bile. Instead, it continuously releases small amounts of bile from the liver into the small intestine.

This change affects how efficiently the body can digest foods, as the concentration of bile decreases and its delivery no longer matches meal times. 

Furthermore, low bile acid levels can impact how well foods and nutrients are absorbed, which may cause changes in gut functions and trigger significant digestive discomfort.

Common signs of low bile include:

• Abdominal distension
• Frequent burping
• Changes in stool consistency 
• Stomach discomfort
• Skin discoloration 
• Floating or pale stools after fatty meals
• Feeling unwell after high-fat foods

If you notice ongoing digestive discomfort, changes in your stool appearance, or difficulty digesting fatty meals, it’s recommended to consult a healthcare provider to discuss potential dietary adjustments or other supportive strategies.

What are bile salts?

Bile salts are the primary bioactive components in bile fluid and exist in two forms: primary conjugated bile salts and secondary bile salts.

Primary bile salts, specifically cholic acid and chenodeoxycholic acid, are synthesized in the liver from cholesterol. These acids are then conjugated with the amino acids glycine or taurine in the liver, forming bile salts. 

Bile salts are secreted into the small intestine, where they help emulsify fats and support digestion. In the colon, some bile salts are modified by gut bacteria into secondary bile acids, such as deoxycholic acid and lithocholic acid.

These secondary forms are more hydrophobic, exert antimicrobial effects, support gut microbial balance, and can also be reabsorbed for further digestion cycles.

According to research published in StatPearls, “without bile salts, 40 percent of ingested fats would be lost in the feces, and a metabolic deficit would occur due to this nutrient loss.”¹

For individuals with low bile availability, bile salts are also available in the form of ox bile extract supplements, which may help support healthy fat digestion and nutrient absorption.

Can you take bile salts after gallbladder removal (cholecystectomy)?

Yes, many people take purified bile salt, such as ox bile supplements, with their meals post-gallbladder removal to support healthy digestion, promote the breakdown of lipids, and help maintain nutrient absorption.

In addition to taking bile salts, adopting beneficial dietary and lifestyle strategies can help promote healthy bile production and flow, even without a gallbladder. 

Dietary fats stimulate the release of bile, supporting digestion. While excessive fat intake may overwhelm limited bile availability, consuming inadequate amounts of fat can reduce bile production over time. 

Aim to consume a moderate amount of healthy fats, alongside a nutrient-rich low-carb diet such as Healthy Keto®, which also avoids highly refined seed oils, sugars, and processed foods that may irritate the digestive system.

Certain foods can support healthy bile production and flow. For example, medium-chain triglycerides (MCTs) found in coconut oil are easier to digest because they bypass the need for bile during digestion.

Beet tops and other bitter greens provide potassium and phytonutrients that support normal liver function. Ginger and artichokes have traditionally been used to promote bile secretion and flow, while the citric acid in lemons and limes may help support overall digestive processes. 

Additionally, herbs such as dandelion greens, milk thistle, and turmeric may support healthy bile metabolism.

Another important factor for optimal digestive processes is maintaining a balanced gut microbiome, as beneficial bacteria assist in recycling bile salts through enterohepatic circulation. 

Research published in Nutrients shows that gut bacteria play an essential role in bile salt metabolism and that gallbladder removal can significantly influence the gut microbial balance needed to support digestion.²

Prioritizing raw fermented foods such as kimchi, sauerkraut, or kefir, and consuming fiber-rich vegetables may also help support the gut microbiome and promote bile salt reabsorption and digestive wellness.

When to talk to your doctor 

Bile salts may help support normal digestive function after gallbladder removal, but it’s essential to consult a healthcare professional before adding dietary supplements to your routine, especially if you have conditions affecting bile acid metabolism, such as bile acid malabsorption syndrome. 

Seek medical advice if you experience persistent diarrhea; signs of fat-soluble vitamin deficiencies, such as vision changes, easy bruising, or poor immune function; jaundice; or significant changes in bowel habits. 

Additionally, individuals with hyperthyroid conditions are advised to avoid bile salt supplements due to the potential acceleration of thyroid hormone conversion.

Bile salts may also affect the absorption of certain medications. If you’re taking bile acid sequestrants, hormone replacement therapy, or fat-soluble drug formulations, discuss potential options with your doctor before taking bile salts.

FAQ

Sources

1. https://www.ncbi.nlm.nih.gov/sites/books/NBK537107/ ?
2. https://www.mdpi.com/2072-6643/15/20/4399 ?