Living Well Without a Gallbladder: A Resource for Treatments

In July, I published my second book, “Living Well Without a Gallbladder: A Guide to Postcholecystectomy Syndrome,” to help patients suffering from symptoms following gallbladder removal (cholecystectomy). As a regular contributor to Hormones Matter, I have written two articles about the gallbladder, The Gallbladder: An Essential Organ Influenced by Hormones, where I discussed the importance of the gallbladder, the gallbladder/hormone link, and ways to avoid a cholecystectomy; and Problems after Gallbladder Removal: Postcholecystectomy Syndrome, where I described conditions and issues that arise following cholecystectomy, and information on obtaining a diagnosis.

In this article, I will complete the gallbladder trilogy with treatment resources for people suffering from symptoms following gallbladder removal due to postcholecystectomy syndrome.

Dietary Basics Postcholecystectomy

Regardless of your postcholecystectomy symptoms or diagnosis, it is very important to follow certain dietary rules now that your body no longer has a gallbladder. The foods your body will have the most difficulty digesting are fats, even healthy fats, due to the change in bile consistency and flow, since bile is necessary for digesting fats. Therefore, a low-fat diet is always recommend postcholecystectomy.

You may have difficulty digesting proteins and high cholesterol foods like dairy and eggs as well. However, I don’t recommend limiting your protein intake. Instead, space proteins out and eat them several times a day and not with a fatty meal. Frequent, small meals will be easier on your digestive system after cholecystectomy. In other words, do not overeat!

Postcholecystectomy patients will have a more difficult time digesting long-chain triglycerides (LCTs) as opposed to medium-chain triglycerides (MCTs). The fats in our food are composed almost entirely of LCTs. When we consume fats composed of LCTs they travel through the stomach and into the intestinal wall. It is in the intestines where most of fat digestion occurs. Pancreatic enzymes and bile are necessary for the digestion of LCT fats.

MCT fats are processed differently. After eating a fat containing MCTs, such as coconut oil, it travels through the stomach and into the small intestine. However, since MCTs digest quickly, by the time they leave the stomach and enter the intestinal tract, they are already broken down into individual fatty acids and do not need pancreatic enzymes or bile for digestion.

Therefore, as your bile output and consistency may be compromised as a person without a gallbladder, stick to MCT fats like coconut oil and palm kernel oil. Butter, whole milk, and cheese all contain MCT fat but they also may contain a high amount of LCT fat. Limit these. Otherwise “healthy fats” may not be so healthy. Foods touted as healthy fats like avocado, olive oil, nuts, and fatty fish may not be so healthy for a postcholecystectomy patient.

Keep in mind that although MCT oils are great alternatives for cooking and acquiring fat for energy, it is well-known that MCTs are not a good source of essential fatty acids. Therefore, if your diet is high in MCTs, you will want to supplement essential fatty acids like Omega 3 and 6. Supplementing with an Omega 3 supplement like fish oil will likely benefit all cholecystectomy patients.

If you are experiencing unexplained symptoms and suspect certain foods may be the culprit, I suggest starting a food and symptom diary. Food diaries are easy tools to identify trigger and safe foods. The most common problematic foods for postcholecystectomy sufferers are: fried foods, spicy foods, fatty and oily foods, coffee and anything with caffeine, chocolate, red meat and pork, alcohol, some fruits especially acidic fruits, and difficult-to-digest raw vegetables.

Along with a low-fat diet, gastroenterologists and dieticians often recommend trying a FODMAP diet. It is usually reserved for irritable bowel syndrome, but some with other postcholecystectomy conditions find it helpful. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These foods contain difficult-to-digest sugars and fibers that can cause bowel problems like excess gas, painful bloating, and constipation or diarrhea.

Liver-Healing Vegetables and Fruits

The juice of certain vegetables can do wonders for the liver and biliary system. Beets, apples, and ginger all support bile formation. Beets are probably the best vegetable for your liver as they are a high-antioxidant vegetable that contain important substances like betaine, betalains, fiber, iron, betacyanin, folate, and betanin.

Pectin, which is a fiber found in beets, can also help clean the toxins that have been removed from the liver, allowing them to be flushed out of the system instead of reabsorbed by the body. Betaine is the substance that encourages the liver cells to get rid of toxins. Additionally, betaine acts to defend the liver and bile ducts, which are important if the liver is to function properly. This substance is also said to decrease the risk of coronary and cerebral artery disease.

Apples contain malic acid which helps to open the bile ducts that run through your liver and reportedly soften and release gallstones. Apples are also high in pectin.

Ginger is reported to increase gut motility and bile production. You can add ginger to food dishes or eat it raw. I prefer to juice ginger and drink a small amount of the extract. The extract can also be added to juiced fruits and vegetables. Be careful, though, as ginger is spicy and pungent. You only need a small amount.

Lemon is purported to benefit the liver as well. The high citrate content in lemon increases the liver’s ability to remove toxins. In addition, lemon contains a bioflavonoid called hesperidin, which protects the liver from damage, assists with digestion in the stomach (enhancing the effect of stomach acid), and inhibits fat synthesis.

Other foods reported to protect the liver and increase bile production are bitter foods such as dandelion and mustard greens, radishes, artichokes, fruits high in vitamin c, and cruciferous vegetables such as broccoli, cauliflower, and cabbage.

Natural Treatments Post Gallbladder Removal

Natural treatments will depend on your postcholecystectomy symptoms and condition. What may work for one condition may hinder another. It is also important to keep in mind that with almost every “remedy” you must give it some time to see if it will help you. I recommend seeking a consultation with a natural health practitioner who can “prescribe” the right natural remedies for you and monitor your progress or side effects.

The most common natural remedies for postcholecystectomy syndrome are:

• Bile Acids—to supplement lost bile acids and help bile flow.
• Digestive Enzymes that contain protease, lipase, amylase, and lactase.
• Herbs—be careful with herbs as they can increase bile flow and can spell disaster if you have a blockage from a stone or biliary sludge. In addition, drug-induced liver injury has been linked to herbs. Therefore, seek a consult with a natural health practitioner to ask about these most common herbs used by postcholecystectomy patients: dandelion root, Oregon grape root bark, gentian root, and wormwood leaves, artichoke leaf extract, milk thistle, gentian root extract, and valerian.
• Turmeric—purported to protect the liver and reduce cholesterol levels, inflammation, fibrosis and bile duct obstruction.
• Choline—aides in the absorption of fat and cholesterol and helps your liver create lipoproteins.
• Betaine—helps your body breakdown and absorb fats.
• Lecithin—keeps cholesterol from solidifying in your body and helps support your digestion of fats.
• Soluble Fiber—may benefit patients experiencing bile diarrhea or bile reflux.
• Magnesium—possesses natural antispasmodic qualities for intestinal and biliary/pancreatic sphincter spasms.
• Fat Soluble Vitamins—since bile helps your body absorb fat-soluble vitamins such as vitamins A, D, E and K, you may need to supplement some or all of these to reach optimal levels.
• Probiotics—some studies have shown probiotics benefited fatty liver disease and biliary cholangitis infections. Raising the level of “good gut bacteria” can be helpful to overall digestion.
• Betaine HCL with pepsin—raises stomach acid levels, which is needed to properly digest food and absorb vitamins and minerals. It is especially helpful for those with bile reflux, which can alkalinize the stomach environment.
• Chinese Medicine—can be helpful in balancing the digestive system and improving qi—the circulating life force whose existence and properties are the basis of Chinese philosophy and medicine.
• Castor Oil Packs, Ayurveda, Essential Oils, Yoga, Breathing Exercises, Meditation, Biofeedback, Reiki, Visceral Massage, Bioidentical Hormones —are all said to benefit a variety of digestive conditions. Information can be found online and through YouTube videos.

Medications

Medications are typically used to treat specific symptoms, rather than as a preventative measure. It is important to not only thoroughly discuss your symptoms with your doctor, but to also educate yourself on prescription medications.

The most common medication for postcholecystectomy syndrome is a bile acid sequestrant (ex. Cholestyramine, Colesevelam, Colestipol) which binds to bile and reduces cholesterol. It is mostly used for bile acid diarrhea. Another commonly prescribed medication is ursodeoxycholic acid (ex. Ursodiol, Actigall). This medication may be used to dissolve microscopic gallstones and “thin” the bile.

Other medications are:

• Prescription pancreatic enzymes (Creon, Zenpep)
• Anticholinergics/antispasmodics (hyoscyamine, chlordiazepoxide (clidinium), dicyclomine, scopolamine, glycopyrrolate, amitriptyline, nortriptyline, atropine and combinations of these generics with phenobarbital and belladonna)
• Muscle relaxants (cyclobenzaprine, carisoprodol, baclofen and buscopan)
• Calcium channel blockers (nitroglycerin, nifedipine, diltiazem, amlodipine and felodipine)
• Anticonvulsants (gabapentin and forms of gabapentin)
• Antidepressants (any, but most commonly prescribed for digestive disorders are serotonin uptake inhibitors)
• Low dose naltrexone—an immune modulator that has been effective in treating autoimmune disorders
• Medical marijuana—seek professional medical advice on the best formula ratio of THC/CBD (the active medicinal ingredients in marijuana) for your condition.
• Hormone therapy/birth control—hormones play a vital role in digestion and medications containing estradiol and/or progesterone have been helpful to some postcholecystectomy patients, particularly women.
• Medications to specifically treat nausea, irritable bowel syndrome and gut motility may also be helpful.

In some cases, the only helpful resolution to postcholecystectomy symptoms is surgery. Your gastroenterologist or a Hepato-Pancreato-Biliary surgeon can help guide you in whether surgery could be helpful or is necessary.

Disclaimer: All material in this article is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.

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