This post comes to you from one-half of the Dynamic Duo you’ve come to know as the Paleo Parents – Stacy Toth. Stacy is a busy mom of three with a full time job, a popular blog on parenting of Paleo kiddos, a loving wife, and a woman without a gallbladder. For those of you in the same boat – or dreading the possibility of losing your gallbladder soon – check out her take here on how to live and eat Paleo without one. This is Stacy’s perspective based on what she’s learned both in the science, and in her own n=1 experience in testing different dietary approaches on herself. Her situation is not entirely unique, but may not be exactly the same as yours. – Diane

Earlier this year I wrote a post on How to Eat Bacon without a Gallbladder. By the response the post received, there’s evidently quite a few of us who have undergone a Cholecystectomy (gallbladder removal) or know someone with Cholelithiasis (gallbladder disease). There was a cry for more information, but since I’m not a nutritionist or medical professional, I didn’t feel qualified to speak further than what’s worked for me.

Problem is, like most modern day diseases, the medical community just doesn’t get it. I appear to be one of the few voices in the paleo community who has this problem and can provide insight and recommendations – after having done a LOT of research.

Where it all began.

Why did I get this problem to begin with? Let’s start with the standard justifications I hear and read in the standard medical community:

• A low-fat, high carb whole grain diet will solve the problem
• If that doesn’t work, don’t worry – your body doesn’t need a gallbladder, removing it will solve the problem

Among the misinformation the medical professionals may or may not realize they’re telling you, the above were the worst offenders for my overall health and wellness. Despite my doctors not believing I could possibly be eating a low-fat diet, I had been for years. And despite following an extremely low fat and whole grain filled diet, my disease progressed and stones worsened. I tell a detailed health history in my earlier post – but essentially, after 7 years as a vegetarian my body was wrecked.

Was my low-fat diet making me fat and sick?

During my twenties, my weight skyrocketed. Having always been overweight, I became morbidly obese and well over 300 pounds in my early twenties. I found myself tirelessly hungry and filled with intense cravings. I realize now that this was a symptom of micronutrient malabsorption. Since I wasn’t able to digest fat or fat soluble vitamins properly, my body wasn’t able to properly digest the foods I was eating. This led me to constantly want more food in a desperate attempt to get my body the proper nutrients it needed.

This is a typical problem for those with Celiac Disease, which I now realize I have. Interestingly, gluten sensitivity is among one of the many undiagnosed causes of Cholelithiasis. Beyond a normal paleo diet, I’ve had to adapt my lifestyle and tailor my diet to meet the needs of my (now) very complicated body.

After my extreme weight loss, the focus on overall health and well-being through diet and lifestyle has been the utmost priority for me. Before I discovered how, exactly, to eat and live I was a health disaster. I no longer have acid reflux, joint pain, headaches, elevated white blood cell count, terrible digestion or any symptoms for Syndrome X.

Since my doctor never tried to figure out why my body was making these stones, I had never healed the root cause. The surgery, like a pill to be popped, simply masked the symptom – not healed the problem. Before I found paleo, my health continued to deteriorate for years after the surgery.

Instead of discussing alternate diets that might help (like gluten-free), I had been told I needed to have surgery. I was also told it wouldn’t affect my long-term health and that digestion disruption would only happen short-term. The only truth I had been told was that it would be an “easy” laproscopic out-patient surgery.

After the surgery, I no longer had intense (worse than child birth) painful gallbladder attacks. I’d say “Yipee!” except, instead I was left with the inability to control my bowel movements. Turns out a permanent state of IBS years after a Cholecystectomy is “normal”.

It wasn’t until a few years later, when I discovered the paleo diet, that I’d remember what normal bowel movements felt like. Honestly, the freedom to eat in public without shame or fear of needing to immediately use the bathroom is one I try not to take for granted. Paleo gave me my health and life back with weightloss, but the resolved medical conditions are what I’m truly grateful for.

My recommendations, based on my experience and research:

So how did I get to feeling normal again? Since I had to figure this out on my own with lots of personal experimentation, here’s my experience with what my gallbladder-less body needs:

1. Beyond the normal paleo diet, I went on a strict autoimmune protocol as outlined in Practical Paleo. Then, I later reintroduced foods to see which caused me a reaction. That means no grains, legumes, dairy (yes, even butter), nuts, seeds, nightshades (tomatoes, potatoes, peppers, eggplant), or eggs. I learned egg whites cause a violent digestive distress for me, whereas nuts and dairy cause skin irritation and joint pain. Every person’s body is different – but, if you or someone you know has Cholelithiasis then it’s likely being caused by a food intolerance and an elimination diet will help them figure out
2. I cannot do ketogenic diets. Occasional high-fat meals are fine, but since my body no longer is able to properly digest fat I need the carbohydrate and protein balance to help digestion be optimized. I find that around 75g of carbs a day helps me maintain weight, while preventing those IBS-like symptoms caused from my body’s inability to digest fat.
3. I cannot intermittent fast. Since the gallbladder’s job is to store up bile and release it when needed, huge meals or meals after a long fasting period no longer provoke the release of extra bile. My body no longer has the “ammunition” needed to digest food properly. If an accidental fast happens, I find that grazing for a longer period of time works better as an introduction meal.
4. I no longer drink a lot at meal times. Since drinking fluids dilutes the stomach acid my body does have, I limit my meal time drinks to just a small glass if needed. And when I do drink, I make sure I have no food in my mouth. This ensures I’m properly chewing my food.
5. I take Ox Bile and HCL supplements with every meal, which mimic what my gallbladder used to do for me. It’s not quite the same as my own body would be, and since I’m not a doctor I won’t tell you what brands or how much, but these have made a huge difference. What I’ve noticed is less cravings when I take them, which means my body’s able to more easily absorb the nutrients I’m giving it with healthy nutrient-dense meals.
6. I eat and drink gut healing foods. It’s not enough to try to do damage control on the front end. The more I do to help heal my gut of the food intolerance I had, which created the gallbladder disease, the better my digestion is. I find that kombucha in the morning is my favorite form of probiotics, since the insoluble fiber of raw vegetables can be difficult to digest. I also add organ meats to our meals where I can and make sure to have bone broth at least several times a week.
7. Most importantly, I only eat fats my body can digest. This means that animal fats are from pastured animals, since grain-fed animals (and egg yolks) can trigger a reaction for me when I digest it. It also means I stick to the Balanced Bites ranking of common cooking fats. Since exclusively cooking with coconut oil, palm oil, palm shortening, lard, bacon grease, duck fat, tallow and butter – my digestive health has never been better!

Learning the differences between oils and fats, why they’re different and how a person’s body responds to them at the Practical Paleo Seminar changed my perspective on what an important piece of the puzzle it was to my health. After that day I started paying close attention to the foods that I ate, how my gut reacted, how my digestion was and ultimately if excretion was “normal” after.

After years on a Paleo diet post-Cholecystectomy, I’ve finally learned how to optimize my digestion. Most importantly, and what no doctor ever told me, is that it is with proper digestion that health and wellness is achieved. If you or someone you know has gallbladder disease or already has their gallbladder removed, Paleo is absolutely a wonderful approach for them.

FAQs

Since the basis of these recommendations goes against conventional wisdom and likely the opposite of what doctors are saying, let’s cover some Frequently Asked Questions.

Q: My doctor says the Paleo diet is too high-fat to be gallbladder-friendly; he says I should go on a vegetarian diet. How can I possibly digest all the fat properly?

A: First of all, the Paleo diet doesn’t have to be high-fat. There are plenty of paleo foods that are naturally low-fat. I ate chicken breasts, salads and steamed veggies my first few months I went Paleo out of fat-phobia. So, until you’re comfortable go ahead and do that. Chris Kresser also addressed this here.

I think it’s easier to avoid sugar and get proper nutrients into you when eating fat, but you’ve got to figure that out yourself. When you’re ready, slowly add in the recommended fats from the Balanced Bites chart above and see how you feel. I found a proper carb-fat-protein ratio that’s ideal for my body; I know because my digestion is fantastic for the first time in years since having gallbladder issues!

Second of all, I was a vegetarian for 7 years. This was the period of time directly before my gallbladder became diseased. My mother was also a vegetarian for nearly a decade, and it was during this time that her gallbladder was diseased. Interestingly, broth was one of the few foods we could eat without triggering painful attacks. Makes sense to us now that we know how great bone broth is for healing the gut!

Q: You’re saying Cholelithiasis is a symptom of something else wrong, not the cause of health problems? What science backs this up?

A: Here’s a link to the GallbladderAttack.com stating food allergies are a common cause of the disease.Here’s a link to Robb Wolf talking about how removal of the gallbladder leads to Dysphagia and other long-term health issues if the cause doesn’t get treated. Here’s a link to Robb Wolf talking about gallbladder removal and autoimmunity, and another about Celiac disease and gallbladders. And then this,this, and this out of PubMed.

Q: When you say “digestive distress” what do you mean? What are some of the things that can happen after surgery?

A: I mean loose, painful, and violent stools unable to be controlled (must-go-now) bowel movements. UsePractical Paleo’s “Poop Pageant” to see if your stools are “fatty” looking (malabsorption of fat) or less than ideal. This is what happened years after surgery; weeks after surgery the situation was so awful and uncontrollable that I (literally) didn’t leave the house for fear of not making it to the bathroom.

Q: How can you reverse the inflammation and gallstones once you start to get them? Is that even possible?

A: I have heard that it is. Since I found the Paleo diet and lifestyle after my gallbladder had already been removed, it’s never been something I looked into. However, several people commented on this postsaying that NDs can sometimes help with supplements. If it were me, I’d get plenty of sunshine and Vitamin D, get plenty of rest, gentle exercise and follow the 7 steps above.