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September 12, 2022

Can Keto Diet Cause Gallbladder Problems?

gallbladder problemCan Keto Diet Cause Gallbladder Problems?

Gallbladder problems can occur on a keto diet. Rapid weight loss regardless of the diet used to achieve it can promote the formation of gallstones increasing the risk of a “gallbladder attack”. Rapid weight loss can occur with the keto diet. Those with pre-existing gallbladder disease should be careful with a keto diet. The keto diet is high in fat and a high-fat diet may increase cholesterol levels in bile plus keto diets tend to be high in dietary cholesterol.

What is Gallbladder Disease?

The gallbladder is located underneath the liver on the right side of the abdomen under the ribcage. The gallbladder assists in helping with the digestion of fats. The gallbladder stores bile which is made in the liver but stored in the gallbladder. Bile is released into the small intestine when fat is present in the diet. Bile is made up of bile acids, cholesterol, water, pigments like bilirubin, metals like copper, electrolytes, and phospholipids.

In addition, to help breakdown fats in the diet, bile also helps with the absorption of fat-soluble vitamins: A, D, E, and K. It also removes toxins and metabolic waste

Bile in the gallbladder stagnates when low fat is consumed in the diet over time. When that happens bile can form stones called gallstones. Then after eating a meal containing fat the gallbladder contracts to release bile but a gallstone can block the release of bile leading to pressure build-up in the gallbladder and inflammation leading to abdominal pain and nausea and vomiting.

Some Risk Factors for Developing Gallstones

Who is most at risk for gallbladder problems and disease? Remember the 4 F’s. Fertile fat females over age forty. Women suffer gallbladder disease 3 times as much as men. Non-bioidentical hormone replacement therapy and estrogen-rich birth control pills increase the amount of cholesterol in the bile and reduce the contractile force of the gallbladder. Statin drugs used to lower cholesterol may reduce gallstone formation. Other cholesterol-lowering drugs like fenofibrate and gemfibrozil increase the risk of gallstone formation. Weight loss surgery is another risk factor for gallbladder disease. As you can see there are plenty of factors that contribute to gallbladder problems.

Symptoms of Gallstones and Gallbladder Attacks

One gallbladder problem are gallbladder attacks that typically start within 30 minutes of eating a meal containing fat. The pain is usually severe, dull, and constant lasting one to five hours. It is located in the right upper abdomen and can radiate to the right shoulder or back. Nausea and vomiting can occur. Fever can be present and some experience bloating, belching, and indigestion. Jaundice can occur with yellowing of the skin or whites of the eyes.

Common Treatments for Gallbladder Disease

Treatment of gallstones includes:

  • observation
  • dietary strategies
  • medication
  • shock wave lithotripsy
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • surgery: laparoscopic or open

Many people have gallstones and don’t even know it until an imaging study (CT scan, MRI scan, ultrasound) is done for some other reason and gallstones are noted on the imaging study. Others have rare gallbladder attacks. In these individuals attempts to dissolve the gallstones can be made using medications like Ursodiol or chenodiol. These medications can dissolve small stones but that may take several months.

In shock wave lithotripsy, sound waves are used to break up gallstones. This technology is used frequently to break up kidney stones. ERCP is a procedure in which there is an attempt to physically extract a gallstone in the common bile duct to avoid surgery.

If asymptomatic, dietary changes can stop the progression of gallstone formation and possibly even dissolve stones that already exist. Dietary recommendations include:

  • Consume more foods high in fiber like vegetables, fruits, beans, peas, and whole grains (oats, brown rice, whole wheat bread).
  • Eat fewer refined carbohydrates and less sugar
  • Consume more healthy fats like fish oil and olive oil.
  • Avoid unhealthy fats found in fried foods and desserts.

Can The Keto Diet Mess Up Your Gallbladder? Is It Good Or Bad?

As we discussed above a keto diet can exacerbate or trigger a gallbladder attack in someone who already has gallstones. It is probably wise to avoid a keto diet if you have gallstones or other gallbladder problems.

What Are Some Effects Of A Ketogenic Diet On Gallbladder Health?

Frequent fasting slows bile production and usage leading to bile becoming stagnate and turning into sludge and gallstones. The Keto diet is characterized by increased consumption of fat which leads to more consumption of cholesterol predisposing to the formation of gallstones and gallbladder problems.

Can The Ketogenic Diet Cause Gallstones Pain?

Keto diets are high in fat which raises cholesterol levels in bile. This can lead to the formation of gallstones and abdominal pain when eating fatty meals. High-fat diets also trigger gallbladder contraction, which can lead to abdominal pain.

Can The Ketogenic Diet Dissolve Gallstones?

There is no evidence that a ketogenic diet dissolves gallstones.

How Much Keto Diet Should I Eat To Avoid Gallstones?

That is a hard question to answer but one should not over consumes calories on a keto diet. If you have risk factors for gallstones that we discussed above you should consider ramping up your fat intake slowly on a keto diet to avoid gallbladder problems.

Is A Ketosis Keto Diet Safe If You Have No Gallbladder?

Patients who have had their gallbladders removed many times go on to experience diarrhea, nausea, and pain following fatty meals. Comments on several keto forums indicate that one can successfully eat a keto diet without a gallbladder with some reporting a resolution of nausea, diarrhea, and cramping that usually accompany the removal of the gallbladder. Digestive enzymes can be used to help break down fats consumed on the keto diet.

One should wait 2-3 months after surgical removal of the gallbladder before going on a keto diet, and then should increase fat intake slowly while on a keto diet.


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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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