Life without a gallbladder

tcolvinOH

In 2016, I had to have my gallbladder removed due to some pretty serious gallstones. Since then, as you might imagine, digesting fats is an ongoing issue. Being a diabetic, I tend to try to stay away from any food that is overly carby. I seem to be pretty brittle when it comes to anything carby, so Ive just distanced myself from it. When I eat more starches (potatoes, sweet potatoes, rice), I seem to have less issues - as I would kind of expect.

My question is what suggestions would anyone make regarding supplementation or dietary improvements to improve fat digestion without adding in carbohydrates. Carbs = additional insulin for me - which if absolutely needed, Im ok with, but along with added insulin seems to come 50 lbs (slight exaggeration). Ive tried supplementing with digestive enzymes and ox bile in the past, with not much success. Im wiling to try these again, but I recently did this for about a week with no real changes in my digestion. I was taking about 500 mg of ox bile, but I read that too much ox bile can cause diarrhea, which Im already dealing with.

Im curious to know what others have tried or what options I might have.

KetoMe

I too am living without a gallbladder. No one ever told me that I should take a supplement?!? I found that out when I started a Keto diet. I was also having problems with the fat. I started supplementing with the "THORNE Bio-Gest", one before each meal and went really easy on fats. I started out with 1 tsp when a recipe called for 1 tablespoon. Once I was able to handle that then I increased it slowly. I am also doing organic psyllium husk powder, 1 tsp in 8 oz water 1-3 times a day depending on your needs. I hope this helps.

tcolvinOH

No one mentioned that to me either, although I had read some where it was a problem for people. The suggestion I was given on the ox bile was from someone who had their gallbladder removed and had had some success with the supplement.

How soon before each meal do you take the Bio-Gest?

I'll read into both. Thanks for the input.

tcolvinOH

I did some reading about Bio-Gest. Its really just a digestive enzyme supplement containing Betaine, Pepsin, Pancreatin, and what looks to be L-Gluatmine, in addition to ox bile. Perhaps I need to work up to a better dose.

I looked at the organic psyllium husk powder also. One thing I hadnt really thought about is increasing fiber. I know full well Im not getting much fiber in my diet. I might give this a try and see if anything improves. What I was reading from WebMD (and Im going to continue reading) (https://www.webmd.com/digestive-disorders/chronic-diarrhea-16/diarrhea-more-fiber ) is that fiber should be introduced slowly, but men should have up to 38g a day. Certainly, this is worth trying.

bracconiere

just to throw my two cents in...

my understanding is that enzyme pills are a gimmick because the whole reason your stomach is acidic is to break the amide bonds between amino acids for digestion...and enzymes are just protein molecules....of course now that i think of it, there is beano...

hopefully an actual 'expert' will join the discussion...

KetoMe

I try to take it 20-30 minutes before but sometimes forget and just take it with my meal. It seems to help however I credit the Psyllium Husk powder just as much in regulating the sudden run to the bathroom! The "suggested use" says that you can take 1-2 capsules with each meal, I only take 1.

tcolvinOH

@bracconiere , this wouldnt surprise me. I'd prefer to get these things through food if its possible, but my concern is always the impact on my blood sugar. If the body truly doesnt digest fiber, then it shouldnt be too big of an issue to add fiber in. I've had zero luck with the enzymes. The only thing that really provides any assistance is over the counter anti-diarrhea meds, which I try not to take unless necessary.

@KetoMe - Good to know. That lines up with my understanding about digestive enzymes. Im going to look further into the fiber supplementation and see what I can discover there.

KetoMe

Once you have your Gallbladder removed bile is distributed in a constant drip rather than dispersing as needed. It is my understanding that the enzymes assist in absorption of nutrients, along with many other issues. I chose the Thorne brand because it has a couple of things that other supplements didn't have: "Thorne offers hydrochloric acid and pepsin from a porcine source.
Pancreatin is a mixture of several digestive enzymes that are produced by cells in the pancreas. Pancreatin is composed of amylase, lipase, and protease. Pancreatin production and secretion by the pancreas is essential to digestion and absorption of numerous nutrients, especially fats."
I feel it has made a difference for me, we are all in this transformation together and any help we can get is much needed. @tcolvinOH I don't have diabetic issues that you have but I can say that since I included the BioGest and the Psyllium husk, slowed my fat intake I am doing/feeling a whole lot better. On the psyllium husk, make sure it is ORGANIC, as there can be a lot of pesticides otherwise. Start slow, maybe one teaspoonfuls am and one pm, make sure you have at least 8 oz of water. Best of luck my friend. ;-)

tcolvinOH

@KetoMe that lines up with what i had read too, regarding the constant bile drip. Its a little more involved than that, from what I read, but the idea is basically that bile isnt there during the entire process, so its much harder to digest fats without the gallbladder.

Since I havent really tried adding fiber to my diet since I had my gallbladder out, thats probably the most likely next step, unless I hear otherwise. Its a fairly easy add to my routine. The slow start also lines up with what I had been reading, as too much fiber too quickly can cause stomach discomfort, nausea, and bloating.

Appreciate the input!

bracconiere

they won't let me edit my old post but i want to add...

@Susan_RD_101 as far as i've seen your the only expert that posts here, out of the 6-7 of the other of us...

I want to hear about all the biochemistry/physiology, and all the other nitty gritty details about this! (you held back on the fructose post)

and just for a laugh i'll include a link....

https://www.youtube.com/watch?v=Ae829mFAGGE&t=2s

https://www.youtube.com/watch?v=ijAYN9zVnwg

tcolvinOH

@bracconiere I second. Which is part of the reason I posted this question. Its been an issue for awhile and Ive mostly just dealt with it. I would love to understand it better.

bracconiere

yeah i was thinking appendix, actually, when i posted the comment about enzymes...i still have my gallbladder, but after reading the Wikipedia info on it..sounds serious, my first thought was a emulsifier like lecithin, google told me it could help with stones but might not with digestion...

tcolvinOH

I just had my appendix taken out May. No real change since.

Very curious about the effects of fiber in relation. I know I'm not getting much, due to the nature of my diet.

bracconiere

since this is fast paced, i'll talk as such....

are you meeting your nutrient needs from food, according to best estimates punching into cron-o-meter? and beans don't have fat, but a lot of fiber, which makes them low on the glycemic index...I've had good 'fasting' blood glucose tests after i had eaten my granola which contains a lot of rice bran, which I've read can lower glucose...and is full of b vit's....

p.s. dev's, your spell check can't correct cron-o-meter for me properly...:)

and i want @Susan_RD_101 to really get into it too, treat all us nerds to some info and explain why bile, an acid, helps absorb another acid...which as far as i know, acids only become soluble with a base...

tcolvinOH

Probably not getting enough nutrients. Its an issue on my list to address.

Unfortunately, as I may or may not have mentioned, my blood sugar is pretty brittle. Most low-gi stuff still blows up my blood sugar, so Ive just stayed away from it. Beans, rice, granola, etc. When I eat them, I'll have leavy greans, broccoli, cauliflower, dill pickles and such. Turnips I can eat. Most of that stuff I cant eat in any great quantity. Lately Ive been trying to eat more organ meats, beef liver specifically, as those tend to be more nutrient dense.

Fortunately, I have no vitamin deficiencies of any kind. But I'd also like to keep it that way. For the foreseeable future, I'll probably stick with what Im doing, since it mostly works. Id rather get nutrients from food, but at the time being, Id like to slowly introduce those things into my diet, especially as some of my activity increases and I can counter the effect of eating some carbohydrates without needing to take more insulin. Ill probably look into either a multi vitamin at some point or a greens powder. Not the preferred method, but also not an issue I want to tackle right now.

KetoMe

Have you read "The Diabetes Code" by Dr. Jason Fung? It is a great read, like I said, I don't have diabetes, but my brother does and I bought the book for him. Dr. Fung also has a couple of websites that might offer you some help as well. Also check him out on You Tube, he gives some awesome information there as well. https://idmprogram.com/ and https://www.dietdoctor.com/

bracconiere

keep in mind leafy green, and vegetables and such don't have a lot of anything other than A, C, K..there's a whole spectrum of b's and other crap...the health guru's i think over state the importance of 'fruits, and veggie's'...but i have to admit you sound like you got it rough, everyone either preaching low carb, or low fat...and your like WTF i can't handle either..:)

not to sound cynical, but there is always whiskey right? lol (no, i don't think that you would meet your nutritional needs)

tcolvinOH

@KetoMe No, I havent. But Ive heard of Dr Fung before. Ive read some things on dietdoctor.com before. Good news is that when I eat clean, like Ive been doing lately, my blood sugar is fine. Its fairly under control. Being type 1, I pretty much just try to keep my insulin usage as low as I can. With the route Im currently going, Im barely using any short term insulin, which is a huge improvement from where I was previously. Thanks for the suggestion though. I'll be sure to check that out.

@bracconiere Thats basically it. Its a complicated situation. I think the fat digestion I can solve or at least manage easily enough. Blood sugar is the primary target and fairly well regulated right now. Im also not in any rush to make a bunch of changes at one time. Like you say in your signature - still learning.

Jij

I'm a T2 diabetic with no gall bladder. For the blood glucose levels: When you eat carbs, be sure to also consume protein in the same meal. As for the gall bladder, no doctor told me about any supplements. But, my endocrinologist seems to think that cheese is the root of all evil - so I avoid it and other full-fat dairy. I got very sick after using a lot of butter once last month, so, avoiding dairy fat is a confirmed strategy for me. I also limit red meat - but it's the dairy fat that's the big deal for me. It may be worth a try for you to eliminate just that.

tcolvinOH

@Jij , thanks for the input. I almost always eat some kind of protein with my meals. I have found in my own experience after several years of trial and error that my body is just very brittle when it comes to carbohydrates. The rules do change some for type 1's vs type 2's, but every person is generally different in their sensitivities. Since I've found my reaction to carbohydrates in general to just be poor due to the state of my diabetes, I just try to keep the carbohydrates to a minimum. Usually less than 30-50g per day and attempt to keep them below 10-15g per meal. If I know Im going to go overboard or am not sure, then I'll compensate with insulin appropriately.

Ive gone without dairy before and haven't noticed much change. I know that many people have issues with dairy and that going through that type of elimination is very helpful in order to get to the bottom of whatever issue is going on.

The wonderful challenge is trying to figure out how our bodies work. One conclusion I've come to over the years is that no two people are the same. I've been to different endocrinologists over the years who havent really understood, in my opinion, nutrition and its impact on the endocrine systems. Sounds like you have a reasonable endocrinologist who is willing to work with you. I have a co-worker, also female, who has had some success with limiting red meat. I want to say I've read somewhere about the different needs for men vs women based on body chemistry and such, but I couldnt tell you any of the specific details now. I personally couldnt imagine not having red meat nor have I read anything of any real scientific value (outside of observational studies that were heavily biased, which I dont believe are real science) that would convince me to detour from consuming it, especially since my health markers and blood work are good.

Dairy is certainly a good suggestion to look at and is definitely something I keep in mind and watch on a regular basis. I try to keep an eye out and not consume too much, in case it is a problem. Considering the number of problems people have with it, its always a consideration.

Susan_RD_101

Thanks for tagging me and sorry for the slow reply! ( I typically jump into these forums twice a week to answer questions - usually Monday and Thursday ).

Alright, let me roll-up my RD sleeves to answer some of these awesome questions!

1) The role of the gallbladder is to store and concentrate bile to help the body digest fats. When your gallbladder is removed, the liver tends to release small amounts of bile into the intestine, which can cause diarrhea. For most people, this problem will resolve in time. However, for some, the issue can be ongoing and worsened by a high-fat diet.

2) If you are experiencing diarrhea post-cholecystectomy (aka - gallbladder removal), you should reduce your intake of fat and especially, fried food. Adding soluble fibre can help with loose stools since it is digestible in water and acts as "stool glue" to create more solid bowel movements that take longer to pass through the digestive tract. The best sources of soluble fibre are: psyllium, flax, chia, beans, lentils, and oatbran. There are also medications called "bile acid sequestrants" that can help to resolve loose stools and as a bonus, lower cholesterol.

3) 99.9% of enzymes available for purchase aren't effective. Our stomach acid has a pH of 1.5-3.5 which causes most enzymes to denature before reaching our intestines. And since structure = function (chemistry shoutout!), these enzymes no longer elicit the desired effect. For a digestive enzyme to be effective, it must be "enterically-coated". If it's not, you are likely just wasting your money. I also haven't heard much about ox-bile, but in all honesty, I have a feeling it could make digestive issues worse, not better since your body is still making bile, just not concentrating it effectively.

4) While SOME of Dr. Fung's work is credible, he is taken with a grain of salt by the medical and nutrition community. Like many, he tends to cherry-pick evidence that supports his thesis, ignoring any solid evidence that could jeopardize what he is suggesting.

5) Carbs aren't as evil as they are made out to be. Sure, the keto diet can be effective in managing diabetes (at least in the short-term), but so too can a diet that is completely the opposite - i.e. a high-carb, low-fat plant-based diet. What's most important in managing a chronic disease is to choose a diet that you can follow for the rest of your life.

Hope this helps! Be sure to let me know if there are any other questions or concerns.

Great discussion, as always!

tcolvinOH

Im not a professional, but I know what I've experienced over the years, so I want to preface what Im about to type with that. Keep in mind that Im a Type 1 diabetic. I think the rules change a bit in this case.

I take some issue with the "carbs arent as evil as they are made out to be." I agree that some carbohydrates are not as bad as others, being refined carbohydrates from bread, pasta, etc vs whole grains, starchy veggies, etc. However....I can tell you from a lot of experimentation, blood sugar pricks and insulin dosages that, at least in my experience, carbs = sugar = glucose = toxic to the blood = insulin. Insulin generally also means weight gain, which Ive found to be true in my experience. So when I have more carbohydrates in my diet, my insulin dosages also increase - dramatically. On a more ketogenic type diet, the insulin dosages are way less. Getting proper nutrients is a problem that Im currently working on. Supplementation does help a bit, but is obviously not the preferred approach to nutrient intake.

For me (I just want to emphasize that, because I firmly believe that there's something to be said for finding a plan that works best for you and that numbers dont lie, necessarily), I have found that the higher fat ketogenic diets work well for me in regards to blood sugar control. in addition, i dont feel as lethargic and fatigued than I might when eating a higher carbohydrate diet.

Im not suggesting that one way is better than the other. Since the gallbladder removal (way to use big words with - cholecystectomy - which I can never remember, so I have to look it up each time), it has made a more ketogenic diet harder to follow because of the diarrhea. I know one area that I was missing was fiber intake, due to the brittleness of my blood sugar and thus not taking in as much carbohydrates as may be normally necessary to fulfill a proper fiber requirement. Are there circumstances where more than 38g daily for males reasonable? Is there min/max range or is 38g-ish the magic number? I'd love to understand this a bit better.

I've heard similarly about Dr Fung in the past, and a lot of other medical professionals in the field, especially with diabetes. It is medical professionals that "cherry pick" details and ignore others that have made me a little cynical toward the medical field, especially in the US (different issue I dont even want to get into). I try not to let that cloud my judgment or be indifferent to other options. its made getting decent care incredibly difficult.

I appreciate you taking the time @Susan_RD_101 to respond. I was hoping you would. I'd certainly be interested in how you treat other type 1's.

TheRegents

@tcolvinOH Cholecystectomy is easy to remember. A) Chol (remember this by thinking of cholesterol), cyst referring to the gall bladder (cyst means pouch, sac, bladder; which the gall bladder is); C) ectomy which means excision (removal). So, cholecyst means gall bladder and -ectomy means remove. Chole comes from the Greek word khole which means gall (so you get chole+cyst = gall sac = gall bladder). Now you can easily remember it and bring this up at parties and stuff.

As a side note, cholesterol was named because it was first observed in the gall bladder (in the form of gall stones).

tcolvinOH

@TheRegents - Interesting. Definitely useful information for parties, followed by "Do you want to see my scars?"

KetoMe

I’ll win that contest HANDS DOWN 🤪

Susan_RD_101

@tcolvinOH

Thanks for sharing your story!

Type 1 diabetes definitely requires special attention and I don't actually work with clients with this condition given the complexity of care that is often required.

That said, I am fairly knowledgeable of T1DM since I taught it to a University class a few years ago. You touched on the greatest issue in Type 1 diabetes - the amount of insulin is prescribed for a certain intake of carbs; the more carbs you eat (especially high glycemic carbs), the more insulin you need to take. And because insulin is a fat-storing hormone, weight gain is inevitable.

In your situation, I absolutely agree that controlling your glycemic response is critical. I'm a huge fan of pumps but want to ensure that we don't need large boluses of insulin to keep blood sugar normal. I can't speak to a keto diet in type 1 diabetes because frankly, I'm not up on the research in the area. However, I do know that close monitoring will be essential to ensure that you don't go into ketoacidosis, which can be fatal if untreated.

My best advice to you would be to follow a higher fat, moderate protein, low carb diet where the carbs that are chosen are low on the glycemic index scale. Staying at a healthy weight and engaging in regular physical activity will also be important to ensure that the insulin you do take is being as effective as possible (as there is a condition called "double diabetes").

Regarding fibre, you can definitely go higher! I prefer males to hit around 50 g per day. Very high intakes of fibre can reduce the absorption of mineral absorption, but this is more of an issue when fibre is around 100 g and the individual is vegan.

Hope this helps!

tcolvinOH

@Susan_RD_101 - Thanks for the input. I appreciate your insight on that.

I prefer using a pump and was actually on one until January of this year. I had a lot of good luck with the pump, but my pocketbook sure didnt. I had a CGM too, which really upped the cost. If I were in a better healthcare situation, I would consider going back to the pump. Although, that said, having the pump was a logistical nightmare, trying to figure out where to put the thing, dealing with the tubing all the time, what happens if it comes out, etc. At the time I was much more active and insulin pumps are not conducive to some of that. Plus my blood sugar would dramatically drop during Crossfit workouts on the pump, so I had to quit wearing it during the workouts and would put it back on after. The results were much better. So back to the shots, which has been much easier - especially with me managing my diet so much better now, I take a lot less insulin. I rarely bolus these days. Maybe once every other day, depending on where my blood sugar is at. It used to be 4x a day.

Monitoring blood sugar has been vital. Im pretty good about checking it, especially when Im having issues.

Thats interesting about the fiber. I seem to be having a decent response to the increase in fiber since Friday (Ive added about 10g per day). So far, the issues I were having are much less. I'll probably start to bump it up here soon and see how my digestive system reacts.

Thanks again for everyone's input.

Susan_RD_101

@tcolvinOH

Glad you are finding the balance to help keep your blood sugars stable. It really is an art as much as a science!

AngieB_65

Ok I had laser gallbladder removal surgery on 9/93 and I had diarrhea after the surgery and I called my gastroenterologist and told him and he said no your not and I said yes I am with everything I eat and I am so weak that I can't hardly move and I can't keep any food down because it goes right through me with diarrhea extremely liquidy and I said what are you gonna do about it and he said he was not gonna do nothing because you are not having diarrhea from your laser gallbladder removal surgery that does not happen and I said I will get my husband on the phone and he will tell you I am having diarrhea and my husband told him and he said the same thing to my husband and I said give me the phone before he hangs up and I said you are gonna do something about this or I am gonna come up there and shoe you I am having diarrhea and then you will do something about it and I ain't gonna hang up until you tell me what you are gonna do about this and he said try Questran and I said what is it and he said it is a packet of orange powder you mix in water as soon as you get up each day and drink it and that should help well I told him you knew what to do and about this but you tried to convince me there is nothing you could do so just send the prescription and I will try it so I went to my pharacy ad I got the generic form of Questran and ever since the first dose the first day I have not had diarrhea with anything I eat and that has been 27 years since I first took the first packet of Generic Questran and my recommendation is to never forget to take it.

AngieB_65

The above comment is for people having diarrhea after gallbladder removal surgery and it tells them what to do and you do not have to live with diarrhea everyday.

robartsd

Not sure why AngieB_65 revived this thread in January, but I read it because I also have had my gall bladder removed and am high risk for diabetes (two parents with adult onset diabetes; overweight - but working that - about 30 lbs lost over 11 weeks of tracking my diet).

I'm pretty sure that having a fairly high fiber diet is the primary thing that has prevented frequent diarrhea for me. I get a decent dose of fiber from green smoothies daily (typically spinach, chard, and kale blended with various fruits including a whole banana with peel). No problems at all since starting tracking my diet (likely due to reduction of over eating fatty foods). I hope I never have to reduce fiber intake to manage diabetes.

Questran (cholestyramine) is primarily prescribed to help lower blood cholesterol levels. It works by reducing absorption of bile acids in the intestines. A common side effect is constipation.