Life After Gallbladder: The Digestive Rollercoaster

So, you've bid farewell to your gallbladder. But what does that mean for your digestive system? Buckle up – it's quite a ride!

There are two common complications that people can develop post-gallbladder-removal. These are called post-cholecystectomy syndrome (PCS) and post-cholecystectomy diarrhea (PCD) (2). (Cholecystectomy = gallbladder removal in surgical terms)

PCS symptoms include: heartburn, bloating, gas, post-meal fullness, nausea, vomiting, and persistent upper right abdominal pain (1)

PCD symptoms include: food intolerances, bloating, and -you guessed it, frequent diarrhea (1) 

Sounds fun, right? These lousy syndromes are problems for up to 45% of post-surgical patients (2). So why do these happen?

Continuous Bile Flow

Your gallbladder is the storage unit for bile, a digestive fluid that helps break down fats. Usually, the gallbladder holds the bile until you eat a meal, then releases it in a big squirt to help break down your food. Without the gallbladder, bile flows continuously into your small intestine, bypassing its previous pitstop. This constant bile in the intestines irritates the intestinal lining, triggering it to secrete extra fluid and speeding up the muscle movements that move poop along, leading to frequent diarrhea (2).

Undigested Fats

With the gallbladder out of the picture, there's less bile available to break down fat during meals. This leaves bigger, undigested fat droplets cruising through your intestines. Now, these fat droplets don’t just come out the other end with no casualties. Unfortunately, undigested fat in our intestines becomes a feast for troublesome microbes, promoting their growth and resulting in dysbiosis (2).

Missing Microbial Defence System

Now, let's talk bile. It's not just a fluid for breaking down fats; it's also a microbial gatekeeper. Bile is bacteriostatic, meaning it can inhibit the growth of bacteria. When released in controlled bursts with meals, it helps prevent troublesome bugs we inadvertently consume with our meals from multiplying. However, after gallbladder removal, bile comes out in a slow, constant drip. This disrupts the balance, allowing harmful bacteria we consume to multiply, and hindering the growth of our beneficial bugs (2). 

Preventing Post-Surgery Woes: A Dietary Approach

In essence, life after gallbladder removal is a digestive rollercoaster. Understanding the shifts in bile flow and microbial dynamics sheds light on the challenges your gut faces. So, what's the takeaway? 

Supporting a healthier microbiome seems to be the ticket to a healthy gut post-cholecystectomy (3). And how do we do this?

- Up Your Fiber:

A high-fiber and low-fat diet has been shown to reduce the risk of post-cholecystectomy syndrome (3). Soluble fiber is recommended to help bind the bile in the intestines, preventing intestinal irritation and normalizing bowel movements in cases of diarrhea (1). Fiber also feeds our good gut bugs, helping to keep beneficial populations strong and potentially harmful populations at bay.

- Avoid Dietary Cholesterol:

A high-cholesterol diet forces the liver to make more bile, leading to more bile dripping into the intestines and exacerbating gut microbiome imbalance in post-cholecystectomy syndrome (3).

- Lower Saturated Fat Intake:

Especially in the immediate post-op period, a low-fat diet has shown notable benefits. Low-fat diets for the first 3 months after surgery are associated with decreased post-cholecystectomy syndrome (2). For the longer term, it may be more about the type/source of fat that matters. High animal protein (often packaged with saturated fats) increases the risk of pathogenic bacterial growth associated with inflammation and metabolic disorders, while plant-based foods have the opposite effect – anti-inflammatory and beneficial to metabolism (2).

Conclusion: Your Path to Digestive Wellness

To reduce the risk of post-cholecystectomy syndrome up dietary fiber, steer clear of cholesterol, and lower saturated fat intake (2). These measures will help give your gut a helping hand as it adjusts to functioning without a gallbladder.

If you’ve had your gallbladder removed, or another GI health issue you’d like to tackle, I'm here for you. I work individually with clients, offering guidance and personalized plans to put evidence-based nutrition recommendations into action. If you have any questions, feel free to reach out. I'm dedicated to supporting you every step of the way.

To your health,

Karen

Sources:  

(1) del Pozo, Reginald. "Diet and Gallstone." (2023).

(2) Lim, R., and S. K. Y. Chang. "The Association between Gut Microbiome and Post-Cholecystectomy Syndrome and Diarrhoea: A Review." Journal of Gastroenterology & Hepatology Reports. SRC/JGHR-123. DOI: doi. org/10.47363/JGHR/2021 (2) 117 (2021): 2-5.

(3) Xu F, Chen R, Zhang C, Wang H, Ding Z, Yu L, Tian F, Chen W, Zhou Y, Zhai Q. Cholecystectomy Significantly Alters Gut Microbiota Homeostasis and Metabolic Profiles: A Cross-Sectional Study. Nutrients. 2023 Oct 17;15(20):4399. doi: 10.3390/nu15204399. PMID: 37892474; PMCID: PMC10609985.