Gallbladder Removed? How to Support Digestion After a Cholecystectomy
A cholecystectomy — gallbladder removal surgery — is one of THE most common surgeries in North America.
Leading causes of this surgery are things like: the presence of gallstones, cholecystitis (inflammation of the gallbladder), cholestasis (slowing of bile production and flow), as well as polyps, and a phenomenon known as “porcelain gallbladder.”
What’s unfortunate is that not all of these circumstances warrant immediate removal of the gallbladder (though of course, this is nuanced and circumstantial), and can be addressed naturally, with the potential for avoiding the need for a cholecystectomy altogether.
But for most of my clients who have undergone a cholecystectomy, they haven’t been made aware of the potential downstream impacts on their digestion, nor how to care for their digestive health post-op.
Which is wild to me because we’ve gone ahead and removed an organ that has really important roles to play in our digestion, detoxification, and hormone status — without any investigation into why someone may have needed a cholecystectomy, or how to care for their body after the fact.
So if you’ve had your gallbladder removed and you haven’t been told why you may be struggling with digestive issues after the fact — even years later — this article is your post-cholecystectomy toolkit!
Bile and the Gallbladder: What is it, and What Does it do?
A quick anatomy and physiology lesson in case you’re unaware of what exactly (😅) the gallbladder, and bile, does for us:
The gallbladder is a small organ nestled into the side of the liver. It effectively serves as a storage container for a substance called “bile.” Bile is made in the liver and sent to the gallbladder to be stored until it’s time to be used.
Bile is mostly made of water, but also contains cholesterol, electrolytes, minerals, bile salts, phospholipids, and bilirubin.
It plays important roles in:
fat breakdown
absorption of fat-soluble vitamins
waste removal
excess cholesterol removal
neutralizing the acidic “chyme” that moves from our stomach to our small intestine during the digestive process
Bile also has naturally occurring “laxative” like properties, which can help promote motility and movement in the GI tract (helping you poop!), as well as antimicrobial properties that can keep microbial populations in check in the small intestine.
Ultimately, bile has far-reaching impacts on our digestion, micronutrient status, hormones, energy, combating oxidative stress, immune function, and more.
How a Cholecystectomy (Gallbladder Removal) can Impact Digestion
It’s not uncommon to have folks who struggled with symptoms pre-op, only to have their gallbladder removed, and STILL struggle with digestive issues after the fact. Or worse, even.
New or worsening symptoms post-cholecystectomy is often due to the domino-like effects having this organ removed has on our system.
Here are some of the ways having your gallbladder removed can have downstream impacts on your digestion, and contribute to symptoms:
Poor Fat Digestion and Fat Soluble Vitamin Absorption
As we know, one of the main roles of bile is to help us break down and digest fats. Without a gallbladder and thus concentrated bile, we’re put as risk for not digesting fats well — which can impact our health across all systems; at a cellular level.
What’s more, is that vitamin A, D, E, K are fat-soluble vitamins, meaning they need fats available to them to be absorbed properly. If our body is struggling to break down fats properly due to gallbladder removal, it could put us as risk for fat-soluble vitamin deficiencies, which can of course have a variety of downstream impacts!
Bile Salt Dumping
Dumping of bile salts is another potential issue that folks without their gallbladders can encounter. With the liver frequently releasing bile into the small intestine, there’s the possibility that our body can’t keep up with the demand for the re-absorption of all of these bile salts, which means that excess bile salts can make their way further on, into the colon.
Urgency, loose stool and diarrhea, and cramping can often be signs of too many bile salts making their way into the colon, unabsorbed (AKA bile salt dumping).
Microbial Imbalances: Dysbiosis, SIBO
Bile is naturally “antimicrobial” and can help keep the careful balance of our microbiome in check. In the small intestine, where bile is secreted to aid in the digestion process, microbial populations are pretty minimal compared to what we find in the gut microbiome in the colon.
Because of these naturally occurring antimicrobial properties, bile actually helps to keep these microbial populations in the small intestine from overgrowing. If you’ve heard of something called “SIBO” (AKA small intestine bacterial overgrowth), this is one of the reasons this overgrowth can occur.
Imbalances in the microbes here — or SIBO — can contribute to symptoms associated with IBS, significant bloating, altered bowel movements, reflux, cramping, etc.
Impaired Detoxification & Waste Removal
We also know that another role of bile is to help us with detoxification and waste removal 🗑 Without a gallbladder to secrete concentrated levels of bile, or if we have poor bile production and flow in addition to a missing gallbladder — it puts us at risk for toxin and waste accumulation, which can burden our elimination pathways (including our lymphatic system, liver, etc).
Irritation & Inflammation of the Intestinal Lining
Without a gallbladder to store, concentrate bile, and release it when we consume meals containing fat, bile is going to be continuously released into the small intestine as the liver makes it — even when we don’t have any food coming down the digestive tract.
If the bile salts are able to make their way into the large intestine, they can irritate the mucosal barrier (the barrier between the inner area of our intestine, and our single-cell intestinal barrier). Irritation and inflammation here can contribute to a variety of digestive symptoms, like diarrhea, urgency, and cramping.
How to Support Your Digestion Post Gallbladder Removal
Okay. If you’re thinking to yourself “dang — I had to get my gallbladder taken out and now me and my digestion are screwed,” I’m here to tell you that there are SO many ways you can support your digestion, intestinal barrier, and nutrient status, AND any symptom you may be experiencing post cholecystectomy.
Here are a few ways you can get started:
Take Care of your Liver
This is where it all starts, right. Our liver is the organ that makes bile, and initiates this entire process. We need to support at the source, and make sure our liver is taken care of so it can produce the bile our body needs.
Here’s how:
get your protein in (our liver requires amino acids from protein during the detoxification process)
eat bitter foods (bitter foods like arugula, radicchio, dandelion greens, dandelion root and green tea, endive, radish, etc., all help promote liver function and detoxification)
brassica (cauliflower, broccoli, Brussel’s sprouts, broccoli rabe, cabbage), and allium (garlic, onion, shallot) veggies are also incredibly supportive for liver function and detoxification
limit alcohol intake (it’s just… not good for us nor our liver)
try a castor oil pack (used traditionally to support liver function and reduce inflammation)
Support your Gut Lining
As we learned about, there’s potential that without a gallbladder, the bile that’s being frequently released into the small intestine can be irritating to the GI tract, specifically as it relates to the mucosa in the colon.
Bringing in various gut-lining-supportive herbs and perhaps supplements can be really helpful here.
Some herbs and other supportive constituents you may want to consider are:
ginger
turmeric
slippery elm
chamomile
marshmallow root
quercetin
l-glutamine
immunoglobulins
In general, eating anti-inflammatory foods, and consuming enough healing amino acids through adequate protein intake is important to take care of our gut lining. Likewise, reducing your exposure to things that can further harm the gut lining could be helpful (things like: antibiotics, NSAIDS, stress, alcohol, etc.)
Adopt Tools & Practices to Help your Digestive System Function as well as Possible
Okay, so you don’t have a gallbladder. Doesn’t mean there aren’t things that can be done to support your digestion despite that! There’s tons of tools you can incorporate from a nutrition, lifestyle, herbal, and supplemental perspective to ensure your gut is in tip-top shape despite missing your gallbladder.
Here are some of my favourite tools to support your digestion and gut health:
prioritize chewing thoroughly (do not underestimate the importance of this! we have teeth for a reason! use them! lots!)
practice meal spacing (spacing your meals at least ~3-4 hours apart gives your system time to properly digest, and move everything along down the GI tract effectively and efficiently)
eat mindfully (eat without distractions, focus on chewing your food, take a couple deep breaths before you dig into your meal)
consume a wide variety of plant foods (for the most diversity in fiber, polyphenols, and antioxidants)
Consider Supplemental Support
Supplements may also be something you want to consider post-cholecystectomy. If you know me, you know that I’m firm on nutrition and lifestyle taking precedent over supplements — BUT I do believe there is time and place where they can be really helpful, and this is one of those time!
Some supplements you may want to look into and consider post-cholecystectomy:
Digestive enzymes with Ox Bile
TUDCA (supplemental bile salt)
Amino acids (like glycine and taurine)
NAC or Glutathione
Magnesium
Fatty acids (EPA, DHA)
Choline
** Note: Just because you’ve had your gallbladder removed, doesn’t automatically mean you’re a candidate for supplementing with something like Ox Bile. Please speak with your provider about getting a strategic supplement regimen together, as certain products are best suited in specific scenarios.
How to Test for the Downstream Impacts of Gallbladder Removal
Certain conventional and functional labs can provide insights into the potential impacts of living without a gallbladder. These labs can test for microbial imbalances, gut inflammation, digestive function, and more.
Here are a few you may want to consider:
Micronutrient Testing: Through conventional bloodwork and tests like the Micronutrient Panel by Vibrant Wellness can provide further information about a variety of vitamins, minerals, essential fatty acids, and amino acids, to help us determine if nutrient deficiencies potentially related to a cholecystectomy and poor digestion is at play.
GI MAP Stool Test: This comprehensive stool test tests for pathogens, bacterial, viral, parasitic and fungal populations, plus markers for inflammation, immune function, digestion, and intestinal health.
SIBO Breath Test: Breath testing is the gold-standard for SIBO (small intestine bacterial overgrowth), which could be present in part due to gallbladder removal surgery (as mentioned above!)
Organic Acids Test (OAT): This test gives us a comprehensive look at markers related to digestive health, bacterial and fungal populations, mold, neurotransmitter status, detoxification, and more.
How Working with a Practitioner can Help you Post-Gallbladder Removal
If you’re looking for support with digestion after having a cholecystectomy (OR if you struggle with gallbladder issues and haven’t had your gallbladder removed yet), and would like to dive deeper to see if there may be any additional imbalances that might be driving your symptoms, working with a practitioner (like myself!) can be really impactful.
Here’s specifically how I can help:
GUT RESTORE METHOD: If you’re looking for go-all-in deep-dive support that includes a personalized gut healing plan and access to things like the functional labs I mentioned above, the Gut Restore Method might be a great fit for you. This is my flagship, high-touch 5 month 1:1 program where we’ll take an investigative, root-cause approach to get to the bottom of your symptoms. You can learn more about the Gut Restore Method here.
