Do you know what the gallbladder does?
Did you know you can live without your gallbladder?
You might know someone who has had their gallbladder removed. Or maybe that person is you. Cholecystectomy is the surgery to remove a gallbladder and is most commonly performed due to symptoms from gallstones. In Australia between 2004 – 2019 this surgery was performed around 50 000 times per year.
So, what is the gallbladder? What are gallstones? And what does eating have to do with it?
The gallbladder is a small organ that sits underneath the liver. Its job is to store bile and release it into the small intestine. It is connected to the liver and the first part of the small intestine (the duodenum) through ‘pipes’ which are called ducts. The gallbladder’s job is to help our body digest fat from the food we eat.
Quick science lesson on fat digestion. Our digestive tract is a watery environment. As we know, fat does not mix well with water. The fat we eat sticks together and becomes one big clump! This clump is too big to be absorbed across the wall of our small intestine.
That is where bile comes in to save the day.
Bile is a substance made by the liver and stored in the gallbladder. When we eat a food containing fat, our small intestine sends a signal to the gallbladder. This signal tells the gallbladder to send bile through the duct and into the small intestine. The bile then breaks up that big clump of fat into smaller molecules that can be easily digested and absorbed.
Put simply, the gallbladder stores bile from the liver and bile is needed to digest fat.
One problem that can arise with the gallbladder is gallstones. Gallstones are hardened digestive fluid. If the gallstone is big enough and in the right spot, it can block the flow of bile from the gallbladder to the small intestine. This blockage can cause pain and other symptoms which could result in needing a surgery to remove your gallbladder. Sometimes, gallstones do not cause any symptoms. But, your doctor may advise you to make some changes to your diet or physical activity levels to prevent the gallstone from getting any bigger.
Kim is an experienced Accredited Practicing Dietitian. If you would like to discover how you can grow your knowledge and confidence around nutrition click the link to discover more.
There is some evidence that certain lifestyle factors can lower your risk of gallstones. These include:
A diet high in fibre, nuts, calcium, fruits and vegetables is shown to be protective against gallstone formation. A diet high in vitamin C, found in foods like oranges, kiwi fruit and, tomatoes, has also been shown to lower the risk of gallstones. Having a large amount of animal protein in your diet can increase your risk of gallstones.
Rapid weight loss can increase your risk of gallstones. Rapid weight loss is defined as losing more than 1.5kg per week. This can occur in people doing very restrictive calorie diets or after bariatric surgery. If this is you, ensure you still have fat and fibre in your diet to lower your risk of gallstones. Once your weight has stabilised, this risk does goes away.
Physical activity is protective against gallstone formation. This is because exercise can help reduce insulin resistance, and increases HDL-cholesterol (the ‘good’ cholesterol). Aim for 30 – 60 minutes of physical activity a day.
If you do develop gallstones you may require a surgery to remove your gallbladder (a cholecystectomy). So, what should you eat if you no longer have a gallbladder? If you ask Google this question, you will be told to avoid sugar, caffeine, soft drink, dairy foods, spicy food, fatty foods and more. That does not sound sustainable or enjoyable to me. The truth is, we do not have good evidence to support removing any food or nutrient from our diet after a cholecystectomy.
You might be thinking, “what about fat! Isn’t the gallbladder important for fat digestion”. Remember, the liver is still making bile. But instead of the bile being sent to the gallbladder for storage, it now goes straight to the small intestine ready to work its magic on the big fat clumps. Studies show that majority of people are able still able to eat and digest the fat from their food without a gallbladder. You can still have pizza!
Some people may experience gastrointestinal symptoms such as diarrhoea, abdominal pain, nausea, bloating or flatulence after gallbladder removal. Your surgeon might recommend a low-fat diet after surgery to help with these symptoms. However, there is very little evidence to support this. Studies comparing patients following a low-fat diet and those following a normal or high fat diet post cholecystectomy, found no significant difference in their symptoms. Basically, cutting out fat did not stop people getting diarrhoea. If you are experiencing these symptoms you should talk to your doctor as it may indicate an underlying condition such as irritable bowel syndrome.
Advice around what to eat after gallbladder removal needs to be given on an individual basis. Every person and their digestive tract is different. While some people may find reducing their fat intake improves symptoms other people may see no difference. Talk to your doctor and dietitian about what is right for you.