Do you know what the gallbladder does?
You might know someone who has had their gallbladder removed or maybe that person is you. A cholecystectomy is the name of the surgery to remove a gallbladder and it is most commonly performed due to the painful symptoms from a gallstone. In Australia, this surgery is performed around 50 000 times per year!
So, what is the gallbladder? What are gallstones? And what does food have to do with it?
The gallbladder is a small organ that sits underneath our liver. Its job is to store a substance called bile and release bile into the small intestine when we eat. Bile helps our body to digest the fat from food. The gallbladder is connected to the liver and the small intestine through a set of pipes called ducts.
Quick science lesson on fat digestion. Our digestive tract is a watery environment and as we know, fat and water do not mix! The fat we eat sticks together to become a large clump. This clump is too big to be absorbed across the wall of our intestine and into our blood stream. This 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 food containing fat, our small intestine sends a signal to the gallbladder. This signal tells the gallbladder to release bile into the small intestine. The bile breaks up that clump of fat into small molecules that can be easily digested and absorbed.
Put simply, the gallbladder stores and releases bile and bile is needed to digest fat.
Gallstones are hardened digestive fluid which can block the flow of bile from the gallbladder to the small intestine. This blockage can be very painful and may result in surgery to remove the gallbladder. However, some gallstones can cause no symptoms but your doctor may advise you to make changes to your diet or exercise levels to prevent the gallstone getting any bigger.
There is some evidence that certain lifestyle factors can lower your risk of gallstones.
A diet rich in fibre, nuts, calcium, fruits and vegetables may 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 is defines as losing more than 1.5kg of weight per week and it can increase your risk of gallstones. This rapid weight loss can occur in people doing very restrictive calorie diets or after bariatric surgery. If this is you, it is important to ensure you are still having fat and fibre in your diet to lower your risk of gallstones. Once your weight has stabilised, the risk of gallstones is reduced. Speaking with a dietitian can ensure your diet and weight loss is safe.
Exercise is protectice against gallstone formation. This is because exercise can help reduce insulin resistance and increase HDL-cholesterol (the “good” cholesterol). Aim for 3 – 60 minutes of physical activity each day.
If you develop painful gallstones you may require a surgery to remove your gallbladder (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, spicy food, fatty food and more. That does not sound sustainable or fun!
The truth is, we do not have any good evidence to support removing any food or nutrient from our diet after a gallbladder removal.
You might be thinking, “what about fat? Isn’t the gallbladder important for fat digestion.” Remember, the gallbladder is responsible for storing bile. Our liver still makes bile but instead of it going to the gallbladder for storage, it is sent straight to our small intestine, ready to work its magic on those fat clumps. Studies show that the majority of people are still able to eat and digest fat without a gallbladder. Phew!
Some people may experience digestive symptoms such as diarrhoea, abdominal pain, nausea, bloating or flatulence after their surgery. Your surgeon may recommend a low-fat diet to help with these symptoms. However, there is very little evidence to support his. Studies comparing patients following a low-fat diet and those following a normal or high-fat diet post surgery found no significant difference in their symptoms. Basically, cutting out fat did not stop people from getting diarrhoea. If you are experiencing these symptoms ongoing after surgery, 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 fid reducing their fat intake improves symptoms other people may see no difference. Talk to your dietitian about what is right for you.