On June 17, 2016, I went to the emergency room following a painful gallbladder attack.  12 days later, I had my gallbladder removed.  I had problems several years ago and thought I had addressed them, but it turns out my treatment was not aggressive enough. I see so many posts from people with digestion problems, hormone imbalances, and because we eat a high fat diet I want to share what I have learned about this important little organ.

The number one question people ask since I started eating a high fat diet is, “did eating a ketogenic diet create gallstones?”  Below is the answer to this and other questions.  If you ever have trouble digesting food, sleeping, have hormonal imbalances, then please read the post below.  This is what I have learned between all of my doctors, a general review of the literature and my own experience.

  1. The gallbladder helps the body process the fats in our diet, so this is one of the most important organs for those who eat high fat. The liver makes the bile that is used to digest fats, but this bile is stored in the gallbladder.  When a person eats fat and cholesterol, the gallbladder squirts out this bile and the fats are digested.  If you have a slow metabolism (hypothyroid) or have digestive issues (constipation, diarrhea, burping, acid reflux, etc.), then your body may also be struggling to digest the food you eat.
  2. Most people in the U.S. have gallstones, but it can take between five and twenty years for symptoms to manifest if at all. This means that if you started eating a high fat diet recently, it cannot be the cause of your gallstones.  (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899548/)
  3. Gallstones are very common among women, especially those who either a) take birth control pills for a year or longer, or b) after childbirth. High estrogen levels can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form.
  4. Indigestion, acid reflux, GERD, and even burping can be signs of a sluggish liver and gallbladder. Leaky gut and the liver/gallbladder are related!  If you know you do not have one, you likely have problems with the other.
  5. Allergies (such as food sensitivities, eczema, chronic hives, and histamine intolerance) can be related to the liver and gallbladder. Sudden new food allergies and histamine intolerance can be a sign that the body cannot detoxify because it is filled with gallstones.
  6. Eating a high fat diet does not cause gallstones! I confirmed this with several sources, including my surgeon. Gallstones are made of cholesterol, not dietary fat, which has not been broken down sufficiently by the body for any number of reasons.  But most of the cholesterol in the body is made by the body and is not from the diet.  The creation of gallstones has to do with the body’s ability to mobilize the cholesterol in the liver.  Eating fat encourages the body to release the bile, which is the function of the gallbladder.  If bile is not released regularly or efficiently, it leads to stone formation, so eating dietary fat is important for maintaining the health of the gallbladder and the liver.
  7. Low fat diets and rapid weight loss can contribute to the formation of gallstones. This is because the body decreases its bile output when calories (and dietary fat) are decreased. Inefficient release of bile from the gallbladder often leads to the formation of gallstones. This is another reason why it is important to eat enough fat and not to cut calories too low. Read for more info: Gallstones result from weight-reducing diet: link 1, Gallstones formed after eating low fat diet: link 2, High fat diet prevents gallstone formation: link 3
  8. Fiber-rich foods can protect against gallstones in two ways. Soluble fiber absorbs the bile that contains cholesterol salts and flushes them out of your body. Insoluble fiber keeps digestion moving, which is another way to flush toxins (including gallstones and bile) out of the body.

Home Remedies

Below is a list of treatments that can support fat digestion

  1. Ox bile salt and digestive enzymes help the body produce enough acid to digest fats and proteins. Additionally, they encourage the body to produce enough bile to break down foods eaten. Everyone eating a high fat diet should at least take these to start, as they train the body to be able to break down the increased dietary fats more efficiently.
  2. Apple cider vinegar (ACV) breaks down hardened gallstones. It contains malic acid, which helps to soften and eventually dissolve stones. If you have indigestion and find that taking ACV helps your stomach feel better, you probably have issues with your gallbladder. Taking 1-2 tablespoons a couple times a day can help soften stones so they pass.
  3. Lemon juice can also soften and dissolve gallstones. Squeezing fresh lemon juice on vegetables is beneficial, as it also contains vitamin C which supports gallbladder health.
  4. Drinking water ensures that the body has enough liquids for the bile stored in the gallbladder. Being dehydrated can prevent fats and proteins from being properly broken down.
  5. Additional supplements that can be helpful (but without much data to confirm their effectiveness one way or the other) include: vitamin C, phosphatidylcholine, taurine, turmeric, chanca piedra, milk thistle, dandelion greens, malic acid, and on and on. If you decide to try any of these, do your homework first before trying any of these.
  6. Magnesium can help increase transit time of food leaving the body. FYI—there is a link between magnesium deficiency and gallstones. Not causative, but I am curious to know whether having higher levels of magnesium would have helped my body to process cholesterol faster. Moral: TAKE MAGNESIUM!

Last Resort—Cholecystectomy, or gallbladder removal surgery

If your symptoms are acute enough, your doctor may recommend having the gallbladder removed. This is necessary in some cases and many people feel much better after removal. However, about 4 out of 10 people still have symptoms post operation because the gallbladder was not the original source of their discomfort. This is not a decision to make lightly so talk to your family and doctor, and get a second opinion if you can. One way to alleviate symptoms after surgery is to eat bile salts and enzymes with every meal.  Bile salts help the body to produce enough bile to digest foods, which can be a challenge once the gallbladder is removed. Enzymes help the body to absorb nutrients from the foods you eat.  After about the year, many who continue to eat a high fat diet discover that the body (namely, the pancreas) has adapted to handle the additional fat and exogenous bile salts and enzymes may not be needed anymore.

If you are interested in other references or additional info, feel free to comment below or contact me at airia@ketosister.com. Hope this is helpful.


Allan PL, Baxter GM, Weston MJ, eds. Clinical Ultrasound. 3rd ed. St. Louis, MO: Elsevier Churchill Livingstone; 2011.

Etminan M. Oral contraceptives and the risk of gallbladder disease: a comparative safety study. CMAJ. 2011:183(8):899-904.

Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Altern Med Rev. 2009:14(3):258-67.

Njeze, G. E. (2013). Gallstones. Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society, 19(2), 49–55.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899548/

Liddle RA, Goldstein RB, Saxton J. Gallstone Formation During Weight-Reduction Dieting.Arch Intern Med. 1989;149(8):1750-1753.http://archinte.jamanetwork.com/article.aspx…

Festi D, Colecchia A, Orsini M, Sangermano A, Sottili S, Simoni P, Mazzella G, Villanova N, Bazzoli F, Lapenna D, Petroni ML, Pavesi S, Neri M, Roda E. Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well). Int J Obes Relat Metab Disord. 1998 Jun;22(6):592-600. http://www.ncbi.nlm.nih.gov/m/pubmed/9665682/

Stokes C, Gluud LL, Casper M, Lammert F. Ursodeoxycholic Acid and Diets Higher in Fat Prevent Gallbladder Stones During Weight Loss: A Meta-analysis of Randomized Controlled Trials. Clinical Gastroenterology and Hepatology , Volume 12 , Issue 7 , 1090 – 1100.e2.http://www.cghjournal.org/ar…/S1542-3565(13)01837-5/abstract

Jeong SU, Lee SK. Obesity and gallbladder diseases. Korean J Gastroenterol. 2012;59(1):27-34.

Jiang ZY, Sheng X, Xu CY, et al. Gallbladder gallstone disease is associated with newly diagnosed coronary artery atherosclerotic disease: a cross-sectional study. PLoS One. 2013;8(9):e75400.

Ko, CW. Prefac: Gallbladder disease. Gastroenterol Clin North Am. 2010;39(2):xiii.

Liu B, Beral V, Balkwill A. Childbearing, breastfeeding, other reproductive factors and the subsequent risk of hospitalization for gallbladder disease. Int J Epidemiol. 2009;38(1):312-8.

Liu B, Beral V, Balkwill A, et al. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: a prospective cohort study. BMJ. 2008;337:a386.

Marx J, Hockberger R, Walls R, eds. Rosen’s Emergency Medicine. 8th ed. Philadelphia PA: Elsevier Saunders; 2014.

Moritz, A. (1998) The Amazing Liver and Gallbladder Flush. Ener-Chi Wellness Press. Ener-Chi.com, USA.

Rai A, Tewari M, Mohapatra SC, et al. Correlation of nutritional parameters of gallbladder cancer patients. J Surg Oncol. 2006;93(8):705-8.

Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96.

Tsai CJ, Leitzmann MF, Willett WC, et al. Long-Term Effect of Magnesium Consumption on the Risk of Symptomatic Gallstone Disease Among Men. Am J Gastroenterol. 2007; [Epub ahead of print].

Venneman NG, van Erpecum KJ. Gallstone disease: Primary and secondary prevention. Best Pract Res Clin Gastroenterol. 2006;20(6):1063-73.

Völzke H, Baumeister SE, Alte D, et al. Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion. 2005;71(2):97-105.

Walcher T, Haenle MM, Mason RA, et al. The effect of alcohol, tobacco and caffeine consumption and vegetarian diet on gallstone prevalence. Eur J Gastroenterol Hepatol. 2010;22(11):1345-51.

Wang F. Oral contraceptives and risk of gallbladder disease. CMAJ. 2011:183(13):1517.