Laura Schoenfeld: Again, I hate to beat a dead horse. I don’t work with immediate post-gallbladder removal surgery clients. That is something that I don’t really have my own personal protocol for. As far as just general dietary guidelines, they’re going to recommend avoiding high-fat foods which includes high-fat meats, dairies, butter, animal fats, that kind of thing, bacon, anything that’s super high-fat. Right after you get your gallbladder removed, you want to keep those low, so doing a ketogenic diet right after getting a gallbladder removal is not a good idea.
Generally, they’re going to recommend a lower-fat, higher carb, moderate-protein diet immediately post surgery. With the first few days after surgery, they’re going to recommend a bland diet so something that doesn’t have a lot of spices, tons of fiber, or anything like that since you are healing the damage to your intestinal tract. If there’s been something surgically removed, there are going to be some wounds that are healing, so you want to do stuff that is low fiber, bland, lots of fluids like broth, water and maybe some fresh juices if you need a little bit of calories there, but you just want to be doing low-fat intake. You would want to be doing steamed or cooked vegetables as opposed to raw. Raw veggies are a little bit tough on the digestive system post surgery, so you want to make sure you’re cooking all the vegetables, and steaming them or boiling them allows them to be cooked without adding fat.
Then, once a person has recovered from the surgery, overall they’re going to recommend lower fat as far as just the general guidelines are concerned. All people who have had gallbladder removal are going to tolerate fats differently, and the other thing to keep in mind is that if you’re taking a exogenous digestive enzymes, ox bile or something like that, which is going to help your body digest fats better. You might be able to tolerate a higher fat intake. It would definitely be something that I’m going to transition slowly to if I had a client who just had gallbladder removal or if they were post surgery, but hadn’t tolerated fat for a while because I do work with clients who have had their gallbladder removed. For whatever reason, it’s not common practice to suggest a digestive enzyme or an ox bile supplement for these patients, and I think a lot of them do very well with having digestive enzymes added to their supplement routine. But basically, we will just want to slowly reintroduce fats to tolerance, and if somebody starts getting loose stool, diarrhea, or fat in their stool, you want to cut it back. You can use the digestive enzymes to kind of figure out what their maximum fat intake is per meal, how much fat they tolerate, and how many digestive enzyme supplements they need to really get good digestion.
The other thing to think about is meal size. Without a gallbladder, you frequently don’t tolerate very large meals, especially right off the bat. Sometimes it is easier for those patients to tolerate small more frequent meals because their liver is producing some bile and getting it into the digestive system. Since there’s no place to store the bile because the gallbladder is not there anymore, the bile just drips out slowly into the small intestine. If they’re going to be eating fat, having small amounts of fat more frequently can allow them to tolerate it better than if they have a really large meal that has got a lot of fat in it.
As far as general guidelines go, you would start low fat. Start with small, bland, easy-to-digest low-fiber meals and then start adding fiber in as tolerance is established and then over time adding fat back in. Mostly sticking to some of the easier to digest fats like coconut oils are really easy to digest fat for people without a gallbladder since it doesn’t require breakdown, and then over time you can introduce some of the more long-chain fatty acids like olive oil, avocado oil, and that kind of thing. Animal fats tend to be about in the middle. Some people tolerate them really well, but for others, it will cause diarrhea, so you want to just figure out which fats they do best with, and over time, you can slowly increase that. The liver will kick in some extra bile output to compensate for the missing gallbladder, but it’s not going to be as much as they would have if they had a functional gallbladder. That is where those enzymes are going to really help get things working better and digesting better, so that way they can tolerate fat because you don’t want them to be on a completely fat-free or extremely low-fat diet just because overall we do need fats. We might not need as many as some people might think when it comes to things like the keto diet and that kind of thing, but avoiding fat entirely is not good for health either. If you have a client with a gallbladder surgery, you want to get them to a place where they can get at least, I would say, at least 50 g of fat per day, and that needs to be spread out amongst five meals, and if they have to take enzymes to tolerate that, then that’s totally fine.