hat can we do for someone after cholecystectomy with complaints of diarrhea and what seems like too much bile flow? The patient denies any further pain, but has had increased loose stools and diarrhea since her cholecystectomy.

The first thing I would actually start with here would be probably just to look at the macronutrients that the patient’s eating. Most of my patients after cholecystectomy actually do well and I don’t normally need to adjust macros too much. But because some patients can be a little bit more sensitive to fats after cholecystectomy, look at how many grams of fat they’re eating each day. If it is in that higher end of the range, maybe think about decreasing fat intake, experiment with different types of fats, and see if those make a difference. If working with diet alone isn’t helpful, then I would probably start by working with different digestive enzymes. I might actually just start with lipase, and again, the question there being is fat the main issue that’s causing the loose stools. Also, I would ask the patient are the loose stools floating? Are they greasy? Is this a question of fat malabsorption? If lipase alone doesn’t do it, then I would probably go to ox bile extract. With ox bile extract, I would start at a lower dose. I think the lower dose capsules are 250 mg and then higher dose capsules, I believe, are about 500 mg, so start at the lowest dose possible. But again, start with dietary interventions, and see if that works. If not, explore different forms of digestive enzymes, so again, maybe lipase or, if needed, ox bile extract. I would start there and see if that helps with the symptoms that started after the cholecystectomy.