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Fatty food is to be avoided by patients with gallbladder disease as it can precipitate or worsen the symptoms. The two main indications for removal of gallbladder are cholecystitis and symptomatic gallbladder disease.

Cholecystectomy - gallbladder removal

There are other less common indications as well for the removal of gallbladder. One of the common complications of gallbladder removal is diarrhea which occurs due to ineffective regulation of the flow of bile from the liver to the intestine. One should modify the diet after gallbladder removal to prevent the complications of gallbladder removal especially diarrhea.

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Cholecystectomy

Cholecystectomy is the procedure by which gallbladder is removed. It can be done by either the open method or by laparoscopic method. In the open method, a large incision is made just below the rib cage to open the abdomen and the gallbladder is removed. In the laparoscopic method, four small incisions are made on the abdomen and slender tubes are introduced through it with which the gallbladder is removed. The laparoscopic method is the commonly employed method to remove gallbladder. About 700.000 cholecystectomies are done every year in the United States.

Effects of removal of gallbladder

In a normal individual, the bile is secreted by the liver. It flows through the bile duct in to the small intestine where it helps in the digestion and absorption of fat. When the individual is not taking food, the bile flows in to the gallbladder where it is stored and concentrated. When the individual eats, especially a fatty meal, the gallbladder contracts and the bile flows through the bile duct in to the small intestine. In the upper small intestine it helps in the digestion and absorption of fat. After the fat is digested and absorbed, bile salts are absorbed from the terminal potion of the small intestine. In individuals in whom gallbladder is removed, the bile is not stored and it flows directly in to the small intestine. The upper small intestine to some extent tries to store bile till it is utilized for the digestion o fat.

But the excess bile salts are too much for the terminal small intestine to absorb and some amount of bile salts escape in to the large intestine. The bile salts irritate the colon and this result in diarrhea.


Why change diet after gallbladder removal?

Person with gallbladder disease are usually instructed to avoid food rich in fat. This is because fatty food either precipitates the symptoms of gallbladder disease or worsens the symptoms. Once a diseased gallbladder is removed, the symptoms which are precipitated by a fatty meal usually do not occur. So most of the times, the surgeon who operates on the individual does not give advice regarding any specific diet after gallbladder removal.

But many individuals who undergo gallbladder removal experience the complication such as diarrhea following gallbladder removal. Studies have shown that ten to thirty percent of patients who undergo gallbladder removal suffer from diarrhea. This complication of diarrhea will subside on its own over a period of time in some individuals. But this may persist for years and subside very slowly.  As mentioned earlier the bile flow is not regulated and the excess bile salts entering the colon cause diarrhea.

In a normal individual who has an intact gallbladder the secretion and flow of bile is under the control of a hormone called cholecystokinin. Once the gallbladder is removed, this hormone no longer controls the flow of bile. It has been found that after gallbladder removal the flow of bile is continuous. Moreover the 24 hours bile output is more in persons who have had their gallbladder removed than in those who have intact gallbladder. The increased amount of bile salts thus secreted enters the large intestine causing diarrhea.
   
Bile salts are required for digestion and absorption of fat. If an individual who has undergone surgery for gallbladder removal eats a meal rich in fat, the fat may not get digested well as the secretion of bile does not occur in an appropriate way. Since fat is not digested well and absorbed, a fatty meal may result in fatty diarrhea.  Studies have shown that fat content of the stool is higher in individuals who have had their gallbladder removed.

So in an individual who has had the gallbladder removed, diarrhea the most common complication occurs due to excess bile salts reaching the colon and the excess fat that is not digested well. This diarrhea is more of a nuisance than a serious medical problem. Though it may not always cause dehydration, it may sometimes result in electrolyte imbalance.
To prevent and to treat this complication, dietary changes are required after gallbladder removal.

Appropriate diet after gallbladder removal

The first step in the diet plan after gallbladder removal is to eat smaller meals and avoid diet rich in fat. The amount of calories provided by fat should be limited to less than 30% of the total calories. Intake of saturated fat should be limited. Food should prepared by steaming and baking. Fried food should be avoided. Similarly processed food should also be avoided.

Improvement may be seen if BRAT diet is taken. BRAT diet is advised by doctors for relief of symptoms from any type of diarrhea.  BRAT diet stands for banana, rice, applesauce and tea/toast. High fiber intake in addition to BRAT diet will provide relief from diarrhea and help pass well formed stools.

The diet after gallbladder removal should include the following:

  • Fruits and vegetables – These should include avocados, apples, berries, grapes, cucumber and beet. These are rich in fiber. They help to control diarrhea and help pass well formed stools. At least one serving of fruits and vegetables should be consumed during each meal.
  • Yogurt
  • Lean meat –  Chicken, turkey
  • Fish
  • Cottage cheese
  • Whole grains
  • Eggs


Certain food item can worsen diarrhea and should be avoided. This includes food items like:

  • Red meat – This contains animal fat and protein that are difficult to digest.
  • Milk and milk products
  • Caffeine
  • Fatty meal
  • Refined carbohydrates
  • Refined flour
  • Fried and processed food
  • Hydrogenated fat
  • www.mayoclinic.com/health/gallbladder-removal/AN00067
  • www.springerlink.com/content/lq334628v02m3428/
  • content.karger.com/ProdukteDB/produkte.asp?Doi=198840

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