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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

While gallstones the most common reason for a cholecystectomy, an operation in which the gallbladder is removed, there are other less common indications for the removal of the gallbladder as well, including being at risk of gallbladder cancer.

One of the more common complications of gallbladder removal surgery is diarrhea, which occurs due to ineffective regulation of the flow of bile from the liver to the intestine. It is important that people modify their diet after gallbladder removal, in order to prevent complications of gallbladder removal — especially diarrhea.

Cholecystectomy: What Happens During Gallbladder Removal Surgery

Cholecystectomy is a surgical procedure during which the gallbladder is removed. It can be done by either using the open method or by using the 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 now the most commonly employed method to remove the gallbladder. About 700.000 cholecystectomies are done every year in the United States. [1]

Effects Of Gallbladder Removal

In a normal individual, bile is secreted by the liver. It flows through the bile duct into the small intestine, where it aids digestion and the absorption of fat. When the individual is not taking food, the bile flows into the gallbladder where it is stored and concentrated. When the individual eats, especially a fatty meal, the gallbladder contracts and bile flows through the bile duct into 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 portion of the small intestine. In individuals in whom the gallbladder has been removed, the bile is not stored and it flows directly into the small intestine. The upper small intestine tries, to some extent, to store bile until it is utilized for the digestion o fat, but this is a less effective process. [1]

The excess bile salts are too much for the terminal small intestine to absorb, and some of the bile salts escape to the large intestine. The bile salts can irritate the colon and this results in diarrhea. [2]

Gallbladder Removal: Recovery

People who have undergone a laparoscopic cholecystectomy are usually able to go home on the day of their surgery, while those who underwent a more traditional open cholecystectomy will need to stay in the hospital for three to five days. When you go home, you will need someone to drive you.

Bruising, swelling, pain (in the abdomen and shoulders), and nausea are all common during the immediate gallbladder removal recovery period. You will be advised to take over the counter painkillers to cope with your discomfort. [3

You can expect to return to your normal daily activities within two weeks of receiving a laparoscopic cholecystectomy, while recovery from an open cholecystectomy can take up to six weeks. Side effects such as abdominal bloating, diarrhea, flatulence, mood swings and fatigue can persist beyond that. [3]

Dietary Changes After Gallbladder Removal

People with gallbladder disease are usually instructed to avoid foods that are 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 time, the surgeon who operates on the individual does not give advice regarding any specific cholecystectomy diet after gallbladder removal. [4]

Many individuals who undergo gallbladder removal still experience complications such as diarrhea following gallbladder removal, however. 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 it may persist for years and subside very slowly. As mentioned earlier, the bile flow is not regulated in people whose gallbladders were removed, and excess bile salts entering the colon cause diarrhea. [5]

In a healthy 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 hour bile output is increased in persons who have had their gallbladder removed compared to those who have an intact gallbladder. The increased amount of bile salts thus secreted enters the large intestine, causing diarrhea. [5]
Bile salts are required for the 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 a the usual 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 will be the most common complication, and it occurs due to excess bile salts reaching the colon and the excess fat is not digested well. This diarrhea is more of a nuisance than a serious medical problem in many people. 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.

What Is An Appropriate Diet After Gallbladder Removal?

The first step in the diet plan after gallbladder removal is to eat smaller meals more frequently, and to avoid a diet rich in fat. The number of total calories provided by fat should be limited to less than 30% of the total caloric intake of these patients. Intake of saturated fat should be limited. Food should be prepared by steaming and baking. Fried food should be avoided. Similarly, processed food, which tends to be rich in fats, should also be avoided.

Improvement may be seen if the BRAT diet is taken. The BRAT diet is advised by doctors for relief the of symptoms from any type of diarrhea, even with cancer treatment regimes [6]. "BRAT" stands for "banana, rice, applesauce and tea/toast". High fiber intake in addition to the BRAT diet will provide relief from diarrhea and help pass well-formed stools.

The diet after gallbladder removal should include the following [7]:

  • 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 items can worsen diarrhea and these should be avoided if you are already vulnerable to loose stools. This includes food items like:

  • Red meat – This contains animal fat and protein that are difficult to digest.
  • Milk and milk products
  • Caffeine
  • Fatty meals
  • Refined carbohydrates
  • Refined flour
  • Fried and processed food
  • Hydrogenated fat

Weight Loss After Gallbladder Surgery

Since obesity and rapid weight loss are both risk factors for developing gallstones, many people who undergo gallbladder removal surgery are familiar with weight struggles. Post-cholecystectomy patients who strictly adhere to the dietary changes advised by their doctors — that is, the advice to eat a healthy, high-fiber and low-fat diet — but whose diet was rich in fatty and processed foods before their surgery, will almost certainly experience spontaneous weight loss after their gallbladder removal surgery. [8]

If you are overweight or obese after your gallbladder removal surgery, you may want to take active steps to lose weight. The healthiest approach to diet after gallbladder removal is the same approach that is best for the general population: you want to eat a balanced diet that includes all major food groups, but restrict your caloric intake. Aim for a weight loss of about 2 lbs per week. Do not forget to add some healthy fats into your diet, as your body still needs those. In addition to eating a balanced diet, a healthy approach to weight loss requires regular exercise,  and should be a gradual, sustained effort. Do not turn to fad diets to lose weight rapidly! 

A portion of post-cholecystectomy patients will find themselves unable to lose weight after gallbladder removal even when they do follow the dietary recommendations. These patients should note that some of the same factors that contribute to gallbladder disease — hypothyroid, indigestion, acid reflux, and insulin resistance, among others — can also make it more difficult to address weight loss after a cholecystectomy.

Until the underlying medical issues that may be standing in the way of their weight loss are properly diagnosed and treated, they will likely continue to experience the same problems. Therefore, if you have trouble losing weight even when following the proper diet and adhering to caloric recommendations, you will need to seek medical help to address potential health issues you are still suffering from.