What to Eat After Gallbladder Removal

Dietary Recommendations for Better Management

In This Article

If you have undergone a cholecystectomy (surgical gallbladder removal), you will likely be advised to adjust your eating habits. Without a gallbladder, the bile meant to be stored there will flow freely into the small intestine, increasing the risk of diarrhea while impeding the absorption of important nutrients. A diet specifically designed to address your body's new needs can help bring these symptoms under control.

There is no standard diet people should follow after a cholecystectomy, but one that is low in fat is suggested. Because bile's role is to break down fat so that it can be absorbed in the intestine, such a diet allows what little bile is trickling into the intestine to work effectively without overwhelming the bowel with fat it cannot absorb.

Benefits

You can live just fine without a gallbladder. In fact, most people who have a cholecystectomy don't experience any long-term effects. However, according to 2016 clinical practice guidelines published in the Journal of Hepatology, between 10% and 40% of people who undergo cholecystectomy will experience diarrhea and other gastrointestinal symptoms.

Those who do develop symptoms after gallbladder removal surgery tend to notice them within the first three years following the surgery. Although there are few ways to accurately predict who will develop symptoms, there are factors that can increase a person's risk.

A 2014 study published in the Asian Journal of Surgery found that men over 45 years who didn’t follow a low-fat diet following a cholecystectomy were more likely to experience post-operative symptoms, including bile acid diarrhea and sphincter of Oddi dysfunction (painful spasms of the valve that connects the pancreas to the intestine).

Research indicates that people prone to diarrhea before surgery are more likely to experience diarrhea better cholecystectomy than those who weren't. Obesity is also known to contribute.

The aims of the post-cholecystectomy diet are simple:

  • By reducing the intake of fat, you temper the laxative effect of free-flowing bile.
  • By reducing the acidity of stool, the motility of the intestine is eased, resulting in more regular bowel movements and fewer intestinal spasms.
  • The reduction in non-metabolized fats will enhance, rather than block, nutrient absorption in the intestine.

By eating a low-fat diet, you can better avoid diarrhea and intestinal pain while preventing the malabsorption of fat than can lead to nutritional deficiencies.

Potential Health Problems Following Gallbladder Removal
Verywell / Cindy Chung

How It Works

Immediately following a cholecystectomy, your doctor will likely place you on a clear liquid diet to prevent nausea, vomiting, and constipation. Acceptable liquids include clear broth, gelatin, juice, popsicles, and carbonated beverages.

Over the next few days, you would advance to a bland BRAT diet. The BRAT diet involves the use of bread, white rice, applesauce, and toast or soda crackers to gently bind loose or runny stool. (If you are already passing normal stools, a BRAT diet may not be necessary.)

This is when a low-fat diet would begin. It would need to be followed for at least a few weeks.

By definition, a standard low-fat diet contains 30% calories from fat or less, with 1 gram of fat equaling 9 calories. For a 1,500-calorie diet, that translates to 50 grams of fat per day. For a 2,000-calorie diet, you can consume up to 67 grams of fat per day.

Generally speaking, you need to avoid anything fatty, greasy, or fried. In addition, processed and sugary foods should be avoided, both of which can promote diarrhea.

People with severe symptoms may also need to limit their intake of dairy, fatty meats, caffeine, spicy foods, and alcohol. Trial-and-error will ultimately direct which of these foods agree with you and which don't.

What you shouldn't try to do is cut out all dietary fat. Fat is essential to supporting cell growth, metabolizing nutrients, protecting organs, and synthesizing hormones. By choosing healthy polyunsaturated and monounsaturated fats—especially omega-3 fatty acids found in fish—you can meet your recommended dietary intake (RDI) of dietary fat while significantly decreasing your risk of bile acid diarrhea and irritable bowel syndrome (IBS).

Other dietary interventions may be recommended, including an increased intake of fiber, which can bind to excess bile between bowel movements and prevent gastritis.

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Duration

As a general rule, a low-fat diet should be used by anyone who has undergone a cholecystectomy, irrespective of age, sex, or health status, for at least a month following the surgery.

Not everyone who has a cholecystectomy will need to adhere to a strict low-fat diet for the rest of their lives, but doing so will almost invariably improve bowel function as well as the function of the heart, kidneys, and liver.

After a month or so, you may be able to normalize your fat and sugar intake. Some people may even be able to return to the same diet they had before surgery. However, if you find yourself struggling with digestion, you may be experiencing postcholecystectomy syndrome (PCS), a condition characterized by stomach upset, diarrhea, nausea, bloating, flatulence, and vomiting. Persistent PCS may require the extended (or permanent) use of a low-fat diet.

What to Eat

There isn’t one post-cholecystectomy diet that works for everyone, but there are foods that tend to be more problematic than others.

Compliant Foods

  • Apples, applesauce, and pears

  • Avocados

  • Bananas

  • Beans, legumes, and lentils

  • Berries

  • Broth and clear soups

  • Broccoli

  • Brussels sprouts

  • Cabbage

  • Carrots

  • Chickpeas

  • Collard and mustard greens

  • Dairy-free milks (soy, rice, almond, oat)

  • Eggs, egg whites, and egg substitutes

  • Fish (salmon, cod, halibut)

  • Grapefruit and oranges

  • Green bell peppers

  • Kale

  • Low-fat Greek yogurt

  • Nuts and nut butters (almond, cashew, walnut)

  • Oats and barley

  • Olive oil (extra virgin)

  • Plums and prunes

  • Rice (white if having symptoms)

  • Seeds (chia seeds, flax seeds)

  • Sweet potatoes

  • Tofu and tempeh

  • White meat chicken and turkey without skin

Non-Compliant Foods

  • Alcohol

  • Butter, lard, vegetable oil, and margarine

  • Caffeine (coffee, tea, energy drinks, soda)

  • Chocolate and candy

  • Fatty and fried food

  • Frozen meals and desserts

  • Full-fat dairy

  • Ice cream, whipped cream, custard, and pudding

  • Lamb

  • Processed and packaged snacks

  • Pies, pastries, doughnuts, cake, and cookies

  • Pizza and calzones

  • Pork, bacon, sausage, and lunchmeat

  • Potato chips and buttered popcorn

  • Red meat

  • Spices (as tolerated)

  • White refined flour (including bread and pasta)

Fruits and vegetables: The soluble fiber in sweet potato and broccoli can help prevent diarrhea. If you find that citrus fruits like oranges and grapefruit are too acidic, stick with apples, bananas, avocado, and berries. Vegetable soups are nutritious and easy to digest, but you may be better served to avoid creamy soups, at least for the short term. 

Dairy: Full-fat dairy products may be too difficult for your body to break down, especially while recovering from surgery. Low-fat yogurt, dairy-free milk alternatives, and some low-fat cheese may be easier to tolerate if eaten in moderation. You can also explore dairy-free cheese made from cashews or tofu. 

Grains: As you begin easing back into a regular diet, focus on increasing your fiber intake from whole grains, such as brown rice and barley. Toast and crackers can be useful when recovering from surgery, but you’ll eventually want to replace those made with refined white flour with ones made from whole grains.

Pizza, calzones, and other foods made with hard "00" flour are especially hard to digest. You can make a lighter, dairy-free pizza made with flour tortillas, lactose-free cheese substitutes, and fresh vegetables.

Protein: You don't need a gallbladder to digest protein, so high-protein foods aren’t likely to cause you trouble unless they are also high in fat. Avoid cuts of beef that look heavily marbled, and trim any excess fat from chicken, pork, beef, and other meats.

Nuts, seeds, and nut butters are excellent sources of plant-based protein (although extremely high in fat). Beans, legumes, and soy products are also healthy choices for you as long as they don’t cause digestive symptoms. 

Beverages: You may initially need to avoid sodas and alcohol after having your gallbladder removed. Over time, you can experiment with the types of beverages you can tolerate, although it is best to avoid those that are high in sugar (including sweetened juices and juice concentrates).

Milky coffee drinks, such as lattes made with whole milk, may be far too difficult to digest. Instead, look for low-fat or non-dairy options made with soy or almond milk. Herbal teas, especially peppermint, can be very soothing to the digestive tract. 

If you are unwilling to cut out alcohol entirely, avoid sweet cocktails and high-carb beers. Even sweeter wines, like port and sherry, can cause problems.

Desserts: Desserts that are high in sugar and trans fat are especially difficult to digest. Ice cream, cakes, cookies, puddings, and chocolate should only be consumed occasionally and with moderation.

There are some good low-fat, non-dairy desserts on grocery store shelves, but keep an eye out for artificial sweeteners like sorbitol than can increase the risk of diarrhea.

Within a span of a few weeks of having your gallbladder removed, you should be able to increase the amount and range of foods you are able to eat. Experiment with different food groups to see how your body responds. By keeping a food diary, you can keep tabs on which foods cause you the most problems and which don't.

Recommended Timing

You may need to experiment with the timing of your meals and snacks. Without a gallbladder to assist with digestion, you may need to eat four to six smaller meals per day rather than the three large meals you may be used to.

If you are on the run, have plenty of low-fat snacks on hand to tide you over. This may prevent overeating when you finally are able to sit down for a meal.

After eating, give yourself time to digest what you've just eaten. Jumping straight into strenuous activity after eating will certainly increase the risk of indigestion.

If eating outdoors, avoid sitting under the hot sun for too long. Overheating the body can increase the risk of diarrhea. Find some shade and drink plenty of water to keep well-hydrated.

Cooking Tips

As much as you may enjoy a big crunchy salad, vegetables bind to bile acid more easily when they have been lightly cooked as opposed to eating them raw. Steaming vegetables is a quick and easy way to make them easier on your system.

You can also steam fish or poach chicken rather than pan-frying them. If you need oil for grilling or roasting, use a spray bottle to lightly coat the food rather than dousing it in oil.

As a general rule, avoid cooking with butter, lard, margarine, and hydrogenated vegetable oils.

Instead of a prepared oil-based dressing, try flavoring salads with a sprinkling of white balsamic vinegar and fresh herbs. You can also substitute mayonnaise dressings for ones made with plain non-fat yogurt, vinegar, garlic powder, mustard, and fresh herbs.

While spices like cayenne, curry, and cinnamon can be rough on the stomach, others like ginger or turmeric may be soothing. As a rule of thumb, always start with the smallest amount of spice to gauge how your body reacts. Over-spicing food may put you on the fast road to indigestion and diarrhea.

Modifications

You may have other health conditions that require dietary changes, such as hypertension or type 2 diabetes. In cases like these, you may need to modify your diet even further to better manage these diseases.

With that said, the foods included in a post-cholecystectomy diet are more or less the same you would eat if working to manage high blood pressure or diabetes. If anything, those diets would be more strict.

The same applies to diets used to treat lactose intolerance or celiac disease. As a rule, those diets require the absolute exclusion of dairy and gluten, respectively, rather than a limited intake.

The one area where a post-cholecystectomy diet may pose challenges is during pregnancy. Gastrointestinal problems are rife during the various stages of pregnancy, including morning sickness, reflux, diarrhea, and constipation. Differentiating the symptoms caused by pregnancy versus those triggered by PCS can be difficult, if not impossible.

Many of the dietary recommendations made during pregnancy may inadvertently exacerbate PCS symptoms. This includes the increased intake of protein and calcium, both of which can promote diarrhea in people without a gallbladder if consumed in excess.

While the nutritional needs of an expectant mother should always be met, a registered dietitian may be needed to explore alternative sources of protein and calcium if meat and dairy are causing problems.

Considerations

When making changes to your diet, it is important to remember that other aspects of your life can influence how easy (or difficult) these changes will be. This includes general nutritional needs, possible side effects, and practical considerations when dining out.

General Nutrition 

The alleviation of symptoms should never be the sole concern when building an effective post-cholecystectomy diet. Whichever plan you devise, it should always meet the daily minimum intake of protein, carbs, fats, and nutrients outlined in the 2015-2020 Dietary Guidelines for Americans issued by the U.S. Department of Health and Human Services.

Recommended Dietary Intake (RDI) Per Day
  Calories Protein Carbs Saturated Fat Added Sugar Fiber
Women 19-30 2,000 46 grams 130 grams under 10% under 10% 28 grams
Men 19-30 2,400-3,000 56 grams 130 grams under 10% under 10% 33.6 grams
Women 31-50 1,800 46 grams 130 grams under 10% under 10% 25.2 grams
Men 31-50 2,200 56 grams 130 grams under 10% under 10% 30.8 grams
Women Over 50 1,600 46 grams 130 grams under 10% under 10% 22.4 grams
Men Over 50 2,000 56 grams 130 grams under 10% under 10% 28 grams

If struggling to meet those needs, make an appointment with a dietitian who can offer ways to bolster your nutrition, such as using additives (like nuts or seeds) or supplements that help you strike a balanced diet.

Flexibility

Dining out can be difficult when managing any medically-indicated diet.

Despite their generally bad nutritional reputations, fast food restaurants often include healthy menu items that fit within a post-cholecystectomy diet. If you anticipate dining at such an establishment, check out its menu items and their nutritional information online in advance.

You may have far more options at a sit-down casual dining restaurant. Since much of the food is cooked to order, you can request that certain ingredients can be left off or substituted.

If dining out with friends, call the restaurant in advance to advise them of your dietary needs. Many will offer suggestions that fit within your diet plan. Others may even prepare a special order if you call a day or two in advance.

Support and Community

Lifestyle changes of any sort can be stressful. If you’re feeling frustrated or disappointed by the changes in your diet, it can be helpful to talk to others who have experienced the same. Online support groups devoted to gallbladder disease can readily be found on Facebook, allowing you to ask questions, share insights, and seek encouragement as you adapt to your new lifestyle.

Your healthcare team can also offer advice and direct you to dietitians, nutritionists, and counselors experienced in gallbladder disease.

Family and friends are also vital to your long-term care. By helping them understand your condition and why certain dietary restrictions are needed, you can avoid having your plans sabotaged by their well-meaning efforts.

Side Effects

Any change in your diet can cause side effects. Your body is an interrelated system that strives to maintain homeostasis (a state of equilibrium). If anything upsets that equilibrium, including changes in diet, your body will respond in an effort to re-establish homeostasis.

When starting a low-fat diet, constipation is a common response. You can usually help ease the symptoms by drinking plenty of water and taking a fiber supplement, if needed.

On the other hand, adding too much fiber (by eating extra vegetables and whole grains) can trigger diarrhea. You can often rectify this with a BRAT diet or by decreasing fiber intake until your body adapts to the new dietary regimen.

Fortunately, side effects like these tend to be mild and will eventually ease after several days or weeks. If they don't, speak with a gastroenterologist to see if there may be other causes for your symptoms.

Dietary Restrictions

You may have other dietary restrictions to consider prior to undergoing a cholecystectomy. You may be a strict vegetarian or vegan with no intention of swaying from a plant-based diet. Or, you may have a food allergy that further limits the types of food you can eat.

Vegetarians and Vegans

If you follow a strict plant-based diet, you will have already tailored your diet to meet your daily protein and calcium needs without the use of meat, fish, eggs, or dairy. The problems only arise if certain proteins, namely beans and legumes, cause digestive distress.

The same applies to certain vegetables, like cabbage and cucumber, that may only cause flatulence in people with a gallbladder but may trigger IBS symptoms in those without one.

Similarly, whole wheat, bran, green beans, potatoes, cauliflowers, and nuts can trigger IBS in people recovering from a cholecystectomy. In such cases, you may need to avoid these foods until your system is better able to handle them.

If symptoms persist, you may need to see a dietitian, especially if alternative sources of protein or carbohydrates are needed.

Food Allergies

People with food allergies are usually adept at monitoring their diets. With that being said, if you are already avoiding certain food allergens, the thought of cutting additional foods from your diet may be daunting.

Some food sensitivities, like lactose and gluten, are easy enough to deal with given that whole-fat dairy and refined white flour are already on the "avoid" list. Other common allergies, such as fish, nut, soy, or egg allergies, can be especially challenging as these are prime sources of protein. If you need to avoid red meat because of PCS, the inability to readily replace these proteins can impact your well-being and health.

As before, a registered dietitian can help guide you through your food options and ensure that your daily nutritional needs are met.

A Word From Verywell

Whether you are like most people who undergo cholecystectomy and only need to adjust their diet for a few weeks, or you need to adopt permanent changes to keep symptoms controlled, adopting a new way of eating can be challenging and emotionally taxing. Try to focus on what the changes you are making mean to your health and quality of life. Over the short term, you may grieve the loss of your favorite food, but, in time, you will learn to adapt.

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Article Sources

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  3. Marcason W. What Medical Nutrition Therapy Guideline Is Recommended Post-Cholecystectomy? J Acad Nutr Dietetics. 2014 Jun;114(7):1136. doi:10.1016/j.jand.2014.05.009


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