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Gallstones

The gallbladder is a small sac-like organ that is attached to the inferior medial (lower middle) side of the liver, under the rib cage on the right side (in rare exceptions, on the left side, when the liver is also on the left).
Its functions are:
  1. To store and accumulate bile (a digestive enzyme made by the liver).
  2. To alkalize the bile (raise the bile pH from acid to basic).  This increases its effectiveness as an emulsifying enzyme.
  3. To contract when stimulated by the presence of food in the duodenum.  The contraction of the gallbladder forces the bile to secrete through bile ducts into the duodenum.
Bile is the digestive enzyme that emulsifies (makes soluble) fats in the duodenum (also called the "second stomach", the first part of the small intestine).  Gallstones are usually composed of pure cholesterol but they may also contain bile salts, bile acids, or a combination of such.  Both diet and stress contribute to their formation.  Gallstones become painful only when they lodge in the bile duct. 

After a fatty meal is eaten, the gallbladder contracts to release bile into the duodenum.  When gallstones block or partially block the bile duct, the passage of bile into the duodenum is impeded, creating back-up pressure within the gallbladder.  Distention of the gallbladder is the primary cause of pain.  Some bile may trickle into the duodenum, but not enough to digest the meal.  Incomplete digestion may create secondary pain due to gas and intestinal bloating. 

Gallstones can be a life-threatening condition because it is possible for the gallbladder to rupture if it becomes very full of bile and cannot secrete it through the bile duct.  Although gallstones can be treated by committing to a strict diet and sticking with it for several months after symptoms have subsided, many medical doctors recommend immediate surgery due to the potential seriousness of the condition.  Gallbladder surgery is not without its own complications, up to and including death, as you will find out when it comes time to sign the medical release at the hospital.  Death would be an unusual complication of gallbladder surgery, but gallbladder surgery is major surgery.  Gallbladder surgery involves removing the entire gallbladder and rerouting the bile directly from the liver into the duodenum. 

It is estimated that ten percent or more of the population of the United State will have gallstones some time during their lives.  A smaller percentage will experience gallbladder symptoms. 

Warning Signs of Gallstones

Gallbladder disease maybe detected by the presence of some or all of these symptoms: 
  • A pain under the ribs on the right or under the right scapula (shoulder blade).  In very rare cases, the pain will be on the left side (if the liver and gallbladder are on the left). 
  • Pain eases when lying with the painful side down and the knees bent. 
  • Floating stool (undigested fat in the stool causes it to float, as oil floats on water). 
  • Pain after ingesting ice cream, sour cream, whipped cream, other dairy, eggs, bacon, pork, fatty foods, oily foods, smoked foods, fried foods, alcohol, coffee, or chocolate. 
  • Gas, bloating, or intestinal cramping.  Breathing may seem restricted due to abdominal pressure on the diaphragm. 
  • Diarrhea. 
Note:  Don't be fooled.  During severe gallbladder attacks, often any kind of food will make your stomach feel better immediately, temporarily, because by then the food is only in the stomach.  Pay attention to how you feel 1 to 4 hours after eating, when the meal moves to the duodenum. 

Your Options:  Gallbladder Surgery vs Gallbladder Support Diet

Gallbladder Surgery

If you have a severe attack or multiple chronic attacks consider surgery.  Your digestion will be permanently impaired, but that maybe a minor trouble compared to the pain and risk of gallbladder rupture. 

Once the gallbladder has been completely removed, the bile will trickle constantly from the liver through the bile duct directly into the duodenum.  The bile will be too acid (the bile's pH will be too low) because the gallbladder is not there to alkalize it.  Bile will also be in insufficient quantity to emulsify a fatty meal properly.  Fats will never again be well digested.  Intestinal bloating and gas will follow fatty meals.  The fat-soluble vitamins:  A, D, and E will be poorly absorbed, which may lead to vitamin deficiencies.  It is therefore recommended that vitamin A be taken in its vegetarian form (beta carotene) which is easier to digest without bile.  Vitamin D should be absorbed primarily through sunlight, or a tanning booth if necessary, thus circumventing the digestive tract.  And vitamin E supplements in tablet or water soluble form will be digested better than capsules or oil. 

After gallbladder surgery, fatty meals in general should be avoided (a more lenient form of the Gallbladder Support Diet is recommended).  Experiment with adding lecithin to your diet.  Lecithin emulsifies fat and will aid digestion.  In some baking recipes you can substitute lecithin for oil. 


GallBladder Support Diet

If you go on the GallBladder Support Diet and do not experience at least some relief immediately, or if you relapse without eating any of the dangerous foods, then you should see your physician immediately and seriously consider gallbladder surgery.  You should also choose surgery if you are unable to stay on this diet, or unable to access your gallbladder status due to inability to pay attention or decreased sensory awareness (which can happen with diabetes or sensory-reducing medication such as pain killers).

The following foods are dangerous and must be completely avoided:
  • coffee, decaffeinated coffee, caffeinated tea
  • chocolate, cocoa (white, dark, milk, all of it)
  • cola drinks
  • dairy in all forms (milk, cheese, yogurt, butter, creamed soups)
  • eggs and egg products such as mayonnaise
  • fried, deep fried, sautéed foods (including potato chips, nachos, tortilla chips, packaged or movie theatre popcorn)
  • fatty meats (chicken skin, duck, shell fish, chicken soup)
  • clams, lobster, shrimp
  • olives
  • avocados
  • nuts and seeds (especially coconut and macadamia)
  • alcohol
  • food additives (food colorings, thickeners, and preservatives)
  • salad dressing with oil, dairy, and/or egg
  • deli meat (salami, turkey, baloney, pastrami, ham, pepperoni, etc)
  • smoked foods (lox, smoked salmon)
  • spicy foods (chili, cinnamon)
  • vitamins or supplements in oil form
  • sourdough bread, egg-bread
Read the ingredients on all packaged foods.  Assume the worst about all restaurant foods.


The following foods help the gallbladder heal and some must be eaten daily (pick which ever of these foods your body tolerates):
  • grapes and/or grape juice
  • grapefruit and/or grapefruit juice
  • whole raw apples
  • cucumber
  • salal berries
  • papaya


The following foods are safe foods and can be eaten anytime:
  • water
  • mint tea
  • baked potatoes (without toppings)
  • sweet potatoes (without toppings or with marshmallows only)
  • steamed rice
  • vegetable soups (but NOT creamed soups)
  • raw, micro waved, baked, boiled, or steamed vegetables
  • salad leaves, raw leafy greens, sprouts (including sunflower seed sprouts)
  • seaweed
  • vinaigrette
  • French bread or toasted bread (French bread does not contain eggs or dairy)
  • jam, jelly, fruit preserves
  • raw fruits (in general, but avoid avocados)
  • carob, tamarind, chickpeas, green peas
  • melon
  • tomatoes, including sundried tomatoes (if not in oil)
  • honey, agave syrup, maple syrup, sugar, corn syrup
  • veal or lean red meat
  • lean chicken (no skin or fat) - baked, not fried
  • lean white meat turkey (no deli turkey) - baked, not fried
  • baked fish - any of these:  flounder, sole, red snapper, salmon, halibut, mahi tuna
  • salt, soy sauce (limit your quantity), miso
  • pineapple, bananas, citrus fruits (monitor your individual reaction)


The following foods are mildly dangerous and can be reintroduced in small quantities with self-monitoring when the symptoms subside:
  • fruit juices
  • margarine
  • raw or dry roasted seeds and nuts (but avoid coconut and macadamia)
  • green tea, yerba mate tea (if you need the caffeine)
  • soy milk, tofu
  • carrots
  • vitamins or supplements in oil form (fish oil, vitamin E)


The trick is staying on this diet for several (three) months after symptoms subside and to reintroduce dangerous foods one at a time and in small quantities while being cognizant of your body's reaction to them. 

Additional techniques may be helpful such as sleeping slightly propped up on a wedge or pillow to aid digestion.  When reintroducing forbidden foods, eating them earlier in the day (rather than later) can aid digestion, also exercising after eating fatty foods may help bile move through the duct better. 

To reduce stress (one of the factors contributing to the formation of gallstones), increase physical activity, and/or meditate.

Soft cheese has a higher fat content (and is therefore worse for people with gallstones) than hard cheese.  In general, nuts have a higher fat content than seeds.  The lowest fat content nut is the chestnut.  Eating raw dark leafy greens (which contain lecithin, vitamin E, and folic acid) will aid in the digestion of a small amount of fat or oil if eaten together or within the same hour. 


Good luck, Ma!