Gastric complaints following gallbladder removal?

Dietary changes may help

Following gallbladder removal surgery (cholecystectomy) for many people a radical change in diet may become necessary, at least for some time.

Simply put, the gallbladder is a storage container for bile that is produced in the liver. Bile is a sap of digestive juices. These juices are needed to break up fats contained in foods that are ingested with meals, such that they can be absorbed in the digestive tract.

When the gallbladder is removed, most frequently due to complaints associated with the production of gall-stones that accumulated in the gallbladder, hearty and fatty meals may cause gastric/digestive complaints.

The gallbladder is a storage container for the bile juices, and depending on how fatty the ingested food is, the gallbladder will excrete more or less bile to aid the digestion of such foods.

With the gallbladder removed this ‘container’ for collecting bile is missing, and the bile juices cannot be excreted anymore on demand, but dripple through the bile duct continuously, into the small intestine. It does this permanently with more or less the same amount and there is no possibility to excrete more at a given moment, when for example a fatty meal is being ingested. Hence the digestion will be more difficult, will take longer and may cause digestive discomforts such as diarrhea, constipation, nausea, bloating, heartburn, dyspepsia, Roemheld syndrome, and even IBS .

For some people these symptoms post-cholecystectomy are severe. The time for the body to adapt to a digestion without the availability of bile juices on demand as needed, can vary. For some people associated complaints can last up to one year after their gallbladder as been removed and some people have to permanently change their eating/dietary habits.

Changes to how and what is ingested can ease symptoms and even can avoid them entirely.

As the bile juices are needed particularly for the break down of fats in food, the reduction of fat intake is one of the first steps to consider right from the gallbladder removal surgery.

1. Avoid or drastically reduce fat intake, particularly in the time right after the cholecystectomy. Fatty foods are generally all foods containing high amounts of fats as in butter, oils, grease, lard, gravy. Foods that are fried or processed. The latter are often high in fats and hence without necessarily being fried in fats/oils, may have high amounts of fatty ingredients. Such foods, high in fat, include fatty meat (bacon, chicken skin etc.), dairy products high in fat (cream, ice cream etc.) and processed foods such as pizza, pastries, cookies, fast food etc.
2. Avoid foods that bloat and are spicy. These foods can irritate the digestive tract and can symptoms of nausea, pain etc. Focus on eating foods that are easily digested such as lean meat (turkey, chicken, lean beef or pork), fish, steamed vegetables (leafy green vegetable), rather than fried, and take it slow with re-introducing foods that are hard to digest such as nuts, whole grains, cabbage, cereals, beans, lentils etc.
3. Increase fibre intake by adding flax seed, chia or psyllium husk to your diet. Avoid high fibre vegetables such as cabbage, broccoli or cauliflower, these promote bloating and hence may promote gastric discomfort.
4. The time for adaptation of the digestive system may be lengthy, as mentioned above, therefore keeping a journal with information on what is well digested and what not, may help navigate through this time and will assist at managing the dietary changes. A journal may also be helpful when foods are gradually re-introduced back into the diet.
5. Of great impact on the digestion post gall bladder removal is changing the quantity of food that is ingested at meal times. It is very helpful eating smaller portions more frequently throughout the day, rather than sticking to two or three major meal times. Splitting meal times into 5 to 6 smaller ones allows the smaller quantities of food be broken down by the reduced amount of bile juice that is available.

If symptoms are severe and persistent, if abdominal swelling, a high frequency of vomiting or even fever appears, or if there is jaundice, a noticeable yellowing of the eyes or skin, then immediate clarification should be sought by a healthcare provider.