Gallbladder before and after low carb

Cocosilk · Jun 17, 2021

Has anyone had an ultrasound done confirming either stones or inflammation of the gallbladder and then continued eating fats on a low carb / keto diet and had a follow up ultrasound to show whether anything changed in their gallbladder?

I've been mostly low carb for a couple of years and a couple of weeks ago I went more keto (even though I have done it on and off over the past couple of years with no problem) but this time I indulged in roasted duck (skin and fat) and noticed a dull ache under my right ribs a few hours later. A bit of googling and I realise it's probably gallbladder related. A doctor's appointment today with a bit of palping confirmed probably inflammation of the gallbladder so I'm heading for an ultrasound soon.

Even though my "attacks" haven't been severe, the doctor has already said most people just have their gallbladders removed.
I'm wondering if anyone has had any luck sticking to moderate fat on a low carb / keto diet and managed to get through gallbladder inflammation, or is it dangerous if the gallbladder is already inflamed to leave it in there? After the ultrasound I should at least know if there are any stones that are likely to block the ducts. But right now it's tender in there so something is already up and I wonder if it's something smaller just working its way through.

In the mean time I have started drinking a bit of blitzed up whole lemon (including skins) and whole apple mixed with water because I read that limonene and something found in apples can help dissolve gallstones. (Not sure if what I read was just anecdotal or whether there was evidence from a study.) I did read that the olive oil / lemon juice gallbladder flush, which sometimes produces green stones, are not actually gallstones but complexes from the olive oil, and I think a flush is possibly more risky than just eating the fat I would be eating on a keto diet.

Anyway, I'd love to hear your experiences! Good or bad - I need the reality here.

Goonergal · Jun 17, 2021

There are a few people on here who’ve successfully used low carb/keto following gallbladder problems. I’ll tag @HSSS and @Rachox but am sure there are others.

Rachox · Jun 17, 2021

Thanks for the tag @Goonergal
My situation was a bit different in that my gallstones were diagnosed in 2000 well before I was diagnosed type 2. I had severe attacks and a scan showed multiple small gallstones.
Following gall bladder removal I developed chronic diarrhoea, a problem a tiny percentage of post op people get, I tried various meds but ended up just living with it.
Fast forward to 2017 when I became type 2, after a few weeks low carb I actually went the other way, very constipated! I upped my fibre intake by adding seeds to my diet and have got the perfect balance.

zand · Jun 17, 2021

I am not sure why you think a liver flush would be dangerous? Less dangerous than surgery surely?

I had made a telephone appointment with my GP before Easter which was then rescheduled for after Easter. I decided to do the flush for 48 hours over Easter and when I told my doctor what I had done, he said that was exactly the right thing to do.

As regards to the very hard green stones, I have read they are a build up of cholesterol over the years rather than a reaction to the olive oil drink I had 12 hours before they were released. I don't believe something that hard could have developed in such a short space of time. In fact I am sure I woke in the night with a sharp pain when it was pushed through the bile duct and that would have been only 4 hours after having the olive oil. Following that pain there was a sucession of popping sensations as the other smaller gallstones passed through. It felt a bit like those sweets (Dweebs and Nerds) popping in your mouth and wasn't painful.

My son did a liver flush a year ago but with no oil added. He also released some green stones.

Cocosilk · Jun 17, 2021

zand said:
I am not sure why you think a liver flush would be dangerous? Less dangerous than surgery surely?

I had made a telephone appointment with my GP before Easter which was then rescheduled for after Easter. I decided to do the flush for 48 hours over Easter and when I told my doctor what I had done, he said that was exactly the right thing to do.

As regards to the very hard green stones, I have read they are a build up of cholesterol over the years rather than a reaction to the olive oil drink I had 12 hours before they were released. I don't believe something that hard could have developed in such a short space of time. In fact I am sure I woke in the night with a sharp pain when it was pushed through the bile duct and that would have been only 4 hours after having the olive oil. Following that pain there was a sucession of popping sensations as the other smaller gallstones passed through. It felt a bit like those sweets (Dweebs and Nerds) popping in your mouth and wasn't painful.

My son did a liver flush a year ago but with no oil added. He also released some green stones.

I just found this re: those green stones from a olive oil flush: https://www.thelancet.com/journals/lancet/article/PIIS0140673605663738/fulltext

To quote:
"
Microscopic examination of our patient's stones revealed that they lacked any crystalline structure, melted to an oily green liquid after 10 min at 40°C, and contained no cholesterol, bilirubin, or calcium by established wet chemical methods.
1
Traditional faecal fat extraction techniques
2
indicated that the stones contained fatty acids that required acid hydrolysis to give free fatty acids before extraction into ether. These fatty acids accounted for 75% of the original material.
Experimentation revealed that mixing equal volumes of oleic acid (the major component of olive oil) and lemon juice produced several semi solid white balls after the addition of a small volume of a potassium hydroxide solution. On air drying at room temperature, these balls became quite solid and hard.
We conclude, therefore, that these green “stones” resulted from the action of gastric lipases on the simple and mixed triacylglycerols that make up olive oil, yielding long chain carboxylic acids (mainly oleic acid). This process was followed by saponification into large insoluble micelles of potassium carboxylates (lemon juice contains a high concentration of potassium) or “soap stones”. The cholesterol stones noted on ultrasound were removed by surgery (figure)."

The reason it could be dangerous to do a flush (or do keto / or binge on fried chicken or pizza) is that anything that stimulates the gallbladder to release the bile can also be pushing any existing stones into the ducts and if the stones happen to be the size that blocks them, the you'll end up needing surgery anyway. I haven't had an ultrasound yet so I have no idea what's in my gallbladder, which is why I feel it's risky at the moment considering I already have some inflammation happening.

I'm sure plenty of people do the flushes without a problem and if they didn't have stones that can block the ducts, they will pass them. (Many of them probably didn't have any stones in the first place.) And many other people have stones and don't even know about it, until they increase the fats in their diet.

Cocosilk · Jun 17, 2021

G

Rachox said:
Thanks for the tag @Goonergal
My situation was a bit different in that my gallstones were diagnosed in 2000 well before I was diagnosed type 2. I had severe attacks and a scan showed multiple small gallstones.
Following gall bladder removal I developed chronic diarrhoea, a problem a tiny percentage of post op people get, I tried various meds but ended up just living with it.
Fast forward to 2017 when I became type 2, after a few weeks low carb I actually went the other way, very constipated! I upped my fibre intake by adding seeds to my diet and have got the perfect balance.

I'm sorry you had severe attacks... Good to know low carb can be done without a gallbladder though and that fibre helps!

zand · Jun 17, 2021

Cocosilk said:
I just found this re: those green stones from a olive oil flush: https://www.thelancet.com/journals/lancet/article/PIIS0140673605663738/fulltext

To quote:
"
Microscopic examination of our patient's stones revealed that they lacked any crystalline structure, melted to an oily green liquid after 10 min at 40°C, and contained no cholesterol, bilirubin, or calcium by established wet chemical methods.
1
Traditional faecal fat extraction techniques
2
indicated that the stones contained fatty acids that required acid hydrolysis to give free fatty acids before extraction into ether. These fatty acids accounted for 75% of the original material.
Experimentation revealed that mixing equal volumes of oleic acid (the major component of olive oil) and lemon juice produced several semi solid white balls after the addition of a small volume of a potassium hydroxide solution. On air drying at room temperature, these balls became quite solid and hard.
We conclude, therefore, that these green “stones” resulted from the action of gastric lipases on the simple and mixed triacylglycerols that make up olive oil, yielding long chain carboxylic acids (mainly oleic acid). This process was followed by saponification into large insoluble micelles of potassium carboxylates (lemon juice contains a high concentration of potassium) or “soap stones”. The cholesterol stones noted on ultrasound were removed by surgery (figure)."

The reason it could be dangerous to do a flush (or do keto / or binge on fried chicken or pizza) is that anything that stimulates the gallbladder to release the bile can also be pushing any existing stones into the ducts and if the stones happen to be the size that blocks them, the you'll end up needing surgery anyway. I haven't had an ultrasound yet so I have no idea what's in my gallbladder, which is why I feel it's risky at the moment considering I already have some inflammation happening.

I'm sure plenty of people do the flushes without a problem and if they didn't have stones that can block the ducts, they will pass them. (Many of them probably didn't have any stones in the first place.) And many other people have stones and don't even know about it, until they increase the fats in their diet.

I guess my situation was different as I had a few signs that my bile duct was blocked already, so something had to be done.

zand · Jun 17, 2021

I am quite alarmed that the doctor said that most people have their gall bladders removed for 2 reasons.

Firstly, a friend of mine was told that he had to have his gallbladder removed and surgery was scheduled for the following week. In the meantime a naturopath friend advised he try the 48 hour apple juice and water fast and his gallstones came out quite effortlessly. The pain had gone and a 2nd scan confirmed that the gallstone problem was now sorted, no surgery necessary, so the article in The Lancet was not correct for him and thank goodness he didn't have unnecessary surgery.

Secondly, I have another friend who only found out about the apple juice fast years after she had had her gallbladder removed. She still has problems with stones sometimes, but now they are liver stones since she doesn't have a gallbladder. She uses the apple juice fast to expel them.

HSSS · Jun 17, 2021

Goonergal said:
There are a few people on here who’ve successfully used low carb/keto following gallbladder problems. I’ll tag @HSSS and @Rachox but am sure there are others.

Thanks for the tag. My gallstones were diagnosed before diabetes after years of excruciating episodes and quite a few misdiagnosis. Twice I called an ambulance due to the sheer amount of pain. Literally crying and rocking on the floor for hours unable to do anything. Once it took 5 hrs to arrive and it was finally fading when they arrived so no action was taken despite not knowing the cause at that time; the other time I was told I had torn my rotator cuff (?) in A&E and a third visit by car I was told it was reflux and treated for that for another couple of years, unsuccessfully. I finally googled enough to come up with the diagnosis myself and a locum finally listened and ordered a scan which lead to diagnosis. The pain drove me to surgery. I had asked about medication to break them down but was told they just come back and it takes years so it wasn’t done. Also some of mine were too big. Post surgery I had some erratic and mild diarrhoea but nothing too awful. It settled after about 6 months to rare occasions when I ate a lot of fat (unusual in those days).

Type 2 and low carb/keto followed about 9 months later. The extra fat unsettled me initially but nothing too awful and once I slowed down the extra fat and added it in more slowly and evenly through the day it was fine. I gradually got to eat as much as I needed to over a few weeks/a month or so.

What I learned was the stones are common in many people and many never have any trouble and can leave well alone. That they are often caused by low fat eating or erratic dieting. Eating fats, pre surgery, did make the pain worse as it made my gallbladder work and contract against the stones and move them about. I do not believe it caused them. The lack of stimulation of the gallbladder by avoiding fat allows the stones to form from stagnant bile.

I must have read the same or similar articles about the apple/oil flushes once finally diagnosed. It wouldn’t have worked for me as at least one of my stones was like a golf ball. I had lots of others of varying sizes too. I’m glad I didn’t try it as each attack was agony (worse than childbirth) and some lasted hours and hours. I’d wait til after the scan to see what’s actually in there.

I finally agreed to surgery as I dreaded an attack that lead to pancreatitis in case it made me diabetic (oh the irony less than a year later). I do sometimes wish I’d tried the dissolving medication. Considering I so drastically changed my way of eating I don’t think they would have reoccurred. Drs don’t expect patients to actually do this. But again mine was probably too far gone by this point in time.

4 yrs on and I am having some issues again that sound like acid reflux to the gp and feel like the gallstone issues to me but with the addition of a sore throat. With a very strong family history of hiatus hernia and oesophageal cancer I got an endoscopy a few weeks back. Nothing abnormal seen except some bile in the stomach which can cause irritation as a result of bile (not acid) reflux. Apparently this is more common post cholecystectomy. Something I was never told about before. I’m still uncertain this is my issue. Stones in ducts could be it too. Or gastroparisis. I have little faith in diagnostics of these pains after the earlier saga.

Overall I’m still glad it’s gone.

Cocosilk · Jun 18, 2021

zand said:
I guess my situation was different as I had a few signs that my bile duct was blocked already, so something had to be done.

zand said:
I am quite alarmed that the doctor said that most people have their gall bladders removed for 2 reasons.

Firstly, a friend of mine was told that he had to have his gallbladder removed and surgery was scheduled for the following week. In the meantime a naturopath friend advised he try the 48 hour apple juice and water fast and his gallstones came out quite effortlessly. The pain had gone and a 2nd scan confirmed that the gallstone problem was now sorted, no surgery necessary, so the article in The Lancet was not correct for him and thank goodness he didn't have unnecessary surgery.

Secondly, I have another friend who only found out about the apple juice fast years after she had had her gallbladder removed. She still has problems with stones sometimes, but now they are liver stones since she doesn't have a gallbladder. She uses the apple juice fast to expel them.

I'm not against trying things at home to remedy the situation - I've been drinking blitzed apple and lemon including the peel just in case it does work to dissolve things somehow - but I guess people just need to know that there might be a small risk of having a serious blockage (gallbladder attack) if there happens to be stones big enough to get stuck and then they go hardcore keto.

If it's just "sludge" in the gallbladder, the olive oil flushes and animal fats you eat on a keto diet probably help to flush that out. I'm hoping this milder pain is because of sludge and not stones. I'll see what the ultrasounds says in a couple weeks. If I don't have big stones, then a flush is certainly worth a try! I can imagine those who have a really big stone in there will probably spend the rest of their lives trying to dissolve it with dietary changes. If it took years to form the stone, it must take while to dissolve it.

P.S. The two young doctors I've seen in our small town are quicker to suggest drugs (statins) and surgery (gallbladder removal) than Clint Eastwood's quickdraw.

Cocosilk · Jun 18, 2021

HSSS said:
Thanks for the tag. My gallstones were diagnosed before diabetes after years of excruciating episodes and quite a few misdiagnosis. Twice I called an ambulance due to the sheer amount of pain. Literally crying and rocking on the floor for hours unable to do anything. Once it took 5 hrs to arrive and it was finally fading when they arrived so no action was taken despite not knowing the cause at that time; the other time I was told I had torn my rotator cuff (?) in A&E and a third visit by car I was told it was reflux and treated for that for another couple of years, unsuccessfully. I finally googled enough to come up with the diagnosis myself and a locum finally listened and ordered a scan which lead to diagnosis. The pain drove me to surgery. I had asked about medication to break them down but was told they just come back and it takes years so it wasn’t done. Also some of mine were too big. Post surgery I had some erratic and mild diarrhoea but nothing too awful. It settled after about 6 months to rare occasions when I ate a lot of fat (unusual in those days).

Type 2 and low carb/keto followed about 9 months later. The extra fat unsettled me initially but nothing too awful and once I slowed down the extra fat and added it in more slowly and evenly through the day it was fine. I gradually got to eat as much as I needed to over a few weeks/a month or so.

What I learned was the stones are common in many people and many never have any trouble and can leave well alone. That they are often caused by low fat eating or erratic dieting. Eating fats, pre surgery, did make the pain worse as it made my gallbladder work and contract against the stones and move them about. I do not believe it caused them. The lack of stimulation of the gallbladder by avoiding fat allows the stones to form from stagnant bile.

I must have read the same or similar articles about the apple/oil flushes once finally diagnosed. It wouldn’t have worked for me as at least one of my stones was like a golf ball. I had lots of others of varying sizes too. I’m glad I didn’t try it as each attack was agony (worse than childbirth) and some lasted hours and hours. I’d wait til after the scan to see what’s actually in there.

I finally agreed to surgery as I dreaded an attack that lead to pancreatitis in case it made me diabetic (oh the irony less than a year later). I do sometimes wish I’d tried the dissolving medication. Considering I so drastically changed my way of eating I don’t think they would have reoccurred. Drs don’t expect patients to actually do this. But again mine was probably too far gone by this point in time.

4 yrs on and I am having some issues again that sound like acid reflux to the gp and feel like the gallstone issues to me but with the addition of a sore throat. With a very strong family history of hiatus hernia and oesophageal cancer I got an endoscopy a few weeks back. Nothing abnormal seen except some bile in the stomach which can cause irritation as a result of bile (not acid) reflux. Apparently this is more common post cholecystectomy. Something I was never told about before. I’m still uncertain this is my issue. Stones in ducts could be it too. Or gastroparisis. I have little faith in diagnostics of these pains after the earlier saga.

Overall I’m still glad it’s gone.

I'm sorry your diagnosis took so long... that's shocking that no one thought of gallbladder issues sooner. I guess that's the advantage of the internet and forums like this one. After googling, I had myself diagnosed within hours of the mild discomfort (felt like a stitch you get from running when you are out of shape) and even before my first visit to the GP, who confirmed it inflammation and has referred me for an ultrasound.
Thanks for sharing your experience!

danziger · Jul 16, 2021

I ate very low fat (medium carbs) from when I was hospitalised with cholecystitis (caused by a rogue gallstone) until I had my gallbladder removed. My understanding is that the gb will always be a potential issue once it’s started playing up and eating fat could cause stones to dislodge and cause infections at any time. Happy to see the back of it!

Resurgam · Jul 16, 2021

As I have been pushed to eat low fat many times, when going back to normal levels I have had painful post meal pangs - one went on for about 20 minutes, but since diagnosis, nothing.
A parent of one of my son's school friends was diagnosed with gall stones, but somehow no date was set for surgery. As there was no point in eating low fat, the diet was abandoned. Eventually it was picked up again, but the scan was out of date, so it was repeated, and there were no stones. ...

Gallbladder before and after low carb

Cocosilk

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Gallbladder before and after low carb

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