in Nutrition /by Jeff Apthorp

I thought I was having a heart attack. The pain and pressure in my chest and shoulders was unbearable. Should I call 911 or try to drive to the hospital? Or was this just the worst indigestion ever?

That’s what I experienced a handful of times prior to having my gallbladder removed. It was horrible and I just wanted it to never happen again.

I scheduled an ultrasound and it showed gallstones. The surgeon recommended a laparoscopic Cholecystectomy. That’s what they call one kind of surgery to remove a gallbladder.

The day of the surgery, I wanted to call it off because I had no symptoms and felt great.

They never told me there was a possibility to heal my gallbladder and that I would have impaired ability to digest fat for the rest of my life.

I learned much later that gallbladder problems can often be reversed and there are simple dietary changes that will help protect the little guy.

Here’s how to protect your gallbladder and what you MUST do if your gallbladder has been removed.

Gallbladder surgery is increasing

Over the past thirty years, there’s been a 20% increase in the number of people suffering with gallbladder problems. It is estimated that 10-15% of the US population (20-25 million people) have gallbladder complications (usually gallstones) that lead to 1.8 million hospital visits and $6.2 billion dollars in healthcare costs annually.

The conventional recommendation for gallbladder problems is removal. There are over 750,000 cholecystectomies annually in the US.

Advanced Functional Medicine nutritionist, Tom Malterre says, “Unfortunately, 10-33% of people who get their gallbladder taken out never resolve their symptoms of gallbladder disease; and in fact those who have their gallbladder removed may suffer from a whole new set of symptoms like fat malabsorption and vitamin deficiencies after surgery.”

The gallbladder serves an important digestive function

The gallbladder is a four inch sac located just below and behind the liver. It stores bile.

Dr. David Williams is a medical researcher, biochemist and chiropractor. He explains, “Bile acids are produced from cholesterol in your liver and then flow into your gallbladder where they are stored and concentrated as much as fivefold.” He says, “With a healthy gallbladder, proper amounts of bile are released into the digestive tract as needed.”

According to, Tom Malterre, bile is made up of: “97% water, 0.7% bile salts (cholesterol that interacts with hydroxylation/CYP450 enzymes and has either glycine or taurine attached to it), 0.51% fats (i.e. cholesterol, phospholipids), 0.2% bilirubin (derived from heme- the substance in red blood cells), and a trace amount of inorganic salts (i.e. potassium, sodium bicarbonate).”

About half of the bile released goes to the small intestine. The other half is stored in the gallbladder until needed.

Tom Malterre explains, “As food travels out of the stomach and in to the small intestines (duodenum), cells that line the intestinal walls “sense” the fats and amino acids in the food and release a hormone called CCK (cholecystokinin/Chole= bile, Cysto= sac, Kinin= mover). This bile sac-moving hormone signals the gallbladder to squeeze forcing the bile into the upper intestines where it helps to digest fats found in foods. Simultaneously, CCK also signals digestive enzymes to be released from the pancreas.”

Dr. Williams simplifies, “As your body senses the movement of fat into the small intestine, the gallbladder releases the bile to emulsify the fat—making it easier to absorb.”

Bile does to fats what dish detergent does to grease. It’s an emulsifier. Bile breaks down fats into teeny tiny droplets, which gives fat-digesting enzymes more surface area upon which to do their work.

90 to 95 percent of the bile squirted into the digestive system is reabsorbed by the large intestines and returned to the liver, where it is reused as many as twenty times.

Your gallbladder is vital for digestion. It releases bile when needed to make fat absorb.

If your gallbladder is diseased or removed, you won’t absorb fat or excrete cholesterol properly

Dr. David Williams summarizes, “With a healthy gallbladder, proper amounts of bile are released into the digestive tract as needed. Without a gallbladder, there is a continuous trickle of bile into your system regardless of the presence or absence of fat. The failure to match bile output to fat presence jeopardizes one’s ability to properly digest fat and, eventually, leads to deficiencies in fat-soluble vitamins and essential fatty acids, poor cholesterol metabolism, and the absorption of improperly digested fat globules.”

Here’s what you can expect if you are not digesting fat properly.

Deficiencies in fat-soluble vitamins

Proper digestion of fat is required to absorb the fat soluble vitamins, which include A, D, E and K.

Vitamin A contributes to immune function, healthy vision and proper cell growth.

Vitamin A comes in two forms. Both require bile for absorption.

According to Dr. Mercola:

  • “Retinol is preformed vitamin A, found in animal products such as grass-fed meat and poultry, liver, fish, and raw organic dairy products like butter. This is the form of vitamin A your body can actually use.”
  • “Beta-carotene is pre-vitamin A, found in plant foods like fruits and vegetables. In order for your body to actually use beta-carotene, it must first convert it into retinol, and to do this, you need to have a well-functioning digestive tract and sufficient bile produced by your gallbladder. Specific enzymes are also needed to break down the carotene for the conversion into retinol to occur.”

Putting grass fed butter or drizzling coconut or olive oil on veggies, helps you absorb fat soluble vitamins – when you have enough bile present to emulsify the fat.

Signs of Vitamin A deficiency:

  • Dry eyes
  • Drying, scaling, and follicular thickening of the skin
  • Night blindness
  • Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks)
  • Respiratory infections

Cells can only produce vitamin A receptors with the assistance of magnesium and zinc.

Vitamin D is critically important for cell function. It is one of the most potent cancer inhibitors. Vitamin D3 sends messages to our genes to control many different functions including preventing cancer, reducing inflammation, boosting mood, easing muscle aches and fibromyalgia, and building bones.

The best way to get vitamin D is from the sun. As soon as the sun’s UVB rays hit your skin, the body produces it’s own vitamin D3. UVB waves are highest at midday so the ideal time for sun exposure is between 10 AM and 4 PM.

Keep in mind that fully activated vitamin D3 (calcitriol) is useless in the absence of magnesium. Zinc also interacts with vitamin D, and it appears they promote each other’s intestinal absorption.

Vitamin D deficiency has been linked to a strikingly diverse array of common chronic diseases, including:

  • Alzheimer’s disease
  • Asthma
  • Autism
  • Cancer
  • Cavities
  • Cold and fly
  • Crohn’s disease
  • Cystic fibrosis
  • Diabetes 1 and 2
  • Dementia
  • Depression
  • Eczema & Psoriasis
  • Hearing loss
  • Hypertension
  • Heart disease
  • Infertility
  • Inflammatory Bowel Disease
  • Insomnia
  • Macular degeneration
  • Migraines
  • Multiple Sclerosis
  • Muscle pain
  • Obesity
  • Osteoporosis
  • Periodontal disease
  • Pre eclampsia
  • Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks)
  • Rheumatoid arthritis
  • Septicemia
  • Seizures
  • Schizophrenia
  • Signs of aging
  • Tuberculosis

Vitamin E is a potent antioxidant and immune-system booster that has a number of cancer-fighting properties.

Vitamin E can do more harm than good for smokers, children with autism and people with a certain a mutated gene. Therefore, it’s best not to supplement unless under the supervision of a qualified practitioner. Food, not a supplement, is your best source of vitamin E. Dietary sources of vitamin E include raw organic nuts, such as hazelnuts, almonds, walnuts, and pecans. You also get vitamin E from legumes and green vegetables, like spinach and broccoli.

Vitamin E deficiency signs include:

  • asthma and allergies
  • brain damage
  • cancer
  • cognitive decline
  • high oxidized LDL cholesterol levels
  • hot flashes
  • menstrual pain
  • poor circulation
  • prostate and breast cancers

Avoid synthetic vitamin E (tocopheryl), as it will not provide your body with the benefits that natural full-spectrum vitamin E will.

Vitamin K1 is most well-known for the role it plays in blood clotting.The initial discovery was reported in a German scientific journal, where it was called Koagulationsvitamin. That’s where the “K” comes from. K-rich foods include spinach, kale, collards, and mustard greens.

Vitamin K2 is also essential. It’s role is to help move calcium into proper areas of your body, like bones and teeth. It also helps remove calcium from areas where it shouldn’t be, like arteries and soft tissues. K2 is prevalent in fermented vegetables like sauerkraut.

Raw dairy products such as certain cheeses, raw butter, and kefir also contain high amounts. However, only grass-fed animals (not grain fed) will develop naturally high K2 levels. This is one of several reasons why I only use grass-fed butter in my coffee.

Vitamin K3 is a synthetic form and not recommended.

Vitamin K deficiency can lead to:

  • Arterial calcification
  • Cardiovascular disease
  • Dementia
  • Infectious diseases such as pneumonia
  • Leukemia
  • Liver cancer
  • Lung cancer
  • Osteoporosis
  • Prostate cancer
  • Tooth decay
  • Varicose veins

According to Dr. Mercola“Vitamins A and D also cooperate to regulate the production of certain vitamin K-dependent proteins. Once vitamin K2 activates these proteins, they help mineralize bones and teeth, protect arteries and other soft tissues from abnormal calcification, and protect against cell death. Magnesium, calcium, vitamin D3, or vitamin K2 also work in tandem, so if you’re considering taking one, you need to take all the others into consideration as well.”

Deficiency in vitamin B-12

The connection between B-12 and bile from the gallbladder is that it takes a lot of stomach acid to to break down this essential B vitamin.

Vitamin B-12 is generally found in all animal foods (except honey). Contrary to rumors, there are no reliable, unfortified plant sources of vitamin B-12.

Vitamin B-12 (cobalamin) is known as the energy vitamin.

Chris Kresser explains why B-12 is important: “Vitamin B12 works together with folate in the synthesis of DNA and red blood cells. It’s also involved in the production of the myelin sheath around the nerves, and the conduction of nerve impulses. You can think of the brain and the nervous system as a big tangle of wires. Myelin is the insulation that protects those wires and helps them to conduct messages.”

Dr. Mercola warns, “And oral B-12 supplementation will not address this issue as they will not break down in your stomach if acid production is low. In fact, if you are one of the people taking these proton pump inhibitors or H2 blockers, the primary way your body can effectively absorb the B-12 that it needs is through inter-muscular injections.”

Signs of vitamin B-12 deficiency:

  • Alzheimer’s, dementia, cognitive decline and memory loss (collectively referred to as “aging”)
  • Autism spectrum disorder
  • Autoimmune disease and immune dysregulation
  • Balance issues
  • Bloating
  • Cancer
  • Cardiovascular disease
  • Constipation
  • Delusions
  • Depression
  • Diarrhea
  • Fatigue
  • Headaches
  • Impulse control problems
  • Infertility
  • Learning or developmental disorders in kids
  • Loss of appetite
  • Mental illness (depression, anxiety, bipolar disorder, psychosis)
  • Multiple sclerosis (MS) and other neurological disorders
  • Nausea
  • Pins and needles in the extremities
  • Shortness of breath that results from only very light exertion
  • Vomiting
  • Weight loss
  • White spots on the skin (typically the forearm) due to decreased melatonin

Deficiencies in essential fatty acids

There are two essential fatty acids, alpha-linolenic acid (an omega-3 fatty acid) and linoleic acid (an omega-6 fatty acid).

Most Americans eat too many inflammatory omega-6 fats (think processed vegetable oils) and too few anti-inflammatory omega-3s, which sets the stage for a number of health problems. The ideal radio is 1:1 (Omega-3 to Omega-6), but the typical Western diet is between 1:20 and 1:50.

The plant based form of omega-3 is alpha-linolenic acid (ALA). Recent studies show ALA is extremely inefficient. Less than 1% is converted to EPA and DHA for use by the body. Sources of ALA include flaxseed oil, canola oil, English walnuts, and soybean oil.

The animal based forms of omega-3 are eicosapentaenoic and docosahexaenoic acids (EPA and DHA) and are mainly found in fish, shellfish and krill. DHA is the primary structural component of your brain and retina, and EPA is its precursor. DHA is found in cod liver oil, fatty fish, and in smaller concentrations in the organs and fats of land animals.

Signs of fatty acid deficiency:

  • Allergies
  • Alzheimer’s disease
  • Asthma
  • Bone weakness
  • Brittle or soft nails
  • Cancer
  • Cracked skin on heals or fingertips
  • Dandruff or dry hair
  • Dry eyes
  • Dry Eye Syndrome
  • Dry, flaky skin, alligator skin, or “chicken skin” on backs of arms
  • Fatigue
  • Frequent urination or excessive thirst
  • Gallstones
  • Heart disease
  • Lowered immunity, frequent infections
  • Lupus erythematosus and other autoimmune diseases
  • Multiple sclerosis
  • Parkinson’s disease
  • Peripheral artery disease
  • Poor attention span, hyperactivity, or irritability
  • Poor mood
  • Poor wound healing
  • Postpartum depression
  • Premature birth
  • Problems learning
  • Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks)
  • Rheumatoid arthritis
  • Schizophrenia
  • Tissues and organ inflammation
  • Ulcerative colitis
  • Vascular complications from type 2 diabetes

Poor cholesterol regulation

One way the body regulates cholesterol is by excreting excess cholesterol through bile, which is mostly made of cholesterol, second to water.

According to R. A. Bowen DVM PhD from the Department of Biomedical Sciences at Colorado State University, “Secretion into bile is a major route for eliminating cholesterol. Free cholesterol is virtually insoluble in aqueous solutions, but in bile, it is made soluble by bile acids and lipids like lecithin. Gallstones, most of which are composed predominantly of cholesterol, result from processes that allow cholesterol to precipitate from solution in bile.”

About 50% of the cholesterol that passes through the small intestines is targeted for excretion. I learned that from course material published by the University of Washington.

Without a healthy gallbladder, you won’t be able to absorb vitamins A, D, E and K properly.

How gallstones develop

A common way for the problem to begin is with damage to the gut.

Tom Malterre lays out the progression:

“Research indicates that both gluten and cow’s milk proteins can cause damage in the intestinal tract that leads to gallbladder stasis. Both foods contain proteins that are capable of exciting immune cells in the intestinal tract that can interfere with CCK signaling by disrupting the intestinal lining. If the intestines are damaged, and CCK secretion is interrupted, the gallbladder never fully contracts to squeeze out all of the bile.”

“Problems can arise when the gallbladder never receives the signal to squeeze. This leads to a condition known as stasis where bile sits in the gallbladder for long periods of time. If the gallbladder is filled with bile that is laden with high levels of cholesterol, and low levels of phospholipids and bile salts, it can form a supersaturated sludge. This stagnant sludge allows for the perfect environment for crystal-like structures to form that precipitate out of solution. These structures are known as gallstones and they can cause irritation in the gallbladder. If the stones are large enough, they may get lodged in the cystic duct or common bile duct. This leads to the symptoms of what is known as gallbladder attacks.”

Gallstones commonly begin with damage to the gut caused by gluten and cow’s milk protein.

Signs of gallbladder disease

Per Dr. Mercola offers several pages on his site about gallbladder problems. He says, “Generally, gallstones do not prompt symptoms. However, if one becomes lodged in a duct and causes blockage, these symptoms may appear:

  • Sudden and rapidly intensifying pain in the upper right part of the abdomen, and/or in the center of your abdomen, just below the breastbone
  • Back pain between the shoulder blades
  • Pain in the right shoulder
  • Nausea or vomiting

Gallstone-related pain may last for several minutes up to a few hours. You should consult a physician immediately if you notice any of the aforementioned symptoms, but most especially if these conditions appear:

  • A high fever with chills
  • Yellowing of the skin and the whites of the eyes
  • Intense abdominal pain that prevents the patient from sitting still or finding a comfortable position

Some gallstone symptoms can be similar to conditions such as appendicitis, ulcers, pancreatitis and gastroesophageal reflux disease.”

Signs of gallbladder disease include pain, nausea, chills, sweating and yellowing of the skin.

How to reverse gallbladder disease without surgery

If your physician doesn’t consider your gallbladder situation life threatening, here are some natural steps you can try to avoid surgery.

  1. Do an Elimination DietTom Malterre describes this step as, “by far the most effective therapy for gallbladder issues I have seen.” You can find my free elimination diet here. Though the baseline elimination diet doesn’t require the removal of eggs and nightshades, you will want to eliminate those as well for gall bladder issues.
  2. Consider a high quality digestive enzyme supplement. Chris Kresser has recommended Now Super Enzymes. Dave Asprey also strongly recommended taking an animal based enzyme product (not derived from plants that are highly susceptible to mold) and listed the exact ingredients in the Now Super Enzymes. I found them to be the best price so that’s what I take. Dr. Mercola recommends Beta Plus from Biotics Research.
  3. Eating at least 6 servings of vegetables and 1-2 servings of fruit per day to help to prevent gallstones. The Wellness Repair Diet tells you how many servings to have of each kind of food group.
  4. Eat 1/4 cup of broccoli sprouts per day. This can decrease bilirubin deposits in the gallbladder to reduce the likelihood of gallstone formation.
  5. Eat beets and raw beet juice. Beets are rich in betaine, which stimulates liver cell function and provides a protective effect for the liver and bile ducts.
  6. Consider a curcumin supplement. Tom Malterre say, “Curcumin extracts from turmeric have been shown to stimulate bile formation and gallbladder emptying. Meriva, a supplement of complexed phophatidylcholine and curcumin, has helped many of my clients with gallbladder issues.”
  7. Apple cider vinegar contains malic acid which can help to soften any gallstones as well as thin out the bile over time. Take a few teaspoons to tablespoons in some water prior to meals regularly for a time.
  8. Eat artichokes. Leaves from the artichoke plant contain caffeylquinic acids, which promote bile flow. The simplest and least expensive way to benefit from these compounds is to eat the artichoke leaves. They’re easy to both prepare and eat. Place two artichokes in a shallow, glass baking dish with about 1/2 to 1 inch of water in the bottom. Cover with plastic wrap and cook in a microwave on high for four to five minutes. To eat, simply break off each leaf and scrape the flesh from the leaf between your teeth and throw the pithy part of the leaf away.
  9. Bitters stimulate your liver to produce more bile and work more efficiently. Many cultures around the world begin meals with a quick burst of bitters. Some will drink a tea made from bitter herbs like dandelion or milk thistle. Others will simply chow down on a small salad filled with bitter herbs like chicory, arugula, radicchio, or even peppermint (peppermint is considered a bitter). Small doses of bitters should be consumed about 15 minutes or so before meals.
  10. Regular exercise is a great proactive prevention step.

The most effective remedy for gallstones is an elimination diet.

What you must do if your gallbladder has been removed

Your liver is trickling bile, but none is being stored for when needed. (Scroll back up to see the long list of digestive problems this causes, if you missed it.)

I like the way Amy Berger from Tuit Nutrition describes bile secretion from the liver without a properly working gallbladder storage tank: “It’s like a leaky faucet that drips constantly, but that you can never get to turn on full blast when you need to.”

There is something you can do.

If you have your gallbladder removed, you will probably need to take a bile supplement with every meal for the rest of your life.

I take Now Super Enzymes because they contain Ox bile, Betaine HCl  and Lipase. I highly recommend using the capsule form and not tablets. I ordered the tablets once and found them to leave a terrible taste in my mouth for an hour. No issues at all with the capsules.

If Betaine HCl gives you an upset stomach, Pure Encapsulations makes a very similar supplement without Betaine HCl. It’s called Digestion GB. If you’re not sure which ingredient is causing discomfort, you can also try ox bile all by itself. Seeking Health makes a ox bile only supplement.

Dr. David Williams: “…there is one step every patient should take: Use bile salt supplements regularly.”

Among the functional medicine doctors, I found the most recommendations for ox bile. This is exactly what it sounds like. It’s the bile from oxen. Consider it your gallbladder in a bottle.

Ox bile should be taken just a few minutes before eating a meal or taking supplements containing fat.

If you take too much, the usual result is diarrhea. If that happens, just reduce your dosage.

One other consideration is that some fats are easier than others on people without a gallbladder. Chris Kresser advises, “Coconut oil is a very good fat for people without a gallbladder because it doesn’t require bile acids for absorption, so it’s rapidly absorbed in the upper part of the small intestine, and it’s transported directly to the liver via the portal vein.  These are medium-chain triglycerides that I’m talking about, and in fact, they’re used in hospital tube-feeding formulas, you know, for people who have had surgery on their intestine or have had parts of their intestine removed because they’re so easy to digest and absorb.  So, coconut oil is definitely your friend if you’re lacking a gallbladder.”

If you have your gallbladder removed, you’ll need to take ox bile with every meal for life.

Key Takeaways

  • Your gallbladder plays a vital role in digestion. Without it, your ability to absorb fat, and the fat soluble vitamins A, D, E and K, can be greatly impaired.
  • Gallbladder disease can often be reversed with diet.
  • If you have already had your gallbladder removed, you can simulate it’s vital function. You will need to take a digestive enzyme supplement containing ox bile a few minutes prior to every meal containing fat.
  • I take Now Super Enzymes because they contain Ox bile, Betaine HCl  and Lipase. I noticed much improved digestion in a day. Within a week I was complemented twice on my skin tone and told the wrinkles on my face were going away. I am supposing this was a result of better fat and vitamin absorption.
  • If Betaine HCl gives you an upset stomach, Pure Encapsulations makes a very similar supplement without Betaine HCl. It’s called Digestion GB. If you’re not sure which ingredient is causing discomfort, you can also try ox bile all by itself. Seeking Health makes a ox bile only supplement.
  • Ask the question, “What caused gallbladder trouble in the first place and has that cause been addressed?” Gallbladder dysfunction is a symptom. It tends to occur along with other symptoms like IBSextra belly fatacne, acid reflux, carpel tunnel, rheumatoid arthritis, anxiety, depression, seasonal allergies and hundreds of others. Spoiler Alert: The root cause is usually a combo of food sensitivitiestoxic exposuresinfections (bacteria, fungus, parasites, viruses), stress and even lack of sunlight exposure. You can control a LOT of these things, which empowers you to do something meaningful for your health. Here’s a plan to help you find and correct the underlying cause.