Food Freedom Friday Edition 190 - No Gallbladder & Keto

Is a ketogenic lifestyle possible, safe and healthy for someone without a gallbladder?

The answer is yes.  

The gallbladder is an organ that aids in the digestion of fatty foods by storing up bile reserves. Bile is generated in the liver and carried to the gallbladder through the bile ducts. The gallbladder will contract to force bile out when it is triggered after fats have been consumed.

Bile serves four primary functions in digestion:

1.     Breakdown fatty acids

2.     Stabilize blood sugar

3.     Inhibit bacterial overgrowth

4.     Remove toxic waste and cholesterol from the liver for excretion from the body.

If your gallbladder has been removed, the liver still produces bile. Because bile cannot be stored for efficient fat digestion, it slowly seeps into the intestines. This results in an inability to optimally digest a meal with a high amount of fat in it.

Gallbladder and Liver Issues

Addressing the function of both the liver and gallbladder is vital to improving health. When the bile ducts of the liver harden, they can form crystallized structures referred to as gallstones that obstruct bile flow and secretion. Gallstones are created from the combination of excessive cholesterol and/or bilirubin.

The liver is responsible for the production of bilirubin. Gallstones and gallbladder dysfunction are indicative of an underlying liver problem.


Someone who has had their gallbladder removed or has a gallbladder disease will not digest fats optimally resulting in a malabsorption of valuable nutrients. These would include essential fatty acids like omega-3 and omega-6 fats as well as vitamins that require fat for absorption (vitamins A, D, E, and K). This results in systemic issues like dry skin, thinning hair and even autoimmune symptoms.

Unfortunately, symptoms of gallbladder and liver concerns do not disappear with the removal of the gallbladder. Individuals can suffer from digestive distress including nausea and vomiting, abdominal pain, gas and bloating, as well as symptoms seemingly unrelated to the abdominal region such as itchy skin, pain between the shoulder blades, headaches and migraines, fibromyalgia and hormonal imbalances.

The Ketogenic Diet

A ketogenic diet comprises approximately 75% healthy fats, 20% proteins and 5% carbohydrates. Generally, protein consumption is between 20 and 35 grams per meal depending on body size and intensity of exercise. Individuals with a sedentary lifestyle only require 10-15% of calories from protein whereas those with high physical demands require 20-25% calories from protein.

The foods consumed on a ketogenic diet include:

Fats: Coconut oil, full fat coconut milk, raw nuts and seeds especially pumpkin seeds, chia and flaxseeds, olive oil, avocados, MCT oil, pastured butter and animal fats (tallow, lard, schmaltz, duck fat) and organ meats such as grass-fed beef and pasture-raised chicken liver.

Proteins: Grass-fed beef, wild game, organic free-range poultry, organic and grass-fed raw dairy and fermented dairy.

Carbohydrates: Above-the-ground vegetables like Brussel sprouts, kale, broccoli, asparagus, collard greens, spinach, celery, cauliflower, cabbage, lemons, limes and other non-starchy veggies.

Keto Strategies for Gallbladder Issues

If you have had liver or gallbladder problems in the past or no longer have your gallbladder than be sure to follow a few simple strategies to optimize the ketogenic diet for your challenges.  Many people without a gallbladder are able to thrive on a ketogenic diet when considerations are made and applied properly.

If you feel extremely tired and irritable for more than a few days, try adding back more healthy carbs with your evening meals.  People with liver or gallbladder issues typically do very well with beets, carrots, green apples, squash and berries.  These would be better sources of carbohydrates than grains and sugar sweeteners.

Stomach Acid Support

Producing adequate stomach acid will support your body’s ability to metabolize fats, absorb essential nutrients, and prevent feelings of discomfort and digestive problems.

Optimal stomach acid levels are necessary for stimulating bile secretion from the liver and destroying pathogenic microbes that can overpopulate the intestines causing inflammation and indigestion. The combination of optimal stomach acid and bile flow is critical to the detoxification process of the liver and digestive tract so that you feel healthy and energized while maintaining ketosis without a gallbladder.

Support stomach acid levels by avoiding water intake within a 30-minute window before and after meals.  Higher levels of stress block the secretion of stomach acid, so it is very important to relax the body before meals.

Digestive bitters diluted in a little water before a meal will support adequate stomach acid and aid digestion. Apple cider vinegar taken before and during a meal will also help stimulate stomach acid production. You may also consider a hydrochloric acid supplement in the form of betaine HCL tablets taken during or immediately following a meal.

Enzymes and Ox Bile

Supplementing with digestive enzymes and ox bile can significantly support fat metabolism without a gallbladder.

Digestive Enzymes: Digestive enzymes contain natural bile salts, betaine HCL, herbs and a complex of enzymes that support the function of other digestive organs like the pancreas. Finding a good quality digestive enzyme is an effective way to produce adequate stomach acid, inhibit inflammation of the intestines and aid in fat metabolism and the assimilation of fat soluble vitamins.

Ox Bile: Ox bile supports the body in breaking down fats without the presence of bile. Some digestive enzymes contain ox bile but it is recommended to be supplemented separately.

Ox bile is also important for sanitizing or killing off microbes and helping to assimilate fats for absorption. Ox bile can help relieve symptoms of indigestion and feelings of an upset stomach that may otherwise be experienced when consuming a higher fat diet without healthy bile concentrations. 

Bile Promoting Foods

·       Ginger is a carminative herb and one of the best foods for producing stomach acid and bile.

·       Apple cider vinegar consumed before or added to meals and beverages can help thin bile for efficient flow from the liver.

·       Artichokes stimulate bile production in the liver and increase its flow into the intestines.

·       Sour foods like lemons and limes improve the tolerance for fats. These citrus fruits cleanse the liver and thin bile for improved digestion and nutrient absorption.  

·       Fermented vegetables and drinks such as sauerkraut and a low-carb coconut water kefir are excellent for improving digestive juice production.

·       Fibrous vegetables and fermented foods and beverages stimulate a healthy digestive system and prevent the overgrowth of intestinal bacteria that can lead to digestive disturbances.

o   Celery and cucumbers are great low carb foods that naturally contain sodium, vitamins B and C and trace minerals for liver health.

o   Celery as well as asparagus are good foods for detoxifying the liver and improving bile flow.

o   Add radishes to meals to support the metabolism of fats from increased bile production.

Ginger and Dandelion Tea

Both ginger and dandelion are considered bitter herbs that increase bile production and boost bile flow for a healthy liver.

Ginger can help relieve symptoms of indigestion and prevent nausea and vomiting. Ginger stimulates the secretion of gastric juices like hydrochloric (HCL) acid and bile. It has also been shown to inhibit inflammation of liver tissue aiding in the removal of toxins.

Dandelion tea encourages and supports healthy digestion and enhances detoxification. Dandelion leaf or greens is also a prebiotic food source that supports a healthy gut microbiome and keeps pathogenic bacteria at bay.


Drinking plenty of purified water is essential to improving gut motility and preventing constipation while maintaining ketosis.  It is also critical for healthy liver function and bile release.

Without plenty of water available to the liver, bile production decreases and the body creates a thick, sluggish bile flow. Aim to drink 32 ounces of purified water within the first hour of waking up and between 32 and 48 ounces of water by noon.

Avoid Long-Chain Fats

Long Chain Fatty Acids take a longer period of time to break down and require significantly more energy for digestion. They require more bile in order to be metabolized into triglycerides.  Small and medium chain fatty acids do not require bile and are easier on the liver. 

Long-chain fatty acids are found in avocados, nuts and seeds, olives and olive oil and meats.  Small and medium chain fatty acids occur in grass-fed butter and coconut fats.

It is especially critical for individuals without a gallbladder to eat small meals. Inadequate gastric juices and bile secretion will cause digestive distress from the inability to break down long-chain fats. Instead, consume 3 or 4 small meals throughout the day. Try using liquid nutrition that is easy on the digestive tract including shakes and smoothies to support liver function.

Include MCT Oils

Medium chain triglyceride (MCT) oils are rapidly metabolized into ketone bodies for efficient energy use. Consuming MCT oil reduces your energy dependence on fats to 60-70% making these fats easy to break down and absorb by individuals without a gallbladder and those with slow or compromised liver function.

Adding MCT oil to your diet is one of the best ways to increase the medium chain triglycerides that favor maintaining ketosis without a gallbladder. Unlike most fatty acids, MCTs do not rely on the production of bile to be metabolized and begin breaking down immediately from contact with enzymes found in saliva. MCTs have been shown to effectively synthesize ketones and cross the blood-brain barrier for healthy brain function.

Surprisingly, coconut oil is comprised of 35% long chain triglycerides, only 15% medium chain triglycerides and 50% lauric acid which is utilized as a long chain fatty acid.

In Conclusion:

It is especially critical for individuals without a gallbladder or with compromised gallbladder or liver function to practice lifestyle habits that support optimizing liver function. Preserve nutrition by consuming organic foods and drinking purified water to reduce the toxic burden on your liver and body.

Incorporating a few dietary tweaks, additions and supplements can support you successfully following a ketogenic diet, even without a gallbladder.

Michal Ofer