Diet with Gallstones and After Gallbladder Removal

Regular habits lower the chance of attacks and new stones.

• Eat regular meals and avoid very long fasts; do not skip breakfast.
• Lose weight slowly if you need to (about 0.5 to 1 kg a week); never crash diet.
• Stay active: 150 minutes of moderate exercise a week is linked with fewer stones and attacks.
• Keep a note of the foods that trigger pain for you and limit them rather than cutting all fat.
• After surgery: walk daily, avoid heavy lifting for the period your surgeon advises, and increase meals gradually.

Two situations: living with stones (before surgery or if you choose not to operate), and recovering after the gallbladder is removed. Evidence strength is stated.

• With stones, moderate evidence for prevention: a Mediterranean-style diet with plenty of vegetables, fruit, whole grains, legumes, nuts, fish and olive oil; fewer sweets, white bread and white rice, sugary drinks and processed food.
• During or after an attack: small, lower-fat meals (grilled or boiled rather than fried; skimmed or low-fat laban and yoghurt; lean meat, skinless chicken, fish) are easier to tolerate. Very large fatty meals, deep-fried food, creamy dishes and fatty meat are the usual triggers. There is no evidence that avoiding fat completely helps, so keep a small amount of healthy fat such as olive oil or nuts.
• Fibre helps: eat vegetables, fruit, oats, whole grains and legumes. Increase gradually.
• Coffee, observational evidence: moderate coffee drinking is associated with fewer gallstones. It is not a treatment, and is not necessary if you do not like it or if coffee upsets your stomach.
• Avoid weight-loss diets that are very-low-calorie or very-low-fat, liquid-only plans, and long fasts. If you plan weight-loss surgery or a fast weight-loss medicine, ask whether a stone-preventing medicine is advised.
• Supplements: there is no proven “gallbladder flush” (olive oil and lemon juice cleanses, herbal flushes). They do not remove stones, can cause severe pain, and may cause pancreatitis or blockage.
• After gallbladder removal, first days to 2 weeks: start with clear fluids, then light foods (soup, rice, boiled potatoes, toast, bananas, steamed fish or chicken, eggs, yoghurt), eating small meals more often, and avoid very fatty, fried, spicy or large meals while you recover. Add normal foods back one at a time.
• After the first weeks, most people can eat a normal balanced diet. A permanent low-fat diet is not needed for everyone. If a certain food triggers loose stools or bloating, reduce it; keep a symptom diary. Fatty meals and large portions, caffeine, very sweet drinks and alcohol are the common culprits.
• If loose stools persist for more than a few weeks after surgery, do not simply cut food further; see your doctor, because bile-acid diarrhoea responds to medicine and other causes need checking. Keep fluids up.

Medicines are for pain, prevention in selected patients, or after-surgery diarrhoea. Always use them under medical advice.

• Pain relief during an attack is given by your doctor; avoid taking anti-inflammatory painkillers on an empty stomach or in large amounts without advice.
• Ursodeoxycholic acid can dissolve small cholesterol stones in selected people or help prevent stones during rapid weight loss; it works slowly and stones may return.
• Bile-acid binding medicines (for example cholestyramine or colesevelam) can treat persistent diarrhoea after cholecystectomy; your doctor decides, and timing with other medicines matters.
• Antibiotics are used for infection of the gallbladder or bile duct.

Procedures treat stones that cause symptoms or complications. Diet does not replace them.

• Laparoscopic (keyhole) cholecystectomy is the standard treatment for symptomatic gallstones and is usually done as day-case or one-night surgery; most people return to light activity within days.
• ERCP (endoscopic removal) is used for stones in the bile duct.
• Open surgery is rarely needed; a drain or tube may be used in a sick patient not fit for surgery.