Gallbladder Disease - Ask the Dietitian®

Gallbladder Disease

Where can I find a dietitian who works with people who have gallbladder problems?

The Medical Nutrition and Nutrition Entrepreneurs dietetic practice groups of the American Dietetic Association provide medical nutrition therapy based on your diagnosis. Dietitians often have their own private practice nutrition counseling services in addition to services provided in a clinic or hospital. You can find a dietitian at the American Dietetic Association. Include your zip code or city / state, the type of service you want (individual consultation) and expertise in digestive disorders and gastrointestinal diseases / disorders.

My sister just found out she needs to have her gall bladder removed (the surgery date will be set later this week). Her doctor put her on a diet of clear liquids last week and she needs to remain on that for a couple more weeks (I am not sure how long after the surgery). My concern is that she will not get all of her nutrients. Plus, I know she is sick of gelatin and broth. What else can she have? (I was thinking of sending her a care package with a few things and wanted to know what I should send her). Thanks.

Your sister can have any liquid that is clear. Besides flavored gelatin and broth (chicken or beef), she can have apple juice, cranberry juice and tea.

A clear liquid diet is low in calories and most vitamins and minerals. Since it is used for such a short time, I wouldn't worry. After your sister has her gall bladder removed, she will be started on clear liquids again, then full liquids (any food liquid at body temperature 98.6 degrees F) and finally a regular diet.

I was reading your Q&A on gall bladder and I wonder if you have the e-mail address of the husband who wrote that his wife was getting sick after gall bladder removal. I have the same problem and would like to see what they found out if anything. Thanks for your help, if you feel it would be wrong to send me their e-mail address please forward this to them.

Hi. I do not keep viewers e-mail address due to the number of persons who write to me. Nor can I forward your letter to them. Sorry.

I would suggest you go back and see your surgeon or another specialist. It is very unusual to have symptoms like below after surgery.

My wife had her gall bladder removed last June as she had several gallstones. Soon after the operation, she would once in a while (2 to 3 hours after supper) experience a very painful burning sensation in her tummy. She would scream uncontrollably at the top of her lungs for several seconds and spit up part of her dinner. She would feel better after a 2 or 3 "attacks" for the evening. I read the Gall Bladder topic Q and A you have and her situation sounds similar except that her gall bladder has been removed. These "attacks" happen less and less frequently except that she just had one yesterday after not having one for about 3 months. She knows that she should not eat foods that are very fat or fried foods. Yesterday's supper did have stir-fried vegetables, but the overall meal was not particularly worse than other meals she has been eating without problems. Is there some randomness to be expected for the amount of fat ingested to trigger an "attack?" Is the attack triggered not necessarily by the most recent meal, but maybe by the most recent few meals?

One note about last night's meal is that the vegetables were spicy. She doesn't remember her doctor mentioning spicy foods, but we will ask him about it the next we see him (my wife goes to him periodically regarding hormone - thyroid hormone replacement). Do you know if she needs to avoid spicy foods also? If so, would this be for both red and black pepper?

You told the person in your Q&A too much fiber should be avoided. My wife does like to have fruit after dinner (she had an orange and a tangerine last night). As such she has had her gall bladder removed, should she avoid too much fiber also? I did give her a glass of Metamucil several weeks ago as she was constipated and this did not give her problems.

We hope to avoid this situation again by watching what she eats, but if she does happen to break down and eat something marginally fatty or lightly fried, would Tums or Pepcid AC type products help her if taken early enough?

I hope to see your reply either by email or posted in your web site. Thanks.

I would recommend your wife immediately go back and see the doctor that removed her gall bladder. It is not normal for someone to experience a "very painful burning sensation in her tummy" after eating followed by throwing up food. This should not happen whether or not they have had their gall bladder removed. You do not specify whether it is in her stomach area above her belly button or in her intestinal area below her belly button. This could help her doctor locate the problem. Would not suggest you "treat" your wife's symptoms with over the counter medicines until you find out what the cause of her pain is. You may disguise the symptoms and delay treatment with periodic periods of relief from such over the counter medicines.

People who have had their gall bladder removed have varying tolerances to the very foods that previous to their surgery may have caused gall bladder attacks. These foods may have been high fat or fried foods as well as whole grain breads and cereals, nuts, seeds or gas producing vegetables (baked beans) from the cabbage family (broccoli, brussel sprouts, cabbage or cauliflower). This may include over the counter bulking agents like Metamucil. Spicy food seasoned with red or black pepper may cause some discomfort for persons with gall bladder disease but not necessarily. Symptoms may range from burping and gas to a feeling of fullness (like the food isn't going the direction it should).

When this current problem is treated, your wife should be able to return to a normal diet if no other medical nutritional therapy is recommended. That means that she would be able to eat anything. If constipation were a reoccurring problem, I would suggest a high fiber diet if she were allowed a normal diet. Whole grain cereals and breads, fresh fruit (including edible peels) and fresh vegetables should be included in her daily menu. Perhaps she should see a Registered Dietitian to address all her health plans into one meal plan.

Hello, I have a brother, 24 years old who lives in Southern California. My other brother and I are trying to help him out. He has been taken by ambulance numerous times to different hospitals that send him straight to county hospital. (He has no insurance). The county Doctor told him he needs his gallbladder out. He has no kidney stones, but has a lot of pain ,throws up everything, including blood and has blood coming out the other end. He also throws up lots of clear and yellow stuff. He has had this for awhile. My question is can a gallbladder burst like an appendix? Also, the past three times he has been to the county hospital, they give him morphine, keep him in for a few days, then tell him to go home and they will take his gallbladder out next time. This has happened three times. Any advice will be greatly appreciated. Thank You.

Yes, a gallbladder can rupture like an appendix. A gallbladder attack is painful and the morphine will control the pain. The pain starts at the bottom of the breastbone like a heart attack and may radiate around to the back unlike a heart attack. Gallstones can get stuck in the opening of the duct to the intestines or cause pain as they are passing through. Sometimes doctors don't like to take out a gallbladder when it is inflamed as the risk of complications or infection could be greater. I would suggest your brother make an appointment to see a county doctor ASAP and schedule to have his gallbladder removed.

Most states have medical coverage for persons who can't afford it or have a pre-existing illness not covered by insurance. You can advocate for him as he may not feel well enough to get adequate help until the pain is excessive. Be persistent with your advocacy for your brother!

If the blood he is throwing up looks like coffee grounds, he may also have an ulcer in his stomach. If it is bright red blood, then it is coming from somewhere higher than the stomach, possibly the esophagus or lungs. The cause of bleeding should be determined.

Bright red blood in the stool can come from hemorrhoids or a fissure in the end of the large colon. Blood loss higher in the intestines or iron supplements usually colors the stool black rather than bright red. The cause of blood in stool should be determined.

Don't know what the yellow vomit is. Though bile is yellow, it is secreted into the intestines, not the stomach.

Until he gets his gallbladder out, I would suggest he avoid any fat, fatty meats, fried foods, whole grains, seeds and skins as these foods need bile to be digested. Bile is produced by the liver and stored in the gallbladder until needed to break down these foods. One can live without a gallbladder because the liver produces bile and can be secreted directly into the intestines.

Lately I have had severe pain in my upper right quadrant, just beneath my ribcage. The pain is "rolling", "cramping", "hard" pain. The onset is almost exactly 2.5 hours after eating a normal meal. For example, a meal of white chicken breast (no skin), baked potato chunks with very little cheese sauce, kale and a root beer float for desert was finished at 7:35 PM. By 10:10 PM, the pain described above occurred. This pain lasts for about 3 to 4 hours, during which time it is always constant although of varying intensity. It seems to radiate toward my back on the same side (right). No aspirin or other commercially available painkillers have any effect. I have used some PERCOCET and this seems to do the trick.

Now. this same pain occurred four years ago. I saw a MD who suspected gallstones. I had a sonogram that showed nothing (all normal).

Question: What the heck is going on??

Well rather than playing doctor whom is not my specialty or yours, I would suggest you get a second opinion. Chest pain is not something to wait around to go away. Actually symptoms of a gallbladder attack mimic a heart attack.

Your description of food eaten, delay in pain after a meal and pain below the sternum with radiation around to the back describes common symptoms of gallstones. I would suggest that you go back to see your doctor rather that waiting out the pain. Newer tests are available to help diagnose the cause.

The above meal contains baked potato skin, cheese sauce, kale and the ice cream portion of the root beer float, which would aggravate gallstones along with large portions of any of the other foods. Until the cause of the pain if found, I would suggest you follow a low fat, low fiber diet with 20% of calories from fat,. Also, avoid foods with seeds or skins, limit whole grains, fresh fruits and vegetables to the cooked version. Also, don't overeat at meals.

Your liver produces bile, which is stored in the gallbladder until a meal. Bile is an emulsifies that pushes fat molecules apart to allow enzymes from the pancreas to break down fats prior to absorption. If you have gallstones, especially if they block the duct coming out of the gallbladder or going down to the intestinal tract, that could be the source of your pain, which will not be, relieved with aspirin or other painkillers. PERCOCET is a prescription narcotic that increases the amount of enzymes from the pancreas in the blood and probably providing you some relief. Go see and doctor.

Have there ever been any studies done on problems with digestion after gall bladder removal? If so, could you direct me to this information?

No studies come to mind and I searched a few references as well. Fat and fiber tolerance varies among individuals after gall bladder removal. Food tolerance ranges from the same foods offending to tolerance of any foods. Commonly, fried foods, fatty meats and sausages, snack chips, seeds (some fruits ) as well as the usual fats, oils and salad dressings seem to bother persons with gall bladder disease.

The gall bladder is merely a storage vessel for bile produced by the liver. After the gall bladder is removed, the liver still makes bile and secretes it into the small intestine via the common duct. Bile emulsifies fats so that dietary fats can be digested by enzymes and transported into the blood or lymph system. Gallstones are usually made of cholesterol, which is a component of bile.

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