One of the first patients I saw as a medical student was a nice lady, who presented to the university hospital outpatient clinic with colicky, cramping abdominal pain. She described the pain as coming on after a meal, and said that it doubled her over with pain. The pain came and went, but had gotten worse over the past few days.

I took a long history from her and performed a physical exam, which included examining her abdomen. When I pushed on her right upper quadrant, she all but yelped and grabbed at my wrist. At that point in my medical education, I knew just enough to be dangerous, so I excused myself, left the exam room and presented this lady’s case to the medical resident running the clinic that day.

He asked me a few questions, which, I, in my ignorance, had failed to ask the patient. A couple of the questions he asked, however, I did know the answers to. The patient was in her forties, she was blond, overweight, and had three children.

The resident then told me she fit the description of the four Fs of gallbladder disease: Fat, fair, forty and fertile. (As I was to learn later, there is actually a fifth F, which is female, and my patient fit that description as well.)

We went back to the exam room together, and the resident took over the exam. He asked about diet, family history, any history of previous occurrences of similar pain, and a few other questions. He said he would send her for some gallbladder studies to make sure, but he was relatively certain she had gallstones.

She asked what would have to be done if she did have gallstones. The resident told her she would require surgery to remover her gallbladder. She instantly burst into tears.

She told us her aunt had died during gallbladder surgery, and that she was terrified to undergo the surgery herself.

She asked if there was any other way she could be treated besides surgery.

The resident replied that there was, but that it didn’t work very well. He told her to get the gallbladder studies done, and if they were positive, he would set her up with the surgery department for further evaluation. And that they would discuss with all the options with her.

I never saw this patient again, so I don’t know how her case ended up.

I did, however, ask the resident what this non-surgical treatment was. He told me it was some sort of drug that dissolved gallstones. I asked him if the drug really worked. He said he thought it did. I then asked why taking the drug wouldn’t be better than fairly major abdominal surgery.

He replied that although the drug did dissolve gallstones, it didn’t treat whatever the underlying problem was causing the gallstones in the first place. Patients who took the drug, got rid of their stones, but as soon as they went off the drug, the stones redeveloped. He said the only effective permanent treatment of gallstones was to remove the gallbladder.

Over the next few years of my medical education, I learned this was the common wisdom on dissolving gallstones. It can be done, but what’s the point? The stones will simply come back.

Treating gallstones

Turns out, however, that there may well be a way to avoid surgery, get rid of gallstones and, most importantly, keep them gone.

I’m going to lay out the approach I would take myself, should I ever develop gallstones, or would recommend to any family member with the same problem.

Before we get into the nuts and bolts, let’s briefly discuss what gallstones are and why they develop.

The gallbladder is a little sack tucked up under the liver that acts as a bile reservoir. Bile is a thick yellowish- green liquid, made in the liver, stored in the gallbladder, and used to help break down or emulsify fat. A duct system runs between the liver and the gallbladder and the gallbladder and the upper end of the small intestine. Whenever fat leaves the stomach and enters the small intestine, the gallbladder contracts and squirts out a measure of bile that then mixes with the fat and starts breaking it up, so the fat can be more easily digested.

One of the major components of bile is cholesterol. Under certain circumstances, if bile sits around in the gallbladder, the cholesterol becomes supersaturated and can form stones called, appropriately enough, cholesterol stones. There is another type of gallstone called a pigment stone, but these kinds of stones are rare in non-Asian countries.

There are a number of conditions that lead to the formation of cholesterol stones in the gallbladder. You can read about them in more detail in this brief article about gallstones and gallbladder disease.

Risk factors for developing gallstones

  • Hormone replacement therapy and birth control pills. Estrogens tend to increase the amount of cholesterol in the bile and reduce the contracting movement of the gallbladder.
  • Some cholesterol lowering drugs. Typically not statins. There is some evidence that treatment with statins might actually lower the risk of forming gallstones, but the jury is out until more research comes in. Certainly not a reason to start a statin.
  • Female. During the reproductive years, women produce plenty of estrogen. Women suffer gallbladder disease at more than three times the rate as men. As many as 20 percent of women have gallstones by the time they are 60 years old.
  • Obesity. Obesity, especially abdominal obesity, leads to increased levels of cholesterol in the bile. At higher concentrations the cholesterol will be more prone to precipitate out into gallstones.
  • Pregnancy. The extra estrogen from pregnancy can, as with HRT or birth control pills, increase the cholesterol in bile and reduce the activity of the gallbladder.
  • Weight loss, especially rapid weight loss. Lack of fat intake allows the bile a chance to sit in the gallbladder and form stones. This last risk we shall cover in more detail.

How gallstones form during weight loss.

When you consume a fatty meal, the fat goes through the stomach and into the small intestine. The bile-filled gallbladder then gets the signal that fat is present and contracts, releasing its contents through the duct into the small intestine to combine with the fat-rich food as it enters the bowel. The bile then begins the emulsification and breakdown process. The liver makes more bile and sends it to the gallbladder to store, awaiting the next fatty meal coming down the pipe.

But what happens if there is not much fat in the diet?

Then there can be trouble.

The gallbladder doesn’t contract, and the bile inside becomes more concentrated. If the gallbladder isn’t emptied, then cholesterol can become supersaturated and a stone could form. Stones that form can stay in the gallbladder causing irritation or can move down through the duct. If a stone gets stuck in the duct, it usually causes severe pain and requires surgery to fix.

From what you know so far, it should have occurred to you that keeping fat coming down the GI tract will ensure the gallbladder contracts regularly and will keep the bile from supersaturating with cholesterol. No supersaturation, no stones.

What kind of diet keeps fat moving down the GI tract? Obviously not a low-fat diet.

But a low-carb diet does keep fat moving down the GI tract throughout the day, emptying the gallbladder and pretty much preventing the formation of stones.

Low-carb versus low-fat and gallstone formation.

About 15 years ago, MD and I ran the largest study group in the world looking at a drug called orlistat (Xenical, now Alli) as a weight loss maintenance drug. We recruited a large number of subjects, put them through thorough physical exams and an exhaustive battery of tests; those who passed, we entered into the rigid study protocol.

Here’s how the study worked.

The drug company insisted that all subjects go on low-fat, calorie-restricted diets, which they were to follow for six months. If the subjects lost four percent of their body weight after six months, they were then to be randomized into one of three doses of orlistat or placebo.

Most of the subjects recruited were in the 200 pound range weight-wise. Which meant each had to lose at least eight pounds (4% of body weight) over the six months of low-fat, calorically-restricted dieting. It was amazing to MD and me how many patients could not lose even that small amount over six months on a low fat diet and had to be dropped from the study.

The other thing we found amazing was the number of subjects who developed gallstones over the six month period.

One of the battery of tests the subjects had to go through to get into the study was a gallbladder ultrasound, a test that determines the presence of gallstones. Any recruits who were found to have gallstones were rejected. So we started the study with a large group of subjects we knew were free from gallstones, put them on the low-fat diet, low-calorie diet and followed them for six months. Those who lost the requisite four percent of body weight then went through another round of testing including another gallbladder ultrasound.

We were stunned. I don’t remember the exact figure, but somewhere in the range of 15 percent of these subjects who were gallstone free at the start of the study had developed gallstones within six months.

That’s what a low-fat diet can do for you. I’ve seen it up close and personal.

In the many years MD and I have treated countless obese patients with low-carb diets, we’ve never had a case of gallbladder disease. I’ve often wondered if our patients had stones but just no symptoms. Now in the light of a new study in press, it appears that dieters who lose weight on higher fat diets do not develop gallstones. So I feel on more stable ground when I say our low-carb, high-fat dieting patients probably didn’t have gallstones.

Ursodiol and high-fat diets prevent gallstones during weight loss

A paper soon to be published in Clinical Gastroenterology and Hepatology, Ursodeoxycholic Acid and High-fat Diets Prevent Gallbladder Stones During Weight Loss: a Meta-analysis of Randomized Controlled Trials, looked at a number of strategies to prevent gallstones in adults who lose weight.

Since it is well known that rapid weight loss is major risk factor for developing gallstones, the authors of this paper searched for weight-loss studies in which subjects were checked for gallstones both before entering the trial and upon completion. Their goal was to see if taking ursodeoxycholic acid (ursodiol or UDCA), sold under multiple trade names, would prevent gallstone formation in rapid weight loss diets.

(An earlier form of UDCA was the drug the resident told me about years ago that would dissolve gallstones. The Wikipedia article provides a pretty good explanation of how ursodiol works.)

The researchers ended up tracking down eight studies in which subjects consuming low-fat, low-calorie diets were compared to others consuming the same diet with the added gallstone-dissolving drug. They also found five studies that looked at subjects who had just undergone gastric bypass, which is another risk factor for gallstone formation. (In fact, some surgeons take the gallbladder during the bypass surgery to prevent stone formation later.) Half the subjects in these five studies took UDCA post-surgery while the other half didn’t.

Finally, for good measure, the authors ended up finding two more studies comparing how subjects fared gallstone-wise on low-fat, low-calorie diets as compared to higher-fat, low-calorie diets. Both diets contained the same number of calories. The diets differed only by fat content.

What were the findings?

Gallstone formation in both the groups of subjects on low-fat diets and post gastric bypass who took UDCA formed significantly fewer gallstones than those who did not take the drug. The effect was a little smaller in the post-gastric bypass group, but still significant.

The observed effect in our meta-analysis seemed to depend in part on the weight loss method, with patients post-bariatric surgery having a smaller benefit than patients on diet alone. UDCA decreased gallstone incidence from 19 to 3% in the diet alone trials and from 28 to 9% in the post-bariatric sugary trials.

How about the subjects on the higher-fat, low-cal diets as compared to those on the low-fat diets?

The lucky subjects randomized into the high-fat arm of the study fared very well. While 45 percent of subjects on the low-fat diet developed gallstones, none developed stones on the higher-fat, low-cal diet. Not a one.

The take-home message from this study is to make sure you get dietary fat should you go on a low-calorie, weight-loss diet. Or, better yet, follow a low-carb diet, which pretty much ensures you get plenty of fat. You want to make sure your gallbladder contracts regularly, so you won’t have the cholesterol-rich bile sitting around in there waiting to precipitate.

One other message is that by taking UDCA, you can dissolve your gallstones without having to worry about them reforming if you make sure to eat enough fat to keep your gallbladder emptying.

Caveat:  Those with known gallstones need to watch fat intake at first until the stones are dissolved. Most people with gallstone problems are aware of how much fat they can get away with eating. I wouldn’t push it much beyond that until the gallstones are gone. Then increase fat intake to keep the gallbladder contracting and new stones from forming.

Back in my surgery days, we did laparotomies (open abdominal surgery) to remove the gallbladder. Today, it’s typically done laparoscopically, which is a much more benign procedure. But still not without risk, especially since a general anesthetic is required. I don’t have gallstones, but if I did, I would do whatever I could to avoid any kind of surgical treatment, so if I were given the option to dissolve my gallstones, I would certainly take it.

I wish I had had this information available when I took care the poor lady discussed at the start of this post. She likely could have avoided the surgery and all the angst that went along with it.

If any readers have had experience with UDCA, I would love to hear about it in the comments.

One last item. I’m posting this at about 11:30 my time and boarding a plane tomorrow morning at 5 AM. So, I probably won’t get comments posted until about midday tomorrow when I have a layover.

Picture at the top:

Woman suffering the cholic
etching by G. Cruikshank, 1819
Courtesy of the Wellcome Library


  1. What I remember learning about UDCA 25 years ago was that, while it did dissolve gallstones, it would require lifelong treatment because it didn’t address the underlying pathophysiology. Furthermore, the drug-treated patients eventually ended up needing their gallbladders out as often as the surgery patients. So the drug just delayed surgery.
    Back then, most drug-treated patients would have returned to the usual high-carb American diet. Maybe that’s why symptomatic gallstones flared up eventually.
    I remember thinking about drug therapy in older folks who were at very high risk of death or other complications from surgery. Back then, the risk of death simply from general anesthesia was 1 in 20,000. Now it’s 1 in 10,000.
    On a related note, researchers have found that high glycemic index and high glycemic load diets increase the risk of gallbladder disease by 26 to 41%. For a few of your readers that may not know, high GI and high GL diets are usually high-carb diets. Reference:

    1. I learned it a little differently. It did indeed require lifelong treatment or the stones would return. But I think a course of UDCA until the stones are gone followed by a low-carb diet would doubtless significantly decrease the chance of stone re-formation.
      Thanks for the link.
      I wrote a post on carbohydrates and gallstones almost ten years ago.

  2. Dr. Eades, I’ve read that those of us without gallbladders (mine was removed more than 25 years ago) have trouble absorbing fat-soluable vitamins and Omega 3s because bile only trickles out of our livers (rather than being stored and concentrated as it used to be in our gallbladders). If that’s true, how big a problem is it for a low-carber, and what action would you recommend?

    1. Often the remnants of the ducts enlarge over time and become pseudo gallbladders. For many people these pseudo gallbladders function just fine.
      I don’t think it would be a problem for a low-carber. Increasing fat intake should decrease the amount of bile sitting around in the pseudo gallbladder.

      1. Hi, my grandpa is undergoing surgery tomorrow to remove gallstones. It is too big to suck it out with a tube and the doctors where he lives are concerned about doing the surgery with his age. (84?) He is a 2 pack a day smoker, drinks regulary, and theyre afraid of a stroke, heart attack, or death. What are the chances of him dying from this surgery?

        1. I can’t give you those statistics because I don’t know them. But the risk is certainly higher than if he didn’t smoke and were a lot younger. But I doubt his surgeons and/r anesthesiologists would operate unless the rewards vastly outweighed the risks.

        2. Hi, my grandpa is undergoing surgery tomorrow to remove gallstones. It is too big to suck it out with a tube and the doctors where he lives are concerned about doing the surgery with his age. (84?) He is a 2 pack a day smoker, drinks regulary, and theyre afraid of a stroke, heart attack,
          are there any solution to remove gallstones without surgery?

          1. Yes, there are medications that will dissolve the stones, but they are available only via prescription. You will need to discuss with your grandfather’s doctor.

  3. I remember developing severe gall bladder pain in my 30s. Having been fat basically since birth, I was always on one diet or another, usually the low-fat, low-cal variety. I saw a doctor in the ER who told me surgery was the only solution, but the pain had subsided by the time he saw me and I decided to wait and see my own doctor. In the meantime, I read one of those Rodale natural remedy books that recommended drinking olive oil to combat gall stones. I started doing that and for many months, I had no more problems. Then I stopped drinking the oil (don’t know why — probably to go on another low-fat, low-cal diet) and before long I was back in the ER, screaming in pain. This time I was admitted and it was bye bye, gall bladder.
    They told me that my body could continue to handle fats just fine without that little organ, and I still don’t understand how, but it’s 20 years later and I’m still kicking so I guess they were right. I wonder, though, if people who’ve had their gall bladders removed have a different experience with low carb, high fat diets? Are we less able to handle the fats, or larger quantities of fat, than people who still have theirs? In other words, are there any indications that people without their gall bladders should limit their fat intake to any degree while following a low carb diet?

    1. Early on after gallbladder removal, some have difficulty with too much dietary fat. But most adapt reasonably quickly as the ends of the ducts that used to run from the gallbladder to the intestine enlarge to form a sort of a pseudo gallbladder, which takes over the function of the real gallbladder and works fine. Low-carb should be no problem.
      Interesting about the olive oil. Thanks for writing.

      1. Yes, the olive oil was part of a cleanse/ flush recipe I was given too.
        From memory it consisted of taking a laxative, sipping apple juice alternated with olive oil and then lying on the right side (i think) and then checking the toilet for passed stones in the morning.

      2. What about full-blown high fat ketogenic? On probably a weekly basis the keto boards get an enquiry about doing keto sans gall bladder – even after reading the available information it’s difficult to really establish whether it’s safe or not.

        1. I think high-fat, ketogenic diets would be fine. I would be careful of coconut oil, MCT oil and butter because of the large amount of SCFA, which absorb differently. There may be some symptoms with some people even without these particular fats, but the symptoms should resolve over time.

    2. i have also heard about olive oil.
      my ballet teacher got a recipe from a herbalist(?) of olive oil + lemon juice; she passed out her stones after 3 days.

      1. thirty years ago i did the same lemon and olive oil and passed one blue stone, recently age 63 i am having rumbles in that area again thinking of doing lemon and oil again.

  4. Hi Doctor Eades –
    Glad to see your post. Thanks for the – as always – helpful information!!
    Love the picture with this . . .
    Back in the early 70s, my mom had gallbladder surgery but before her doc would remove the gallbladder, he removed ALL fat from her diet – for six months. Needless to say she lost weight like crazy, gained it all back after her surgery, and wound up in her later years with severe dementia and non-Hodgkins lymphoma. I’ve always wondered how or if those medical issues were connected. I do feel fairly confident that her over-indulgence of sugar (she was a Scot – biggest consumers in the world) during her no-fat diet (an indulgence that she didn’t give up after she resumed “normal eating”) didn’t help her health at all.
    On another note: Where you have “They increase fat intake” do you mean “Then increase . . .?”:
    Most people with gallstone problems are aware of how much fat they can get away with eating. I wouldn’t push it much beyond that until the gallstones are gone. They increase fat intake to keep the gallbladder contracting and new stones from forming.
    Just checkin’

    1. Thanks for the heads up on the typo. All fixed. When I went in to fix that one, I found a half dozen more and fixed those, too. Yeesh.

    2. you contradicted yourself in last paragraph saying:::
      1… people are aware of fat amount they can get away with
      2…. I would NOT increase fat amount more than that
      3…. they INCREASE fat to keep gallbladder contracting
      you don’t just increase ANY FAT like butter icecream meats etc and yes you DO INCREASE the olive oil on day 3 of a 3 day gallbladder cleanse
      some cleanses are just in the morning every morning for as long as you want
      before eating
      1…juice one lemon in 1 or 2 cups water
      2…eat unsweetened applesauce or applejuice
      3… one hour later take 1 tablespoon olive oil
      milk thistle and greens are good for gallbladder and liver

  5. I was misdiagnosed as having an ulcer for over 20 years. I first experienced the abdominal pain of gall stones when I was 27, probably as a result of an extremely low fat diet and rapid weight loss. I went to several doctors over the years, and was told that, even though ultrasounds did not show ulcers, that I had ulcers. I was prescribed ulcer medication which I took for at least 20 years. In my 40’s I had two severe gall bladder attacks and THEN I was finally diagnosed. My gall bladder was removed a couple years ago. I have never had, do not now have, ulcers.

      1. I had a kidney stones attack just before I started LCarbing at 2007. So far it didn’t happened again. I see a connection with my kidney stones forming and frequent migraines I had before LCarbing. I was always dehydrated during migraines for 3 day due to a severe vomiting I usually experienced if I ate or drunk for the duration of a migraine. Ketosis is very good for migraines prevention, so I have much less of it, with shorter duration.
        So, if kidney stones formed because general health got worse, like in my case, LCarbing would help indirectly.

  6. I had acalculous cholecystitis last summer and spent three weeks on IV antibiotics. Not wanting surgery and having an abscess in or around my gallbladder I agreed to have a biliary drain put in which I had for two months to remove said abscess. Supposedly since I didn’t have stones my gallbladder collapsed upon itself (scar tissue fused) and having the drainage tube in place the bile went into the bag. It took two months for this to happen. Have you ever heard of that procedure. According to my surgeon I now have a non-functioning gallbladder fused together and hopefully I won’t have anymore problems, I can eat whatever I want. I just hope he knows what he is talking about because I don’t every want to go through that again.

    1. Sounds brutal. Sorry you had to go through it. I have never heard of the situation you describe, but it sounds reasonable. If your gallbladder had indeed fused, then I doubt you will have a recurrence.

  7. This article, for me, is very timely.
    I am a 57 year old white male and have been on a low-carb, or paleo diet, for almost 3 years. during which time, I have managed to lose, and keep off, around 45 lbs, having been around 195 at commencement, but now currently approximately 150 @ 5’8″ tall. Most of that 45 lb, weight loss occurred during the 1st 5 months of the transition.
    About a week ago, I experienced what I assume was a gall bladder attack which eventually subsided, but I have experienced some noise and rumblings subsequently underneath my upper right rib cage, the area of the original cramping and acute pain.
    Since the attack, I’ve been wondering what approach to take to resolve and have decided to try and keep my gallbladder and stay on the Paleo diet and see if the problem resolves in due time.
    Modifications I plan include reducing boiled egg intake from 6 to 3 per day, severely limiting dark chocolate consumption and avoiding over-eating after a fast.
    Thanks for logical explanation of the process and providing some hope of a satisfactory resolution short of surgery.
    Sincerely yours,

    1. You should have an ultrasound of your gallbladder to determine if stones are present or not. An ultrasound is a non-invasive procedure that just takes a few minutes. If you don’t have stones, you’re in the clear. But if you do, you’ll know it and can decide what steps, if any, you want to take.

    2. I have gallstones as well and plan on keeping my gallbladder. You aren’t supposed to have any eggs, they are the #1 gallbladder attack triggering foods . 🙁 organic apple cider vinegar is good and said to help soften the stones. Also add malic acid, taurine, beet root extract to your diet those are said to help with dissolving gallstones . And enetric coated peppermint oil. There is a natural gallstone dissolving drug available only in Europe I believe, the main ingredient is the peppermint oil,s o give those a try . Also for gallbladder attacks, the vinegar helps relive those attacks fairly quick(15-20 min. ) but stay away from the eggs, sorry. I miss eggs 🙁

      1. I’m curious as to your source regarding eggs. Is it anecdotal — you can’t tolerate eggs, and/or know someone who can’t — or is there is a study or studies one could review?
        The possibility of an allergic response or some other problem unique to the patient seems high. After all, the cholesterol in eggs has been long proven to have extremely little to do with blood cholesterol, so curious minds want to know 🙂

  8. Interesting article! I had my gallbladder removed two months ago as an “emergency procedure” due to complications and pancreatitis. Though looking back I had symptoms of gallstones for 2-3 years prior. Interstingly enough I female and fifty but none of the other F’s apply and had transitioned to low carb/high fat eating style during the period when the gallstone symptoms first started. But my mother, her sister, and my sister each had their gallbladders surgically removed dur to gallstones and the havoc they caused.
    I would love to read an article on how to manage low-carb/high-mod fat diet now that mine is gone, as I was told to severly curtail fat consumption since I will no longer excrete bile in sufficient quantity.

  9. Very interesting. Do you know if ox bile (OTC supplement) contains significant amounts of ursodeoxycholic acid like bear bile does?

  10. I had a gallbladder inflammation diagnosed at 10 years old (my gallbladder ducts had a tendency to have spasms), a cholesterol sand was found in my gall bladder than. All my childhood I had some gall-bladder cleansing and draining procedures from time to time which was a part of a standard medical treatment in Russia. I suspect gluten was my problem, but I can only speculate. When I grew-up, I stopped the procedures because I didn’t have symptoms of gallbladder inflammation any longer , at 38 I started to have colics first after eating fat food, than any food, at 39 my gallbladder was removed. It took me at least 3 year, may be 5, to be able to eat fat again without running to a nearest toilet. Many report an uncontrollable weight-gain after such surgery. Probably, the necessity to avoid fat , especially at the beginning, is an important contributing factor. I am eating a low-carb/high fat diet for lat 6 years (since 46 years old).

  11. FYI
    need a link to go with this sentence..
    “There are a number of conditions that lead to the formation of cholesterol stones in the gallbladder. You can read about them in more detail in this brief article about gallstones and gallbladder disease.”
    also, formatting issue in Chrome..words on bullet list items are run together top to bottom so it’s hard to read..

    1. Sorry about that. I put up the link. Thanks for the heads up.
      As to the bullet items…
      My tech guys are supposed to be fixing that, but apparently they’re dragging their heels. I’ll have to get on them. I’m out of the country for a few days and have limited internet access, so it’s hard to stay on top of it. Be back in the US Thursday night, so I’ll be able to deal with it better then.

  12. Dr. Eades, My son was given something that may have been UDCA, I’m not sure. It took a long time to give him relief and I think he has to keep taking it. His obesity issues are getting worse in the meantime, and he is resistant to my suggestions to read your books,a story for another time. Since UDCA is a bile acid, is its action similar to the action in the cleanses touted by the natural cure crowd who may use lemon juice or cider vinegar and olive oil, or eat only apples for a day or two as part of another regimen I read about, examples that have claims of success? Other than what I assume may be a high risk for obstruction with such drastic methods, are those natural approaches on to something that has studies to back it up that could accomplish the same thing as UDCA ,with say an amended low carb diet over a longer term?

    1. I am not aware of any studies showing the efficacy of the natural remedies. I’ve never tried any of them, so I have no patient experience to go by. Wish I could be of more help. I doubt they’re harmful, though, so a little experimentation might be in order.

  13. Hi Dr. Eades,
    Wondered if you are familiar with the use of gold coin grass in treatment of gallstones? I have tried it, and *seemed* to have luck with it, although I was never actually diagnosed — just woke up one night with a supernova going off in my abdomen, did a couple rounds with this herb, and haven’t had any issues since. Purely anecdotal, so I really don’t know what all was going on. I cannot seem to find anything about what the active chemical in GCG is, but wondered if it is UDCA or something similar. Thanks!

  14. I have wondered about low carb, high fat diets *after* gall bladder removal. Is a high fat diet possible with no gall bladder?
    That has been my experience, gall bladder pain with low fat eating & no problems (since) in 10 years of high fat way of eating but I still have my gall bladder, my sister doesn’t & thinks my way of eating is horrendous.

    1. Yes, a low-fat diet is possible after gallbladder surgery. It may take some time to adapt, but ultimately it all seems to work fine.

  15. The reason that obese people would tend more to get gallstones was not addressed here. Could it be that obese women might tend to have higher levels of estrogen?
    Also why would fair-complexioned people tend to get more gallstones? Could it be that these people are not yet as well adapted to grain-centered diets as more southern people, such as the Egyptians, who have used cereal based diets for thousands of years?

    1. Obese people, especially those with abdominal obesity, tend to have more gallstones because the cholesterol concentration in their bile is higher. The abdominal viscera drain directly into the liver via the portal vein, so that may have a lot to do with it.
      As to complexion…
      Nordic people tend to have a higher incidence of gallbladder disease, but so do Pima Indians. Some African tribes have virtually none.

  16. I had severe gallstones after doing the Isagenix protein shake, low-fat, low-calorie diet and it was horribly painful. I had no idea that rapid weight loss caused gallstones but my sister did. After multiple bouts with stone “attacks” with severe pain after eating anything with fat, still not knowing what was wrong, I “passed” the stone. I felt it go through, and within 30 minutes, I felt totally different. Now I eat higher protein & higher fat & low carb & haven’t had a single day of trouble. Never, ever do I want to have those symptoms again……very very painful.

  17. What a timely post! At least from my standpoint.
    After several years of having infrequent episodes of central epigastric pain, I found the episodes were suddenly more frequent late last year. After spending an uncomfortable week, I went to my doctor. The ultrasound she ordered showed gallstones, and I was immediately referred to a surgeon. Not being too keen on surgery, I looked into it online. By the time I reached the surgeon’s office a week later, I had pretty much decided as long as I could handle the once more infrequent episodes, I would forego the surgery.
    Also, even though the US showed gallstones, I wasn’t entirely convinced they were the problem since my symptoms seemed atypical compared to what I read online: the pain was central not right sided, there was no associated nausea or vomiting and there didn’t seem to be any association with meals or fat consumption. And I found could even make the pains lessen or stop by forcing myself to burp repeatedly. It may be wishful thinking, but I actually got the impression the doctor assumed I had gallstones because I fit the 5F profile and when the US confirmed her suspicions, she just knew she was right. Anyway, I’m sure I didn’t endear myself to her by nixing the surgery. I doubt she’d go with the drug option. Maybe if the episodes increase again, I’ll see if I can give it a try.

    1. You have always got the option of another doctor. Maybe someone else might prescribe the meds and follow your progress.

      1. Thanks for the reply.
        This is a new doctor for me. I switched mid 2013, trying to find one who was more in tune with my understanding of proper thyroid treatment. She was on the list of functional medicine physicians, but she has turned out to be pretty conventional as far as her ideas on thyroid, i.e., TSH and T4 only.
        I’m considering another switch to a more integrative/naturopathic style physician. It’s just such a pain to find a good one and make the move. But this may be the push I need.

  18. When I learned of bile-binding acids back in the 90’s in biochemistry, I asked the prof if it really makes sense to put patients taking them on a low-to-no fat diet. I got kind of an empty look and a repeat lecture on how the drugs work.
    I followed up and asked if the amount of bile released from the gall bladder was a graded response dependent upon the amount of fat present (titrated) or if it was an all or nothing mechanism (thinking that the answer might point to a ideal range of fat intake to maximize the effectiveness of the drug). Apparently I was wasting time with these questions because he got a little testy and moved on without answering either.
    I’m sure the answer to the former is if you’re going to put someone on a drug like that then you better get their bile flowing so it has something to bind to.
    I confess I still don’t know the answer to the latter question (though I suspect lower amounts of fat can be handled directly by the liver and that there is a threshold that stimulates the bladder to expel all it has). I haven’t thought about it in years. Maybe I’ll do a little research.
    Great post as usual. If I have time to follow only one twitter feed, which is the norm, it is yours. Thanks for all you do.

    1. Thanks for the vote of confidence.
      Your second question is an interesting one. I don’t know the answer, but I suspect it is probably closer to an all or nothing rather than a graded response. I don’t think the gallbladder is that exquisitely controlled, but I may be wrong. When I get some time, I’ll try to track this one down.

  19. An elderly woman in our church drank a quanity of apple juice followed by an amount of oil, then lay on her side to sleep through the night. In the morning she found many globules of what looked like oil floating in her toilet (after a BM). She put them in a jar in the car (unfortunately in the sun). They melted, but she showed it to her doctor who said those were not gall stones. “They would have just been cholesterol.” Would this be a safe “home remedy” for gall stones?

    1. I’m assuming this lady had been diagnosed with gallstones and was trying to treat them with her home remedy. If the gallbladder is filled with stones – as it sometimes is – it won’t work properly. If that were the case, she would not have secreted enough bile to deal with the oil she consumed. Since the bile makes the oil digestible, not having the bile would allow the oil to pass into the colon. The colon isn’t designed to digest oil, so the oil would have passed out in the stool, which is probably what she saw.
      I doubt the regimen she used would work to treat gallstones.

  20. I had gallbladder surgery nearly 14 years ago. It was laproscopic, supposedly routine. As a mother of a toddler and a 2 month old, it never occurred to me that this surgery could possibly leave my children motherless. But it very nearly did. I woke from surgery with acute pancreatitis. Things went downhill quickly from there. So much so that my family was called in to say their goodbyes after a week and a half of hell for me. I remember very little of the two weeks I was hospitalized. I remember having a central line inserted below my collarbone, waking screaming in pain multiple times, being “quarantined” with c-diff, and having my abdomen so swollen that I looked 11 months pregnant. I have on multiple occasions since then tried to talk many people out of this surgery. All of them proceeded their doctors assurances. I wish I had known there was any other way. I did ask my doctor multiple times.

    1. One of the many reasons surgery should be avoided if there are other alternatives that work as well. Sorry for your misery. Your case is an unusual one, however. In all the gallbladder surgeries I’ve been a part of, I’ve never seen this outcome. But, as you discovered, these things can happen. Even if they happen in a very small percentage of times, if they happen to you, it’s 100 percent.

  21. Wow, I may actually have been part of one of those studies! Years back, before I discovered Protein Power (the diet that got me started with low carb) I was over 300 pounds, and totally unable to stick to the diet of the day – low fat! I tried, but I was so miserable I felt I would rather be over 300 pounds than eat that way for another day. But a doctor I saw at the time insisted I would probably be dead within a few years at my weight – this was back in the early 90s as I recall. And he said his clinic was running a drug trial. He said it was know that ursodiol dissolved gallstones, and it was known that rapid weight-loss on a low fat diet caused gallstones to develop. His clinic, in addition to seeing patients, also made money from putting people on Optifast. He said if I qualified for the study I would get 16 weeks of Optifast along with weekly counseling sessions and medical test for FREE. I truly wanted to lose weight so I decided to sign up. To qualify I had to be scanned for gallstones, and I had none, so I was accepted. There were several groups of patients – some getting daily ursodiol in a standard dose, some getting ursodiol in a much smaller dose, and some getting a placebo, The hope was that ursodiol would prevent gallstone formation.
    Did it? I never heard a result, but at the end of 16 weeks I had lost about 70 pounds , and a new scan revealed that I now DID have gallstones! Clearly either ursodiol didn’t work preventively, or I was in the placebo group. I then was given a free year’s worth of ursidiol to dissolve the stones. I was supposed to be retested after the year – but by the time the year was up the skinny young doctor who had threatened me with near death had died of cancer, and their whole Optifast program was shut down. So I never went back.
    But years later, in 2007, I developed the classic gallbladder symptoms as you describe above. I was in my 50s at that point rather than the “40” but I was still fat, fair, female and fertile. The doctors thought I was a classic case. Except that scans revealed I had no gallstones at all! Further tests revealed my gallbladder was working perfectly normally. Except that if so much as a trace of fat crossed my lips I would be shrieking in unbearable agony with dreadful pain in my right quadrant. I begged them to remove my gallbladder anyway as I was in such agony. I think I would have asked them to remove my head if it would have helped.
    But they wouldn’t, and could not find anything else wrong with me either. I was in perfect health! Just suffering from unbearable gallbladder-like pain. My doctor at that time suggested that I might look into herbal remedies as she had had one patient who didn’t want surgery, who had resolved her galllbladder issues with herbs – doctor didn’t know which. But some googling led me to try milk thistle, and within weeks of taking it my pain completely vanished. I’ve eaten lots of LCHF meals since that time and been fine. If I skip the milk thistle for a bit I’ll occasionally get twinges, but as long as I take it I’m fine. I still have my gallbladder.
    But to this day I wonder about the Optifast and ursodiol drug trial and wonder which group I was actually in.
    And those counseling sessions … run by a skinny nurse who had never had a weight problem. She told us things like “if you want a bologna sandwich just put ONE SLICE of bologna on it, and use two thick slices of bread” Sheesh, no wonder none of us were successful at the end of the program. .
    I think that Optifast diet messed me up for some time, and of course afterwards I gained all the weight back trying to eat the way they told me to eat. It took low carb to lose it again.

    1. Interesting history. I suspect you were in the placebo arm. Glad things have cleared up for you.

  22. I am not so clear on this after reading it twice. The headline suggests that one can get rid of gallstones without surgery. But the article suggests how to PREVENT gallstones. Can I then assume that to get rid of gallstones and to prevent them requires the same action? i.e., high fat, low carb diet? Or am I missing something here?

    1. Yep, you’re missing something. It’s both. It’s about avoiding gallstones by keeping the fat flowing through so the gallbladder will contract. And it’s about treating gallstones without surgery by taking UDCA.

      1. Dr. M — I have to admit I was a bit confused with the article also. How much UDCA do you take — and is it an over-the-counter item? Thank you for your help — I’m in the middle of a gallbladder attack right now — I started a ketogenic diet 1.5 weeks ago — trying to be faithful. Perhaps I am doing too much fat, but I don’t think so. Would love to know dosage and where to buy. THANKS —

        1. UDCA is a prescription medicine. You’ll have to have it prescribed by your physician. It can’t be purchased over the counter.

  23. Love your old-timey illustration of the lady with “The Colic”! That’s just how I felt when I had kidney stones a couple of years ago.
    While I will probably never have gallstones due to my many years of LCHF eating, I am a bit concerned about possible relapses of kidney stone formation. Any tips?
    Thanx for your many fabulous blog articles! I’ve been a fan for years, and you never disappoint. I don’t always find you comforting, but I do always find you thought provoking. Your efforts are greatly appreciated!

    1. Keep your fluid intake up. It’s been my experience that people on long-term, low-carb diets tend a little toward dehydration.

  24. Thank you Dr. Eades for sharing this information. Your post is exactly what happened to my wife when she was in college. Extremely low fat and low calorie diet followed by gall stones a year later.
    This was ten years ago and we eat a low carb diet now. She is still a bit fat phobic and concerned that increasing fat in her diet might cause problems since she has no gall bladder. Would you consider this to be a concern for a patient?
    Thanks as always for sharing so much great information.

    1. No. At this stage, she should be able to do fine on a low-carb, higher-fat diet. If she has symptoms, she should back off the fat a little, but I doubt she will.

  25. Thanks for the post, only 30 years too late. 😉
    I also wish I knew then what I know now.
    In my youth I had a couple of incredibly painful attacks.
    The de rigueur was to remove the GB as you have stated. There was never any talk of dissolving the stones or any need for digestive enzymes afterwards.
    I must be one of the fortunate few in that I seem able to consume quite prodigious amounts of fat with little or no adverse consequences. Large boluses of coconut oil or MCT oil can cause some explosive diarrhoea and unpleasantness tho. Fatty food and lots of butter are problem free.
    Would my lack of a GB be causing me to not absorb my fat properly? Would I also be missing out on any fat soluble vitamins etc as well?
    I have tried Digestive enzymes with oz bile and noticed no difference so when the bottle was finished I didn’t purchase any more as they were hard to find and expensive to boot. Should I continue them?
    PS. I am in Australia so this isn’t related to the USDA but the lack of advise before during and after my surgery is exactly the same as you describe.
    Thank you for the article and any help you may offer.

    1. I believe you have developed a pseudo gallbladder from the stump of the duct that runs from the intestine to the gallbladder. This formation often happens after gallbladder surgery, and people seem to do just fine with it. They sometimes run into a bit of trouble if they overdo it with coconut or MCT oil and even butter because these are short chain fatty acids and are absorbed differently. They can still be consumed (and should be), but just watch the doses. I doubt you need the digestive enzymes. They are more for breaking down protein anyway.

      1. Thanks for the reply. That’s interesting about the pseudo GB forming. I’m just curious, I assume the original GB would be a muscular affair capable of contracting to squeeze out a measure of bile. I’m thinking that a pseudo GB pocket that formed would lack this ability and while better than nothing wouldn’t have very fine control.

        1. I’m not sure how much fine muscle control there is in an intact gallbladder. The bile released is recycled back through the small bowel through the liver into the gallbladder or pseudo gallbladder, so it doesn’t matter much if a little too much goes into the bowel under the stimulation of a fatty meal.

  26. A little off the gallbladder topic, but would you consider writing about the ‘dawn phenomenon’? I have done a search on your previous posts and have not turned up anything. Different sources recommend a bunch of different fixes, none of which seem particularly low carb friendly. Your opinion, please?

    1. I’ll add it to my list of things to post about. In the meantime, Dr. Bernstein has a pretty good section in his book about the dawn phenomenon. BTW, in my view, this is the best book available on treating diabetes with a low-carb diet.

  27. I have successfully used one of the traditional remedies to gallstones. This was before I was on a paleo diet, but it was a moderately low fat, calorically restricted diet. I was none of the five F’s, assuming the fertility part means female fertility; I ate a low calorie diet because I didn’t like eating much – hey, it was a boring standard American diet – not because I wanted to lose weight.
    As background, part of the theory behind these remedies has to do with cholesterol solubility as a function of pH. You may be able to confirm or deny this; I’m just repeating what I read. Apparently cholesterol is more soluble at lower pH. The use of apples and lemon juice is to try to lower pH in the gall bladder to soften or break up the gallstones.
    Once I did go paleo, I ran across the idea that stomach pH is higher when one eats a lot of grains due to lower generation of stomach acid. This suggests to me that grains may contribute to gallstones for pH reasons and not just because of lack of fat.
    At any rate, to the extent that I can recall, the remedy I used consisted of getting a lot of acidic fruit in the diet for a week, then going through a 24 hour water only fast. Toward the end of the fast, some epsom salts are included in the water to relax the bile ducts and ease the passage of gallstones. By the end of the fast, the stuff coming out of my rear end was basically clear water.
    I then drank a concoction consisting of 4 oz of lemon juice and 4 oz of olive oil mixed together, over the course of a few minutes. This is what causes the gallstones to be ejected.
    The process was painful, presumably as the gallstones were pushed out through the bile ducts. The pain was roughly as much as a regular gall stone attack. For me, this was enough to inhibit any physical movement but did not double me over; I was able to sleep through most of it.
    I retrieved and examined the stones that came out the next morning. They were irregular, light green to dark green in color, and felt like hard wax, which I believe matches what gallstones are expected to be like, though you could confirm that. Mine were maybe 1/4 inch across on average, with the biggest about 1/2 inch across.
    My gall bladder pain went away for a few months, but did come back later, and I did do one additional flush, though I was sloppier about the fast and did not collect the stones. I added fruit to my diet more regularly, and that seemed to keep the gall stone attacks to infrequent nondebilitating discomfort. Eventually I went paleo, and I haven’t had any gall bladder pain since – probably because of the extra fat, as you say, and possibly also because of extra stomach acid to digest rare meat instead of bread and potatoes.
    I’d be interested in your opinion of why this kind of flush works, and in particular of whether the pH connection makes sense.
    People who want more detailed instructions on the procedure might try googling “gall stone flush”, or “hulda clark gall stone flush”.

    1. Interesting history. Thanks for commenting.
      I wouldn’t think the apple juice or lemon juice would have any effect on the pH of the bile for a couple of reasons. First, the stomach acid is so strong, the mild acid of the juice wouldn’t produce any change in overall pH. Second, the bile is made in the liver, so even if the pH of the stomach acid were somehow increased, I don’t think it would affect the bile.
      I’m not sure what you found were gallstones. Gallstones can be the size you describe, but would have great difficulty getting through the bile duct and common duct and into the small intestine. Usually small gallstones, sand-grain size or a little larger, get into the ducts and cause pain. Large stones stay in the gallbladder.

      1. I have read several of your articles since a hospital visit a week and a half ago made necessary by excruciating pain and resulting in a post CT stomach scan diagnosis of multiple gallstones and evidently passing one.
        Several times you have posted a comment like this or a similar one, “Gallstones can be the size you describe, but would have great difficulty getting through the bile duct and common duct and into the small intestine.”
        Is it possible that as the gallbladder spasms and causes a stone to block the bile duct, that the continuing spams would cause the stone to temporarily enlarge the bile duct, and push the stone through. (like a woman giving birth to a child) And I have been unable to learn what might happen to a stone if and when it would make it through the duct. Is it dissolved or reduced in size as it travels through and is eventually expelled from your body, or might it be in essentially the same size and condition as when passing through the bile duct.
        I am still researching but amazed to find that upon release I was told to go on a low-fat diet (which I have been on for a year or more) and was referred to a surgeon for gallbladder removal.
        Thank you for this article. Will be looking for the response and continuing my research but have eliminated surgery as an option after reading of the complications of gall bladder removal including bile reflux which you did not mention but is of concern to me.!

        1. As to the stone making it through the bile duct… It is certainly possible for a stone to push it’s way through as long as it isn’t too big. Some stones are so large they will never make it through, but other smaller ones can and do. Once the stone passes through the bile duct it goes into the common duct, which is larger and should offer less resistance. Once through the ducts, the stones drops into the small intestine and makes its way on through like the rest of the intestinal contents.

    2. I have done homeopathic gall bladder flushes 3 times now in the last 8 years. The first 2 times produced a lot of stones. Didnt have any this last time. Involves 1l of apple juice daily for a week to soften the stones. On the 6th evening epsom salts (magnesium sulphate) at 6pm and 8pm, at 10pm 1/2 cup olive oil mixed with 3/4 cup grapefruit juice. The epsom salts relax the ducts so the stones can pass through painlessly. Next morning upon waking, epsom salts again, then for the last tome 2 hrs later. If those green stones comming out of me in the morning were not gall stones, then I sure don’t know what they were and would like to have opinions on what people think they are, but I definately believe it was gall stones. I find the only fatty food that sets off an attack are crisps – and I think it is because of the specific TYPE of oil used to fry them – Palm Oil or Corn Oil – cheap and nasty stuff that my body just can’t take. Any other fats I can eat with no problem, just not crisps!

  28. I had my gallbladder removed over 15 years ago — after several months on a Nutri-System diet — I lost over 20 pounds, worked out and felt great — until I ate ANY fat. At that time NutriSystem was an extreme low – to VERY-no fat diet. Surprise! Your gall bladder doesn’t work much. Then you end up with gall stones. I’m more convinced that it is the very low fat diet, not the rapid weight loss, that causes the gall stones. Again, if the gall bladder doesn’t work (no fat) then, it has nothing else to do but create gall stones.
    More pain than I can remember at any time in my life. I looked for any ideas on how to get rid of gall stones and found NONE. I asked my doctor, my surgeon, anyone I could think of. NO WAY I was told — no way to get rid of gallstones.
    So, they all were happily ill-informed, or they lied. There was a way — and no one either knew, or no one bothered to say anything. It is only in the past eight years or so that I have found any information on removing gall stones without removing the gall bladder. (Go Internet!) Too late for me.
    Lucky for me, I still have no problem with fats. I have read that many people, after gall badder surgery, develop a “pocket” that stores the gall, and give one a store of gall, albeit without the gall bladder to parse it out. Still, the bile seems to get parsed out. So I am lucky. I can eat a high fat diet (over 60% to 70% good fats) with no problem. Lucky me.
    I only wish I still had my gall bladder.

  29. Please delete my comment. It says awaiting moderation for 4 days now and my Q has been answered. Thank-you

    1. All deleted along with my answer. Sorry for the delay, but I was out of the country and had limited and unreliable internet access.

  30. I’m 47 and I’ve never had gallbladder pain, but if I eat a certain amount of fat my entrails make some very interesting noises that subside in the evening. If I keep it up, within three or four days a large amount of green comes out the other end, along with small round things that I’m positive are stones. After that everything goes back to normal. This happens about four times a year. Apparently I have been blessed with a self-cleaning gallbladder, for I had much the same thing happen after taking milk thistle for a while. Since the bile duct goes right into the intestine it makes sense to me.

  31. Interesting post and I was wondering about this because I work in the ER so as you could imagine a decent amount of patients I come across have gallstones. The recommended approach is always surgery. I’ve found myself wondering what I’d do if I had gallstones as I’ve never heard any of the EDMD’s recommend another approach besides surgery.

    1. They all probably learned the same thing about gallstones as I did: you can dissolve them, but they’ll just come back, so what’s the point. Just take them out.

  32. Hey Dr. E,
    What are your thoughts on liver/gallbladder flush w 2T Epsom salt in water 2 hours apart then drinking 1/2 cup olive oil mixed w lemon juice and eating lots of heavy cream. Repeat Epsom salt and ware 2x’s again in morning.
    I did about 8 of them until the last one just made me sick. I couldn’t drink Epsom salt again for the life of me. Ever and according to all the info I won’t have to as long as I stick to my high fat, low carb eating.
    A lot of stones appeared (won’t go into details) but is this too harsh on liver/gallbladder? It made sense at time and I just wanted the stones gone but now I wonder how harsh this could be.
    Have you seen this video

    1. I can’t see mechanistically how this regimen would work to get rid of stones. The high fat content would definitely cause the gallbladder to contract, but other than ramming small stones down into one of the ducts, which would be truly problematic, I can’t see how it would get rid of gallstones. The duct draining the gallbladder is small, so the large ‘gallstones’ people report seeing in their stools, can’t really be gallstones because stones that size would never make it through the tiny ducts.

    1. I watched a bit of the video. What I saw is accurate, but I didn’t watch the full video, so can’t comment on it in its entirety. I’ll see if I can make it through the whole thing when I have more time.

  33. I had my gall bladder removed after the birth of my daughter.
    I had undiagnosed gall stones for years through my 20’s. I remember at that time the Rosemary Conley Hip and Thigh Diet was all the rage – which is a no fat diet. I remember the first chapter so well, she quit eating fat because of gall stones, – the side effect was she lost a heap of weight.
    I duly did that silly diet. Yeah it did work but i was starving!
    I used to find that if i ate a combination of eggs and cheese or excessive cheese i’d get an attack. What i now realise is that i always ate these things with grains – via toast or pizza.
    Eventually after the birth of my daughter and some excruciating attacks my gall bladder was examined etc and no presence of gall stones but lots of scarring and damage.
    Gall bladder removed through keyhole surgery and no problems whatsoever since.
    Funny how you’re saying to eat fat when i was told the opposite back then.

  34. Just was wondering how much UDCA to take to dissolve the stones? My mom has gallstones (has had at least for a couple of decades) and she would like to get rid of them in a natural way. She is now 73 years old and suffering from infernal pain every now and then.
    Btw, I was prescribed UDCA when I had obstetric cholestasis a few years ago.

    1. My post was written from a theoretical perspective. I have never given UDCA to a patient, so I have no hands-on experience. The dosage instructions say it is to be taken in a dosage of 8-10mg per kg of body weight, divided into two or three doses and taken with meals. Physicians experienced in its use may use a greater or lesser dosage. It takes from 6 months to a year to dissolve most gallstones.

  35. I have never had gallstones (a recent ultrasound would have shown gallstones and none were detected). My diet is lower-fat, high carbohydrate, vegetarian.
    I am wondering how the Fat Fertile Female Fair women ever got fat and then developed gallstones. If they were on low-fat diets (leading to gallstones), then how did the Fat Fertile Female Fair typical gallstone sufferer get there via a low-fat diet? .

    1. Most are not on low-fat diets. Most are on the high-everything diet. Obesity and fertility (high estrogen) lead to gallbladder stasis and the formation of stones.

  36. Gallstones caused me to stop my LCHF diet back in 2011, the pain after meals and oddly enough the pain from just standing all day at work(it didn’t hurt much while sitting) proved to be too much to bear. I took it as a sign that what everybody was telling me about low-carb being bad for my health was right, so I stopped and the pain went away but, the weight came back with a little extra.
    After reading mass amounts of info on how low-carb actually benefits health rather than injure it, and how gallstones are likely formed from my SAD, I decided to give it another shot, and I’ve lost close to 50lbs since November, however, the gallstones are back with a vengeance. So, do you think this pill would work for me, since I already have gallstones? If so does this pill require a prescription? Thank you.

    1. Yes, the medication requires a prescription. You’ll have to get it through your doctor. Once you start taking it, it takes anywhere from 6 months to a year to dissolve the stones. You can follow the progress via ultrasound. Once the stones are gone, a low-carb diet should keep your gallbladder cleaned out.

  37. This is an awesome article, and the first to confirm what I’ve always known is true. Back in the early 90’s I had gallstones. At one point, lying there, breaking out in a sweat and thinking “Oh God, I’m going to have to go to the emergency room.” Well, yeah, with the grace of God it passed.
    Back then I was doing strict low fat, it was called The T Factor Diet for anyone remembering diets of the 80’s/early 90’s. I counted my fat grams in everything I ate religiously. Women were allowed between 20-40 fat grams. The lower I kept them, the more virtuous I felt. This diet could have killed me.
    As soon as I switched over to low carb (well, really paleo for me), my symptoms went away in a matter of weeks. It’s been about 20 years now, and they’ve never returned. I KNOW it was my low fat diet, but you are the first doctor who has ever confirmed it for me.
    Dr. E, you are awesome!

  38. p.s. I might add, there was no rapid weight loss for me on the low fat diet. It was the minimal amount of fats I was consuming that wrecked my system.

  39. Man, I wish I would have read this six months ago. I did have abdominal pain, went into the hospital and my gall bladder is no more. I had to go back in to the hospital and have a drainage tube placed in my side to clear out my bile ducts. My question is, what can I do diet-wise to keep my bile ducts clear? Is it just too late? I still have pain occasionally around my stomach, but it dissipates quickly. Yes, I am obese and would like more information on Protein Power. Thanks in advance!

    1. If your gallbladder is gone, some of the ducts are gone as well. You’ve probably formed a pseudo gallbladder from the stumps of the ducts, and it should function almost like a regular gallbladder. If you are obese and plan on losing weight, I wouldn’t recommend a low-fat diet as those significantly increase the risk for stones forming, although it is much less likely without a fully functioning gallbladder. Protein Power is a book MD and I wrote almost 20 years ago. Most of the information in it still holds trus, especially the dietary information. It or any of the low-carb options out there would be a better weight-loss strategy for you.

  40. Hi, I was recommended to have my gallbladder removed after a painful visit to the hospital about a year ago. As well as going on the Perfect Health Diet I did 6 Liver and Gallbladder Flushes over a 5 month period with consistently decreasing amounts and sizes of stones passed. 2 days after the third flush I ended up at the hospital again with the most excruciating pain. After much reflection I continued with the monthly flushes until a minute amount of small sand sized particles came out and I have had no more issues. I did lose 12 kgs over the three month period from when I started the PHD diet and the flushes. I exhaustively read everything I could find regarding the pros and cons of the gall bladder flush and I am convinced that it works in combination with the right dietary and supplemental support. The flush process itself is unpleasant but it is not painful. I keep up my levels of choline and always have apple cider vinegar or lemon juice in my daily food intake.

  41. I’m two weeks post-op gall bladder removal. Fats were a bit of an issue the first couple of days, but I’m already seeing significant improvement in my ability to handle them. I’m even consuming Bulletproof Coffee (with both GF Butter and MCT oil) with no problems.
    Dr. Eades, you have commented on this thread about fats from butter and MCT oil being an issue for people like me, could you explain whether it is a medical issue or merely a symptomatic one? In other words, if I can handle the MCT oil and butter without any ill-effects, should I still be careful about how much I consume, or is your warning only for those who have symptoms (I’m assuming you are alluding to diarrhea or similar GI problems)?
    Also, is this a long term issue or can an individual with no gall bladder eventually handle just as much butter and MCT oil as someone with a GB (when the ends of the ducts adapt to become the pseudo GB you refer to)?

    1. Actually, the butter and MCT oil are less of a problem than longer chain fatty acids. MCT is, by definition, medium chain fats and butter is mainly short chain fatty acids. Both short and medium chain fats are absorbed directly by the liver in the same way as are carbohydrates. The longer chain fats need the bile to be broken down so they can be absorbed. When they are absorbed, they don’t go directly into the liver, but end up in the lymphatic system. So, post GB surgery, you shouldn’t have nearly the problems with MCT and butter as you would with other fats, say, those found in meat.
      You’ve just got to work into fat consumption slowly and go as quickly as your symptoms will allow. Ultimately, you should be able to consume all the fat you want.

  42. I had gallstones about 10 years ago. I could not afford surgery so I looked for a doctor that would discuss alternatives. It took about a year. A very painful year. I found an OD and he did tests and determined that I had gallstones but not a diseased gallbladder. He put me on Ultrazyme. It has ox bile and has worked wonders for me. I take it daily and can eat anything I want. Not one pain. Recently I have gone on a Paleo diet which has good fats but little carbs. It is hard to do but I think a more healthy way to eat. I have never been overweight so I ate lots of sugar and fat which led me to be pre-diabetic. In a little over two months on the Paleo diet I am back down to normal blood sugar levels. No meds needed just a change in diet.

  43. Watch our for those Paleo diets! Someone I know had kidney stones on that diet and their doctor said it was common for Paleo diet people to get kidney stones
    I DO have gallstones and am taking Stone Free (Planetary Herbals) and lost a lot of fat on low-fat diet, but know I need to watch carbs too

    1. I don’t think it is a true. I doubt your doctor knew enough about paleo diets to claim that. I had an experience with both low-fat and low-carbohydrates-high-fat diets. I had a kidney stones exigent while on a low-fat diet, so far the issue didn’t resurface while I am low-carbing since 2007. My gallbladder was removed at 2002 due to gallstones.

    2. I doubt it, unless you and they misunderstand what a Paleo diet is.
      I think they need a new doctor too.
      If you are eating low-fat and watching carbs what exactly are you eating? You may lose some fat eating low-fat but sooner or later you are going to have to increase your fat intake.
      Remember, your stones probably formed due to your low-fat diet in he first place.

  44. i have a gall stone i my gall bladder…bur formally i do feel pains.bur now i no longer feel d pains.bur d swell is stil there.and my urine has a thick color and smells.pls what can i do

  45. Spitting out gallstones every time I go to the bathroom – apple cider vingar (miracle for the digestion), Stone Free supplement and something else (Ease Pearls, a Chinese medicine from naturopath) – it’s all amazing! I can see some cholesterol stones that are so pure white inside! I think I can eat more fat again too. The “Net is full of people doing the gall bladder flush (not quite ready for that), Gold Coin Grass and Chanca Piedra too!
    Good luck all!

  46. Re; Paelo Diet – it is not me, but I do live in an area where it is a big fad, so I would hope the doc would know what it means – the person regretfully got off the Paleo after the kidney stones

  47. Hi,
    I am from Chennai India and I happened to gaze your site which I found really constructive. My sister has been diagnosed with gall stones in her ultrasound 7 months ago after she had episodes of Excruciating stomach pain and all other indigestion symptoms. I am basically a Research fellow and my pursuing my PhD in science. Having known a little about how the system works, diagnosis and treatment I denied of getting her operated at the first go and I advised her to take 2 or three opinions. Two of the doctors threatened us with the fact that she had to be operated immediately, refraining from which they said might get her into serious problems. A third doctor who is an experienced gastro specialist put her on medication for a month and promised to do the surgery after a while. He asked her to continue with different combo of medicines for few months but surprisingly after 4 months of her medication he suggested us not to go for a surgery and asked her to continue with the medication. Despite the fact that my family is happy of having avoided the surgery, I am perplexed as to how such serious condition (to a level of immediately operating it) can now be cured with just medicines. We are all the more confused now whether to go in for a surgery or to continue with the medicines and avoid doing the same. But the doctor seems to be quite confident that there’s no necessity for a surgery, however he said he would confirm the same with a scan after a month’s time. I would be grateful if you can give in your valuable suggestions and help us get over our dilemma.
    Akshaya Krishnagopal.

    1. I can’t possibly make a diagnosis or a recommendation over the internet without examining the patient. But it sounds like your doctor has it under control. If the tests show the stones have dissolved, then there should be no need for surgery unless they recur.

  48. Hi I am lying in a hospital bed right now in Australia contemplating the prospect of having my gallbladder removed I am a 53year old non smoking overweight male and have been dieting vigoursly by cutting out most fatty foods ( wish I had read this earlier ) where in Australia might I get this drug as surgery is the last thing I want I also suffer laryngeal spasms and have attacks while under anesthesia any info would be greatly appreciated thanks

    1. I would assume it’s available in Australia. Most docs know about it, so ask yours.

      1. It appears Australian doctors don’t know about it I have been advised it’s off to surgery scared not wanting it but I guess you have to do what the doctor’s and medical staff say feeling of Dred is huge but I guess if anything goes wrong I will never know about it good luck all and thanks for the help and advise ( I have had several surgeries but this one has me the most scared) thanks again going down shortly hope they’re good

  49. Here is a story which may be inspiring to some gallstone sufferers:
    In 2004 I was diagnosed with gall stones. Ultrasound showed the gall bladder was nearly full of numerous small stones. This, after months of suffering pain after eating certain meals, and actually started to lose weight because i didn’t want to eat. Doctor recommended gallbladder removal. Dairy and hamburger meat were the worst for triggering pain.
    Both my parents had theirs out, so genetics may play a role here. But I suspect another contributing factor to developing my stones was a sudden and dramatic weight loss in 2001 from a food poisoning episode. Back then i also think i was buying a lot of low-fat products and had a lot of carbs in my diet.
    Instead of surgery, I worked with naturopathic doctors and a homeopath to change my diet and took supplements. I tried gall bladder flushes though i don’t think any stones came out – just those green blobs. I even tried tapping the subconscious with hypnotherapy to dissolve them. Within days/weeks with natural medicine and dietary changes, my symptoms dramatically improved and i felt fine 80% of the time. But the stones kept being an irritant.
    In 2013 an ultrasound confirmed that the volume of stones in the gallbladder had gone down from “nearly full” to approximately 40% of the gall bladder. I was absolutely thrilled since something I had done obviously worked. Or would the body have gradually dissolved these stones anyways over time? Hard to say.
    Now it’s June 2015 and I can eat anything without triggering an attack. I’ve been able to save my gallbladder and restore it’s function (I assume). However the stones are still a a regular irritant with pain mostly in the mornings on a regular basis.
    So after reading this article I researched oral dissolution therapy and believe I am in the small % of patients who are good candidates for it. Thank you Dr. Eades for this article and giving me new hope in treating my gallstones. All the doctors i have consulted over the years have always dismissed oral dissolution therapy saying it’s not that effective and the stones come back after you stop taking it. I have thoroughly researched this to find numerous medical articles that suggest otherwise, in some cases.
    I’m going to print off the medical research articles I found stating that, and take them to my doctor next week. Hopefully he will agree to write a prescription and I can try the medication(s) to see if that can finally get rid of the remaining stones.
    If successful, I hope that my changed diet and lifestyle will keep them from coming back.

    1. Thanks for the interesting history. I’m hoping your doc will let you give it a try. Keep us posted.

  50. Actually I’m Suffering from Gallstones in Gallbladder and it is stuck in the neck of Gallbladder with a present size of 14mm as of previously 12mm i.e previously it was 12mm but its been increased to 2mm more i.e of overall 14mm . So kindly suggest the remedies for curing the gallstones Waiting for ur reply as soon as possible

    1. You need to discuss with your doctor the gallstone dissolving medicines mentioned in the blog post. These medicines require a prescription from a physician and careful monitoring.

  51. …so what’s the cure? …in one/two sentences (I hate scouring an article for nothing).

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