Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
3 Jun

Dear Mark: Gallbladder-less, CrossFit on Hiking, and Gluten Cutter

gallbladderWe’ve got a three parter for today’s edition of Dear Mark. First up is a question about gallbladders and a Primal way of eating. Or, more specifically, the lack of a gallbladder, and how one can make Primal work without one. Just because your ability to digest fat is a bit impaired doesn’t mean you can’t eat this way. Next, I explore what CrossFit really thinks (or doesn’t) about walking, hiking, and other sorts of frequent slow moving. After all the anaerobic WODs, is there room for a relaxing walk with your significant other? And finally, I discuss the usefulness – or not – of Gluten Cutter and other gluten digestive aids. These products claim to help even sensitive people digest and detoxify gluten safely, but are they legit?

Let’s go:

Hi Mark,

I wonder if you have any advice for those of us who wish to eat primally but don’t have our gallbladders anymore, and are therefore lacking some of our body’s equipment for digesting fat. I have been eating more-or-less primally for about 3 months now, and while a lot of my gastro-intestinal problems have cleared up as a result, I find that on days when I eat a higher proportion of fat I have a lot of pain and discomfort that I know from experience is related to the gallbladder removal. For a long time after my gallbladder removal I could eat hardly any fat without serious consequences; these days I can eat rather more but the quantities promoted by the Primal Blueprint diet are rather beyond what I can cope with. I do not want to go back to getting calories from grains and sugar as I have experienced how much better life is without them (thanks to Marks Daily Apple!). Do you have any suggestions for how to manage being primal and eating a high fat diet without a gallbladder?

Thanks,

Sarah

The gallbladder is a storage facility for bile produced by the liver. It also serves to concentrate the bile during storage, making it more potent. When fat is consumed, the gallbladder releases bile into the small intestine to help emulsify the fat. Once emulsified by bile into much smaller droplets, fat can then be more easily digested by lipase (the fat-digesting enzyme). Without emulsification, the fat globules remain large and mostly inaccessible by lipase. Emulsification increases the surface area of the globules and allows greater access and more complete digestion. So, although your liver will still produce bile without a gallbladder, it will no longer be concentrated in the gallbladder and super potent.

So yes, when it comes down to it, you simply don’t have as much fat-digesting equipment as most people. That’s fine, and you can still eat healthy and Primal, but it does mean your ideal macronutrient ratio may look slightly different from mine or the next person’s. Don’t think you have to eat the quantities of fat promoted by others. I like the high-fat approach for myself and most other people coming from a Standard American Diet, simply because it seems to work best. You have to work with what you’ve got. You can’t try to replicate what others are doing because those people aren’t you and they aren’t dealing with your situation. You may – gasp – have to eat less fat than you thought you would be eating on a Primal eating plan. As long as you stick to the basics – animals, plants, good fats – and avoid grains, refined sugar, and processed seed oils, you’ll do great. Heck, it seems like you’re already doing great. Tweak the fat, carb, and protein ratios until it works for you, and don’t get caught up in any kind of perceived “ideal macro ratio.”

There are also a few other ways to support your gallbladder-less digestion:

Ox bile: Since you don’t have a gallbladder, supplementing with ox bile can partially replace the bile your nonexistent gallbladder would have been producing. To use, take a 500 mg (the usual starting dose for ox biles) pill a few minutes before consuming fat. Note your digestion and the supplementary bile:dietary fat ratio. If all is well, you likely have the right dose. If you get diarrhea, you may need a different dose next time.

Bitters: We possess the ability to perceive bitter tastes for a couple reasons. First, “bitter” often indicates the presence of toxins or poisons. When something is bitter, we know to be wary of it (and sometimes, that bitterness indicates the presence of polyphenols (plant “toxins”), which in adequate amounts can act as healthy hormetic stressors to increase antioxidant action in our bodies). Second, bitter herbs – and the concoctions made from them – have the interesting tendency to stimulate the digestive process. When something bitter is tasted, salivation increases, gastric acid production increases, pepsin (which breaks down protein) is released, and bile production is upregulated in the liver. This may be the body’s way of moving things forward to get the offensively tasting food (and possible toxin) out of the body quickly, but it has the helpful effect of stimulating digestion of all subsequently consumed foods. If you don’t have a gallbladder, using bitters ten to fifteen minutes before eating a meal that contains fat might help you produce more bile than you otherwise would.

Though I haven’t used it expressly as a digestive aid, I do keep a bottle of Angostura bitters around in case I want to make the odd rum cannonball or Carrie makes sangria for a party.

Short-chain fats: Shorter chain fats, like coconut oil and pastured dairy, require less “work” from the gall bladder. When you do add fat, consider favoring these sources.

Good luck and let me know how it goes!

Dear Mark,

First of all, I want to say that I greatly respect you for all that you do to educate people about health.

I know that you advocate low level aerobic exercise. However, I have read that you also advocate CrossFit, which actually claims that aerobic exercise is bad and that it causes decreases in muscle mass, strength, speed, and power. CrossFit does not distinguish between low level aerobic exercise and sustained aerobic exercise above 75% of maximum heart rate – “chronic cardio,” as you call it. Do you think that CrossFit is referring strictly to chronic cardio? If you think that CrossFit is NOT referring strictly to chronic cardio – and thus considers low level aerobic exercise to be bad as well – why do you think that CrossFit makes this claim?

Phil

CrossFit can be an effective way to get fit. It makes ample use of the group dynamic, so instead of working out alone in a gym somewhere, you’re working out with comrades in barbells and making friends. This can be extremely inspiring. CrossFit can also be a great way to learn the standard barbell and Olympic lifts, provided the coaches are proficient. Some CrossFit as practiced is a little overboard for me, veering into the realm of overtraining, but then again, I’m coming from a history of extreme training, and I’m very careful to avoid making those same mistakes and feel obligated to help others avoid them, too.

I think you’re right in some respects. CrossFit doesn’t talk a lot about slow moving, or the benefits of walking, hiking, and long leisurely activity. The reason being when you’re at a CrossFit box, you’re there to work out in that facility and do the workouts they prescribe. People who sign up for CrossFit are generally interested in doing CrossFit workouts. On the coaches’ side, time is money, and they can’t really lead the class on a two hour hike and still hope to fit enough classes in the day to reach their other clients. I’m sure individual boxes might tell their clientele to do “active recovery,” to “go on hikes” or “get ten thousand steps” and other such activities on their off days, but it’s not their main focus.

However, if the official CrossFit Training Guide (PDF) is any indication, there is what appears to be a blanket condemnation of cardio. Like me, they’re cautioning against relying on traditional “cardio” to get in shape and lose fat, while highlighting the effectiveness of shorter, more intense workouts. Unlike me, they fail to mention that walking, hiking, and other low-intensity activities, which shouldn’t be lumped in with chronic cardio, also deserve spots in your schedule.

But that doesn’t mean CrossFit precludes hiking. If you were to ask your coach whether you should go for walks with the family, or take the dog on a long hike every weekend, I imagine he or she would say “Go for it.” The omission in the Training Guide was likely just that – an inadvertent omission. It’s just too bad that slow moving doesn’t get more fanfare in CrossFit circles. The average CrossFitter could really benefit from taking things down a notch and giving their bodies frequent respites. Their silence on the matter, however, is not indication of condemnation.

That’s why I’ve always held that even if you wholeheartedly throw yourself into CrossFit, you should still keep one foot in the Primal door. Let CrossFit be your “lifting heavy things” and “move really fast once in awhile” and the Primal Blueprint be your reminder to move frequently at a slow pace, get plenty of rest and relaxation, spend time outdoors, and all that other good stuff (that matters just as much for health and wellness as the traditional fitness).

Hi,

I just came across this ad on the internet: Gluten Cutter – claims to make a meal with gluten into gluten free. The web site is glutencutterdotcom. Your opinion, please – could this product actually work and make gluten safe again? I avoid gluten like my life depends on it because it makes me feel like I need to die.

Thanks for all you do,

Wanda

Under “simulated gastric conditions” (a test tube masquerading as a human stomach), the primary enzyme used in Gluten Cutter and other gluten digestion aids was able to reduce the toxicity of moderate amounts (not all) of gluten. Authors dubbed it an enzyme with “modest gluten detoxification properties.” This was not a real human stomach, mind you, but for a full-on celiac or gluten sensitive person, “modest detoxification” isn’t nearly enough.

You sound like a person who absolutely should not rely on a gluten digestion aid. In the FAQ section for Gluten Cutter, it “is recommended that those with Celiac Disease first consult with a doctor prior to using Gluten Cutter.” If it makes you feel like you’re going to die, that’s not to be trifled with. You might keep some on hand to pop in case you get inadvertently glutened while eating out, but that’s all. I’d be extra wary of popping it like candy and carrying on with pasta, pizza, cake, and other gluten-rich foods like nothing was wrong. Even if you did take it and even if it did make you feel like you could eat wheat and be fine, you don’t know if it’s still doing hidden damage to your body. After all, many effects of celiac go unnoticed for years. It doesn’t always present with digestive symptoms, so it may be hard to know if you even have a sensitivity to it.

So, Gluten Cutter and other similar products could work. It might make gluten safe again. But I wouldn’t count on it just yet. Research is still in its infancy, and we have yet to determine if these products work in actual stomachs found in actual human celiacs. For what it’s worth, a far more “natural” and permanent solution might be infection with parasites. As I mentioned in yesterday’s Weekend Link Love, they’re starting to discover that certain parasites modify our immune response to dietary irritants or allergens. This is the “Old Friends” hypothesis, and it posits that for most of human history, we co-existed with intestinal parasites that, rather than simply harming us or being “bad for us,” actually helped regulate our immune systems and with whom we may have had somewhat symbiotic relationships. Pretty interesting stuff that I’m sure we’ll learn more about in the coming years and far more promising than some supplement you have to take every time you want to eat wheat.

That’s it for today, folks. Thanks for reading, thanks for commenting, and be sure to keep sending in the questions that vex you.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. As a Crossfit coach and affiliate owner since 2008 I wholly agree with Mark’s answer re: hiking & CrossFit. While the format of our classes does not support hiking and walking I strongly encourage my athletes to move at lower intensity out of doors as much as possible. It is a great way to recover from the intensity of our CrossFit WODs.

    The Crossfit prescription actually encourages athletes to engage in as many different sports outside their Crossfit training as possible. I think hiking, walking, kayaking, skiing, cycling, swimming and most primal movements qualify.

    Mark is correct in identifying the risk of overtraining inherent in the Crossfit training methodology. Interestingly this seems to be the case more frequently with affiliates that do their own programming. I have found that following the program created by CrossFit HQ at http://www.crossfit.com reduces overtraining risk and provides much better athletic balance.

    Anything taken to its extreme can be detrimental to your health, that’s why I always enjoy and value Mark’s balanced approach to health & fitness!

    Corey wrote on June 3rd, 2013
    • ” I have found that following the program created by CrossFit HQ at http://www.crossfit.com reduces overtraining risk and provides much better athletic balance.”

      Well, yes and no. For a long time, I only had access to Crossfit.com and other related websites. (No gyms within a 100 mile radius of me.)

      Thus, with no coaches, I tried very hard to do everything “right”, including doing 3 sets of warm-up plus a modified WOD on the days prescribed. (3 days on/1 day off)

      If I even came close to doing that, I spent most of my time very tired. I have no idea how anyone would have the energy left to do anything else, despite it being very much encouraged. Hiking and other sports are still exerting energy, despite it being at a lower level. There’s no “real” recovery time built into Crossfit — recovery actually requires that you stop moving for a while. ;)

      As I mentioned below, reversing the rec and shooting for at most 3 WODs/plus warmup per week, (ideally 1-2) was what worked the best for me. I’m still progressing (it’s slow, but it was always slow for me) and more importantly I have the energy, strength and time for fun. It’s the ratio that Crossfit supports and enhances my life, rather than being a burdensome “something to do”.

      Amy wrote on June 3rd, 2013
    • Thanks for the info! This sort of validates my “crossfit 5 or 6 times a week is scary” feeling. At some point you’re not recovering, you’re not giving yourself time to rest, etc. I use it as my “lifting heavy stuff and doing work” activity three times a week, and at that level I can tell I’m getting stronger and faster, but not leaving myself totally sore and exhausted all the time. My box is also not into Olympic lifting or huge weights or pushing you beyond what you are able.

      Thanks for the validation. :)

      Sarah wrote on June 4th, 2013
  2. I think Crossfit is overdoing it personally. Keeping one foot in the Primal door is great advice and using the Crossfit as your heavy lifting/sprinting…then taking it easy! How do you spell obsessive?

    Nocona wrote on June 3rd, 2013
    • Agreed.. I’m totally on board with the affiliates who really think long and hard about their programming, as to not riddle their clients with injuries. But the others who are just on the Crossfit bandwagon because it’s “hardcore”… I can only imagine how many people will suffer injury at those affiliates.

      I’ve blogged about this topic before and criticized the program (to the chagrin of the folks who know me and do Crossfit) – for anyone who wants some laughs, scroll to the bottom of the page and watch the video. It never gets old.

      http://www.brainbodybelly.com/2013/05/07/about-crossfit/

      Mark P wrote on June 3rd, 2013
  3. I had my gallbladder removed over 10 years ago and still suffer ongoing digestive issues because of it. After reading Good Calories, Bad Calories last summer, I started increasing the fat in my diet with disastrous results. (I’ll spare you the gory details) My acupuncturist recommended a supplement that has made a huge difference in my ability to comfortably process additional fat in my diet. It’s called Lypo Gold and I take one with every meal. You can buy it in many vitamin and health food stores, but it’s cheaper on Amazon. I hate to be a shill for a specific product but I’ve never found anything else that works like this.

    Jacqueline wrote on June 3rd, 2013
    • Is that supplement an enzyme of some sort? I’ve always been curious as to how someone with a gall bladder removed can be paleo without digestive issues. Then, it came to me that digestive enzymes could help with the digestion of fats and proteins, since the already-existing enzymes already in the body are inefficient without emulsification of the fats.

      Mark P wrote on June 3rd, 2013
      • It is an enzyme, specifically lipase to aid in fat digestion. I also take more general purpose enzymes with every meal, but that wasn’t sufficient to handle the increased fat consumption that comes with being primal.

        Jacqueline wrote on June 3rd, 2013
        • Ah, alrighty. Thank you for clarifying. That’s good to hear that you’ve found something that has helped your digestion.

          Mark P wrote on June 4th, 2013
      • I have been lucky I guess. I had my gall bladder out about 15 years ago and never had issues with fat (that I know of) OK there was the one time I ate pizza and ice cream in the same meal but needless to say that combo won’t happen any more!
        An example of my day includes cheese or bacon and eggs for breakfast, cheese on my salad, steak, whole milk latte etc. None of these cause me issues.

        Jason wrote on June 4th, 2013
      • I haven’t had a gallbladder in 13 years; I take Now Super Enzymes, and can eat all the bacon and bulletproof coffee I want without issue as long as I take enough. 3-4 caps for normal meals, more for higher fat ones.

        I tried another from VRP, and it just didn’t have enough lipase, the key is the oxbile. I wouldn’t mind trying others, but yeah, you don’t have to limit fat ingestion, just be sure to take some sort of ox bile right before meals.

        raydawg wrote on June 17th, 2013
    • My gallbladder departed from me 8 years ago.
      When eating crabs, like bread and potatoes, I bloat easily. The fat is obvious my fuel now and some days I have a serious craving for bacon or olive oil on my salad.
      Cravings for fat are higher then for protein.

      Still I’ve noticed that fat get’s not completely dissolved in the body. And digestion is not stable on primal choices either.

      I did find out that supplementing with magnesium helps.

      Just hope it helps somebody in this community.

      Petra wrote on June 3rd, 2013
    • Its odd, I have had no problems increasing the fat in my diet, Very high fat at that, I drink coconut oil. My gallbladder was removed in january 2010, on my birthday, haven’t had any side effects. My sister also has hers removed but she gets constipation alot. I may have to suggest the enzyme to her, but for me I haven’t seen any problems.

      Brandi wrote on June 6th, 2013
  4. I have found oxbile has done wonders for my constipation. I still have my gallbladder and do not have stones, but have had a bit of trouble with it in the past, leading to a couple hospital stints. Was recommended oxbile and have gone from bowel mvmts 2x a week to almost every day.

    Allison wrote on June 3rd, 2013
  5. Glutin cutters and parasites? Just to be able to eat something the body neither wants nor needs? Wow. A much better idea would be to get a handle on the fact that glutin grains, and maybe all grains, are both harmful and addictive for many people. Then bite the bullet and learn to live without them. It’s really not that hard, even for people who eat out a lot. Most restaurants now offer paleo/glutin-free selections, although I wouldn’t look for them at the pasta and pizza joints.

    Shary wrote on June 3rd, 2013
    • i agree, it’s like eating ball-bearings so you can digest loads of yummy broken glass… a ridiculously unecessary (and not guaranteed safe) fix to a non-problem.

      I just don’t get the issue people have with avoiding grains, especially wheat, when the payoff for everyone I know who’s quit them (celiac dx or not) has been so immense and beneficial. Are we really such babies in the face of a piece of cake, unable to refuse “coz it’s yummy” or something?! I despair of the species sometimes, I really do! :)

      And I don’t think it’s the case that we NEED parasites (many can be harmful and get into your brain, spinal column, liver or other organs) so much as we adapted to be able to function adequately with them, but I wouldn’t put them in the same category as gut bacteria, which don’t have the same tendency to take up residence in, for example, your frontal lobes. ;)

      Patrick wrote on June 3rd, 2013
      • I think the phrase “symbiotic parasite” is a bit of an oxymoron, considering that parasites feed off their host at a detriment to the host, where as symbiotic organisms gain mutual benefits. I don’t think that Mark was suggesting that we all go swallow some hookworms or tapeworms, but that there may have been more symbiotic organisms in human evolution that currently exist.

        Mantonat wrote on June 3rd, 2013
        • Actually, there is some evidence that parasites such as hookworms ARE symbiotic. At the very least, we evolved with them and our bodies evolved expecting them. People can and do use hookworms to “cure” autoimmune diseases such as Crohn’s. See the book “An Epidemic of Absence” by Moises Velasquez-Manoff for more info.

          Karen C. wrote on June 3rd, 2013
    • I will never eat gluten again willingly, but I would like to have a backup for those times (all too frequent) when — despite my most diligent efforts — I unwittingly ingest some of that evil protein. Truly microscopic amounts of gluten — the amount I might inhale and then ingest going past an active grocery store bakery — make me sick. This level of sensitivity is along the lines of a severe peanut allergy, although (unlike a peanut allergy) the gluten won’t kill me … it just makes me feel as if I’m dying. A digestive enzyme that actually worked would be a godsend to me and to many others with celiac and gluten sensitivity who just want to be able to order gluten-free in a restaurant without getting sick the next day.

      Jane wrote on June 3rd, 2013
      • Jane, I in NO way want to imply “it’s all in the mind” and therefore not real, but you may find you can tone down the DefCon 1 alert your body goes on just from the scent of wheat by using techniques like Emotional Freedom Technique (EFT), Cognitive Behavioural Therapy (CBT), or even plain old meditation.

        These have clinically measurable effects on the (ortho-) sympathetic nervous system, which among other things controls glandular action, heart rate and various other things that are outside of our usual conscious control.

        It is possible for your body to have an allergy-LIKE reaction in the absence of any physical allergen, and I had good results using EFT to tackle a medical issue but I’d rather not get into too much (boring) detail. Please know I’m not saying “you’re imagining it” but I AM saying, you may be able to control this, and step your reactions back down, using methods that are primarily thought-based.

        An allergy is an acquired disorder, whereas gluten & wheat are probably toxic on a dose-ratio effect to most people, and their ill effects appear in a range from sub-clinical (mind-fog, poor digestion, aches and pains) to the serious and life-threatening extremes that are then diagnosed as celiac disease.

        There’s some talk of desensitisation being effective for kids with severe peanut allergies, and also as far as I understand it, gluten intolerance has to do with harmful chemicals found on the protein and in wheat in general, and is not actually an allergy as such, which is an abnormal reaction to any protein, including ones that are generally healthful.

        Patrick wrote on June 3rd, 2013
        • I don’t see why someone couldn’t be desensitized to it, so at least they don’t get uber sick after accidental ingestion. The science existed at least 25+ years ago, if not longer.

          I’m allergic primarily to dairy. I had “allergy shots” when I was kid. The goal was in fact to desensitized me. They wore off after about age 30 or so and it’s simpler for me to avoid unprocessed or under processed dairy. I’d do a shot regime again so I would have to be hypervigilent about gluten, which is harder to avoid.

          Amy wrote on June 3rd, 2013
  6. I’m about to try out Crossfit to see what the fuss is about. People keep telling me it will change my life which I find somewhat disconcerting.

    Alison Golden wrote on June 3rd, 2013
    • I’m about to get started in some Crossfit WoD’s and I only plan on doing it 3x/week tops. Going to treat it as my strength/sprint workouts and leave it at that.

      Some people do it 5x/week…that seems a bit much to me.

      Jacob wrote on June 3rd, 2013
    • The problem with Crossfit is that it attracts some very intense people.Thus, people who work out the 6 days a week telling you how it “changed their life”. What they are really saying is: “I’m the kind of person who really likes/needs this ramped up kind of athletic challenge.” The rest of us find Crossfit rather less life changing. ;)

      That said, Crossfit is, without a doubt worth the time. The “warm-up” is a workout in and of itself and hits practically every major body movement. Learning the WOD will get you knowing Olympic lifts (handy for lifting real stuff), runs, and just a lot of Paleo type movements. It can be fun if you ignore the intense, workout til you puke, “elite fitness” bit of it.

      My experience is that if I even vaguely attempt their 3 days on/1 day off regimen, I end up cranky and tired all the time. Progress was hard. If I reverse the rec, with about 3 days off and 1 day on (thus doing one WOD during their “on” schedule), I make progress and am not tired. So now I shoot for 1-3 Crossfit workouts a week. Those looking for elite fitness are welcome to more. ;) I personally can’t afford to be bone dead tired around the kids all day.

      Amy wrote on June 3rd, 2013
      • 3 times a week makes a great Crossfit schedule. That was me for the first year with great results. Now I go for 4 WODs and 1 skills day per week with plenty of energy. Recovery time is faster than it used to be, even though I’m 55 years old. Love my Crossfit!

        Kathy wrote on June 3rd, 2013
  7. If you want to read some fascinating stuff about the microbes that live in our gut and help us digest food, check out Michael Pollan’s new book, Cooked. It’s got a lot on the history, culture, and science of human interaction with food. The chapter on fermentation is packed with good info.

    BonzoGal wrote on June 3rd, 2013
    • I read the review (NYTimes?). Sounds like a great book, I’ll check it out.

      Nocona wrote on June 3rd, 2013
  8. Mark, after reading Sarah’s note, it struck me that she would need to make up calories somehow. If you can’t digest a lot of fat, might it be okay to eat more starchy carbs? She could certainly eat more sweet potatoes, plantains, etc. and not ever have to go back to grains and “fillers.” It might not be strictly primal, but certainly an acceptable version of paleo. If it were me, I’d much rather eat simple food rather than supplement all the time and worry how it’s going to affect me.

    Crossfit – I’ve never been to the gym, but sometimes do a modified WOD. I recently looked at Crossfit kids (for ideas on how to keep my kids active). There’s a significant focus on balance, agility, coordination, etc. in addition to strength. I’m not a kid, but what adult doesn’t need to work on balance and being more agile? It seemed like play to me, so I’m doing the Crossfit Kids WODs a few times a week this summer.

    Kim wrote on June 3rd, 2013
  9. I had my gallbladder out 6 months ago. The Primal Blueprint diet brought me to a health benchmark that I had never before seen in my life (I am 33 years old). Thank you to all in the primal/paleo community for making it possible. My family, wife and two kids, are now transitioning to a primal lifestyle as well. Life is good!

    Adam wrote on June 3rd, 2013
  10. I have been (very happy) missing gall bladder for 2 years. The paleo lifestyle is best thing ever! I have found cooking with coconut oil really helped. Probiotics seem to make a difference too. I have not “lost” much weight, but it sure is shifting around. At 47 I think this is just fine.

    Laura wrote on June 3rd, 2013
  11. I would encourage anybody who reads this stuff and thinks (as I once did) that wheat is probably only an issue for a minority of people with diagnosed celiac disease, and that the rest of us are cranks, bandwagon jumpers or hypochondriacs, please search online for “gluten + schizophrenia” – over 60 YEARS of research shows clear links between gluten and this one crippling illness alone, and that’s often in people who the tests didn’t classify as having celiac disease.

    Furthermore, the wartime (WW2) reduction in grain consumption corresponded to a drop in the annual number of first admissions to hospital for schizophrenia in five different nations, something that was studied and published in The American Journal of Clinical Nutrition as far back as 1966.

    If there’s one thing I regret in life, it’s that I dismissed the concerns over wheat as something for cranks and tinfoil hatters for years after I first became aware of them – but after only 7 days wheat & gluten free, oh boy did the scales fall from my eyes, and the blinkers from my thinking!

    Patrick wrote on June 3rd, 2013
    • Thank you for the reference to schitzophrenia, I have a relative that suffers with either that or bipolar. I may suggest that he go grain free for a while to see if he feels better.
      Thanks again!

      2Rae wrote on June 3rd, 2013
      • Dropping wheat stopped my bipolar symptoms – was a revelation!

        Kelda wrote on June 3rd, 2013
      • Problem is that if someone is too far in, it’s hard to convince them to change their diet. I have a couple of relatives that I feel would very heavily benefit from Paleo, both physically and mentally. If I repeated the suggestion they drop the carbs and specifically the bread/wheat, they’d look at me like I had beamed down from Mars and asked them to cut off their right arm (again).

        Amy wrote on June 3rd, 2013
        • Same here, My brother had a heart attack at age 43, He is a low cholesterol heart attack, his HDL was 17! Instead he follows the Heart Associations recommendations because he won’t believe me when I tell him saturated fat will raise his good cholesterol, he needs it. He has problems producing his own cholesterol but absolutely won’t eat eggs or butter, I fear he will have another heart attack. At least he has reduced his soda to 4 cans a day or so(eye roll), and is quitting smoking soon. He won’t give up Pepsi.

          Brandi wrote on June 6th, 2013
  12. This is great info for my inlaws with no gallbladder and a sudden realization that her pancreas is not bulletproof.

    Joshua wrote on June 3rd, 2013
  13. I’m a decade gallbladder free and have never noticed any problems digesting fat, except when I had bacon right after the surgery and ended up back in emerg with the pain lol, my digestive tract was not ready for that!!

    I look enviously into the crossfit facility in my neighborhood and think “I’m in no shape to do that!” I want to drop some more weight so I don’t die in there.

    MissZ wrote on June 3rd, 2013
    • @MissZ,

      I might be a little biased (being a Taekwondo instructor and all), but you might also look into a quality martials arts studio based off your goals. Any school worth its grain in salt will be able to help you with balance, coordination, strength, flexibility, and plus it’s hella fun!

      Jacob wrote on June 3rd, 2013
    • Martial arts is good and very much worth considering. :) (My kids will be starting next month)

      Also, consider going the Crossfit facility and talking with the instructor. The point of Crossfit is that it can be scaled. A good instructor will be able to do that and make you feel good about the process.

      And be clear on your goals. You’ll probably be working out along side a few , “if I’m not puking, I’m not happy” kind of people. You don’t have to do that. You’ll still make progress if you walk away with lunch intact. (You probably have more fun, too.)

      Anyway, you don’t need to wait until you’ve lost weight. The right instructor will make sure you remain among the living. :)

      Amy wrote on June 3rd, 2013
  14. I had my gallbladder out 7 years ago and fortunately have had no problems eating fat since then. My husband had his out about 5 years ago and is the same. I do worry though that I’m not getting the benefits of eating fat and wonder how much of my fish oil supplement just goes through me into the toilet. Talking to a gastroenterologist, he told me that the liver is still making bile but instead of it being concentrated in the gallbladder for use as needed, it’s just constantly being dripped into the small intestine.

    I’ve read that your poop is the key. If it floats, it has too much fat in it. Taking a lipase supplement daily takes care of that for me – too bad the stuff is so darned expensive.

    Marie wrote on June 3rd, 2013
  15. The brewery my partner brews for, Rickoli’s in Wheat Ridge, Colorado, uses Clear Firm, which is a gluten remover in their beer (except the wheat beer). After testing, their beers are at 5ppm of gluten, which is below the threshold that allows for safe consumption by Celiacs.

    Anecdotaly, we have many customers who are Celiacs and gluten intolerant and have no negative effects. I also notice a huge difference between when I drink RIckoli’s beers vs non-reduced beers.

    The best part of this is that the beer is brewed with traditional ingredients, so that flavor does not suffer (as it can with beers made with non-barley ingredients).

    Dev wrote on June 3rd, 2013
  16. Regarding the Glutten Cutter… I have to say that I tried some this weekend and it did offer relief. I have been gluten free for two years. Never diagnosed with anything, just moderate abdominal pain and bloating when I have gluten. I never intentionally eat gluten and would never think these are magic pills to take whenever I want to indulge.

    But, I had to travel this weekend to visit family that I do not see very often and was invited to two home-cooked dinners… both containing wheat products. It was an awkward situation and I didn’t feel comfortable picking through my food. There were NO gluten free options.. no veggies or sides, no salads. I felt terrible after the first meal and went to the drug store and found these and took them. Then, took them before the next meal just in case it was the same situation. It was. I took them for two days and the effects of the gluten were minimized. Definitely something to keep in mind.

    LauraPh2009 wrote on June 3rd, 2013
  17. I started CrossFit in January of this year after years of being bored with working out at the gym and chronic cardio. People would tell you I am one of the obsessed ones right now :p, probably because it’s the first time I have found something I truly love to do that has done more for my strength and endurance than anything else I have done, and I love the variety and different things we get to do like gymnastics and olympic lifts. That being said, I am starting to be more mindful of taking rest when I need it and doing mobility work and slow moving exercise on my days off. Our coaches promote CrossFit as a way to be in optimal shape for the rest of the things we want to do like hiking, swimming, sports, etc… not as the be-all end-all.

    Merry wrote on June 3rd, 2013
  18. I have had few problems since my gallbladder was removed over a decade ago, but I do take ox bile as often as I remember in the last few years. It certainly doesn’t hurt.

    Apparently, a fair proportion of people who have their gallbladder removed are lucky and develop a “pouch” which sort of substitutes for the gall bladder, making more gall available during meals. I assume I’m one of those lucky ones.

    dkd2001 wrote on June 3rd, 2013
  19. I had my gallbladder removed a few years ago, but never noticed any difference after eating a fatty meal (pre vs post removal). If I’m not experiencing any known changes, do I still need to adjust my fat intake?

    Alison wrote on June 3rd, 2013
    • My gall bladder was removed almost forty years ago when I was rather young and I didn’t notice any difference at all, which surprised me. My diet is high fat, moderate protein and low carb.

      gibson wrote on June 3rd, 2013
      • Simalar here: GB removed 2010, high fat, mod protein, low carbs, no problems.

        Brandi wrote on June 6th, 2013
  20. Question for all you gallbladderless folks; what causes you to have it taken out? Is it the Conventional Wisdom diet? I’ve never heard of so many people without the gallbladder. Sounds like an epidemic from here. Please enlighten me. Thanks!

    Nocona wrote on June 3rd, 2013
    • I can’t speak for everyone of course but knowing what I know now, I am certain my husband’s was removed because of the very low fat diet we had him on. It was on the almost (but not quite) vegetarian, very low fat, low salt diet we were on for his “health” that his gallbladder because infected and had to be removed. He didn’t have a problem with it when eating SAD by the way. Just when we went to a “healthy diet”. From what I know now, the extreme low fat diet is probably what caused it.

      Shannon wrote on June 3rd, 2013
    • Cholecystectomies are actually one of the most (if not THE most) common surgeries performed in the united states.

      Smocksinabox wrote on June 3rd, 2013
    • Mine was removed because I had gallstones. I’ve heard the only thing more painful is a kidney stone. I literally thought I was suffocating, the pain was so intense. I had a family history (mom/aunt/grandmother) so I assumed I was doomed to continue forming stones unless I had my gallbladder removed (which is the only recommended treatment in Western medicine). If I knew then what I know now, I would have tried alternative therapies before resorting to surgery. Everyone adapts differently to the surgery – my mom has no problems, but chronic digestive issue are not uncommon.

      Jacqueline wrote on June 3rd, 2013
    • I had mine removed almost 2 years ago, I was 36 after my fifth child was born. Although I was and have never been more than 40 pounds over weight. I believe that before finding Mark’s site, and if I would have known then what I know now, I would still have a gallbadder. So, yes, in my opinion, I believe most gallbladder removals are related to the CW diet. What I find scary…. I had no idea that I was not healthy even after losing 40 pounds at weight watchers. My husband finding Mark’s site 15 months ago changed our life.

      Rebecca wrote on June 5th, 2013
    • I agree with the Idea that it is becomes a problem when you have been on a low fat diet and it just sits there not getting used. When its bored, to pass the time it creates stones. My younger sister had hers out after pregnancy. A cousin my same age had hers removed just before me. I had mine out in 2010, with no apparent ill affects. My biggest problem with my gallbladder, was the doctor I, after two terrifying instances I visited the doctor to get it checked out. She insisted it was indigestion and sent me home, a few days later, 12 hours of intense pain and I finally got some morphine, got it removed. My boyfriend gets angry because the first thing he was taught in EMT training was how to spot gallbladder problems, which is truly telling about the extensive gallbladder problems out there.

      Brandi wrote on June 6th, 2013
  21. I have become somewhat of a poster child for those of us without a gallbladder on Paleo; it IS possible! After 3 years I’ve now figured out my own body’s “sweet spot” for how much carbohydrate I need in order to digest my higher fat diet. Like Mark notes, the quality and type of fat is key – but intermittent fasting and large meals are extremely hard no matter what you eat. I’ve documented the journey, posted on our site, guest posted on BalancedBites and even podcasted about it you’re looking for more info: http://paleoparents.com/tag/gallbladder/

    Stacy wrote on June 3rd, 2013
  22. This diet sounds remarkably like the Atkins’ Diet of a few years ago?? for losing weight. Trouble was, the weight was lost because of the huge amount of meat, which forces the body to work very hard in order to digest it. What of the risks from cholesterol, fat and so on?
    I counted 145 g of protein – mostly meat – in the sample daily menu – over twice the usually- recommended amount for a male.

    The debate is strong on both sides: primal/paleo vs its problems, as I see it on the internet…..Just thinking….

    n.anderson wrote on June 3rd, 2013
    • “What of the risks from cholesterol, fat and so on?”

      If the “risks” you mean are the ones that have been hyped by various public health bodies in the past 50 years, please consider the following:

      Did we have an “obesity epidemic” BEFORE low fat, high carb diets were promoted as healthful, and before grains were recommended as the base of every human’s nutritional plan?

      Did we have type 2 diabetes threatening schoolchildren, with up to 1 in 3 kids now in some areas at risk?

      Did we have an Alzheimers “epidemic” – and Alzheimers is considered by many authorities, including diabetes.co.uk to possibly be “type 3 diabetes” insofar as it’s charactereised by abnormal insulin resistance in the brain (http://www.diabetes.co.uk/type3-diabetes.html). Quote: “The researchers pinpoint resistance to insulin and insulin-like growth factor as being a key part of the progression of Alzheimer’s disease.”

      The answer to all those questions is no.

      And these aren’t just stories of personal pain, or families financially and emotionally crippled, these will nobble our future collectively, no matter how we fund healthcare, because they’re just so damned prevalemnt and attackiong every generation of our society, from toddlers to seniors.

      And then once you’ve taken the time to have a good look at all these modern “epidemics” we’re being lectured about, have a look at the timeline of the obsession with dietary fat, cholesterol etc linked from my name (not my site) – you can verify everything mentioned there from 3rd party independent websites.

      Keep an open mind, and try reading the info on this site regarding fat, cholesterol and the unwisdom of the past 50 years or so of dietary recommendations. Weston A Price’s site has some good stuff as well.

      Patrick wrote on June 4th, 2013
    • @Anderson,

      This main similarity between this diet and Atkins is the fact that it is a low-carb (but not no-carb) diet.

      That being said, Mark advocates eating a TON of fresh non-starchy vegetables. If you have never measured out 100 grams worth of carbs comprised of vegetables, its hard to appreciate just how much carb-based food you will actually be eating (just so you know, I calculated a huge salad made of 8 cups of mixed veggies + 1 carrot and it only amounted to 49g of carbs).

      Also, I wouldn’t say this is a high protein diet per se. Usually Mark suggests you get to your protein requirements based off your lean body mass and then consume any extra calories from fatty foods (but he does say protein is fine if you want to eat an extra steak ;) ).

      Mark explains the issues of cholesterol, fat, and most everything else in his daily articles. You’ll just need to search for them.

      Hope this helps! And anyone correct me if you see that I’ve missed something or am off.

      Jacob wrote on June 4th, 2013
  23. I had my gall bladder taken out in 2001 and had problems digesting fat afterwards. I started a paleo/primal diet 2 years ago which is higher in fat than I was eating previously. My digestion actually significantly improved on the higher fat primal diet due to the elimination of vegetable oils. At least in my case, I could not effectively digest vegetable oils but have no trouble with natural fats in meat and high fat dairy.

    Ken wrote on June 3rd, 2013
  24. Hey Mark, thanks for answering my gall-bladder question! I will definitely try out your recommendations. I was particularly interested to read what you said about bitters, as I just recently happened to read about a 19th-century laird in the Scottish Highlands who consumed the following bitters before his (no doubt very rich and meaty) breakfast every morning: “On the sideboard there always stood before breakfast a bottle of whisky, smuggled of course, with plenty of
    camomile flowers, bitter orange-peel, and juniper berries
    in it — ‘ bitters ‘ we called it — and of this he had a wee
    glass always before we sat down to breakfast, as a fine
    stomachic.” (Osgood Mackenzie, “100 Years in the Highlands”)
    Looks like I might be experimenting with this concoction soon! (though perhaps at dinner time rather than at breakfast, and legal not smuggled… ;)
    I’ll let you know if I notice any improvement. Thanks for the tips!

    Sarah wrote on June 4th, 2013
  25. For Wanda -I use a digestive enzyme that you can pick up at any health food store for far less than this company is charging. It does not allow me to freely eat gluten, but it does help with that dying feeling if I get some on accident or when I am being less than careful.

    pocketheather wrote on June 4th, 2013
  26. My gallbladder was removed after finding several large stones blocking the cut. I had an attack in October 2005, went to the ER because of this intense pain mid-chest and they diagnosed me with reflux. I knew they were crazy and refused to take any meds. The next attack was in February when I had the ultrasound that showed the stones. The pathology showed that it was “ulcerated and hemmorhagic” so I didn’t feel bad about having had it removed. We do have a family history – my maternal grandmother had hers out at about age 50 (about the same age as I was when mine was removed) and my mother had several attacks but never had it removed. After the fact, I discovered cleanses on the web that are supposed to help but it was too late for me to try them and see if they would have helped.

    Marie wrote on June 4th, 2013
  27. That’s supposed to say “blocking the bile duct”.

    Marie wrote on June 4th, 2013
  28. I am so excited to see a post tackling a missing gallbladder. My grandma, without a gallbladder, seems to take butter, cheese, coconut oil and bacon grease well.

    xinwei wrote on June 4th, 2013
  29. When I first started to eat a primal diet, I had severe problems digesting more fat. Even as a kid I was sensitive to animal fat and got sick easily, I guess my gall bladder was not very efficient. And then I avoided to eat fat for many years – because fat makes you fat – got it all wrong, like so many others. What really helped me was a product called Enzygest (Metagenics). I had do use it almost every day with fatty meals at first, then I got more and more independent from it. You can train your body to develop all the digestive enzymes and acids again. I took it regularly for about 3-4 months. Now after 6 months primal I don’t need it anymore. I’d recommend to try this if somebody has problems digesting more fat.

    Margit wrote on June 5th, 2013
  30. While I just wrote a post introducing CrossFit to my readers and I am intrigued by the whole CrossFit concept, I find long hikes are great ( and much needed) mind clearers. Almost meditative…and outside, where we belong.

    Goddess wrote on June 6th, 2013
  31. Hmmm, I had my gallbladder removed i 2010 and I haven’t had any pain or intestinal problems. I am currently on a high fat moderate protein low carb primal diet Im 7 days in and I haven’t had a problem. I like to swallow down strait up coconut oil or eat a coconut oil chocolate I made. I cook with the coconut oil and I am about to make my first olive oil mayo and with the mayo a ranch dressing. I eat bacon and eggs in the morning. No problems, I guess Im weird like that, Im concerned that she feels pain there.

    Brandi wrote on June 6th, 2013
  32. Symbiotic parasites? I may have been correct about them? I was being facetious.
    I guess the oyster I ate yesterday with all the orange weird-worm-looking things ingrown may not have been so bad.
    I used to have signs of a bad gallbladder: yellowish skin and poop, which wasn’t fully processed. There were undigested chunks of food. That was in jail. I was given one of the institution’s books about biology by someone that seemed to explain that. I worked in the kitchen but still didn’t get much of a choice in what to eat. After getting out, eating mostly primal cleared that up. I have, I think not perfect, but good digestion.
    Now I can eat grains without noticeable problems. I’ve had to.
    I found a bunch of food stashed – boxes of meal kits – and took them. There were also three bikes and some headlamps and batteries. Got caught with a bike and the lights and batteries (public intoxication, lying down by an outdoor tap in the camping park and blurting stuff out I can’t remember, think I was making fun of people for camping in RVs) and had to lead detectives back to my campsite to get the other two bikes.
    They let me keep the food at least, as it was out of the packaging boxes and dirty. (It took a couple nights to lug it back and animals got to it).

    Animanarchy wrote on June 22nd, 2013
  33. I had a light gallbladder attack recently and more than one doctor’s orders are to get my gallbladder removed. My internist already recommended this ten years ago when identifying gallstones in my gallbladder, but I didn’t taken it too seriously since (here in Germany) the tendency among medical practitioners is to recommend expensive procedures to patients who are privately insured. However, since my gallbladder attack I began taking it a bit more seriously. I have since done a series of two-day olive-oil and grapefruit-juice cleanses once a month (done with a strictly-timed procedure involving intake of apple juice, epsom salts, etc.) and am now on my sixth one. It seems that some of the stones have been eliminated but not the calcified ones in my gallbladder. Therefore, my bile production may now be enhanced, but gallstones are still occupying the main storage space for bile.

    I have to say that these cleanses seem to have contributed to some improvement in fat digestion, possibly because the liver has been freed up. However, another decisive factor is definitely leaving a good few hours in between meals so that bile can accumulate again. I make a point of eating until I’m really satisfied so that there’s no need to snack. I also don’t combine coffee with high-fat meals as this tends to cause cramping at a time when bile needs to flow freely. Intermittent fasting is great for me too.

    I have hypothyroidism, which slows down the metabolism, which in turn is said to increase production of gallstones. Therefore, I see my gallstone issue as an ongoing one. I feel that the best I can do is to eat a very healthy and clean (organic, non-processed) paleo diet with certain healthy fats, as well as to continue efforts to eliminate or work away at the stones (though, as mentioned in a post by Mark long ago, the effectivity of some of these kinds of techniques are far from medically proven). I’m hoping that continuing fat consumption will enhance bile production, and that the other measures will slowly work away at the stones. Wish me luck in keeping my gallbladder from being removed!

    Andrea wrote on October 7th, 2013
  34. So, if you would have to choose between Ox Bile or more coconut oil, what would it be?
    Or both?

    cookie wrote on March 15th, 2014

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