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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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October 03, 2016

Dear Mark: High-Fat Diet, Gall Stones, and NAFLD

By Mark Sisson
27 Comments

Gallbladder and Gallstones in lineFor today’s edition of Dear Mark, I’m answering two questions. Both concern the gallbladder. First, how does a high-fat ketogenic diet relate to the presence of gall stones? Can the former cause the latter? Or is the story a bit more complicated than that? Then, I discuss which fats are most amenable to the gall bladder-less. Also, where does non-alcoholic fatty liver disease, or NAFLD, come in?

Let’s go:

So I’m currently in school for diagnostic medical sonography, and interestingly enough, while learning to scan gall bladders I found that I have a stone! It’s mobile, but currently looks like it is too big to migrate into the cystic duct (whew). I have been doing a ketogenic diet for a few years, and am curious if you have any knowledge of data on people on the diet and gallbladder pathologies?

Also I have a report do in a month or so, and am choosing to focus on the ‘leaky gut syndrome’ that I’ve heard you speak of, and was wondering if you have access to any data about that?

Ok, well thanks for everything man! love your work!

-Ben Yarbrough

Gallstones are a tricky one. We all know that gall stones and gall bladders have something to do with how much fat we eat.

Here’s how I currently understand diet’s relation to gall stones:

The primary role of the gall bladder is to collect bile from the liver, concentrate it into potent super-bile (my term), and release the concentrated bile to break up incoming dietary fat into smaller molecules that lipase can attack and digest. Dietary fat is the biggest driver of gallbladder emptying.

If the gall bladder isn’t regularly emptied, gall stones can form. Usually made of hardened cholesterol, gall stones are quite common and often produce no symptoms. Problems arise when normal gall bladder emptying flushes out a stone small enough to make it into but too large to pass through the bile duct and a blockage occurs. Gall stones can also directly damage the walls of the gall bladder, leading to cholecystis, or gallbladder inflammation.

A high-fat diet can exacerbate or even uncover gall stone issues by increasing gall bladder emptying. Remember: the more fat you eat, the more often you empty your gall bladder—and everything in it.

But the original cause of the gall stones isn’t the high-fat diet.

It’s not eating enough fat, believe it or not. That’s right: assuming there aren’t any gall stones present, eating more fat will keep your gall bladder clear of stones.

Risk factors for gallstone formation are as follows:

  • high intake of high-glycemic carbohydrates.
  • High estrogen levels, which concentrate cholesterol deposition in the gall bladder. This is why women, especially pregnant women and/or those taking hormonal birth control, are more likely to have gall stones.
  • Obesity, which also increases cholesterol levels in the gall bladder.

One of the bigger risk factors for gallstone formation is weight loss, with a caveat: high-fat diets reduce and even prevent gallstone formation. In fact, when you compare people who lose weight on a low-fat diet to those who lose it on a high-fat diet, research shows that 45% of the low-fatters develop gallstones while none of the high-fatters develop them.

That’s right. Zero.

When you don’t eat enough fat, and the gall bladder isn’t emptied regularly, the bile gets more concentrated. Anything that’s in the bile, like cholesterol, also becomes more concentrated. If it hardens, you’ve got yourself a stone.

Although the common treatment for gall stones is to just remove the bladder, there are other ways that don’t involve removing an organ. You can use ultrasound to break the stones up into tiny, easy-to-pass pieces. That same study found that a drug called ursodeoxycholic acid, or UDCA, can dissolve gallstones already present in the gall bladder.

What I think is happening in your case? I’m not a doctor, but I’d say your ketogenic diet hasn’t caused the gallstones, but the increased fat intake may flush them out. Ask your doctor about UDCA. Once you’ve got the gallstones cleared out or dissolved, sticking with a high-fat intake should decrease your risk of developing any more.

As for leaky gut, I wrote a decent post that contains many references on leaky gut. You should find it a good place to start.

Where do coconut and mct oil fall in this category? Especially for someone without a gallbladder and NAFLD? Thanks!

For folks without gall bladders, coconut and MCT oil are probably better options than longer-chain fats. The shorter-chain fatty acids found in coconut oil and MCT oil don’t require as much bile to break apart, so the concentrated bile produced by the gall bladder isn’t necessary.

Remember, your liver still makes bile without a gall bladder. It’s just not the super-concentrated potent stuff a gall bladder spews out.

Honestly, it’s unclear how having a non-alcoholic fatty liver changes things. There’s some evidence that missing your gall bladder increases the risk of fatty liver, but that’s neither here nor there. You’ve already got NAFLD. What to do?

Well, short chain fats seem to be better for fatty liver than others. One study compared soybean oil (high PUFA omega-6) to coconut oil in rodents, finding that coconut oil was better for fatty liver than soybean oil. That’s good news.

You can also take some extra steps to improve liver health and bile activity.

Support your liver with choline from liver and egg yolks. Higher fat intakes require greater amounts of choline to allow the liver to process the fat.

Support glutathione production and recycling with whey isolate, NAC, fibrous green veggies, alpha lipoic acid, raw dairy, and any polyphenol-rich foods you can imagine (turmeric, chocolate, blueberries, etc).

Consider some taurine (or beef heart), which increases bile production.

Consider some ox bile products, which may replace some of the effects the gall bladder typically provides.

Consider bitters (or foods with bitter flavors), which have been used for centuries to improve digestion.

You may have to moderate your fat intake until you get everything sorted out. Use your symptoms as a guideline: if you feel nauseated, get loose stools, and have stomach issues after eating a high-fat meal, dial it back.

That’s it for today, everyone. Thanks for reading!

I’d love to hear about your experiences with gall stones or without a gall bladder. Extra points if you’ve dealt with NAFLD, too.

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27 Comments on "Dear Mark: High-Fat Diet, Gall Stones, and NAFLD"

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Mark Sanders
Mark Sanders
3 months 15 days ago
I did about a year and a half of a little to no carb diet that did not go well. Part of the bad results were my first experience with pain from gallstones. I found a home remedy of downing some diluted apple vinegar that took car of the pain, but after a while I had to take the apple vinegar every night before bed, otherwise the gallstone pain would wake me in the middle of the night. After I introduced carbs back into my diet, I’ve rarely had any problems with my gallbladder. Just one person’s experience.
Steve
Steve
3 months 14 days ago

Strange how everybody reacts differently. Mine is the opposite experience (see my post below). I don’t feel my gallbladder unless wheat becomes a regular part of my diet for a few months.

Nocona
Nocona
3 months 15 days ago

Darn, I have to support my glutathione production and recycling by eating dark chocolate, blueberries and turmeric. Why do you torture us with such things…

Elizabeth Resnick
3 months 15 days ago

lol, was thinking the same thing. Just another excuse to eat my some of my favorite foods. (Don’t actually love turmeric, but can’t get enough blueberries and dark chocolate. And actually just posted a picture on instagram of my am coffee blended with coconut oil, collagen and turmeric!)

Beth
Beth
3 months 15 days ago

I’ve heard said that the 3 risk factors for gall stones are 40, fat, & female.
In view of what Mark wrote, this makes so much sense: what other group is concentrating so hard on a low fat diet?

nat
3 months 13 days ago

I am 42, female but NOT fat 🙂 I am a size 8-10. I have just been diagnosed with gallstones. I have been following primal for over 4 yrs. Recently been diagnosed with IBS and now chronic reflux? This is how they found the gallstones. They are saying likely removal as I have multiple and some pretty large.

Anjanette
Anjanette
2 months 25 days ago

Hi, nat, have you been checked for food intolerances? Your symptoms sound like that might be a good idea. Eating food that you have trouble digesting (e.g. lactose or gluten) are thought to be involved with gallstone formation.

Kyle
3 months 15 days ago

This seems like it should be manageable. What are some examples of bitter foods?

primalplum
primalplum
3 months 15 days ago

Bitter foods include arugula, chicory, collard greens, bitter melon (never tried this personally), unsweetened cocoa, coffee, citrus peel, nettles, dandelions, chard, endive, rocket. From an internet search, it looks like several of the cruciferous veggies (broccoli, cabbage, Brussels sprouts, cauliflower) are also considered to be bitter.
When I prepare some foods that I consider to taste bitter, but I know are good for me, I add just a splash of cider vinegar, which seems to cut the bitterness some. I use a weak vinegar solution to wash my garden lettuce that has bolted too, which seems to reduce its bitterness.

HealthyHombre
HealthyHombre
3 months 15 days ago

I was having some issues with my gallbladder, went though a lot of tests and no stones were detected. I started hydrating more and taking a curcumin supplement (working up to a full daily dose, as curcumin causes the gallbladder to contract, which is good … unless you have gallstones). So far after several months (knock on wood) have not had any “ouch my side I just want to crawl into bed and lie in the fetal position” kind of attacks.

Todd Kneass
Todd Kneass
3 months 15 days ago
I just recently (9/23) had my gall bladder removed because of inflammation and it was “the most packed with stones” the surgeon had ever seen. This article is very interesting to me now. So far, I have been eating as before and haven’t had any problems. I’m also almost fully recovered and back to most of my normal activities, except going back to the gym. I’ll give it a little more time before doing that but I am working on body weight movements otherwise. I’m male, 47 and in fairly good shape. Still experimenting with food since the surgery but… Read more »
Andrea
Andrea
3 months 15 days ago

If you don’t mind my asking, can you describe your diet before the surgery? Low, moderate or high fat or carbohydrates? And if you ate fats, what kind were they in general? In any case, best regards as you recover and may your health continue to improve.

Todd Kneass
3 months 15 days ago

Andrea, I’ve been eating mostly paleo’ish (maybe 80%) for the last 5 years or so. I often fall off the bandwagon for a day or 2 and eat all sorts of crap food tho. While I’m still experimenting with what I can now tolerate, I know that I need to clean up my diet and take a closer look at what I’m eating.

Robbin
Robbin
3 months 13 days ago

Hi Todd.
Had mine removed in 93. In hindsight I probably created the problem by all kinds of extreme low-fat dieting for about 16 years and generally bad nutrition. Anyway the first year without your gall bladder can be tricky, until the system adapts. I had to avoid red wine especially because of the sulphate. Your body will definitely make its voice heard. Just listen to it and try with things gradually and in small amounts. Nowadays I eat and drink everything without a problem. (Paleo/LCHF)

Donna
Donna
3 months 14 days ago
OK, very good article. As someone that has been battling my gall bladder for 30 years, this really explains and lot but also leaves me with questions. I was on birth control for about 6 years in the ’70’s. Then in the ’80’s or so a “new diet” emerged of very low to no fats. 🙁 Yes, lots tons of weight but that is when I began the gall bladder war. I’d eat something fatty have a flare up and husband would have to do Foot Reflexology to relieve the spasm. Over and over and over again through the years.… Read more »
Steve
Steve
3 months 14 days ago
Great read. 5 or 6 years ago I had a series of half a dozen or so gallbladder attacks over the course of a year. Most only lasted a couple minutes to a couple hours, but two of them were 23 and 30 hours of the most intense pain I’ve ever felt. I was hunched over in bed, or in the shower, thinking that death would be a welcome alternative. It was over a one year waiting list for the gallbladder surgery, and by the time they called me for an appointment, I already had it under control with a… Read more »
Lauren Price
Lauren Price
3 months 14 days ago
If gallstones are still a manageable size, you can do a flush to clear them out. There is a book (The liver and gallbladder miracle cleanse) which gives the details of the cleanse. To make it more low carb friendly you can substitute malic acid powder in water, or gold coin grass tincture to soften and break down gallstones and omit grains from the cleanse guidelines. I have done this and seen my gallstones come out the other end. Though it is not useful once gallstones become too large, it is a good preventative tool for those of us who… Read more »
Darlene
Darlene
3 months 13 days ago
I’ve followed this protocol a couple of times from the book, The Amazing Liver and Gall Bladder Flush by Andreas Moritz. One week on a vegetarian diet and malic acid. I started on a Monday and did the flush on a Sunday. On the last day you eat lightly, drink an olive oil and citrus drink before bed. In the am you tend to have several bowel movements. I passed whitish, calcified irregular shaped pieces along with pea green putty consistency pieces. The book recommends once a month or six weeks to continue this protocol until one no longer has… Read more »
FJ Doorbe
FJ Doorbe
3 months 13 days ago

Liver flushes absolutely work. I’m a big fan. Had gallbladder pain back in 2010, did the liver flush per Hulda Clark/Andreas Moritz with epsom salts and olive oil/grapefruit juice, and six years later, I still have my gallbladder and haven’t had another attack. I do them whenever I feel I’m metabolizing drugs and toxins more slowly than usual.

Filipe Freitas
Filipe Freitas
3 months 13 days ago

My wife started feeling some pain after she went primal, and the doctor found some gall stones and she said she should stay away from a high fat diet, even said she should avoid dark green veggies.
I thought it was extremely simplistic of them and a way to not address the issue. Im glad you guys put some information out about it!

Tanya E
Tanya E
3 months 13 days ago
After my pregnancy I had severe pain from gallstones. This was before I was primal. I had “quite a few” gallstones and as per the advice I went low fat as it stopped the pain. However, I was concerned that eating no fat was really not healthy (though I lost a stone of the baby weight) and after researching started eating some fats that I found I could tolerate, oily fish, avocados, olive oil, nuts. Eventually, I had a date for surgery, but my symptoms had gone and on the advice of my doctor, cancelled the operation. I went primal… Read more »
Denny
Denny
3 months 13 days ago
No experience with gallstones, but i have experience with NAFLD: 2011: had an ultrasound, liver was diagnosed with mild non-alcoholic fatty liver, was unhealthy and overweight back then, read about low carb diet, tried it 2012: still on low carb diet, picked up running and occasional body weights and sprinting, started to train for a full marathon 2013: still on low carb diet and occasional body weights and sprinting, ran and finished the actual full marathon, 3 months later went for ultrasound again, still no noticeable change from previous mild fatty liver ultrasound 2014: a friend got me into regular… Read more »
Denny
Denny
3 months 13 days ago

Extra Notes: i’m male, 175cm (5ft10in)

Between 2011 and 2012: 78kg, lost 15kg to become 63kg (139 lbs)
Between 2012 and 2013: Gained 2kg
Between 2014 and 2015: Gained 10kg
Despite my final weight being similar to my initial weight, my body composition was very much different due to the weight training

nat
3 months 13 days ago

I have currently been diagnosed with multiple gallstones, some at 1.5cms. I already eat a high fat diet? I have done for over 4 yrs, as paleo/primal. Only rarely eat organic sourdough ancient grain bread, monthly meals out which i eat what I like and rice on occasion, but otherwise always heaps of coconut products, including oil and yogurt, lots of bacon with the fat on. Yet was diagnosed with IBS and now have constant reflux which led to the multiple gallstones been seen by US.

mtmc
3 months 11 days ago

Appreciate for the information shared. Great post. thanks

Alana Wylie
3 months 11 days ago
Thank you for this. I started having gall bladder attacks the very first month I did the Whole 30. I continued to have them as I changed my diet over to a paleo protocol. Six months in, I was diagnosed as having gallstones. I refused to have surgery–but I also stopped eating paleo, afraid of having attacks. (They would last 3 days on average.) Another one came, inevitably, but this time there were two stuck in the duct between the pancreas and the gal bladder and the pancreas was secreting so many enzymes to cope with the intruders it was… Read more »
Leaf Eating Carnivore
Leaf Eating Carnivore
3 months 6 days ago
I’ve been HFLCMP for about 6 years now (lost 45lbs, gained back over half trying to move off plateau with whey shakes – turns out I’m very susceptible to the insulin-raising nature of whey – who knew?), after years of lowered fat, “healthy whole grains”, root veggies, and canola (SUCH a good girl!!!). Not to mention years of high dose Ortho-Novum… Turns out I have 2 large stones, ~1.5 and 2.5cm. They don’t give me any trouble – save the occasional twinge – but I would like to get rid of them without losing any bits and pieces. I would… Read more »
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