We’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?
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?
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.
Good luck and let me know how it goes!
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?
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).
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,
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.