One of the biggest problems I hear about when some of my clients begin eating in the Paleo or Primal way, is gallbladder issues and gallstones.
Conventional wisdom tells us that gallbladder issues are aggravated by eating large amounts of fat, so of course the standard doctor’s advise is to avoid fatty foods. As usual, none of these doctors can tell us why some people have gallbladder issues in the first place.
The gallbladder is a small pouch attached to the liver that holds a reserve amount of bile, which it releases into the duodenum, in response to a relatively large amount of fat in the stomach. The bile from the gallbladder aides in the digestion of this additional fat load.
When a person eats a standard USDA MyPlate style high carbohydrate diet, over a long period of time (probably years), which is typically quite low in fat, the gallbladder does not get called upon to do it’s job very often, and thus the bile inside the gallbladder is not needed. After a while, the unused bile clumps together and hardens, becoming what we know as gallstones. Gallstones are more commonly found in people over 40, so they can take a very long time to form. Once gallstones are formed however, there are only a few options available to us to get rid of them.
“Our findings suggest that a high intake of carbohydrate, glycaemic load, and glycaemic index increases the risk of symptomatic gall stone disease in men. These results add to the concern that low fat high carbohydrate diets may not be an optimal dietary recommendation.” 
Symptoms of a sluggish gallbladder, or one with gallstones can include:
- Moderate to severe pain under the right side of the rib cage
- Pain may radiate through to the back or to the right shoulder
- Severe upper abdominal pain (biliary colic)
- Burping or belching
- Attacks are often at night
- Attacks often occur after overeating
- Pain will often but not always follow a meal with fats or grease
- Pain may be worse with deep inhalation
- Attacks can last from 15 minutes to 15 hours
Surgery is of course an option. Sometimes the gallstones can be removed, leaving the gallbladder intact, and other times a doctor may insist that the gallbladder has to be removed. I’m personally against gallbladder removal, because of the problems it causes to the host after removal, and because I believe that the gallbladder can often be rehabilitated. There are a huge number of anecdotal reports on internet gallbladder forums, that pain and gallbladder “attack” symptoms persist even after removal. Why have an organ removed from your body, unless it is absolutely necessary?
If a doctor tells a patient that their gallbladder is completely non-functional, then having it removed is probably a legitimate treatment, although still a terrible shame in my opinion. Removing the gallbladder does not address the cause of the malfunction. I’ve spoken to people who have been told by their physician that, they should have their gallbladder removed, even though it was functioning at a diminished capacity, but functioning nonetheless. In such a situation, I believe that removal should be a last resort, and not a primary course of action. Poor diet is the primary cause of a malfunctioning gallbladder, so if a person drastically changes their diet before any irreparable damage is done, the problems can conceivably be reversed.
“Major risk factors for gallbladder disease include a sedentary lifestyle and a diet rich in refined sugars. In genetically prone individuals, these two factors lead to an abnormal bile composition, altered gut microflora, and hyperinsulinemia, with resulting gallstone formation. As a large percentage of gallbladder patients have continued digestive complaints following cholecystectomy, the author examines complementary and alternative medicine (CAM) treatments to counteract gallstone formation. Herbal medicine such as turmeric, oregon grape, bupleurum, and coin grass may reduce gallbladder inflammation and relieve liver congestion. Elimination of offending foods, not necessarily ‘fatty’ foods, is often successful and recommended by many holistic physicians. Regular aerobic exercise has a beneficial effect on hyperinsulinemia, which is often associated with gallbladder disease. Dietary changes that lower plasma insulin levels, such as a change in dietary fats and substitution of unrefined carbohydrates for refined carbohydrates, may also be helpful.” 
So, as the above passage says, there are multiple reasons that people develop gallbladder problems, and they all potentially stem from a S.A.D diet, that contains too many refined carbohydrates, and compromised gut integrity. The prescription for treatment is also quite clear, refined carbohydrates, and excess sugars must be cut from the diet.
In order to proactively avoid gallbladder issues, or to attempt to rehabilitate any existing condition, my recommendation would be to follow a lower-carbohydrate Paleo protocol. The protocol would resemble a standard autoimmune Paleo plan, which excludes all grains, legumes, and dairy, but also excluding all fruit and starchy vegetables.
Although high-fat foods are not the cause of gallbladder issues, people often find that they have a sluggish gallbladder when they switch to a high-fat diet, because of the increased fat intake, and therefore an increased load on the gallbladder. Oftentimes these people will experience some of the symptoms associated with a gallbladder attack, which is quite scary, and will sometimes push them to either drastically lower their fat intake, or to completely drop their new dietary habits, in an attempt to alleviate the symptoms. While it seems logical that temporarily lowering fat intake to ease the gallbladder back into optimal operation would be a good course of action, it’s not easy to do if a person is eating a whole food diet like Paleo. After all, it’s not exactly possible to lower the amount of fat in a steak, aside from just cutting off the visible fat deposits.
A way to help take of the pressure away from your gallbladder, if you’re a recent Paleo, Primal, or low-carb convert, is to acquire some high quality digestive enzymes from your local vitamin store. Initially, you should take the enzymes before each meal. The additional digestive enzymes should aide in the digestive process, and you should be able to wean yourself off the enzymes after a few weeks, by which point your gallbladder should be gaining in strength and capacity.
The take-home message here is that eating Paleo, Primal, or standard low-carb will enable a practitioner to completely avoid any issues with the gallbladder in future life, and possibly reverse any existing damage that has already been done. The Paleo lifestyle could honestly be the healthy cure-all that many people claim it is. Try it, and you’ll see!
Not convinced? Check out these articles for additional information:
 – Dietary carbohydrates and glycaemic load and the incidence of symptomatic gall stone disease in men, 2005, C-J Tsai, M F Leitzmann, W C Willett, E L Giovannucci.
 – Volume 60, Issue 1, Pages 143-147, January 2003
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Barry Cripps is a Paleo-based Nutrition and Wellness Consultant, who operates out of Bowling Green, Kentucky.
For more information please visit: www.undergroundnutritionist.com