Hitting a snag due to gallbladder troubles

[Rose1942]

I have been low carbing for a little over 2 months now, and until this week, everything has been going fine. Getting pretty good sugar control, losing weight, generally feeling well. This week, however, my gallbladder started acting up. Mostly short attacks, a half hour or so, but last night I was miserable for about 3 hours. First a nauseous feeling, then pain in upper right shoulder area that did not respond to anything I could think of to do.

Now, I have had an attack like this before, but it has been over six months since, and I sort of forgot about it. One before that was about 5 years, so this was not a frequent event for me until now. Looking up things on Google, I found that interestingly, existing - but dormant - gallbladder problems can surface during weight loss. I have only lost 13 pounds, but that is a lot for me as my highest weight was only 148 (down to 135 since Jan 1). Furthermore, I see that low fat diets are bad, but I never did do the low fat thing anyway, so that's not it. I do have diabetes though, another risk factor, and I am female, on the elderly side (65 now but I refuse to believe that :)

The suggestion seems to be that low fat is bad - high fat is also bad - but medium fat is the best way to try and help the gallbladder. This poses a problem with doing LC because we are encouraged to introduce more fat into the diet. My two biggest priorities are #1 keep control of the blood sugar and #2 give my gallbladder a break and try to avoid surgery. Further weight loss is fine if I can manage it, but not such a priority at this point. In fact I have upped my goal a bit, realizing that what I had thought when I started was not realistic for me, at my age. I will be happy to get 20 pounds off and maintain it, frankly.

Anyway - anyone here who is a diabetic had this happen? I am not talkiing those with NO gallbladder, because I saw in several articles that one the gallbladder is gone, the LC with higher fat diet is not a problem - however it does indeed seem to be a problem when the gallbladder is there, but causing trouble. What sort of protocol is best here - try and reduce my fat intake somewhat, try and get a bit more fiber into my diet (thus probably increasing my carbs a bit too)? And all the while trying to keep the sugar down?

I dunno, this is getting complicated! Help!!

[eddiemcm]

An ultrasound test will show the state of your gallbladder.Gall bladdrer problems are caused by
an accumulation of bile sludge and gallstones in
the gallbladder.This is usually caused by high
cholesterol.The University Florida Medical School
developed a short term diet that is supposed to
work well in purging the gallbladder-green apples,celery,soy protein.Be very wary of the
olive oil gallbladder purge-it has caused problems for many people.
Hope this helps
Eddie

[KiaKaha]

I was a very successful LoCarber back in 2001 - 3 - 31/2 stone gone in 3 months without a backward glance!!! But I was a victim of my own success - sometimes rapid weight loss will bring on gall bladder problems. I'd never had them before but had some really debilitating attacks in rapid succession.

I didnt know what they were and ended up going to A&E after the 3rd one in 10 days. I was just retching for an hour or two (very nauseous) and had a very bad pain up under my ribs on the left hand side. They checked that it wasnt my heart and did an ultrasound and found that I had gall stones. They got me a referral 2 weeks later and within a week of seeing the specialist I had my gallbladder out.

Now the deal is you really cant lo-carb when you have gallstones - high fat worsens the problem as does weight loss for many people. I think you could try the diet that Eddie suggested or try and modify your diet to be reasonably low carb and low fat. Green leafy veg, fish and lean chicken, lower carb fruit and even med. carb veges as you dont want to regain weight but you also need to be able to eat and the fibre will help fill you up - but generally I would stay away from grains because they wont help your blood glucose levels. (In my experience anyway)

Definitely get it checked out - I didnt have a clue about gallbladder issues and was lucky I was living in Australia where they have fabulous, efficient free health care. You can die from gallstones that are left untreated (under dertain circumstances) and I know when I saw the surgeon he didnt like what he saw on the ultrasound and bumped someone else to get me in.

I know it is popular to try and purge the gallstones but I guess it depends on how bad they are and without an ultrasound you wont know. Fair, fat and forty is the profile of the average candidate for gallbladder removal so you'd need to self diagnose on that one. I was exactly that - if you have not been particularly overweight for a longer period, arent of european origin or are younger than that and dont eat fatty foods a lot etc - maybe you can sort it out.

I know of someone who got it sorted but she was a thin 28 year old and it did take her 2 years of various remedies to fix it.

If you have to have it out it is generally no big deal. If you are very unlucky they have to do an open surgery but generally it is done laparoscopically. I could have easily left hospital the next day but they keep you in for a couple of days. I wasnt sore or anything.

After that you can go back to lo-carbing but may take a few months to fully cope with fatty foods again (these issues are very minor and only experienced by some people - most people can eat high fat from day 1).

Just if you do stop locarbing - dont fall off the wagon completely! I did because I couldnt face induction and everything again. So stupid of me - now I am fully diabetic and have a further 100lbs to lose and am so much wishing I hadnt let the gallbladder issue derail me. Lo-Carbing is so effective in managing diabetes that even without needing to lose weight -it is really the only way to eat for life. Particularly if you want to slow down the progression of the disease and/or stave off medication (which brings more health risks and complexity).

Good luck with getting the gallstones sorted out!

[Rose1942]

Thanks Eddie and Kia. I do realize now that I need to be more careful with the fats, and add some grains for the fiber (along with the veggies, which I already do).

Curiously, this situation came to a head after only one week taking fish oil. Hmmm, I thought I was doing myself a favor, but now I'm not so sure. Fish oil, vitamin e in a soft gel, evening primrose also in a soft gel - all that additional oil could have put me over the top.

Frankly, I am also very disappointed in Dr. Bernstein and Dr. Eades for not addressing this subject in their books. I have both of them and there is not a mention of cautioning people about gallbladder issues when going on a high fat, high protein diet. Now, I consider these guys to be the best in every other way, but to neglect to point out possible _glaring_ dangers of their diets is a sin of ommission. I have also read Gary Taubes' book forwards and backwards and over and over and he too conveniently sidesteps this issue. Makes you wonder if in their enthusiasm for low carb, high fat for so many health problems, they are afraid to include even one little negative for fear that it will taint the whole concept............ but that is wrong. They need to be up front and not hold important information back.

I also read some forum comments about Atkins, and his ommission of this subject too (they were old threads still available on Google) and people rose to defend him saying in essence 'well that's why Dr. Atkins recommends a thorough medical check before starting the diet'. I don't think that is a valid excuse for not bringing it up in the book itself. The words gallbladder disease should have a chapter - everything else does. If only the benefits are touted and not the drawbacks, we are not being given the whole truth.

[Lisa N]

I also read some forum comments about Atkins, and his ommission of this subject too (they were old threads still available on Google) and people rose to defend him saying in essence 'well that's why Dr. Atkins recommends a thorough medical check before starting the diet'. I don't think that is a valid excuse for not bringing it up in the book itself. The words gallbladder disease should have a chapter - everything else does. If only the benefits are touted and not the drawbacks, we are not being given the whole truth.

Dr. Atkins does address gallbladder problems in his books; both following low carb after having your gallbladder removed and following it while having symptoms. In both cases, he did state that a lower fat version of the plan could be followed.
Dr. Bernstein's book focuses on blood sugar control through low carbing, not every aspect of low carbing; he's an endocrinologist, not an internist or surgeon. Fact is, you can experience gallbladder problems while losing weight on any diet or while not following any particular diet at all; the risk factors that I learned in nursing school were: female, fair[skinned], fat and fortyish.
What has always puzzled me, having experienced severe gallbladder attacks and the surgery to remove it, is why people will endure such pain and suffering to avoid the surgery. If the surgeon uses the more modern laparoscopic method, it's really no big deal and the recovery time is very short; I had mine out 14 years ago and even then, I was only in the hospital overnight and was back to work in less than a week.
Oh...and if fiber is what you feel you're missing, try flax seeds before grains; you'll get a lot more fiber for a lot fewer carbs. :idea:

[pennink]

My dh and ds suffer terribly from having their gb out. Running to the bathroom at the slightest bit of fat.
I was lucky, I passed my stone and the surgeon told me if I was going to keep high fat I'd be fine, but no low fat diets for me anymore.
(my troubles started after a Susan Powter diet)

[Rose1942]

Lisa, what I guess I object to is that all the low carb diet gurus place so much emphasis on high fat being so good for you - and high fat is really not good for the gallbladder. Low fat isn't either - there's a middle range that is beneficial. It's not the low carb, it's just the fat problem. I think they should at least mention specifically that a high fat diet is not for people with gallbladder disease.

I do know now that any weight loss diet is apt to result in gallbladder trouble if one is predisposed to it (and many do not know they are, but then again - wise to have a heads up that it is possible) but I never read that in any low carb book or article or forum, and I read plenty. So a person gets blindsided after thinking they have researched the thing so well, and here comes something that should have been in all the books - all of them.

I am not afraid of having my gallbladder out, but I don't want to have a surgery if I can help it. There are always risks to a surgery of any kind, and some people do not recover well (ex: see pennink's post above). I had a coworker that had had her gallbladder out years before and still could not digest many foods. To be undelicate about it: much of her food went out the same way it went in, undigested. So I would want to try and save the organ if a better diet can do that, rather than jump into surgery, at this point.

I should say also that I am not planning on putting a lot more grains back, just maybe a little whole wheat bread, which I tolerate very well and it doesn't seem to bother my sugar much. I get a brand that has 11 gr. per slice, so if I eat a poached egg on one slice, it's not too bad. So the occasional sandwich, that would not be too drastic an addition. Maybe also a little brown rice, some barley in soups etc. I do take flaxseed quite often, especially in yogurt.

[pennink]

The odd thing is, I have the worst time with high fat mixing it with fibre.
I can't (not that I would now) have tuna and mayo and then eat an apple. The doctor said, then don't eat like that.

uh... ok.

[JayRob]

Rose, I think you've done some good research and find like many trying to do low carb that there are no easy answers as to the causes; weight loss seems to be one of the causes.

Have you had an ultrasound done recently? This might help in deciding which direction to take as far as surgery, etc. For example if your gallbladder is packed full of large stones, surgery may be the only option. They also do a test called the HIDA Scan which tests how efficiently your gallbladder is operating, this also helps with the surgery decision.

There is a drug called Ursodiol and another very similar called Actigall that can be prescribed to help dissolve certain types of smaller stones and crystals. It doesn't work in all cases. It has been very helpful in my case. The treatment is rather expensive, and lasts at least a year. It is often given to those whom surgery is high risk.

There are certainly risks to surgery, especially for diabetics. Probably close to 25% of non-diabetics have some problems after surgery, sometimes the problems resolve, but for others the problems as you saw can be life long.

[KiaKaha]

JayRob - that's interesting the number of people who do have problems post surgery. What they dont tell you before you have it!!!

Rose, in fairness to the Doctors Atkins, Bernstein and Eades - most of us have gallbladder problems because of the way we ate prior to the dieting which perhaps pushed us over the edge. If some of us knew we had gallstones before we started we probably wouldnt have started lo-carbing because we would've adopted a low fat eating plan. Quite possibly, we may have lost the weight and ended up in the same place.

And maybe they dont focus on it because they feel it is a more 'minor' concern compared to the benefits.

As to surgery - it is a lottery but you cant worry too much about it. I have had 4 surgeries in the last 7 years - 3 were a piece of cake and on the 4th - the simple act of childbirth - I nearly died.

[eddiemcm]

Regardless of what some doctors tell you,the gallbladder has two important functions:
1.It stores bile
2. It emulsifies fat
Some people who have had their gallbladders
removed do okay.
Others are prone to blood infections
Others have trouble digesting fat
Eddie

[Rose1942]

JayRob, when you mentioned Ursodiol I was reminded of the time that I had a small, elderly dog who had liver disease which also involved his gallbladder. Yep, dogs can have that too! I had a good vet who saved him during a crisis, and then as he recovered, he was put on Ursodiol. Yes, quite an expensive medicine, but worked - the little guy lived another few years without further complications.

P.S. to all - thanks for the concern, I appreciated it, especially the other day when I was still feeling pretty nasty after the attack. I am feeling much better now, I don't even have any twinges or upsets in the tummy. Of course I have been babying myself, eating very small meals, nothing too fatty, nothing too spicy, etc. And no sugar of course! Eeek, can't 'fall off the wagon' on that, as y'all pointed out! Maybe this episode is over, fingers crossed.................

[Lisa N]

There are certainly risks to surgery, especially for diabetics. Probably close to 25% of non-diabetics have some problems after surgery, sometimes the problems resolve, but for others the problems as you saw can be life long.

JayRob, I'm interested in where you found that particular statistic. Can you post a link? From what I've read, the figures are much lower; in the range of 10% or less experiencing problems following gallbladder removal and it didn't break it down between removal for those with various health conditions such as diabetes.

[JayRob]

Lisa, my guestimate does appear to be a bit high.

I am a member of a health forum where gallbladder issues are discussed and I was initially surprised at how many did have complications. After all common wisdom seems to be that laproscopic surgery is a snap and you don't really need a gallbladder.

Post-cholecystectomy Syndrome."Study-to-study variability is great. PCS is found in 5-30% of patients, with 10-15% being the most reasonable range."

http://www.emedicine.com/MED/topic2740.htm

[RobLL]

My mother's laproscopic gall bladder surgery went very bad over the next two years. It then became a case of 'if at first you don't suceed, try try again' and the second time the same doctor nigh well killed her, 63 days in the hospital. A firiend found out there is a doctor in Seattle whose practice is mostly repairing other surgeons mistakes.

ps Her surgeon has/had a good rep