Disclaimer: This article talks about food and poop, because this is real life and food becomes poop. Also, I am not a doctor and am not qualified to give medical advice. This is a story about personal experience with cholecystectomy and its effects on diet.
Food choices made easy, a new diet plan by Failed Organs Ltd.
Edit: Updated Jan. 3, 2022 with new information and learning from this experience, new medicine and doctor’s opinions. I will use strikeouts for new information.
The world is full of cheese. And, I can’t eat any of it without spending the next day drawing tick marks on the bathroom wall while playing prison blues on a harmonica.
No, I’m not lactose intolerant Turns out I am lactose intolerant AND I don’t have a gallbladder. It’s unclear of those things are linked since my mother is also lactose intolerant. Two years after having mine removed, she had hers removed, too. I discovered the lactose intolerance through consistent food journaling.
“In the United States, an estimated 10 to 15 percent of adults have gallstone disease,” according to Johns Hopkins Medicine. “About one million new cases are diagnosed each year, and some 800,000 operations are performed to treat gallstones, making gallstone disease the most common gastrointestinal disorder requiring hospitalization. The medical cost of gallstones in the United States is estimated to be about $5 billion yearly.”
Chances are you might encounter gallbladder issues in yourself or someone you know. I can count eight 12 people, including myself, who had theirs removed. Two were this month.
But the problem is, not many doctors can explain the whole deal, what happens next and why. So this story is for people who have recently discovered their gallbladder is a rock collector and needs to be removed or for someone who recently got a cholecystectomy and wants to know why certain foods make them feel terrible.
The emergency room bill for my first major gallbladder attack. That EKG is when they thought it was a heart attack. The IV therapy was an opioid. The best part is that an ER visit gets you into the GI doctor in one day! Image of my actual ER bill. Seriously.
When your gallbladder attacks
In 2017, I went to San Francisco for my wedding anniversary. Traveling is really more of an excuse to eat a bunch of new things and see some stuff, so when I woke up at 3 a.m. in the hotel room with stomach pain, I thought it was the dumplings. The pain persisted through the morning and was probably a five on the 1-10 “everything sucks” scale.
But it went away by breakfast, so I ignored what was actually the latest symptom after months or even a year of increasingly poor digestion, pain and diarrhea. Hashtag, “this is 30,” I told myself. Take a shot of Fernet and eat less fish and chips, I thought while eating fish and chips.
A week later, a coworker celebrated his new house purchase with free pizza for the office. I ate my usual three pieces…whatever, it was free, stop judging me.
That night, I went to the emergency room at midnight when the pain from the previous week hit level 11. The pain presented as:
- Stabbing pain inside the front right ribs that radiated to the rear and under the scapula. It felt like a prison shiv had pierced front to back.
- Continued pain radiated throughout my entire middle abdomen, creating bloating pressure. It felt like I was being filled with compressed air.
- Feeling like I had to poop and also puke.
- Actually puking green liquid and nothing else.
- Numbness and heart attack symptoms when combined for long enough.
These are textbook symptoms, according to Mayo Clinic.
I was not having a heart attack, but at least the ER acted like it at first. I slept doubled-over in the waiting room for an hour before being seen again.
The ER doctors gave me two gastric cocktails meant to reduce gas and acid, like prescription strength Mylanta, and two IVs of the opioid pain killer, fentanyl. That lowered the pain from an 11 to a 6 until the IVs emptied. Then the pain returned until morning.
Many women who’ve experienced what I now know as a “gallbladder attack,” say the pain is worse than childbirth. At the time, I was not diagnosed, nor did I have any idea what the hell had just happened.
So let’s back up to figure that out.
A simulation of what happens during a gallbladder attack. Prison-issue shiv pictured. This is not at-all medically accurate but it is metaphorically relatable. Animation by Mike Higdon
What does a gallbladder do, anyway?
The purpose of the gallbladder directly leads to what happens when you don’t have one.
Your gallbladder is a thumb-sized organ that holds bile for the liver (The Awkward Yeti web comic explains this in a cute series). When you eat high or dense fat foods, a hormone from the lower stomach triggers the gallbladder to squeeze additional bile into the upper small intestines to help break down fat before moving on.
If the gallbladder is doing its job right, you’ll never know you have one. If it’s failing, you’ll wish you didn’t.
Bile is made of cholesterol and other neat things. When the cholesterol levels get too high, they form stones. Unlike kidney stones, made of salts, doctors cannot blast gallstones with lasers. Those stones can become lodged in the bile ducts that transfer bile to the intestines, which causes pain and reduced function. It can even lead to blockages and infection.
Here’s a visual way to understand what goes wrong:
Mayo Clinic graphic of gallstones and how awful they are with scale drawing of organ relative to the liver, which everyone knows about because we punish it so, so much. Click to enlarge. Source.
Put an imaginary water balloon in your hand (or a real one, this could be educational). Fill it with a little bit of water so it’s not overflowing. Then put a few tablespoons of sand in it. Now push some large pebbles into it through the small opening.
See how it stretches and becomes stiff and lumpy? Now wrap one hand around it and try to squeeze all the water out. Crush your second hand over the first. Feel how the skin of the balloon protrudes and stabs at your palms and radiates pain into your fingers? Notice how the rocks and sand get in the way of the water coming out?
That’s imaginary gall sludge and gallstones.
“High-fat diets significantly increase risk of gallstones,” said Shelley Rael a Registered Dietitian Nutritionist, “Some people will not suffer, or, more likely are experiencing ‘minor’ discomfort. Many people don’t suffer significant pain.”
Rael is my cousin. Her gallbladder was removed, too. She hears a lot about my issues.
It shouldn’t be a surprise to anyone that gallstones are more prevalent in Western Europe and the United States compared to Asia, according to Johns Hopkins Medicine. Of the 10 percent of people with gall disease, one to two percent will need surgery due to pain or infection, according to Johns Hopkins.
Before my gallstones, I enjoyed a lot of fried foods and cheese.
Today, I do not.
“What is happening is the liver and gallbladder have to deal with the high volume of fat,” Rael said. “And it can only handle so much. The gallbladder can’t handle the extra work and the gallstones can develop enough to cause pain.”
Me two days after gallbladder removal with my Awkward Yeti gallbladder plush. Photo by Mike Higdon
What happens without a gallbladder?
Gallstones are discovered with an ultrasound (the ultrasound of you screaming at an ER doctor that it’s not “just gas,” lol…). Stones are easier to see than sludge (I saw mine during the ultrasound), but both can cause problems.
The surgery was easy enough (I did it in my sleep). My gallbladder had enlarged. As it failed, it consumed more blood, which caused enlarged blood vessels. The body has no way of correcting a failed organ until it has been removed. So it just kept dumping more resources (blood) at the problem without fixing anything (just like government…OK enough asides).
Removal was my only option, according to my doctor, though some people try to control the attacks with diet.
It took me a year and a lot of conversations with Rael and other gallbladder survivors to figure out how to even approach eating right. There’s not a lot of literature on a proper diet because not everyone reacts the same way. My surgeon, who also had no gallbladder, suggested trial and error and fiber pills.
That was terrible advice. But he did explain how everything works now:
A cholecystectomy reroutes the liver to drip bile directly into the small intestines, the way a leaky faucet drips all day. There is no longer a reservoir to hold onto bile for fatty meals.
That means I have a per-meal fat budget that cannot exceed the capacity of the leaky faucet.
So what happens when you eat too much fat?
Skip this part if you don’t want to read about poop… When eating too much fat in a meal or day, gallbladder-less bodies decide that they cannot process the food and trigger a system dump. Everything goes, regardless of liquid absorption, level of digestion, etc. That kind of diarrhea can only be described as prolific. Bathroom emergencies can happen immediately after eating something bad or the next day and take precedent over everything else happening in that moment in your life. Baby’s first steps? That’s cute, but where’s the bathroom? These emergencies are frequent, often multiple times per day and/or for long periods of time. You will start to sign petitions for better public toilet paper and buy a bidet for home (seriously, buy a bidet, Americans are woefully behind in bathroom comfort and hygiene). You will consider inventing a portable pocket-sized bidet. You’ll have to explain to your boss why you disappear before important meetings.
OK, that’s enough poop talk. It’s shitty though, seriously. OK done this time.
This turned out to be sort of true but not completely true after two years.
What was actually happening?
While my mom was having her gallbladder removed two years after mine, I consulted with her surgeon (good multitasker), who knew more about the situation than anyone I had previously met. I explained the above symptoms and while he said that is somewhat true, my issue was actually more unique.
My gallbladder’s condition caused some of the duct work to enlarge. My surgeon mentioned rerouting from the liver, which is normal, but my ducts were already a bit big. My mom’s surgeon explained that my liver was dumping too much bile into my stomach on a regular basis now that the gallbladder was gone and could not regulate that process. The diarrhea I was experiencing every day was actually excess bile in my digestive system that had nothing to consume. So the dumping scenario was, in fact, being triggered, but it’s because the stomach acid had no where to go.
He recommended a medicine called Cholestyramine. The drug is a resin-based orange-flavored powder meant to soak up excess bile, like kitty litter on an oil stain. I take 4g a day with water before bed and it keeps me regular. I sometimes forget to take it or travel without it, and the old symptoms come back immediately and can ruin the day. This has benefits if I’m feeling a bit constipated though. So I will likely be taking this the rest of my life.
But it has given me back normalcy and routine so I will drink the weird orange-colored resin powder forever.
Food choices between high-fat and low-fat.
Every food choice creates a quandary
Every food choice has a significant consequence on my quality of life. How much pain will I be in after eating? How close will I need to be to a comfortable, clean public restroom? Can I go hiking for four hours in the wilderness? What about camping? Can I go out to eat at the place other people want to go or places I used to enjoy? Will I have to explain the last year of digestive health in a public setting in order to justify why I’m not eating the fucking nachos that Judy ordered to share?
This is luckily no longer the case since I began taking Cholestyramine.
After surgery, eating more than a fist-sized portion caused nausea, so it was easy not to eat much. I lost 20 pounds and kept it off for a few years. Congratulations, the easiest diet ever: suffer child-birthing pains, remove an organ, learn to stop deriving joy from food, decide that hating food is the only answer, eat a lot of sugar because sugar is great, learn that sugar also has health consequences, continue to hate food.
Fast forward through a year of really unfun trial and error and now I eat mostly vegan.*
*Or dairy-free vegetarian**
**Or pescatarian once a week***
***Unless there’s chicken or blood sausage****
****OK, I also loved the back bacon in Scotland and that was fine, in fact, Scotland was great. So what the hell is up with American food?*****
*****ALSO, WHY IS THERE CHEESE ON EVERYTHING!?!?!
FFS people, stop putting cheese on everything!
Now I can eat normal again but no dairy, which is lactose related.
Sorry. Ahem. Anyway.
For me, ordering the vegan option on a menu and telling waiters that I’m lactose intolerant is easier than negotiating all of these things or explaining them to waiters. Although, invariably people want to know if I’m now a vegan and then talk about food choices.
Which, is also exhausting.
Rael said the amount of fat can be more important than the type of fat. And it’s easier to look at something on a menu or in the grocery store and see that it’s oily or fatty than to try to decode all the types of fat.
At least, most of the time. Coconut milk has way more fat than regular milk, so nothing is safe, really. Humans love fat. There is a much larger commentary here about the way we eat and how it literally causes our organs to press the eject button.
Luckily, food science has given me safe, tasty alternatives to cheese and animal fat. Nut juice and nut cheese are great and make cashew ice cream and cashew cheese pizza an occasional treat. Equally relevant, I’ve always loved cashews.
If I were to sum up my diet, I basically alternate vegan with small portions of lean meat. Sometimes, I look at nachos.
What’s next?
It’s been one year, but my body may never reset back to life without its gallbladder buddy. Rael’s gallbladder was removed 14 years ago and her experience mirrors my current digestive situation. Others I’ve consulted also say the same after similar time spans. But because our dietary concerns are loosely related to quantities of nondescript fat, and lactose intolerance, everyone experiences different things.
The only true advice I can legally give is to keep a food journal to craft a personal diet. And then call it the “Gallbladder Diet™” when people ask about what you just ordered so you don’t have to spend 1,500 words explaining your shit at dinner.