Cholecystectomy may not be inconsequential from a metabolic standpoint. It is still considered the best treatment for symptomatic gallbladder disease; however, studies have shown a strong association between gallbladder removal and the development of non-alcoholic liver disease (NAFLD) years after surgery (Nervi & Arrese, 2013); this association was not shown in patients who had gallstones and managed the symptoms with diet and medication.
The gallbladder is not a vital organ, but its removal has shown to have nutritional and metabolic consequences due to its role in food digestion. Changes in bowel habits were found in 30% of patients who had a cholecystectomy (Del Grande, Leonardo de Mello et al., 2017). The hormonal mechanism that signals the gallbladder to contract when fatty foods are consumed is interrupted by cholecystectomy and as a consequence a modified gastrointestinal motility occurs which leads to diarrhea and possible changes in the composition of the gut microflora (Altomare, Rotelli, & Palasciano, 2017). In addition, patients may experience symptoms of gastritis secondary to duodenogastric reflux of bile acids. This reflux may also be responsible for symptoms of a condition called post-cholecystectomy syndrome.
Post-cholecystectomy syndrome causes nausea, bloating, diarrhea and abnormal pain and may lead to unintentional weight loss. Patients should be followed by a dietitian to alleviate symptoms of this syndrome and to receive guidance in maintaining long-term lifestyle changes that will assure future metabolic health. Recent studies report patients who had a cholecystectomy may experience weight gain with metabolic syndrome and liposoluble vitamin deficiency (Altomare et al., 2017), which can be corrected through nutritional counseling. If patients did not previously follow a healthy diet and lifestyle, it is important to not go back to “old habits.” A gradual lifestyle change is encouraged. Having a well-balanced diet with adequate amounts of nutrients from all food groups, maintaining a healthy weight, and exercising are key for a healthy life, especially after cholecystectomy.
Although there is no specific diet prescribed post-surgically, some nutritional recommendations have shown to improve symptoms of gallbladder removal syndrome. Oral supplementation of probiotics and fat-soluble vitamins (A, D, E, K) also seem to be relevant since patients can experience shorter gut transit time for up to four years after surgery which can lead to inadequate synthesis and absorption of these nutrients (Altomare et al., 2017; Marcason, 2014). These recommendations are listed in the tables below.
| Time period | Targeted disturbances | Nutritional suggestions |
| Post-surgery | Nausea, vomiting, diarrhea, abdominal pain, gastritis, reflux | -Low fat diet (cholesterol <200 mg/day) -Slowly increase intake of fiber, especially soluble fibers -Avoid alcohol, refined sugar, caffeine, spicy and fried foods, carbonated drinks -Smaller & frequent meals -Probiotics & fat-soluble vitamins (A, D, E, K) |
| Long-term | Metabolic syndrome, NAFLD, cirrhosis | -Weight management -High fiber and low saturated fat diet -Mediterranean diet/Exercise |
Examples of foods that contain soluble fiber:
| Food | Serving Size | Grams of Soluble Fiber |
| Oatmeal (cooked) | 1 cup | 4 |
| Mango | 1 small | 3.4 |
| Figs (dried) | 3 | 2.8 |
| Black beans | ½ cup | 2.4 |
| Navy beans | ½ cup | 2.2 |
| Oat bran cereal (cooked) | ¾ cup | 2.2 |
| Kidney beans (light red) | ½ cup | 2 |
| Brussels sprouts | ½ cup | 2 |
| Apricots (fresh) | 4 | 1.8 |
| Orange | 1 small | 1.8 |
| Pumpernickel bread | 1 slice | 1.2 |
| Flaxseed (ground) | 1 tablespoon | 1.1 |
References
Altomare, D. F., Rotelli, M. T., & Palasciano, N. (2017). Diet after cholecystectomy. Current Medicinal Chemistry, Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28521679
Del Grande, Leonardo de Mello, Leme, L. F. P., Marques, F. P., Ramos, A. T., Ramos, P. T., & Souza, F. A. d. (2017). Prevalence and predictors of changes in bowel habits after laparoscopic cholecystectomy. ABCD = Brazilian Archives of Digestive Surgery, 30(1), 3-6.doi:10.1590/01026720201700010002
Marcason, W., RDN. (2014). What medical nutrition therapy guideline is recommended post- cholecystectomy? Journal of the Academy of Nutrition and Dietetics, 114(7), 1136. doi:10.1016/j.jand.2014.05.009
Nervi, F., & Arrese, M. (2013). Cholecystectomy and NAFLD: Does gallbladder removal have metabolic consequences? The American Journal of Gastroenterology, 108(6), 959-961. doi:10.1038/ajg.2013.84
