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Gallstones & Gallbladder Diet: who to see and what helps

Gallstones & Gallbladder Diet · Kitchener, Waterloo & Cambridge

Gallstones are hard, pebble-like pieces of cholesterol or bilirubin that form in the gallbladder. Most people who have them never get symptoms and need no treatment. When stones do cause attacks, guidelines recommend surgery to remove the gallbladder, and there is no specific diet that treats them. Food still matters in a narrower way: avoiding what sets off your attacks until surgery, and eating normally again afterwards. At CARESPACE that work starts with a Registered Dietitian, once a physician or nurse practitioner has made the diagnosis.

What gallstones are

Gallstones are small stones that form in the gallbladder. Cholesterol stones are yellow-green and made mostly of hardened cholesterol; pigment stones are dark and made of bilirubin. The Canadian Liver Foundation’s figures, from 2012, are that gallstones occur in up to 20% of Canadian women and 10% of men by age 60, and that about 80% of people with them have no symptoms. Those are called silent gallstones.

Trouble starts when a stone blocks a bile duct. The pain that follows is called biliary colic, or a gallbladder attack. Gas and indigestion on their own are not specific signs of gallstones. Other conditions can produce symptoms similar to gallstones, among them acid reflux, ulcers, pancreatitis and appendicitis, all of which should be treated by a doctor as soon as possible.

Symptoms of a gallbladder attack

  • Severe, constant pain in the upper right abdomen, just under the ribs, or in the middle of the abdomen
  • Pain that lasts longer than 30 minutes and up to several hours
  • Pain that may spread to the right side of the back or the right shoulder
  • Feeling sick or vomiting
  • Attacks that often follow a heavy meal and usually come in the evening or during the night

What causes gallstones

Stones are more likely in women, over the age of 40, with a family history, and in people living with obesity, diabetes, Crohn’s disease or cirrhosis. Eating patterns are on the list too: a diet high in calories and refined carbohydrates and low in fibre. So is losing weight quickly, for example after weight-loss surgery or on a very low-calorie diet.

How gallstones are diagnosed

With an ultrasound scan and liver blood tests, which the UK’s NICE guideline says to offer to anyone with suspected gallstone disease. If a stone in the bile duct is suspected and the ultrasound has not shown one, an MRI of the bile ducts is the next test to consider. These are ordered by a physician or nurse practitioner.

When gallbladder pain is an emergency

Call 911 or go to an emergency department if you have sudden, severe abdominal pain; pain that spreads from your abdomen to your back while you are vomiting; a very high temperature, or feeling hot, cold or shivery; or yellowing of your skin or the whites of your eyes. Go to an emergency department as well if, during or after a gallbladder attack, you have abdominal pain that has lasted several hours, nausea and vomiting, any fever, even a low one, or chills, or tea-coloured urine with light-coloured stools. These can be signs of a serious infection or inflammation of the gallbladder, liver or pancreas. Do not drive yourself: ask someone to take you, or call 911.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner the same day, or go to an urgent care clinic, about abdominal pain that lasts longer than 30 minutes when none of the signs above is present. Feeling sick is part of many attacks, but pain that comes with nausea and vomiting, or that has not eased after several hours, belongs with the emergency signs. The first emergency list and the same-day sign are the NHS’s, from the UK. The second list is the one the National Institute of Diabetes and Digestive and Kidney Diseases in the United States says to see a doctor about right away; we keep all five of its signs at one level.

What the evidence says about treating gallstones

Two guidelines cover this. The UK’s NICE guideline shows strength through its verbs: “offer” marks a strong recommendation. The European liver association’s guideline labels each recommendation strong or weak and rates the evidence behind it. It gives a weak recommendation where there is uncertainty about the factors behind it.

  • Silent stones are left alone. NICE says to reassure people whose stones cause no symptoms, in an otherwise normal gallbladder and bile ducts, that they do not need treatment unless symptoms develop. The European guideline agrees (weak, very low-quality evidence).
  • Stones that cause symptoms: surgery. Keyhole removal of the gallbladder should be offered, and the European guideline calls it the preferred option (strong, moderate-quality evidence).
  • Tablets and shock waves: not recommended. Dissolving gallbladder stones with bile acid tablets, alone or with shock wave treatment, is not recommended (strong, moderate-quality evidence).
  • Before surgery, avoid your own triggers. The advice is to avoid the food and drink that trigger your symptoms until the gallbladder or the stones are removed.
  • After surgery, no banned list. NICE advises that people should not need to avoid those foods once the gallbladder or stones are gone, and should go back to their doctor if eating or drinking brings on old or new symptoms after they have recovered.
  • Fat: the sources do not agree. British Columbia’s dietitian service says a diet lower in fat, but still with some, is often recommended to try to reduce symptoms, and that removing all fat is usually not necessary. The NHS says people waiting for surgery may be advised to eat a low-fat diet. A UK hospital dietetics leaflet says that a low-fat diet for symptoms is not needed in every case and that there is little evidence to support it, and that removing fats from the diet can lead to rapid weight loss or nutritional deficiencies.
  • Prevention is lifestyle, not medicine. A healthy lifestyle and diet, regular physical activity and keeping an ideal body weight might prevent gallstones (weak, low-quality evidence). Medicine to prevent them is not advisable in the general population.
  • Rapid weight loss is the exception. During very low-calorie diets or after weight-loss surgery, a temporary course of a prescribed bile acid may be recommended until weight has stabilized (weak, moderate-quality evidence). That is a physician’s decision.

What a physician or surgeon may offer

CARESPACE does not provide scans or surgery, but it helps to know where they fit. Planned gallbladder removal is usually keyhole surgery done as a day case. For an inflamed gallbladder (acute cholecystitis), the operation should be offered within a week of diagnosis. Stones in the bile duct are cleared during the operation or with an endoscope procedure called ERCP. People may be able to return to work one to two weeks after surgery.

How each CARESPACE service helps with gallstones

Nutrition & Dietitian

While you wait for surgery, a Registered Dietitian can help you work out which foods set off your attacks and how to avoid them without stripping all the fat out of your diet, which can lead to weight loss and nutritional gaps. They can look at meal timing, because missed meals and fasting reduce gallbladder emptying, and if you are losing weight they can help you keep it gradual. After surgery the job changes: getting you back to normal, balanced eating, and dealing with loose stools if you are one of the people who has them for a while.

See our dietitians →

Nurse Practitioner

A Nurse Practitioner can assess upper abdominal pain, order the ultrasound and liver blood tests that confirm or rule out gallstones, and refer you to a surgeon when stones are causing symptoms. Anything on the emergency list above goes to an emergency department, not to an appointment.

See our Nurse Practitioner service →

Other services people ask about

Naturopathic Medicine, and gallbladder cleanses. A gallbladder cleanse or flush is usually a mix of olive oil, herbs and fruit juice taken over several hours. Mayo Clinic’s assessment is that there is no reliable evidence it prevents or treats gallstones, that the “stones” people pass are globs of oil, juice and other materials, and that some people have nausea, vomiting, diarrhea and abdominal pain during one. None of the guidelines we read recommends an herbal product or supplement for gallstones. Talk to a pharmacist, physician or nurse practitioner before taking one.

Where most people start

If you have had attacks and no diagnosis, start with a Nurse Practitioner or your physician. If you know you have gallstones and are waiting for surgery, or your gallbladder is already out and eating has not settled, start with a Registered Dietitian.

How your team works together

One practitioner covers most of what CARESPACE does for gallstones: a dietitian, on the eating side. The diagnosis and the decision about surgery sit with a Nurse Practitioner or your physician and a surgeon.

  1. Weekend availability

    Samantha Rocca, BASc, PMDip, RD

    Dietitian

    CARESPACE Waterloo GoodLife

    When food feels confusing, stressful, or harder than it should, Samantha Rocca, BASc, PMDip, RD helps you make sense of it in a way that feels practical, compassionate,…

    Book now About Samantha

Browse by service: dietitians and Nurse Practitioner.

What to expect at your first visit

  1. Your attacks. How often, how long, what time of day, and what you had eaten beforehand.
  2. Where you are in the process. Ultrasound results, a surgery date if you have one, or how long ago your gallbladder was removed.
  3. How you eat now, including foods you have cut out and any recent weight loss.
  4. A plan to leave with.

What you can do at home

  • Avoid the foods and drinks that trigger your symptoms until you have had surgery.
  • Eat regular meals. A late, heavy supper after an afternoon shift is the kind of meal attacks tend to follow.
  • Eat more fibre: fruits, vegetables, beans, peas and whole grains.
  • Eat fewer refined carbohydrates and less sugar.
  • Choose healthy fats, such as olive oil and the oil in fish, and go easy on the fats in desserts and fried foods.
  • If you want to lose weight, stay away from crash diets and talk with a health professional first. A UK hospital leaflet counts more than 1 kg a week as rapid.
  • Be active: at least 150 minutes a week of moderate activity is the American institute’s advice.

Outlook

Most people with gallstones never get symptoms. For those who have the gallbladder removed, you do not need it for normal digestion. A small number of people have softer, more frequent stools after surgery; that is usually temporary, and diarrhea that goes on or affects your quality of life is worth raising with your health care provider. None of the sources we read says how often silent stones go on to cause attacks.

Gallstones support in Kitchener, Waterloo and Cambridge

Kitchener. Nutritionist & Dietitian in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nutritionist & Dietitian in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutritionist & Dietitian in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

What foods should I avoid with gallstones?

The ones that set off your own symptoms, until your gallbladder or the stones are removed. There is no specific diet for gallstone disease. On fat the sources differ: a diet lower in fat, but still with some, is often recommended to try to reduce symptoms, while a UK hospital dietetics leaflet says there is little evidence to support a low-fat diet for symptoms and that not everyone needs one.

Can a diet or a cleanse get rid of gallstones?

There is no reliable evidence that a gallbladder cleanse prevents or treats gallstones. Dissolving them with tablets is not recommended in the European guideline either. Stones that cause symptoms are treated with surgery.

Do I need a low-fat diet after gallbladder removal?

No. You should not need to avoid the foods that used to trigger your symptoms, and a normal, healthy diet is the advice. Smaller meals may be easier for the first few days.

Can losing weight cause gallstones?

Losing it quickly can: very low-calorie diets and weight-loss surgery raise the risk. Gradual weight loss can reduce it. If you are working on fatty liver or another reason to lose weight, pace matters.

Why do I have diarrhea after gallbladder surgery?

Some people do. It usually stops soon after surgery. If it continues, speak with your health care provider.

Who can I see about gallstones in Waterloo?

See Nurse Practitioner in Waterloo for assessment and tests, or Nutritionist & Dietitian in Waterloo for the eating side. You can also call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Digestive Issues & Gut Health
Acid Reflux & GERD
Gastritis
Fatty Liver

The CARESPACE Central Reception Team

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Book online with a Registered Dietitian or a Nurse Practitioner, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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