Sevi Rutgrink – Keto Coaching

Keto and your gallbladder

Do you have gallstones or maybe no gallbladder at all? Then it is good to know that a ketogenic lifestyle can help: the symptoms you experience often quickly disappear. Read on to find out more!

How do gallstones form?

Bile is produced by the liver and is used to break down and burn fats. The bile is temporarily stored in the gallbladder before being passed through the bile ducts into the intestines.

If you are on a standard diet, i.e. high in carbohydrates and low in fat, you naturally need very little bile to digest the food you eat. Sometimes, however, excess bile in the gallbladder stagnates and thickens. This results in the formation of gallstones. You could say that in this case, gallstones are the result of a diet low in fats. You may also have an infection in the gallbladder that causes the bile to thicken, also resulting in gallstones.

Hormones can also play a role in the formation of gallstones, for example if you are a perimenopausal woman, pregnant or on the pill. Other risk factors are obesity and hereditary factors.

The most common symptoms are severe abdominal pain, discoloured stools (beige instead of brown) and jaundice. Sometimes complications arise when a gallstone gets stuck in the bile ducts for a long time. These include inflammation of the bile ducts or gall bladder, or acute inflammation of the pancreas.

Good to know: you can also have gallstones without even noticing it!

So how does keto help?

When you start a ketogenic lifestyle, you will not only be eating fewer carbohydrates, but also more (healthy) fats. Your liver will start to produce more bile in order to break down these fats. This also allows the bile to flow normally again. The chance of developing gallstones on a keto diet is therefore much smaller than on a standard diet low in fats.

Good to know: if you already have gallbladder problems and you start keto you will notice that your symptoms will quickly diminish and often disappear completely.

What if I don’t have a gallbladder?

Sometimes a person suffers extremely from gallstones. The decision can then be made to remove the gallbladder. You then no longer have a storage area in your body for the bile produced by your liver. Instead, the bile goes directly to the small intestine. This can cause temporary diarrhoea symptoms. Other symptoms that may occur are nausea, heartburn, pain and vomiting. The diarrhoea symptoms usually disappear quickly.

But can I do keto without a gallbladder?

Absolutely! If you’ve just had the surgery I do recommend that you wait until you’ve recovered from it. This usually takes about two weeks. In all other cases, you can start immediately.

Anything I need to worry about?

The vast majority of people without a gallbladder in my practice have no trouble at all switching to keto. Of course, it is possible that you are that one person who suffers from diarrhoea and/or nausea after starting keto because of the increase in your fat consumption. Your liver then has difficulty producing enough bile. Not everyone experiences issues from this, it is very individual. But if this is the case for you, fortunately there are things you can do to prevent or help reduce these temporary symptoms.

Good to know: many of my clients come from the United States and it seems that gallbladder removal is much more common there than here in the Netherlands. So I have plenty of experience exactly that situation.


You can try the tips mentioned below if you find that the fat content of the keto diet is causing problems without a gallbladder. It may take some time to find what works best for you, but before you try any of the tips: always make sure to give your body plenty of time to get used to the new lifestyle. Sometimes your body just needs a little extra time.

  • do not start eating to your complete fat macro immediately but build it up slowly; this will give your liver the chance to slowly produce more bile fluid.
  • instead of eating 3 full meals a day, eat 4-6 smaller meals and divide your fat macro evenly over these meals.
  • make sure you don’t drink anything before/during/after a meal; water (but also other drinks) dilutes the bile fluid and this makes it harder to digest fat.
  • certain types of food are best avoided as their fat requires much more bile to be broken down; these include avocado, nuts and seeds, olives, egg and meat. So if you notice that you’re having problems with certain foods, that’s a clear sign to leave them out.
  • apple cider vinegar can sometimes help, as it thins the bile fluid and makes it flow more easily; mix 1-2 teaspoons with a small glass of water and drink this half an hour before your meal
  • fermented products such as sauerkraut or kefir stimulate the liver to produce bile.
  • if you are prone to diarrhoea, looking at your fibre intake may help; fibre can help bind together thin stools. Be sure to increase your fibre intake only with high-fibre vegetables and do not use fibre supplements such as psyllium.
  • if all the above tips do not help, you can consider two types of supplements for temporary use: digestive enzymes and ox bile.

Do you have any questions about this? Please feel free to contact me here: