Question:

I am 22 and I had my gall bladder removed October of 2004. Three years later I still suffer from chronic diarrhea and heartburn. When I graduated high school I was extreamly overweight at 380 lbs. I lost a lot of weight and got myself down to 250. Then I had the attacks, and the doctor made me remove the gall bladder. After the surgery my doctor wouldn’t let me get back to exercising regularly again for another 3 weeks. Finally when I got to exercise again, I wasnt loosing any weight. I actually gained weight since, and now I am back at 280. I don’t know what to do. I know that certain foods like spinich and lettuce do NOT digest AT ALL. Are there certain foods I should most definitly stay away from? And are there any foods that I can stick with that can help me loose weight? I am seriously stuck at the plateu and I exercise regularly.

Answer:

Digestive difficulties may occur after gallbladder removal The main reason is usually a difficulty in handling fats in the diet. Fat and certain fat-soluble vitamins require bile in order to be absorbed. When the gallbladder is present, it stores bile that the liver makes. During a meal, the gallbladder contracts, releasing a pool of bile into the intestine that is used for fat absorption. After the gall bladder is removed, bile is still produced by the liver, but it is released in a continuous, slow trickle into the intestine. Thus, when eating a meal that is high in fat, there may not be enough bile in the intestine to properly handle the normal absorption process.

The change in intestinal bile concentration during high-fat intake may cause diarrhea or bloating, because excess fat in the intestine will draw more water into the intestine, and because bacteria digest the fat and produce gas.

People who have had their gall bladder removed have varying tolerances to the very foods that previous to their surgery may have caused gall bladder attacks. These foods may have been high fat or fried foods as well as whole grain breads and cereals, nuts, seeds or gas producing vegetables (baked beans) from the cabbage family (broccoli, brussels sprouts, cabbage or cauliflower). Spicy food seasoned with red or black pepper may cause some discomfort for persons with gall bladder disease but not necessarily. The undigested spinach is unusual, but not unlikely. Does it make a difference if it is raw or cooked? Symptoms may range from burping (heartburn) and gas to a feeling of fullness (like the food isn’t going the direction it should).

Things you can do to reduce your symptoms:

• choose leaner meats, skinless chicken and fish and remove visible fat before cooking
• be careful with foods containing hidden fats such as fast foods, convenience meals, toasted sandwiches, pastries, nuts and nut butters.
• use low-fat dairy products such as skim or low fat milk, reduced fat cheeses, low fat yogurt and reduced-fat spreads
• take care when eating out – choose foods such as vegetable soups, dressing-free salads, grilled fish (with no lemon butter), grilled chicken with no skin and rice or baked potatoes. Eat small portions ( plan on taking some home)
• limit the fat and oil intake to no more than 2-3 portions per day (1 portion = 1 tsp. oil/butter/margarine.

Note that all these suggestions are good for weight loss too. Go to Mypryamid.gov and put in your age, gender, weight, height and activity level to determine how many calories you should be eating. Then subtract 500 calories per day to create a 3500 calorie deficit over the course of a week. You will lose a pound for each 3500 calorie deficit. You may need to make some adjustments in your discretionary calories (those not assigned to any food group) to make them more carbohydrate calories instead of fat calories if you are still getting diarrhea. Carbohydrate is found in any food containing starches or sugars, including breads, rice, biscuits and muffins (also has fat), cereals, pasta, and other grains, dried beans, vegetables, milk and yogurt, fruit and fruit juice, and table sugar, honey, syrup, and molasses, as well as foods sweetened with these items.

If you are currently eating fewer calories than MyPyramid minus 500 would suggest, you may have inadvertently put your body in starvation mode. When this happens your body reduces its basal metabolic rate (BMR) so that you can ‘live’ on fewer calories. Keep your body from going into this mode by spacing food intake no more that 4 -5 hours apart (except overnight). Do not eat 3 large meals per day, have 5-6 small meals, but stay within your calorie limit. Eating small frequent meals spreads out your fat consumption so that more of it can be digested properly when it reaches your intestines as well as keeping your basal metabolic rate higher. Another benefit to eating small, frequent meals is a reduction in heart burn (reflux).

Good luck to you.

For more information:

Go to the Diet and Nutrition health topic.