Saturday, December 12, 2009

My Response To A Question About Low Carbs and Pancreatitis

Tying in to the low carb/health theme here, I've got a relative who'sbeen having issues related to a fatty liver. He's in a hospital rightnow with complications resulting from gall stones blocking hispancreatic duct(s) and has a nasty case of pancreatitis. Nearly everything I've read on the web recommends (not surprisingly) a highcarb, low fat diet for pancreatitis, which just strikes me as soooooowrong (fat is inflammatory and will make your pancreas work harder??)!I've found great articles on low carb for fatty liver, but nothingdefinitive regarding pancreatitis. Any ideas?Thanks!

My response;

Pancreatitis is a tricky thing.The term pancreatitis refers to inflammation of the pancreas. Unfortunately in this condition the pancreas literally 'eats itself.' When the pancreas is inflamed the treatment is generally to starve the body and allow the inflammation of the pancreas to subside. Problem is that the pancreas is responsible in the digestion of all foods. That is, carbs, proteins and fats.So even backing off on the carbs, the inflammation will persist since the pancreas creates the enzymes needed to digest protein and fat (cholesterol is utilized in a different manner, it is not digested like proteins and fats are.)

Having said that, certainly backing off on carbs will help the pancreas heal because it will not have to create the enzymes needed for carb digestion, and since insulin is also created by the pancreas, this secretion will be less as well. Thus, backing off on carbs will help the pancreas get its well needed rest, and will be beneficial in this disease as well. Of course, the individual will stay on a restricted carb regimen for the rest of their life; not jut while they treat the pancreatitis.

Now with a patient with gallstones, all bets are off. First off, they usually need the gallbladder removed, this almost always cures the pancreatitis. (Side note-the 2 most common causes of pancreatitis are gallstones and alcohol abuse.) If the stones have blocked the pancreatic duct, they will usually have a diagnostic test referred to as an MRCP (Magnetic Resonance Cholangio Pancreatography) this will help show the docs where all the stones are that may be blocking the pancreatic duct. In this particular situation, that is, gallstones which have migrated to the pancreatic duct, the gallbladder will be removed.

Once the gallbladder is out, the person may start a low carb regimen. The only caveat is that they need to be careful with their fat and cholesterol consumption in the first few months, and sometimes up to a year after the gallbladder was removed. This is to allow the body to adjust to the amounts of fat/cholesterol the person is consuming. Therefore, this person may well have to eat 5-6 meals a day, instead of the usual/customary three.

Remember that the gallbladder is the reservoir for bile and in response to a fatty or cholesterol containing meal (and after the gallbladder is greeted with a hormone referred to as cholecystokinin) it contracts, releases bile, and the bile helps to emulsify the fatty/cholesterol containing food particle; thus aiding in digestion.

I have had many a patient start a low carb eating style after removal of their gallbladders. So long they eat smaller fatty/cholesterol meals, they do just fine. As a side note, since the gallbladder contracts in response to a fatty/cholesterol meal, that is precisely why we need to avoid these foods when we have stones. If we eat a meal with fat/cholesterol, the gallbladder will contract. Not only is this extremely painful for the person, it can cause infection of the gallbladder and facilitate the progression to a gangrenous gallbladder.

As another side note, the reason we develop gallstones is because we are NOT eating fat/cholesterol in our foods. Reason: The gallbladder responds to a fat/cholesterol meal by releasing the bile stored within. If one follows a fat/cholesterol free diet, the gallbladder has nothing to do, the bile just sits there, and eventually starts to precipitate stones. It is because the person is not eating fat/cholesterol that stones develop. After the stones develop and the person eats fat/cholesterol, it will cause severe pain and the person winds up in the ED or doc's office. It is there that the misguided physician will exclaim "Ah,hah. See eating fat and cholesterol did this, so you need to not ever eat that stuff again." This doc obviously does not understand that it was the avoidance of fat/cholesterol that created the stones, not the other way around.

There was mention of steatosis, or fatty liver, and yes, this condition absolutely responds to a low carb regimen. I have a number of patients with this condition who have been cured with a low carb approach. Unfortunately, I have a few patients who had a fatty liver and were treated the conventional way (low fat/cholesterol) before they got to me who went on to develop cirrhosis. Luckily, they are responding to a low carb approach and even though I limit their protein intake, they are still eating more than mainstream medicine suggests; and their numbers continue to improve.

Hope this helps!

dr jim


  1. Dr. Carlson,

    I'm sure you must know this and the error was just a typo but for the benefit of your readers and since it is relevant to gallbladder dysfunction I must point out that you probably meant to write "steatosis" or "steatohepatitis" as a synonym for 'fatty liver' rather than "steatorrhea" which is as you know, excess fat in the stools which can be caused by such things as pancreatitis, cholelithiasis (gall stones) as well as some other digestive disorders.

    All the best,

    KW (a somewhat pedantic fan, RN, lowcarb fanatic and LI boy living in the South).

  2. Yup, you're right :-) I'll fix it. Thanxs!

  3. Hi,

    I have enjoyed your webcasts that Greg posted for us on LCF's..I am a lowcarber and have been for 8 years.

    However, in the midst of my lowcarbing I had my gallbladder removed.
    Honestly, I have never had any major digestive problems because of its removal. However, are you saying that it might be better if I eat smaller meals and more meals during the day for better weight loss?

    I have gone from 195 to 135, then bounced back to 153, which is where I am stuck. Of course, I am older (60) and hypothyroid, but optimized with my meds.

    So, do you think that I should be taking in less fat for a better result
    because I don't have a gallbladder..


  4. Coming in late on this but my little girl's dad is missing his gallbladder. He has trouble with some dietary fats even now (and it's been out something like seven years or more), but he finds that medium-chain triglycerides don't seem to have that effect. Coconut oil doesn't bother him.