Unless you’ve had a gallstone or your gallbladder has been surgically removed, you probably think little of it. And that’s fine. But if it’s causing you serious pain or other problems, you may need to ditch this little organ.

  1. Your gallbladder serves as a storage pouch. While the liver is hard at work making the dark green bile that helps with digestion, the gallbladder holds the bile until you actually need it, says Erin Gilbert, MD, an assistant professor of surgery at Oregon Health and Science University in Portland. “It concentrates the bile into the form that’s best used for digestion,” Dr. Gilbert says. “When you eat, the bile is squeezed out of the gallbladder and goes into the first part of the small intestine, the duodenum, through the common bile duct.” The liver produces anywhere from 500 to 1,000 milliliters (ml) of bile per day, but the gallbladder can concentrate that bile up to tenfold and store 30 to 50 ml of the denser bile.
  2. Gallstones are formed mostly from hardened cholesterol.  Gallstones form when one of two substances — cholesterol or bilirubin — become supersaturated in the bile and crystallize, much the way sugar crystallizes when someone makes rock candy. Bilirubin is a brownish-yellow substance found in bile that results when old red blood cells in the liver break down. Your body normally eliminates bilirubin through your bowels (it’s the reason for the color of feces). Bilirubin-caused gallstones are rarer than those formed from hardened cholesterol, and are more common in those with blood disorders, such as sickle cell anemia.
  3. A low-cholesterol and low-fat diet is best for a healthy gallbladder. What’s the best diet for a healthy gallbladder? “Most gallbladder stones are formed from cholesterol, so eating a low-cholesterol and low-fat diet is best for gallbladder health,” says Cathleen Khandelwal, MD, a general surgeon at Cleveland Clinic.
  4. A diet good for your heart is good for your gallbladder, too. Any diet that would qualify as “heart-healthy” is “gallbladder-healthy,” too. That means a diet with some healthy monounsaturated fats, such as those in nuts, avocados, seeds, olives, peanut butter, and the oils from these products. Polyunsaturated fats should be part of that balanced diet, too, and are found in fatty fish, walnuts, flaxseeds, and vegetable oils. Avoiding foods that increase your cholesterol levels also reduces the risk of gallstones. Almost as important as what you eat, however, is how frequently you eat. “If you eat one large meal a day, it increases the likelihood of stones, because the bile sits in the gallbladder for a long period of time before it’s excreted,” Gilbert says. The longer bile sits around, the more time there is for cholesterol in the bile to become supersaturated and crystallize into gallstones.
  5. Rapid weight loss could cause gallstones. In addition to a healthy diet, a healthy weight keeps the gallbladder functioning well. Individuals with obesity have a higher risk of gallstones, but that doesn’t mean you should go on a crash diet to lose weight: Rapid weight loss can cause stones, too, Gilbert says. It’s fine to lose weight, but “you wouldn’t want to lose it all at once,” she says. Another way to stave off stones is to keep your cholesterol under control, including by taking statins if you have high cholesterol, she says. Some evidence supports regular vitamin C supplements to prevent gallstones, and oddly enough, drinking coffee appears to offer some protection against gallstones formed by cholesterol, too.
  6. Close to 12 percent of the population has gallstones, but only a few cause problems. In addition to those with obesity, and those who eat a poor or high-fat diet or have high cholesterol levels, pregnant women are also more likely to get gallstones, which means they may need to pay extra attention to fatty foods during pregnancy. Those with certain blood disorders, such as sickle cell anemia, may have a higher risk of the bilirubin-caused stones. Older adults and people of certain ethnicities, such as Native Americans, also have a higher risk of gallstones, and having a family history of them can double your risk of developing one. Certain medications, such as oral contraceptives, may increase the risk of gallstones, but the increased risk is small and should not prevent someone from taking the needed medication. In fact, up to 12 percent of the population has gallstones, Gilbert says, but only a minority of those cause problems.
  7. The most common sign of gallstones is intense pain. Up to 80 percent of people will never have symptoms for their gallstones, and nothing needs to be done about that, says Gilbert. But if there is a problem, you’ll usually know it: the pain can be intense. “The pain is generally described as sharp, stabbing, and very excruciating — a 10 on a scale of 1 to 10,” Gilbert says. The pain most commonly comes after eating a fatty meal because “fat is the strongest trigger for the gallbladder to empty,” she says. The  where your gallbladder is, below your breastbone, and can radiate to your back, Dr. Khandelwal says. It can last several hours and may be accompanied by nausea, she adds. But the pain can also be a dull ache on the right side, like an upset stomach or heartburn with bloating, Gilbert says.
  8. The best test for gallstone is an ultrasound. The best test for gallstones is an ultrasound. “It’s quick and safe and gives us a lot of information about how the gallbladder looks, and it has pretty high accuracy,” Gilbert says. The ultrasound tech will be able to see gallstones or gallbladder irritation, such as a thickened wall or fluid around the gallbladder. Some patients may be referred for a second kind of test called an HIDA (hepatobiliary) scan, in which a radioactive chemical is injected into your arm and the tech watches what happens when it reaches your gallbladder. Generally, HIDA scans are only performed on patients who have other underlying conditions or who have gallbladder pain symptoms, but no stones on an ultrasound.
  9. Escaped stones could lead to jaundice or pancreatitis and require surgery. If it’s not causing symptoms, or if you pass it as a few lucky people do, nothing. “But if they are causing trouble,” Gilbert says, the gallbladder may need to be removed. If the person is experiencing pain, called biliary colic, or develops a gallbladder infection, called cholecystitis, gallbladder surgery is probably in the stars. “If the stones get outside your gallbladder and travel down the duct, they can cause some pretty serious complications, so it’s important to have them taken care of if you’re having a problem,” Khandelwal says. Escaped stones can cause obstructions in the ducts that lead to jaundice or pancreatitis, Gilbert says. Any of these symptoms would require gallbladder surgery, called cholecystectomy.
  10. Gallbladder removal surgery is usually an outpatient procedure. If you need a cholecystectomy, or gallbladder removal surgery, it will usually mean a week or two off from work. The laparoscopic surgery involves one incision by the belly button, and two or three under the ribs on the right, Gilbert says. Although it’s usually an outpatient surgery, it does require general anesthesia because the surgeon will fill the abdomen with carbon dioxide to expand it and make it easier to work. Expect three to five days of soreness, which may require narcotic pain medication, and avoid strenuous activities for at least two weeks, Gilbert says. People typically fully heal within four to six weeks and may experience diarrhea in the short-term. Maybe one to two percent of people will have loose stools whenever they eat particularly fatty or greasy meals, Gilbert says. But removing the gallbladder should not cause weight loss or weight gain, and will not cause any vitamin deficiencies. Most people without a gallbladder should not expect other changes over the long-term. “In fact, they’ll be able to eat things they couldn’t before,” Khandelwal says. “The liver continues to make bile and drip it into the stomach and intestines. It may take a little longer to digest fried chicken, but maybe not.”