What are the dietary recommendations after gall bladder removal?

Q: I suffered gallbladder induced acute pancreatitis so pancreas operation/ERCP was done. Thereafter I underwent gallbladder removal. Presently I am only on antacid and eat well. During the whole episode my weight had come down to 51 kg from 68 kg. I am 175 cm tall. My present weight is 60 kg. Please advise me on what diet should I take?

A:Acute pancreatitis is the inflammation of the pancreas and is associated with sudden onset of severe abdominal pain. It usually develops as a result of passage of gallstones through the common bile duct. Because the gallbladder and pancreas share a drainage duct, gallstones that lodge in this duct can prevent the normal flow of pancreatic enzymes and trigger acute pancreatitis. It is not uncommon to have temporary digestive difficulties after gallbladder removal (cholecystectomy). 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 cholecystectomy, bile is still produced by the liver, but is released in a continuous, slow trickle into the intestine. Thus, when eating a meal that is high in fat content, there may not be an adequate amount of bile in the intestine to properly handle the normal absorption process. The change in intestinal bile concentration during high-fat intake may cause diarrhoea 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, brussel 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. Symptoms may range from burping and gas to a feeling of fullness (like the food isn't going the direction it should). The guidelines are as follows:- 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, mithai, peanuts etc. - use low-fat dairy products such as skim or low fat milk, reduced fat cheeses, low fat yoghurt 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 - limit the fat and oil intake to no more than 2-3 portions per day (1 portion = 1 tsp. oil/butter/margarine.While keeping in mind the restrictions in fat intake, balance your calorie through high carbohydrate intake. Carbohydrate is found in any food containing starches or sugars, including breads, rice, chappati, biscuits, 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.Also, make sure since the diet is low in fat you are getting enough of omega 3 fatty acids. The best source of omega 3 fatty acids would be fish. Flaxseed oil is another good source of omega-3. Other sources include soybeans, alfalfa, and walnuts. Adequate protein can be obtained from low fat milk and dahi, pulses, legumes, meat, fist, chicken, eggs. Watch out for the fat in the non-vegetarian food though it is naturally high and you might want to prepare those dishes with very little oil to balance it out.Do not eat 3 large meals per day, have 6 small meals. Eating small frequent meals also helps level out lipid levels. This way you spread out your fat consumption so that more of it can be digested throughout the day.Eating small frequent meals can also help you if you can't eat enough. If you have a problem with feeling full before you have adequately had enough to eat, it could be the cause of your weight loss. Eating small, frequent meals gives the digestive system smaller amounts of work at a time. Another benefit to eating small, frequent meals is a reduction in heart burn (reflux).