17: Why Do Fatty Foods Cause Bloating? Your Gallbladder & Bile May Be the Missing Link
Do fatty foods leave you bloated, nauseous, uncomfortable—or running to the bathroom?
It might not be a food intolerance. And it might not be “just IBS.”
In this episode of Team Gut Girls, Dr. Dominique Vanier, ND, Dr. Whitney Baxter, ND, and Dr. Christina Carew, ND explore the overlooked role of the gallbladder, liver and bile in fat digestion—and why problems with this system can look a lot like IBS.
We break down what actually happens when you eat fat, from the liver making bile to the gallbladder releasing it and pancreatic enzymes finishing the job. You’ll learn why a normal gallbladder ultrasound doesn’t always mean your gallbladder is functioning normally, what biliary dyskinesia is, and why a HIDA scan may sometimes be used to assess gallbladder function.
We also dig into bile acid malabsorption (BAM), an often-overlooked cause of chronic diarrhea and urgency that may be hiding behind an IBS-D diagnosis.
And if you’ve had your gallbladder removed but still experience diarrhea, bloating or unpredictable digestion? We explain why digestion can change after gallbladder removal and why bile may still be part of the conversation.
If your digestive symptoms seem especially connected to fried foods, creamy meals, avocado, oils or other high-fat foods, the pattern itself may be worth paying attention to.
Your toilet bowl can give you clues, too. Greasy or oily residue, floating stools, unusually pale stools or changes that repeatedly occur after higher-fat meals are useful information to bring to your healthcare practitioner.
The goal isn’t to diagnose yourself or spend your life eliminating more foods. It’s to understand the pattern, ask better questions, and investigate what might be happening upstream.
Because Better Gut Health Changes Everything.
In this episode:
- Why fatty meals can trigger nausea, bloating, urgency and diarrhea
- How your liver, gallbladder, bile and pancreas work together to digest fat
- Why a normal ultrasound doesn’t necessarily rule out a functional gallbladder problem
- Biliary dyskinesia and the “lazy gallbladder”
- The connection between bile acid malabsorption and IBS-D
- Why diarrhea can happen after gallbladder removal
- Why going completely fat-free isn’t necessarily the answer
- What greasy, oily, floating or pale stools may be telling you
- Signs that warrant a conversation with your healthcare provider
- Practical ways to track patterns and ask better questions about your digestion
00:00 Fatty Food Fallout
01:35 Detox Trend Talk
03:21 Myth: A Normal Ultrasound Means My Gallbladder Is Fine
04:22 Bile as “Dish Soap” for Fat Digestion
05:45 Myth: Fat Makes Me Sick, So I Should Go Fat-Free
08:45 The Fat Digestion Relay Race
10:30 IBS or a Bile Issue?
14:16 Signs of a “Lazy” Gallbladder
17:53 Digestion After Gallbladder Removal
20:39 What Your Stool Can Tell You
24:07 Liver & Bile Clues
27:46 Practical Next Steps
32:33 Recap & Closing
Transcript: 17: Why Do Fatty Foods Cause Bloating? Your Gallbladder & Bile May Be the Missing Link
Fatty Food Fallout
Dr. Domnique Vanier, ND: Welcome to another episode of Team Gut Girls. So today, we’re talking all about the gallbladder and liver connection. If you’ve ever eaten something rich like a burger, fries, a big avocado, maybe a plate of pasta with creamy sauce, and then about 30 minutes later you’re feeling like a greasy brick has taken up residence in your upper belly, this episode is for you, and so is the bathroom situation that nobody wants to talk about after brunch.
Dr. Whitney Baxter, ND: A lot of the patients tell me, “I just can’t handle fatty food anymore.” They feel sick or queasy from takeout. Creamy meals or sauces make them feel like a rock, and they’ve been quietly starting to avoid half the menu
Dr. Christina Carew, ND: And of course, the internet, TikTok, and Instagram has a verdict for all of us. Some people will tell you it’s a food intolerance, or you might need to detox, or go carnivore, or go [00:01:00] fat-free, or buy this super great supplement that solves all of your problems.
But a lot of time, the real issue is upstream of food entirely. We actually just had a conversation about how food is often to blame, but not often the cause.
Dr. Domnique Vanier, ND: Yeah, and so today we’re talking all about the two chief organs that do the quiet, unglam- unglamorous work of fat digestion, and those are your liver and gallbladder, and then what happens when they stop pulling their weight.
Because when fat digestion breaks down, it shows up in ways that can look exactly like IBS, and we’re gonna talk a lot more about that.
Detox Trend Talk
Dr. Domnique Vanier, ND: But first, Christina will talk about what’s trending this week
Dr. Christina Carew, ND: So this week’s reels that might have entered into your inbox could be things like, feeling sick after fatty food or the need for a liver detox.
You might see some amazing, infographics about castor oil packs or juice cleanses. So [00:02:00] certainly there’s a lot of discussion about, you know, do I need to detox? Is it the time? and so what do you think about that?
Dr. Domnique Vanier, ND: It’s interesting. I feel like maybe one of the top questions I get in practice is do I need a liver detox?
‘Cause certainly there’s so much marketing around this. and like we’ve talked about in previous episodes, it’s packaged like this simple thing that is easy, we can point to. If I detox, I’ll feel better. But the thing that I think people should know is that our liver is detoxing, it’s do- detoxing 24/7, and is its role.
and so if fatty meals are making somebody feel miserable, I think the more useful question isn’t, like, how do I detox? It’s is my body actually making bile? Is it storing it? Is it releasing it on cue when fat shows up? We wanna think of this like it’s more of a plumbing question, and there’s gonna be no cleanse that actually fixes plumbing
Dr. Whitney Baxter, ND: Yeah, I like that.
And detoxes sell because, like [00:03:00] we’ve said before, it’s easy, it’s packaged. It- they make it make sense and really easy. But another thing we’ve talked a lot about is that digestion is a whole series of coordinated events. There’s a lot of hormone signaling and different functions, and if that gallbladder isn’t squeezing, some green juice isn’t going to make it squeeze.
Myth Normal Ultrasound
Dr. Whitney Baxter, ND: All right, so let’s move into our myth-busting segment. Starting with the first myth, my ultrasound is normal and I still have my gallbladder, so my gallbladder can’t be the problem.
Dr. Domnique Vanier, ND: Mm-hmm. Not necessarily. so when a gallbladder looks perfectly normal on an ultrasound, and what we mean by normal is they’re looking for, things like stones, sludge, inflammation, it can still fail to contract properly, and that is not gonna get picked up on an ultrasound.
And that is a real named condition called biliary dyskinesia, and I’ve only ever had a handful of patients that actually have come to me and said, “I have this clinical diagnosis,” but certainly I know a lot of them, [00:04:00] would meet that diagnosis if they actually had the right test. so this condition refers to a gallbladder that’s present, but we’ll think of it like it’s lazy.
so we’ve got a lazy gallbladder. So no stones is not the same as, working and functional, and this is actually exactly where a biliary dyskinesia diagnosis is considered a functional gallbladder disorder.
Bile As Dish Soap
Dr. Domnique Vanier, ND: So we wanna think of the gallbladder more like in the metaphor that bile is dish soap.
And so when we think about a greasy pan in the kitchen, we know that cold water the grease, and so it rolls right off the grease. But when you add dish soap to the greasy pan, grease will break into tiny droplets and then they’ll more easily rinse away. And you wanna think of bile like your body’s dish soap.
So it’s gonna break these big blobs of dietary fat into microscopic droplets so that your, then your enzymes can come in and actually get at them, and this allows your body to absorb the fat. So there is a [00:05:00] whole process around this. But when we don’t have soap on the pan or no bile, when we’re discussing the gallbladder, that grease is gonna hang around inappropriately, which when you look in the toilet, that’s exactly what you’re gonna see.
A- another… We love our analogies on this podcast. So another analogy is salad dressing. And if you didn’t know about this, you may wanna try it. So you have your oil and your, vinegar, and so vinegar is more of the water properties, oil is your oil properties. But when you add mustard, it’s an emulsifier and it mixes it together.
and that’s why bile is absolutely essential to allow your body to absorb fat, because it acts as an emulsifier
Dr. Christina Carew, ND: Amazing. I love the dish soap. I’m gonna use that this afternoon.
Myth Go Fat Free
Dr. Christina Carew, ND: so the second myth, fat makes me sick, so I should just eat fat-free forever. There’s also in this sort of category is, people that eat fat-free because they think fat makes them gain fat, and also people that eat [00:06:00] fat-free because they think that’s healthier.
And so in reality, fat-free actually causes quite a bit of symptoms. I often will ask people, “Why do you do that?” And actually it’s someone this morning why she did that, and she said, “Because my previous practitioner told me that I should do that.” And I was like, “Okay.” But, like, why? And, was it for a reason?
How long were you doing it for? And so what happens when we eat fat-free is that fat, is used to absorb fat-soluble vitamins. It’s one of the reasons why sometimes your practitioner will tell you to take a vitamin D or a vitamin A that’s in fat instead of it being in a powder form. And if it is in more of a tablet or powder form, they’ll tell you to have it with food that has fat in it.
And part of that is the fat-soluble vitamins need fat in order to trigger the bile so that can be reabsorbed. So when we’re eating fat-free, we’re often avoiding some of those fat-soluble vitamin absorptions, so that’s vitamins A, D, E, and [00:07:00] K. And so we know that, some of these play a big role in skin health, in hormonal health, in immune system health, in bone health, so certainly a big player in lots of things that we’re going through.
And then on long-term, ultra-low-fat eating can actually result, not only just in those low vitamins, but then also like the body’s starting to see, low fat content. So you might see, dry eyes, dry skin, dry vaginal tract, dry inside of your mouth. So fat is really important. If we didn’t have it, we would all just melt like sugar.
Dr. Whitney Baxter, ND: It’s true. love. yeah, it all comes together, like these digestion things and like nutrient malabsorption. And we always think about food sensitivities or intolerance. So why do you think many people who have difficulty digesting fats stay stuck on this it’s just a food intolerance piece?
Dr. Domnique Vanier, ND: I, I think, for at least for some of them, they may have already been [00:08:00] just slapped with you have IBS diagnosis, so therefore, like I have a food intolerance, which we know is true in IBS. There’s many food intolerances that can happen, which we’ve gone into in other episodes. So th- these individuals will have the same symptoms that overlap perfectly with IBS, the bloating, the urgency, loose stools, the discomfort or even pain after meals, sometimes even the pain radiating like to other areas.
and so they’ll get the IBS label to cut the foods, and that’s it for some people, where they may just not look further at the bile system underneath. but for a number, a surprising number of people, that is a key piece that has been missed And so let’s talk a little bit more about that insight and education piece, more about fat and its role.
Relay Race Digestion
Dr. Domnique Vanier, ND: And so point number one is that fat digestion is a relay race. At least that’s how we want to think of it. So digesting fat is not just one step. It’s more of like a handoff between many players. And if any one of them [00:09:00] fumbles or has an issue, somebody is going to feel it. And so that means, the liver.
We know that makes bile continuously. We want to think of it as like the soap factory. Then we have the gallbladder, and the gallbladder is your storage. It’s gonna store and concentrate that bile in between meals. and it’s going to squeeze it out when it’s needed. Then we have something called CCK or cholecystokinin, which is a gut hormone.
And let’s think of that one like it’s a doorbell. So when fat arrives in the small intestine, you’re gonna have your CCK hormone. It’s gonna ring and tell the gallbladder we need to release bile now. And then lastly, the, we’ve got pancreatic lipase, which is a digestive enzyme that actually chops the emulsified fat into small pieces, small enough to absorb.
So it is one coordinated process, the liver, the gallbladder, CCK, and your pancreas all acting harmoniously together in order to allow somebody to digest their dietary fats [00:10:00]
Dr. Christina Carew, ND: So really when you think about it, there’s like all these different processes or all these different steps that need to be done in order for the body to relay and have a smooth-running system.
And so there’s all different kinds of issues that might show up. So bile showing up late, maybe it’s in the wrong amount, maybe there’s no bile at all that’s coming out. And when fat marches through the system kind of half-digested, we start to see some digestive symptoms, which can include bloating.
IBS Or Bile Issue
Dr. Domnique Vanier, ND: And then certainly bloating on that topic is a lot of times we think about IBS, so the point number two being the IBS fat digestion overlap. and this is a really big one, and there’s some stats that may surprise people. There’s a large percentage of people who have been diagnosed with irritable bowel syndrome, or IBS, specifically the diarrhea prom- predominant type, that actually don’t have textbook IBS symptoms.
They, actually have a bile problem that’s hiding within the [00:11:00] diagnosis itself. And so I like stats, so I like thinking of this kind of like in numbers, and we know that there’s roughly one in four people that are diagnosed with, the diarrhea type IBS that actually turn out to have a bile acid malabsorption.
even some research puts it as high as one in three people who have IBSD actually have the bile acid malabsorption issue. and so for comparison, this affects around 1% of the general population. and when you think of it in comparison to other digestive issues, celiac disease also affects about 1% of the population, which we screen for all the time.
So the point being is this bile acid malabsorption issue is more prevalent than we think and is definitely going, I believe, under the radar for at least a lot of pa- patients. and so in translation, bile acids that were supposed to be reabsorbed and recycled, instead they’re gonna spill into the colon, where they act [00:12:00] like a, an irritant and a laxative, and their laxative effect is, brought upon by like them actually just pulling in water into the colon, and that will affect transit time.
It can also lead to things or symptoms like urgency, loose stools, even sometimes burning stools. And again, all this looks like IBS, but it’s a fat issue, and it gets treated like IBS. But the driver is bile, not exactly a sensitive gut. Or it’s bile, but it… and then it’s causing the sensitivity, but the upstream issue is the bile
Dr. Whitney Baxter, ND: But that’s really interesting ’cause people do spend years cutting out foods that sh- would otherwise trigger IBS, and these could be, like, good foods, high fiber, which we need to fuel the microbiome to keep things in check, but also even dairy, which could be high in fat, right?
Dairy,
Dr. Christina Carew, ND: yes.
Dr. Whitney Baxter, ND: And then it starts to become confusing, oh, what’s triggering this still, though? It’s random. I had a lot of avocado and oil, and I had n- no dairy or any gluten in my salad, but I’m [00:13:00] still getting this random urgency. So this is interesting. That could be cutting out the wrong foods this whole time.
Dr. Domnique Vanier, ND: And I also wonder, some people can have multiple diagnoses, right? some people may actually have IBS and biliary dyskinesia happening at the same time, and that’s where it can be quite confusing. but the whole cutting out the foods aspect or chasing foods to cut out w- not, when it’s not necessary absolutely matters, because bile, a bile problem has its own path to feeling better.
sometimes patients may respond partially to a plan, maybe not at all, when it’s for IBS and they actually don’t, they don’t have IBS. the goal, again, is not to be chasing food triggers forever.
Dr. Christina Carew, ND: It’s interesting ’cause, this can also be, a functional problem, right? We could have, the ileocecal valve, which is supposed to be this one-way trap between the small intestine and large intestine not closing, and so we’re getting the bile dumping in, which can be causing this, bile acid diarrhea, which isn’t even a [00:14:00] dyskinesis issue.
It’s like a, it’s like a function issue. Yeah. And so there’s, like, all these different places along the route where maybe things aren’t working or aren’t moving in the way that’s planned. Everything is in steps, and so you don’t go to grade eight before you go to grade two. Same kind of idea.
Lazy Gallbladder Signs
Dr. Christina Carew, ND: And so the third area that we want to talk about is, biliary dyskinesis or the gallbladder not squeezing.
So think about the gallbladder is, one of those, stress balls, and when you squeeze pushes bile into the system in order for it to go and help to break down your fat and emulsify it as Dr. Dominique shared, and then also help to break down protein. And the gallbladder’s bile is actually a signal to our small intestine to get the transit system moving.
And so if that’s not happening, things like constipation and bloating are more com- more common. And so when the gallbladder doesn’t squeeze, it’s actually a function. So when you think about an X-ray or an ultrasound, it’s a picture. It’s not really [00:15:00] showing when something is happening or not, which is sometimes why it’s frustrating that we can get all this investigation but not really see it.
So there is a scan called a HIDA scan where doctors can actually measure the ejection fraction, so how much bile is squeezed out of the gallbladder. It’s just, not commonly really done. And so what often happens in those types of tests is they find that the gallbladder firing is maybe 30 to 40%, so it’s much more weaker.
two in five times that you’re eating, it’s coming out, but the other three it’s not, which starts to understand, like, why sometimes is it okay when I eat this food and sometimes it might not be. Where are we seeing the patients that we see? We’ll see, a nagging pain or nausea.
They often talk about up right, upper right, belly sorta symptoms. So if you take your hand and you put it under your ribcage, that’s where your liver and gallbladder lie for most [00:16:00] people. And so sometimes that oh, it got a stitch there. It feels, a little uncomfortable.
it may look very normal. So often it will look normal when someone lifts up their shirt or if they look on a imaging diagram because it’s not that the gallbladder has changed shape in any way. It’s not enlarged. It’s not smaller. It’s just not squeezing. about 10 to 20% of people have gallbladders removed, and probably even more of you who are listening to this podcast, ’cause if you don’t have your gallbladder removed, some of these bloating things may actually not be a problem.
And so it’s a very common situation. And so a gallbladder removal doesn’t mean you no longer have bile, it just means you don’t have a storage vehicle for it. So it’s every time you made food, if you didn’t have a fridge to put it in to preserve use it now or lose it. And so even though the gallbladder can look normal, or even if you don’t have a gallbladder, you still need bile to make some of [00:17:00] these, processes move.
And so if it’s not coming out, then it’s not really helping. And so a clear ultrasound or a clear imaging scan doesn’t necessarily mean that this isn’t the problem. It just means that there isn’t something blocking the e- the exit.
Dr. Domnique Vanier, ND: Mm-hmm. Yeah. said. Yeah, it’s interesting ’cause the biliary dyskinesia being a functional issue, right?
we can’t see it on an ultrasound, but we can see it on that specialized scan that pretty much nobody gets. it progresses and it continues to be an issue, this dyskinesias, it can result in a gallbladder removal, right? That’s more then we have a structural issue. So it’s, it’s a path that we want to avoid
Dr. Whitney Baxter, ND: And it’s so common in a lot of different age categories, right?
young people are co- now coming in with gallbladder removals, or they’re on the list. that is the next step for their symptoms, which is a lot of people.
After Gallbladder Removal
Dr. Whitney Baxter, ND: So let’s talk about this, life after this gallbladder re- removal. So do all of your symptoms go away, all the pain- … all the cramping, [00:18:00] all the diarrhea-
once this is done? And what are your follow-up instructions? What are the dietary instructions? What education are you getting afterwards? Who’s following you? Who’s helping you? It’s interesting. You get your post-op follow-up, and then da.
Dr. Domnique Vanier, ND: Bye-bye.
Dr. Whitney Baxter, ND: And then they come see us. So Dr. Christina just gave us a really good picture of this, right?
So once that gallbladder is gone, that little storage container, you no longer eat a fatty meal, triggers your gut to now squeeze out that bile to help. Like the pancreas, it’s all one organ. It gets signaled, and makes the enzymes, and then dumps it into the small intestine. The liver and the gallbladder have to work together.
So when we remove that extra storage facility, things still need to happen. The liver is still continuously making bile. It’s just now getting trickled into the small intestine instead of into its little storage sack, whether or not there’s a meal to work on. In some people that’s [00:19:00] okay. They don’t notice this consistent release of bile into the intestine.
But for ever, that steady drip overwhelms the recycling system downstream, so into the colon, like Dr. Dominique talked about earlier, and this is where it’s going to cause looser stools. So roughly 20% to 30% of people are noticing these looser stools or diarrhea after their gallbladder is removed. At least for a little while maybe their system will recalibrate and get used to this new signaling system essentially, but that can happen initially.
And then among those people who develop ongoing diarrhea afterwards, the majority is driven by those bile acids, so once they hit the large intestine. So the same mechanism as bile acid malabsorption, it’s just triggered by the surgery.
Dr. Christina Carew, ND: I had a woman this morning that had this. She had her gallbladder out six months ago, still getting, episodes of diarrhea and constipation.
Dr. Domnique Vanier, ND: Which [00:20:00] is frustrating for people ’cause typically leading up to a gallbladder removal, they’re having issues, and then the surgery happens, and then not, it doesn’t resolve things for everybody. but I think the question being is this something that people just are expected to live with when they have symptoms p- post-gallbladder removal?
And the answer is no, and that’s the point here. it’s often manageable once it’s actually named and discussed with somebody’s provider. the challenge is really when somebody just assumes this is how I am now forever, and I will therefore, maybe cut out some foods. so definitely talking about it with somebody’s, naturopathic doctor or medical doctor or what have you is a really important point.
Read The Toilet Bowl
Dr. Domnique Vanier, ND: Next tech- educational point is maybe my favorite, which is called reading the toilet bowl. And yes, we really mean that. Actually, we have these conversations with our patients all day long, pretty much every day of practice. there’s sometimes people maybe are a little too polite to bring it up.
But looking in the toilet bowl absolutely [00:21:00] gives us a lot of really important information as to what’s going on inside, and is genuinely one of the most useful signals that your body can give you. So when it comes to fat, and when fat is not being absorbed, or digested, and when it comes out the other end, there will be a distinctive looked, look in the toilet bowl.
and so what we mean by that is somebody may see several of the following, all of the following or just one of the following, but, greasy or oily stools is one of them, and you might see an oily film or droplets on the surface of the water. Somebody may see fl- a floating stool that’s particularly difficult to flush, and that’s because this extra fat makes the stool more dense, and so it floats to the top.
Somebody may, also see a change in the color of their stool, which is normally supposed to be a darkish brown. but they may see a pale clay colored or even tan instead of a normal brown, and that’s because bile gives stool [00:22:00] its color, and so pale may mean bile isn’t getting through. what’s also important is looking like after the toilet has flushed, whether there’s a greasy stain or greasy mark left on the toilet bowl itself, which would be a residue that’s difficult to rinse away, and that residue is itself undigested fat.
And then somebody may also notice like an unusually foul-smelling stool, let’s say like they’ve been eating their normal diet, like maybe a high dense meal, like high vegetables, good proteins, et cetera, but it smells quite off. that may be an indication that they have a fatty stool.
but another important note is that like this may happen i-infrequently or just occasionally after like more of an indulgent meal, and that’s not really something to worry about. It’s more an issue if it’s happening quite regularly, there’s a regular pattern, and that may mean that your fat digestion system is waving a flag.
And like we’ve mentioned, chronic fat malabsorption can also slowly lower somebody’s [00:23:00] fat-soluble vitamins, which are A, D, E, and K over time, and that in itself can lead to other issues in other systems of the body
Dr. Christina Carew, ND: I also ask people, if they use a lot of toilet paper.
Dr. Domnique Vanier, ND: Ooh.
Dr. Christina Carew, ND: do you feel like it’s just always there?
because that sometimes, they may not check as much, but they might be like, “Oh yeah, like I’m using an enormous amount of toilet paper.”
Dr. Domnique Vanier, ND: That’s helpful.
Dr. Whitney Baxter, ND: And it’s important to bring these up and ask these specific questions because people aren’t looking, people aren’t talking about this with other people to understand what’s normal, abnormal, right?
They might not think much of it and think it’s a thing. Like even the cl- the floating or the color of our stools.
Dr. Domnique Vanier, ND: Totally.
Dr. Whitney Baxter, ND: Like ever thought, like what is
Dr. Domnique Vanier, ND: normal? no such thing as TMI in our offices. Yeah. Start looking. let’s talk about it.
Dr. Christina Carew, ND: I had one guy bring me a video. I was like, “This is a lot.
Probably don’t need the video.” Video might be too hard.
Dr. Whitney Baxter, ND: Maybe just pictures. Pictures are okay.
Dr. Christina Carew, ND: Pictures are… Yeah. they also, like it [00:24:00] was a series of pictures that were made into a video. Yeah. Well- It’s a lot. I get the, I get a lot.
Liver Sluggish Clues
Dr. Christina Carew, ND: So we talked a lot about the gallbladder itself, and the gallbladder, as we alluded to, is really attached to the liver, and the liver and gallbladder sort of work in tandem.
And so sometimes the issue isn’t necessarily, the bile. It may also be the liver. And it’s interesting because a lot of the treatments that support one support the other. And how do we know which one needs to be adjusted or fixed? it’s not necessarily that we have to be so certain about it, because a lot of the treatments do overlap, but when the d- the liver is sluggish, then it can affect certainly the bile.
And a sluggish liver, what that might look like is you might have been told on an ultrasound that you had a fatty liver. you might see something on your, blood tests, [00:25:00] like a high triglycerides or high fasting insulin. we know that those are kind of indicators that the liver’s, storing things and are more likely to be indicators of fatty liver.
your liver enzymes might be higher, so those can be objective or sub- subjective things, objective things that can tell us. when we’re thinking about the quality and the flow of bile, then we’re thinking about some of these descriptions about what does the stool look like, how do you feel, are you getting symptoms?
and really, gut symptoms and liver bile symptoms, they all in the same tube, in the same system, and so it’s hard to know, which one is which one. what are things that should make you go see a doctor more frequently? So certainly, Dr. Dominique alluded to, having things that were a long time persistent, for sure.
If we’re getting any kind of, pale or clay-colored stools, so some people will even say, they have white stools. anything that’s, darkening of [00:26:00] urine, so it might be, like, really dark yellow. Once in a while, totally understandable if you’re dehydrated or first thing in the morning, but if your urine’s always really dark.
some people will notice that their skin or the whites of their eyes become a little bit more yellowed. so those can be ones. Itching can be another one, so it’s like skin feeling really itchy. We might have that upper right-sided, belly pain, so like right under the ribcage. It might be severe, it might be dull, but like always there.
we might see things like, those fat-soluble vitamins on blood tests, like, “Oh, my vitamin D is really low, but I keep taking vitamin D.” Yeah. we may have unexplained weight loss, so anything where we’re not absorbing our fat. I would say, like fat is also a big driver of memory and skin health and anything that has any kind of, like watery texture to it.
So like those might be not things we’re thinking about, but if all of a sudden you’re like, “Oh, and my memory is [00:27:00] also failing me, and my eyes are really dry,” then we’re starting to think about like what are the things that connect this all together? and then bile will change the color and texture of things.
So that’s like a good part is that, this changing of the stool will help us. The bad part is if you have iron, for instance, that you’re taking iron because you’re low in that because you’re not absorbing very well, your stool’s always gonna look black, but it’s maybe that the stool is black.
and so sometimes it’s even, important to take a break from your vitamins, especially the ones that color the stool, for a short period of time if you’re thinking, “Oh, maybe I do have some bile issues or digestive issues.”
Dr. Domnique Vanier, ND: mm-hmm, or like taking a break from blueberries and beets and other things that we know can add some color to the stool.
Yeah.
Practical Next Steps
Dr. Domnique Vanier, ND: So let’s talk about some practical takeaways, and remember, this is not prescription. It’s the education part. We want to watch the pattern, not just the food. So let’s take a step back from the food and look at the full picture. [00:28:00] We want to notice whether symptoms track with fat specifically. So thinking am I reacting to a greasy takeout, creamy sauces, fried foods, rather than with a single, like a single bad, quote, bad ingredient?
A fat pattern we know is gonna point somewhere very different than a gluten or dairy pattern. And also, let’s maybe break that down even further and start noticing like is the type of fat, changing my stool patterns or my digestive symptoms? So for example, am I reactive to the monounsaturated fats, like olive oil and avocados or polyunsaturated fats which tend to be easier to digest, or is this happening with just the saturated fats like the high-fat dairy or like fatty meats?
those are all important pieces of information that your practitioner can help you work through.
Dr. Whitney Baxter, ND: And then afterwards, and that could happen like pretty quickly or within that week of having those meals, take a peek. Look back at your stools. Notice if you’re [00:29:00] wiping more or if it has a different odor than what it typically does.
it’s not gross, it’s data. It’s data for it’s data for your practitioner. And it just helps connect the dots to figure out if this is fat. and then to see, like Dominique said, what types of fats could be making this worse if this is an o- a thing that you’re dealing with chronically and you’re not really notice any change or worsening.
But maybe the amounts or types could be flaring things.
Dr. Christina Carew, ND: And not just going fat-free, but instead thinking about, what are you eating with the fat? So if we eat more fibery things, that can help to absorb, or we’re not eating fat on its own only, that can make a big difference. we might try spreading fat out, so instead of having, a really greasy, crazy breakfast or meal, spreading it out a little bit so that you’re having some fat with every meal instead of a lot all at once.
But cutting it out entirely can be a problem, [00:30:00] and often we’ll see that as a result of low vitamin D, low vitamin A, and some of those others. So it’s not really a strategy to just say, “I’m gonna go low fat, low fat.” It’s more about, how do we integrate it in a way that feels more comfortable.
Dr. Domnique Vanier, ND: I wonder how many people, back when there was the low-fat craze, whenever that was, ’80s, of, like, how many people that were, chasing zero fat were actually deficient in a lot of important vitamins.
That would be interesting know that information. lastly, there are ways that somebody can naturally support their own bile flow gently, and we wanna think about, the bitter foods. So bitter foods include arugula, lemon, there’s many others, some of the cruciferous veggies. Again, cruciferous veggies sometimes can irritate IBS, but anyway, th- there- there’s a large number of foods underneath the bitter foods category.
staying well-hydrated is also important. Moving after meals, can be low risk and can support the movement of somebody’s digestion, [00:31:00] everyday habits that support the whole bile and motility system. So this is obviously not a cure, but it’s more just, a friendlier baseline while somebody is trying to get some further answers.
and then, concurrently, somebody will likely be talking to their practitioner throughout all this. And so some helpful phrases that, somebody can bring to their next appointment could be, for example, my symp- saying, “My symptoms seem tied specifically to fatty meals. Could this be a bile or gallbladder issue, not just IBS?”
Maybe mentioning that, your stools, somebody’s stools are greasy, pale, floating. Can we look more into fat malabsorption or even bile acid malabsorption? Somebody may have already been labeled with the IBS diarrhea diagnosis, but still having symptoms, so asking their practitioner if they can consider bile acid malabsorption specifically, since it’s common and often missed Maybe even requesting that specialized scan or the gallbladder function test that we talked about earlier and [00:32:00] discussing with their practitioner if they think that it’s worth investigating.
and then, maybe having the discussion that the digestion changed after the gallbladder removal. It’s been some time, and maybe things haven’t really adjusted as one has expected. Could this be bile acid related, and is it treatable? And we also wanna validate that the fat spec- the fat-specific pattern is it’s a real clue, and so rather than, again, just slapping an IBS diagnosis on it, we really wanna think about how somebody’s bile and gallbladder are doing.
Recap And Closing
Dr. Domnique Vanier, ND: And so let’s take, a moment just to do a quick recap. And maybe Whitney, you can start off.
Dr. Whitney Baxter, ND: Yeah. So we went over how it all works, how the digestive tract works, and how this could be starting higher up in the digestive tract. I liked thinking about it as a relay. I thought that was a good analogy. So liver makes the bile and signals the gallbladder to store and release it when you eat that meal, and then enzymes finish the job [00:33:00]
Dr. Christina Carew, ND: About one in four people with diarrhea type IBS may actually have bile malabsorption issues, and that’s a very treatable problem, but sometimes hidden inside this label of IBS or I’m not really sure why you’re having diarrhea.
Dr. Domnique Vanier, ND: And then we know a gallbladder can look normal on imaging and still not squeeze properly in the context of biliary dyskinesia. And we also know life after gallbladder removal can shift digestion too.
Dr. Whitney Baxter, ND: So take a peek after you have a bowel movement. If it’s greasy, floating, pale, or there’s stale leaving after you flush, this could be a clue that it’s fat in your gallbladder.
Dr. Domnique Vanier, ND: So the next time, a fatty meal liv- leaves you regretting your food choices or the toilet bowl is trying to tell you something, remember it might not just be IBS or just a food intolerance. It might be the quiet plumbing of bile, and that’s worth investigating because remember, better gut health changes [00:34:00] everything
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