FROM THE ACADEMY

Question of the Month

What Medical Nutrition Therapy Guideline Is

T
HE GALLBLADDER IS A PEAR- is one of the most common digestive
shaped organ that functions diseases requiring hospital admission movements. Be sure to increase the
as the reservoir for bile, which and financial resources.2 Surgical re- amount of fiber slowly over several
is produced by the liver, until moval of the gallbladder either as an weeks. It has been suggested that adding
it is needed for digestion of fats in the open operation or as laparoscopic cho- soluble fiber to the diet will act as a
small bowel. The liver produces about lecystectomy is standard treatment sequestering agent and bind the bile in
3 to 5 cups of bile every day. Bile is a for gallbladder disease. Laparoscopic the stomach between meals to avoid
green-brown fluid that is composed of cholecystectomy is considered the gold gastritis.4 If reflux is an issue, avoid
bile salts, fatty compounds, cholesterol, standard for treating patients with alcohol, caffeinated and carbonated
and other substances. Bile salts act as symptomatic gallstones.2 drinks, chocolate, citrus foods and juices,
emulsifiers/surfactants to reduce the A number of post-surgical complica- coffee, vinegar-based dressing, onions,
size of the fat droplets. tions following cholecystectomy have tomato-based foods, spicy foods, and
Risk factors for gallbladder disease or been cited in the scientific literature. mint, and eat smaller meals.1
stones include the following: female, The Nutrition Care Manual states diar- Conflicting research regarding post-
especially if pregnant, on hormone rhea may occur in some people, prob- cholecystectomy complications con-
therapy or using birth control pills, or ably as a result of an increased amount tinues to be cited in the literature. As a
over the age of 60 years; people with a of bile in the large bowel. In most cases, registered dietitian nutritionist, it is
history of rapid or significant weight the diarrhea lasts no more than a week imperative to use critical-thinking skills
loss using very-low-kilocalorie diets; to a few months, with increased dura- to assess and interpret data to provide
increased fat and sugar intake in the tion of diarrhea with higher intake of appropriate MNT for each patient.
food history; and a sedentary lifestyle.1 fatty food.
Being either Hispanic or Native Amer- Post-cholecystectomy syndrome References
ican also predisposes an individual to (PCS) may occur when abdominal 1. Academy of Nutrition and Dietetics. Nutrition
Care Manual. Gallbladder. http://www.
gallbladder disease. In addition, the symptoms develop after surgery. Prev- nutritioncaremanual.org/topic.cfm?ncm_ca
prevalence of gallstones is associated alence of PCS has been reported from tegory_id¼1&lv1¼5522&lv2¼145224&ncm_
with a number of diseases: type 2 5% to 40% of people following chole- toc_id¼18679&ncm_heading¼Nutrition%20
Care. Accessed April 25, 2014.
diabetes, dyslipidemia, and hyper- cystectomy.3 Symptoms may include
2. Poetincasa P, DiCiaula A, Bonfrate L,
insulinemia.2 The majority of stones upset stomach, nausea, vomiting, gas,
Wang DQH. Therapy of gallstone disease.
appear to remain “silent” and do not bloating, diarrhea, or persistent pain in World J Gastrointest Pharmacol Ther.
require medical or surgical treatment. the upper right abdomen. It is thought 2012;3(2):7-20.
When mild symptoms are present, a that the symptoms are not caused by, 3. Glasgow RE, Mulvihill SJ. Treatment of gall-
low-fat nutrition prescription (<30% but are exacerbated by, the cholecys- stone disease. In Feldman M, Friedman LS,
Brandt LJ, eds. Sleisenger and Fordtran’s Gas-
energy from fat) with a modest protein tectomy. In addition, patients may trointestional and Liver Disease, 9th ed, vol. 1.
content, small, frequent feedings, and experience symptoms of gastritis sec- Philadelphia, PA: Saunders; 2010:1121-1138.
the avoidance of alcohol may assist in ondary to duodenogastric reflux of bile 4. Mahan LK, Escott-Stump S, Raymond JL.
controlling symptoms. In an acute gall- acids. The reflux may also be respon- Krause’s Food and the Nutrition Care Process.
13th ed. St Louis, MO: Saunders; 2012:667.
bladder attack, all food is held until an sible for symptoms in the post-
5. Yueh T-P, Chen F-Y, Lin T-E, Chuang M-T.
evaluation can be completed and treat- cholecystectomy syndrome.4 In a
Diarrhea after laparoscopic cholecstectomy:
ment options considered.1 recent article by Yueh and colleagues, Associated factors and predictors. Asian
The prevalence of gallbladder disease other issues noted were indigestion, J Surgery. 2014. http://dx.doi.org/10.1016/j.
ranges from 10% to 15% in adults and fatty food intolerance, and heartburn.5 asjsur.2014.01.008.
There is not a standard guideline for 6. Escott-Stump S. Nutrition and Diagnosis-
Related Care. 7th ed. Baltimore, MD: Lip-
medical nutrition therapy (MNT) post- pincott Williams & Wilkins; 2012:516-518.
cholecystectomy. MNT should be indi-
This article was written by Wendy vidualized based on the patient’s issues
Marcason, RDN, of the Academy of Related Resources
Nutrition and Dietetics’ Knowledge and a number of diet modifications may National Digestive Disease Information Clearing-
Center Team, Chicago, IL. Academy be indicated. Fat intake should be limited house (NDDIC)-Gallstones. http://digestive.
niddk.nih.gov/ddiseases/pubs/gallstones/
members can contact the Knowledge for several months to allow the liver
Center by sending an email to American College of Surgeons- Cholecystec-
to compensate for the gallbladder’s ab-
knowledge@eatright.org tomy. http://www.facs.org/patienteducation/
sence, should be introduced gradually, operations.html
http://dx.doi.org/10.1016/j.jand.2014.05.009
and excessive amounts at any one MedlinePlus: Gallbladder Diseases. http://www.
meal should be avoided.6 Increased nlm.nih.gov/medlineplus/gallbladderdiseases.html

1136 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS ª 2014 by the Academy of Nutrition and Dietetics.