FOOD

If you suffer from gallstones or a grumbling gallbladder as I did before I had my gallbladder out, whether you have opted for natural treatment or you are waiting for surgery, you will need to watch your diet.

Although experts believe that a no-fat diet can be harmful, it does seem to be universally accepted that cutting down on fat intake reduces the likelihood of a gallstone attack, as, without fat, the gallbladder will not be stimulated to release bile into the small intestine.

The gallbladder collects and stores bile, made by the liver as a result of its many detoxification processes. It then releases the bile into the small intestine when food enters from the stomach.

This helps with the digestion of food because the gallbladder contains bile salts and other substances that neutralize the acidic contents of the stomach as they arrive in the duodenum (the first part of the small intestine) and emulsify and break down fat.

The bile duct, which connects the gallbladder to the small intestine, can become blocked by gallstones, making it difficult for bile to be released from the bile duct. This is what may cause symptoms—the extreme pain, bloating, nausea and vomiting associated with a gallstone attack.

Low-fat pancakes
In this recipe I use a sugar alternative because it's best to avoid sugar generally. You can omit it altogether if you don't want your pancakes sweet.

Ingredients
½ cup (75 g) gluten-free flour
1 Tbsp stevia
¼ tsp baking powder
¼ tsp salt
1 large egg white
½ cup (118 mL) skimmed milk
¼ tsp vanilla extract
Small amount of coconut or olive oil cooking spray, or water for steam frying

Directions

1) Mix the flour, baking powder and salt in a large bowl. Add the stevia or sugar.
2) Whisk the egg white, milk and vanilla extract in a small bowl.
3) Add the wet ingredients to the dry and stir well.
4) Heat a nonstick frying pan for a couple of minutes on high, then squirt a few sprays of the oil spray into the pan (or a few drops of water if you are steam frying).
5) Immediately pour your batter into the pan and cook until bubbles form and the edges appear dry, then flip and cook for another 1-2 minutes.

To serve: Add blueberries, bananas, raspberries and pomegranate seeds. Drizzle with honey for a little extra indulgence.

Here are some easy ways to cut down on fat:
• Avoid processed foods and cook from scratch whenever possible. This will give you control over how much fat goes into your food.
• Check labels for high fat content.
• Bulk out meals with vegetables and pulses. For example, you could make a gallstone-friendly Bolognese by replacing the meat with lentils, kidney beans and mushrooms.
• Use only "good" oils or oil spray like olive or coconut when cooking.
• If you are cooking anything that sticks to the pan, use a few drops of water rather than oil. This is known as steam frying. I have also used wine to 'fry' food. Wine adds moisture as well as flavor. Most of the alcohol will burn off in the cooking process.
• Make your own dressings using low-fat yogurt, lemon/lime juice and herbs.
• Remove all visible fat and skin from meat and choose leaner cuts. I avoided all red meat while I waited for my operation, but I did eat some poultry and fish.
• Avoid eating out, but if you do, ask the kitchen to dry roast, grill or bake your food. Some will agree to do this.
• Avoid sauces, dressings and gravies.

Penne perfecto
Ingredients
2 cups (125 g) gluten-free, whole-grain penne (or whole-grain pasta of your choice)
1 tsp dried oregano
1 tsp dried thyme
1 tsp chili flakes
2 garlic cloves, crushed
Coconut or olive oil cooking spray, or water/wine for steam frying
12 cherry tomatoes
7 oz (200 g) can of chopped tomatoes
1 Tbsp tomato purée
Juice of 1 lemon
Salt and pepper

Directions

1) Cook the pasta according to the package instructions.
2) Meanwhile, heat a frying pan on medium heat for 2 minutes, then coat the base with the cooking spray (or wine/water).
3) Add the oregano, thyme, chili and garlic and sizzle gently.
4) Cut the cherry tomatoes into quarters, then add to the pan with the canned tomatoes and tomato purée; cook about 5 minutes, until the cherry tomatoes are soft.
5) Add lemon juice, salt and pepper.
6) Drain the cooked pasta, and then stir into the sauce.

Good digestion without a gall bladder: what to do after gall bladder removal
According to Dr Sandra Cabot, MD, and Margaret Jasinska ND in their book, Save Your Gallbladder Naturally and What to Do if You've Already Lost It: "A significant number of patients who have had their gallbladder removed continue to suffer with pain and digestive problems.

According to a study published in the British Journal of General Practice, it was found that having the gallbladder surgically removed does not always relieve upper abdomen pain.1

"Without a gallbladder, your liver continues to manufacture bile, but there is no longer a place to store it or concentrate it. Therefore bile continually slowly trickles into the intestines. If you eat a fatty meal, you will not be able to secrete a large enough amount of bile into your intestines, therefore the fat will be poorly digested.

"This means many people experience diarrhea, bloating, nausea or indigestion. Some common symptoms of poor fat digestion are dry, brittle hair; dry skin and premature aging of the skin; weak nails and painful joints."

If you don't digest fat well, says Dr Cabot, you won't be able to digest essential fatty acids or the powerhouse fat-soluble vitamins, like vitamins A, E and D.

So if you no longer have a gallbladder, she suggests the following:
• Minimize consumption of dairy products and grains, particularly gluten
• Check out any food allergies or sensitivities, particularly if you're still having pain after the surgery. Besides gluten and dairy, you should also be suspicious of eggs, pork, onions, corn and soy.
• Eat some good fats, while strictly avoiding the bad fats. Although your doctor may recommend a low-fat diet after surgery, Dr Cabot says that is potentially harmful because we all need good fats. She recommends eating "moderate quantities" of extra virgin olive oil, coconut milk, avocados, nuts and seeds.
• Eat some bitter and sour foods, such as lemons, limes or salad vegetables like radicchio lettuce, chicory, endive and dandelion leaves. They help you digest fats.
• Have digestive enzymes with every meal as well as an ox bile supplement with each meal, to counter indigestion, diarrhea or light stools.
• Take a daily vitamin D3 supplement, since vitamin D stores are often poor in people with compromised digestion.
Suggested daily dosage: 5,000 IU
• Take taurine, an amino acid needed for producing bile, which will also aid digestion and help prevent stones forming in your liver.
• Investigate a good quality liver tonic, such as Livatone. It should contain St Mary's thistle, dandelion root and globe artichoke leaves—all of which increase bile production and flow.

Sweet potato risotto
Ingredients for the rice:
2¼ cups (500 g) brown rice
3 cups (700 mL) water
½ cup (118 mL) low-fat coconut milk
2 Tbsp apple cider vinegar
Salt

For the sauce:
4 large sweet potatoes
Coconut or olive oil cooking spray
1 cup (236 mL) water
Salt and pepper
1 tsp cinnamon
1 Tbsp apple cider vinegar
3 Tbsp nutritional yeast
1 Tbsp ground cumin
Juice of 1 lemon
3 garlic cloves
Handful of fresh cilantro (coriander)
1 cup (225 g) spinach

Directions

1) Preheat the oven to 350°F/180°C, then put the rice into a large saucepan with 3 cups (700 mL) of water.
2) Add the coconut milk, 2 Tbsp of apple cider vinegar and salt.
3) Bring to a boil, then reduce to a simmer, cover and cook for around 40 minutes or until the liquid has been absorbed.
4) Meanwhile, chop three of the sweet potatoes into bite-size chunks, place them on a baking tray and coat them thinly in cooking spray; then add salt, pepper and cinnamon and put the tray in the oven for 30 minutes.
5) Peel the fourth sweet potato, cut into bite-size chunks and place in a steamer until very soft.
6) Once the steamed potato is cooked, add to a blender with 1 cup (236 mL) water plus the remaining apple cider vinegar, yeast, cumin, lemon juice, garlic, salt and pepper and blend until smooth.
7) Once the rice is cooked, stir in the blended mixture along with the roasted sweet potato chunks, cilantro and spinach.
8) Allow to cook until the spinach has wilted, then serve immediately.

Grilled fish and greens with capers and lemon salsa
Ingredients
4 whitefish fillets (e.g. cod, sea bass, hake, haddock), sustainably sourced
2 cups (350 g) tenderstem broccoli
1 cup (150 g) trimmed green beans
1 bunch spring onions
Coconut or olive oil cooking spray
Salt and pepper
1 lemon
Small bunch fresh parsley
1 Tbsp capers
To serve:
Lime wedges

Steamed rice

Directions

1) Heat the grill to high, then coat the fish, broccoli, beans and spring onions with a few sprays of oil and season well with salt and pepper.
2) Put the vegetables in a large shallow baking tray, reserving the fish, and grill on high for 4 minutes.
3) Meanwhile, for the salsa, trim the skin off half the lemon, slice the peeled lemon into thin rounds, and then cut the rounds into small wedges, discarding any seeds; put these in a bowl.
4) Finely chop the parsley and mix with the lemon and a few sprays of the oil.
5) Drain the capers, add to the lemon and parsley mixture with some salt and pepper and mix well.
6) Add the fish on top of the vegetables, then grill for 4-5 minutes more (or longer, depending on the thickness of the fish fillets) until the fish is just cooked and the vegetables are soft and sweet.
7) Squeeze over the remaining lemon and serve with the salsa and lime wedges.

Nearly no-fat banana bread

Ingredients
Coconut or olive oil cooking spray
1½ cups (200 g) gluten-free flour or whole-wheat flour if tolerated
¾ cup (140 g) caster sugar or 1½
cups stevia
1¼ tsp baking powder
½ tsp baking soda/bicarbonate
of soda
½ tsp ground cinnamon
2 egg whites
3 ripe bananas, mashed
4 Tbsp apple sauce (recipe below)

Directions

1) Preheat the oven to 350°F/180°C and lightly grease an 8×4 inch (20×10 cm) loaf tin with a few pumps of the cooking spray.
2) In a large bowl, stir together flour, sugar, baking powder, baking soda and cinnamon.
3) Add the egg whites, bananas and apple sauce and stir until just combined.
4) Pour the batter into the prepared tin. Bake in the preheated oven for 50 to 55 minutes, until a skewer inserted into the center of the loaf comes out clean.
5) Turn out onto a wire rack and allow to cool before slicing.

Top tip: If your bananas are already black but you can't make a cake right away, simply peel them and pop them in the freezer. Defrost the bananas whenever you're ready to bake

Unsweetened apple sauce
Ingredients
4 medium cooking apples
1 cup (235 mL) water
½ tsp cinnamon
1 Tbsp lemon juice

Directions
1) Peel, core and chop the apples (or you can leave the skins on if preferred).
2) Add the apples to a saucepan with the cinnamon and lemon juice. Add half of the water, and then top up with more during cooking as needed (to get the desired consistency).
3) Bring to a boil, reduce the heat, cover and then simmer gently for 25-30 minutes until apples are soft.
4) Mash it all together using a potato masher or hand blender.
5) Leave to cool and transfer to a jar.
Store in the fridge until needed. It should keep for up to 7-10 days.

Chocolate brownies
Ingredients
Coconut or olive oil cooking spray
1 cup (128 g) gluten-free flour
¹⁄³ cup (35 g) unsweetened cocoa powder
½ tsp salt
½ tsp baking powder
¼ tsp baking soda/bicarbonate of soda
¼ tsp ground cinnamon
½ cup (125 g) brown sugar or 1 cup stevia
¼ cup (30 g) fat-free dry milk powder
1 egg white, slightly beaten
1 cup (255 g) unsweetened apple sauce (recipe below left)
1 tsp vanilla extract

Directions

1) Preheat the oven to 350°F/180°C. Lightly coat an 8×4 inch (20×10 cm) baking pan with cooking spray and then set it aside.
2) In a large bowl, sift together the flour, unsweetened cocoa, salt, baking powder, baking soda and cinnamon until well mixed, then set the bowl aside.
3) In a medium bowl, beat together the sugar, fat-free dry milk powder, egg white, applesauce and vanilla extract with a spoon until well combined.
4) Stir the wet mixture into the dry mixture, mixing just until the dry ingredients are well moistened. Do not over-mix—once they are moist, stop mixing.
5) Spread the brownie batter evenly in the prepared baking pan and bake in the oven for 20 to 25 minutes or until a toothpick inserted in the center comes out clean.
6) Cool on a wire rack and give the brownies a light dusting with powdered sugar, if desired.