The most common symptom of biliary sludge — when it causes symptoms — is pain in the abdomen often associated with nausea and vomiting. This occurs when the particles obstruct the ducts leading from the gallbladder to the intestine.

Now, it’s not the worst pain I’ve felt in my life. I can certainly imagine pains that are deeper and more acute. However, it’s a very frustrating pain. My first few attacks, I didn’t even know what it was. I thought it was food poisoning. The nausea that accompanied it made me feel like vomiting might help, but it never did.

I tried a variety of products to lessen the symptoms. Alka Seltzer seemed to be the only one that had any effect.

When I finally talked to a doctor about it, he suggested that a pain reliever like Advil might help. “Take a few Advil when you feel the pain coming on.” So that is what I do now. When that pain starts to come on, I take a few Advil and/or some Alka Seltzer and lie down. Surprisingly it does the trick.

Now these attacks are infrequent. I had several last fall, but I think I’ve only had two this year. The hypothesis that I’m currently working under is that starches in my diet aggravate it. The first few attacks I had were after large meals with lots of rice. I also noticed that the lignans that accompany flax seed oil also irritate it, as do ground flax seeds themselves (the oil without lignans seems to be fine).

I’m now two weeks into a very low carb diet and one of my hopes is that it would improve my gallbladder. I have felt a little better lately. Although, I have occasionally felt a bit of pressure near my gallbladder, it has been faint and less frequent since my diet became mostly meat, eggs and cheese (I also consume a fair amount of walnut and flax seed oil).

But yesterday, I had another attack. It would have been bad if I’d not taken the Advil right away and been able to lie down for an hour. It did pass, but now I’m left with a mystery. What if anything in my diet brought on the attack? Here is what I can remember about my diet in the previous 24 hours:

• The bulk of my diet was meat, eggs and cheese. That morning, I had two eggs and some ham for breakfast.
• I also had some yogurt with a few berries for breakfast. I haven’t had any yogurt for at least a week. It’s always gone down easy before however.
• The night before I had a diet Pepsi. I haven’t had one of those in a while. It doesn’t feel like a likely cause however.
• I had an early lunch consisting of a small piece of grilled chicken, a boars head hot dog and a small sandwich with a slice of salami, some colby cheese and a slice of whole wheat bread. I had also had a single piece of this same bread the night before.

I’m left with several possibilities. One is that the low carb diet is not helping. Perhaps it’s even worsening my gallbladder, and that what you are eating over the medium term (the last few weeks) is more important than what you have eaten in the last 12-24 hours.

Another possibility is that one of the new items in my diet brought on the attack. The most likely candidate was the whole wheat bread. I had decided to add some bread back into my diet and bought the most whole wheatiest bread I could find, from the local health food store. I had one slice on Tuesday night, just after I bought it and another Wednesday morning with my small sandwich.

If it was the bread that set off my gallbladder, that is very alarming. A single piece of wheat bread brought on an attack (maybe two small slices including the one from the night before). This makes me quite sad, I really like dense, grainy breads and hoped that I could reincorporate them once I had lost a few more pounds. If I’m right, I may not be able to ever eat them again, or at least for a very long time.

Of course the other most likely culprit is the low carb regimen in general. Perhaps I’m bound to have more and more of these attacks and that the added fats in my diet are two much for the gallbladder.

Lastly, the medical literature often speak of “rapid weight loss” as a factor in gallbladder sludge. Perhaps I’m doomed to have gallbladder problems as long as I lose weight.

For now, I’m going to keep bread completely out of my diet and see what happens. If it’s the low carb diet doing it, I’ll have another attack sooner rather than later. If it is the bread, then this should help.

After five days, I’ve had no real weight loss. After a big meal, I’ve occasionally felt a bit overfull, which probably means I’m eating more than I need to. And on day two I had a small carb crash. But in general I’ve felt good. I haven’t felt very hungry. The food is relatively satisfying and the restrictions haven’t been hard to stay within. I miss the fruits and vegetables a bit, but I’m thinking that I’ll add a few servings of them back eventually.

I’ve also noticed many slight improvements like better oral hygiene, and there is no delicate way to put this… I have no gas. Yep all you vegetarians, I can confirm, it’s the carbs that are making you fart. I’ve had barely a peep the last few days.

Is this too much information? I think it might be, but in order for this experience to be of any use to something reading this, they have to hear the details. With all this fat in my diet I’m experiencing none of following:

• Heartburn
• Gas
• Indigestion
• Constipation
• Abdominal pain or discomfort

In other words, the body seems to process this food easily. This is hardly surprising since humans have been meat eaters for something like 200 million years. But it’s also not very meaningful. It will take a few months like this to figure out if there is much benefit to it.

Lastly, I think that my gallbladder feels a bit better. Of course, I’ve not had an attack, but also, the slight pressure that I’ve often felt on my right side is missing. Again this doesn’t prove much, since I’ve had plenty of good days over the last six months. The real proof will be having another ultrasound in months and finding that the gallbladder looks much better. I’m looking forward to a checkup after 3 or 4 months free of any gallbladder issues and report to my doctor that I achieved it by doing the exact opposite of what he suggested with lots of cholesterol rich foods like eggs and cheese.

Oh and I would not recommend this to someone who is having gallbladder issues. It’s a shot in the dark and I could easily be very wrong. Check back in a few months and I’ll let you know if I’m still feeling better.

The book is dense, bringing together a huge number of scientific studies that date back to the beginning of the the 20th century. His goal seems to be to overwhelm the reader with evidence that many of the assumptions about diet, obesity and disease are wrong. He isn’t content to give you one or two examples of studies that suggest that carbohydrates are the primary factor behind obesity, diabetes, heart disease, cancer and a range of other modern illnesses that were rare before the 20th century. He piles it on, determined to make sure that someone can’t read his book and dismiss it as “some fad diet book.” If you say he is wrong, you better bring your citations with you.

I’ve enjoyed the ride, but I wonder how many readers get bogged down and don’t finish it, or don’t care so much about the reams of evidence that Taubes has compiled and want to skip to his conclusions. One passage near the end that jumped out at me as something that people need to know:

By the mid-1960s, four facts had been established beyond reasonable doubt: (1) carbohydrates are singularly responsible for prompting insulin secretion; (2) insulin is singularly responsible for inducing fat accumulation; (3) dietary carbohydrates are required for excess fat accumulation; and (4) both Type 2 diabetics and the obese have abnormally elevated levels of circulating insulin and a “greatly exaggerated” insulin response to carbohydrates in the diet

He has done a good job. His book is why I’m trying a low carb diet. I’m taking a gamble, even going directly against my doctor’s orders to lower my already low cholesterol, hoping that would help my ailing gallbladder (after all, my first three gallbladder attacks all came after large restaurant meals full of carbs).

I’m going to give it a try. I’ll see how I feel in a month. Will I feel better? Will I lose the 20 pounds I have left to lose? Will I have another gallbladder attack? I’ll let you know.

UPDATE: I blogged too soon. I’m now in the epilogue and he has 7 main points he was trying to communicate in the book. I’ll add them here later.

I am probably too easily swayed by these kinds of books, ones which set out to prove that conventional wisdom is dead wrong. Years ago, before the Oliver Stone movie, I read way too many books about the Kennedy assassination and was convinced that elements of the CIA were involved (something I still find credible). Later I read a book about how the primary hypothesis about AIDS may well be wrong, and was, for a time, convinced. So I know that I need to temper my enthusiasm for this book.

In the last few years, I’ve had a couple of warning signs about my health. Minor problems, but they were the canaries in the coal mine, warning me that if I didn’t get my act together I’m heading towards obesity, heart disease maybe even diabetes. The first warning sign was my sleep apnea, which was diagnosed in 2003 and seemed to coincide with a gain in weight the year before. Then last year, it was my gallbladder. In my video journal, I talked about “food poisoning” in Scottsdale. After a few big restaurant meals, I experienced some rather nasty abdominal pains and nausea.

Finally after a particularly bad episode over Thanksgiving, I went to see the doctor. After an ultrasound, it was confirmed. My gallbladder was full of sludge which it was having trouble expelling into my digestive tract. Although I had no stones, I might eventually. This was not good. It could require surgery. However, he suggested we try another route. He gave me some medicine and told me to cut back on saturated fats and to exercise. We would meet back in a few months and see how I’m doing.

So that brings me to Taubes book. One of Taubes major points in his book is that fats (even saturated fats) are unlikely to be the kind of poison that we are led to believe. That maybe we don’t all need to be obsessed with cholesterol. And that the scientific evidence points towards refined carbohydrates like sugars, white flour and white rice as the main dietary factor in everything from heart disease to appendicitis. He has made a great argument so far that sugar and other refined carbohydrates are unambiguously bad for us. I’m not so convinced by his ambivalence towards saturated fat though.

I have been doing my own research, trying to find scientific studies published online that contain support for these ideas. Today I found this, a study from 90s which tried to identify risks for gallstones. This study did confirm that sugar likely plays a part in gallbladder problems:

A positive association between intake of refined sugars and risk of gallstone formation has been reported consistently. However, a diet rich in refined sugars is usually poor in complex carbohydrates and fiber; therefore, whether refined sugars and fiber have independent effects on gallstone risk remains to be fully clarified. Our findings suggest that refined sugars and fiber from cellulose may have independent effects.

Well what about fats?

The potential etiologic role of other fats has not been investigated thoroughly. Our study found no evidence of a link between polyunsaturated fats and risk of gallstone formation. The limited available evidence on the relation between these fats and gallstone formation is conflicting. The link between monounsaturated fats and risk of gallstone formation has not been investigated. Monounsaturated fats, as all fats, have been shown to have a powerful effect on the rate of gallbladder emptying. However, the effect is different from that of saturated fats because monounsaturated fats increase the ratio of HDL to LDL cholesterol and therefore may have important protective effects against gallstone formation.

Still the news was not so good for saturated fats, especially for men and saturated fats:

Of potential importance was the observed significant interaction in our study between sex and saturated fat intakes with regard to gallstone formation, indicating that the association between saturated fat intake and gallstone formation may be weaker in women than in men and that men in the highest quartile of saturated fat intake may be at greater risk than women.

You can see in this chart that the associated risk of saturated fat is much more significant for men.

The last week, I’ve shifted my diet towards an Atkins style diet. I’m no longer eating the ‘fat free’ versions of foods like yogurt and cottage cheese. I’m eating more meat (fish, turkey and chicken) and I even had a steak the other night. The main thing I’m restricting is sugar and other carbs. My doctor would not be pleased, but it has broken through my weight plateau. I am losing again. Now, I’ve got to pull it back. I don’t want to aggravate my gallbladder again. It has been getting better the last couple of months, and I can’t afford to be sick right now.