After gallbladder removal fat absorption falls, so patients should eat more fat (e.g., 200 g instead of 100 g) such as butter and ghee.
Original statement
يعني انا لو بدخل 100 جرام دهون وب وشلت المراره لا يا باشا دخل 200 بقى عشان شويه دهون يعرفوا يخشوا جسم حضرتك
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
After gallbladder removal fat absorption falls, so patients should eat more fat (e.g., 200 g instead of 100 g) such as butter and ghee.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! تحليل الدهون (Open source)
- Published
- 28 July 2025
- Timestamp
- 0:45:01 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Claimed mechanism
Loss of the 40 ml bile reservoir reduces fat digestion.
- Claimed health effect
Fat malabsorption; need to increase fat intake.
- Population concerned
People after cholecystectomy
- Geographic restriction by Elawady
none found
Diverging source versions
اي اكل حضرتك فيه ضرب لا اللي بيشيل المراره ما ياخدش ما ياخدش املاح مراريه المراره اما اتشالت عملت مشكله واحده بس ان انت الاملاح المريه في مخزون 40 ملي بيبقوا
People whose gallbladder has been removed should not take bile salts; removing the gallbladder causes one problem: the loss of the bile-salt store (about 40 ml).
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! تحليل الدهون (Open source)
- Published
- 28 July 2025
- Timestamp
- 0:42:34 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
Scientific assessment
Potentially false – The available evidence tends to speak against the statement, but is not conclusive.
Certainty of evidence: very low – Any assessment is very uncertain.
1. What was claimed?
Eat more fat after cholecystectomy.
2. What is demonstrably correct?
The gallbladder stores and concentrates bile; after removal bile flows continuously (basic physiology).
3. What is wrong or exaggerated?
No evidence supports doubling fat intake (e.g. 200 g/day) after cholecystectomy, and the available indirect evidence points the other way: post-cholecystectomy diarrhoea occurred in 13.3% of patients and was linked to high-fat meals in two studies (A-ORG-09), and low-fat diets tended to improve bile-acid diarrhoea (I-ORG-132). The absorption percentages he cites are not sourced.
4. What remains unclear?
Not systematically searched. In a second passage of the same video he says people without a gallbladder should not take bile salts and that removal causes only one problem, the loss of the bile store (about 40 ml). That the gallbladder stores bile is basic physiology; the volume he gives is plausible but was not checked against a source here. 'Only one problem' is an oversimplification: post-cholecystectomy diarrhoea occurred in 13.3% of patients in a systematic review (A-ORG-09). No evidence was searched on bile-salt supplements after cholecystectomy; we make no judgement on that advice.
5. Which studies support it?
Only for the premise: I-ORG-133 (faecal fat slightly higher after cholecystectomy despite similar diets; small 1982 study). No evidence for the advice itself.
6. Which studies contradict it?
A-ORG-09 (indirect): post-cholecystectomy diarrhoea 13.3%, associated with high-fat meals or not following a low-fat diet in two included studies. I-ORG-132 (indirect, very low certainty): fat reduction tended to improve bile-acid diarrhoea; in one study diarrhoea returned when fat intake was increased.
7. What applies to Germany and Europe?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. What is known about Egypt?
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
9. What practical conclusion is appropriate?
There is no evidence that eating more fat helps after gallbladder removal, and it may worsen diarrhoea in people who develop it. Dietary advice after cholecystectomy should come from a clinician or dietitian.
Assessment details
- Rationale for certainty of evidence
No trial has tested fat intake after cholecystectomy. All indirect evidence points against the advice: a systematic review found post-cholecystectomy diarrhoea in 13.3% and linked it to high-fat meals in two studies (A-ORG-09), and a systematic review of bile-acid diarrhoea found that reducing dietary fat tended to improve symptoms, with diarrhoea returning when fat was increased in one study (I-ORG-132, very low certainty, mostly ileal-resection patients). A small 1982 study found slightly higher faecal fat after cholecystectomy (I-ORG-133), which supports the premise but not the advice. Very low certainty because the evidence is indirect and small.
- Source quality
Mechanistic reasoning with unsourced numbers.
- Regional transferability
n/a
- Individual exceptions
Some patients develop bile-acid diarrhoea after cholecystectomy (13.3%, A-ORG-09), which could plausibly worsen with high fat intake (not tested here).
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Not supported by high-quality evidence – There is no good evidence for the claim; this alone does not prove it wrong.
Research question: After cholecystectomy, is fat absorption reduced, and does increasing dietary fat (e.g. 200 g/day, butter and ghee) improve outcomes?
Research question in detail (PICO)
- Population
- Adults after cholecystectomy
- Intervention or exposure
- High/increased dietary fat
- Comparison
- Usual or reduced fat intake
- Geographic scope
- universal biology
- Outcomes
- Fat absorption
- Post-cholecystectomy diarrhoea
- Symptoms
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Fat in stools after gallbladder removal
Brydon WG et al.. Digestion 1982 · PMID 7166207 · DOI 10.1159/000198840 Case-control studyabstract checkednewly addedSmall 1982 study: faecal fat higher after cholecystectomy despite similar diets (premise only).
- Actual result
- No numbers in abstract.
- Methodological quality
- very low (small observational)
- Relevance
- direct for premise, not for advice
- Limitations
- Tiny, old.
What speaks against the claim?
Diet for bile acid diarrhoea
McKenzie YA et al.. J Hum Nutr Diet 2022 · PMID 35274385 · DOI 10.1111/jhn.13005 Systematic reviewabstract checkednewly addedSystematic review: low-fat diets tended to improve bile acid diarrhoea; diarrhoea returned when fat was increased in one study.
- Actual result
- Very low certainty; 5 studies, n = 181 for fat reduction.
- Methodological quality
- low (SR of small cohorts)
- Relevance
- indirect (mostly ileal-resection BAD)
- Limitations
- Very low certainty.
Diarrhoea after gallbladder removal
Farrugia A et al.. BMJ Open 2022 · PMID 35177439 · DOI 10.1136/bmjopen-2020-046172 Systematic reviewfull text, structured risk-of-bias assessmentSystematic review: post-cholecystectomy diarrhoea in 13.3%; two studies linked it to high-fat meals.
- Actual result
- 462/3476.
- Methodological quality
- moderate (SR, full text)
- Relevance
- indirect
- Limitations
- No intervention trials.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Fat digestion may be slightly less efficient after cholecystectomy, but no evidence supports eating more fat; the limited evidence on bile-acid diarrhoea points the other way (less fat, fewer symptoms).
Why some studies weigh more
No RCT exists; the direction of the indirect evidence is consistent against the advice.
Is a causal relationship established? Not established No trials of fat intake after cholecystectomy.
Remaining uncertainty
Optimal diet after cholecystectomy.
Justified conclusion
The advice to double fat intake is unsupported and may worsen diarrhoea in susceptible people.
Does this depend on the country?
- General biological effects
- Universal.
- Eating habits
- Butter and ghee are common in Egyptian cooking; a 200 g/day fat intake would be far above usual intakes in any population.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Not applicable.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egypt-specific monitoring data identified.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Effect sizes – No pooled estimates; recalculation impossible (narrative synthesis only) not recalculable from the published data
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Symptoms after cholecystectomy with increased fat intake
- Starting level
- low (observational studies)
- Reasons for downgrading
- indirectness
- imprecision
- risk of bias
- Result
- very low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- NICE: Gallstone disease: diagnosis and management (CG188), Recommendations (2014) · Original publication
Reassure people with asymptomatic gallbladder stones that they need no treatment unless symptoms develop; offer laparoscopic cholecystectomy for symptomatic gallbladder stones; early cholecystectomy within 1 week for acute cholecystitis; bile duct clearance plus cholecystectomy for common bile duct stones (I-ORG-141).
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (cholecystectomy OR postcholecystectomy) AND (TITLE:diet OR TITLE:dietary OR TITLE:"fat intake" OR TITLE:"fat absorption" OR TITLE:"fat malabsorption" OR TITLE:steatorrhea OR TITLE:"low-fat") | both directions | 250 | |
| PubMed | 26 October 2026 | (cholecystectomy[tiab]) AND (fat absorption[tiab] OR fecal fat[tiab] OR faecal fat[tiab] OR steatorrhea[tiab]) | supporting evidence | 24 | |
| PubMed | 26 October 2026 | ("bile acid diarrhoea"[tiab] OR "bile acid diarrhea"[tiab] OR "bile acid malabsorption"[tiab]) AND (low-fat[tiab] OR "fat intake"[tiab] OR "dietary fat"[tiab]) | contradicting evidence | 25 | |
| PubMed | 26 October 2026 | cholecystectomy[ti] AND (bile acid malabsorption OR bile acid diarrhoea OR bile acid diarrhea) | both directions | 27 |
Open questions
Trials of dietary fat after cholecystectomy.
How deeply was this checked?
3 linked studies: 1 checked in full text (1 of them with a structured risk-of-bias assessment), 2 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Unclear / insufficient evidence (very low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Verdict changed: Unclear / insufficient evidence (very low) → Potentially false (very low)
Changed from “Unclear / insufficient evidence” to “Potentially false” (certainty stays very low). The systematic review on bile-acid diarrhoea (I-ORG-132) adds to A-ORG-09: all available indirect evidence points against increasing fat intake (low-fat diets improve bile-acid diarrhoea; high-fat meals linked to post-cholecystectomy diarrhoea), while no evidence supports the advice. Evidence remains indirect and weak, so a stronger verdict is not justified.
New sources: I-ORG-132 I-ORG-133
In plain language
Elawady advised people without a gallbladder to eat about twice as much fat. It is true that fat digestion may be slightly less efficient after the operation. But no study shows that eating more fat helps, and the limited evidence suggests the opposite: about 13% of people get diarrhoea after gallbladder removal, and eating less fat tends to ease this kind of diarrhoea. The advice is therefore probably wrong, although no trial has tested it directly.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (2)
-
Diarrhoea after gallbladder removal
Farrugia A et al.. BMJ Open 2022 · PMID 35177439 · DOI 10.1136/bmjopen-2020-046172Systematic reviewcited by the Tayebat archivefull text, structured risk-of-bias assessmentAbout 13% of patients developed diarrhoea after the operation.
After gallbladder removal fat absorption falls, so patients should eat more fat (e.g., 200 g instead of 100 g) such as butter and ghee.
Does the study support the specific claim? Yes · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
PCD rate
- How was the study done?
Systematic review
- How many people, animals or samples were studied?
3476
- What was actually found?
13.3%
- How large was the observed effect?
13.3%
- What do the results mean in everyday life?
A common side effect to discuss before surgery
- What are the study's limitations?
Crude pooling of heterogeneous, mostly uncontrolled studies; rates 2-57%; no standard definition
- What does it say about Elawady's specific claim?
Supports informed consent
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Causes; exact rate; whether the gallbladder should be kept; that more dietary fat helps
-
Diet for bile acid diarrhoea
McKenzie YA et al.. J Hum Nutr Diet 2022 · PMID 35274385 · DOI 10.1111/jhn.13005Systematic reviewindependent cross-checkabstract checkedEating less fat seemed to ease bile acid diarrhoea, but the studies were small and of very low certainty.
Low-fat diets tended to improve bile acid diarrhoea; increased fat brought diarrhoea back in one study.
Does the study support the specific claim? No · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Review non-drug treatments for bile acid diarrhoea
- How was the study done?
Systematic review
- How many people, animals or samples were studied?
8 small studies, 192 patients
- What was actually found?
Low-fat diets tended to help
- How large was the observed effect?
Not pooled
- What do the results mean in everyday life?
If diarrhoea follows gallbladder removal, more fat is unlikely to help
- What are the study's limitations?
Very low certainty, indirect
- What does it say about Elawady's specific claim?
Runs against the advice to eat more fat
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Cannot prove benefit or harm of fat changes after cholecystectomy
No study in this group is marked as key.
Studies with mixed or unclear results (1)
-
Fat in stools after gallbladder removal
Brydon WG et al.. Digestion 1982 · PMID 7166207 · DOI 10.1159/000198840Case-control studyindependent cross-checkabstract checkedMen without a gallbladder lost somewhat more fat in their stools than men with one, though they ate the same diet.
Faecal fat higher after cholecystectomy (premise partly supported); no evidence that more dietary fat helps.
Does the study support the specific claim? Partly · Methodological quality: very low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare stool fat after cholecystectomy
- How was the study done?
Small comparative study
- How many people, animals or samples were studied?
Men; number not given
- What was actually found?
More fat and heavier stools after surgery
- How large was the observed effect?
Not reported
- What do the results mean in everyday life?
Fat digestion may be slightly less efficient without a gallbladder
- What are the study's limitations?
Very small, old
- What does it say about Elawady's specific claim?
Supports the premise, not the advice
- Do the results apply to Germany and Europe?
Uncertain
- What can explicitly not be concluded from this study?
Cannot tell whether eating more fat compensates
No study in this group is marked as key.
Regional context
Germany / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypt
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
What applies in my country?
General scientific assessment
Potentially false Probably wrong advice: no evidence supports eating more fat after gallbladder removal, and limited evidence points the other way.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Postcholecystectomy diarrhoea rate and predictive factors: a systematic review of the literature.. Farrugia A et al.. BMJ Open 2022 · PMID 35177439 · DOI 10.1136/bmjopen-2020-046172
- Effectiveness of diet, psychological, and exercise therapies for the management of bile acid diarrhoea in adults: A systematic review.. McKenzie YA et al.. J Hum Nutr Diet 2022 · PMID 35274385 · DOI 10.1111/jhn.13005
- Diet and faecal lipids following cholecystectomy in men.. Brydon WG et al.. Digestion 1982 · PMID 7166207 · DOI 10.1159/000198840