Today, I’ll tell you why the standard advice doctors give people with gallstones—to eat more carbs and cut down on fats—is flat-out wrong. Instead, science shows that cutting carbs and eating healthy fats can slash your risk of a future attack.

If you’ve experienced the excruciating pain of gallstones, what I’m about to say will probably sound like heresy. But here it is anyway:

Don’t avoid fats.

Now, I’m betting that’s not what your doctors are telling you. If they’re like most physicians, they firmly believe that to avoid developing new stones, you need to eat a high-carbohydrate, low-fat diet. So they’ll tell you to center your diet around foods like cereal, bread, rice, and pasta.

Here’s my response to this advice: It’s dead wrong. In fact, the evidence shows that adding fats to your diet will reduce your risk of gallstones, while loading yourself with carbs will put you at higher risk. To understand why, you need to know a little about how the gallbladder works—and how things can go wrong.

The facts about bile, carbs, and fats

Your liver makes bile, which is mostly water but also contains cholesterol, some fats, and bile salts. When you’re not eating fats, your bile gets stored in your gallbladder. When you eat a food that contains fat, your gallbladder contracts and squeezes bile out through a duct. This bile goes into your small intestine, where it helps break down big fat globules into tiny ones that are easier for your body to handle. Now, if you eat a significant amount of healthy fats, like coconut oil or fish oil, your gallbladder empties out pretty often.

But what if your diet is mainly wheat, rice, and corn, and contains almost no fat? Then that bile can sit around for a long time. And as it sits, the cholesterol in it can get more concentrated, eventually forming a gallstone. Then, if your gallbladder does need to squeeze out some bile to handle a load of fat, and that stone whooshes into the duct and gets stuck—you’re in big trouble. As anyone who’s had gallstones knows, the pain is horrific.

So what’s to blame here—the fat that caused your gallbladder to squirt out bile (which is its job, after all), or the low-fat diet that caused the sludge to collect and form stones in the first place? In my view, the answer is obvious. Here’s what it boils down to: Giving your body a moderate, steady supply of fats helps clean out your gallbladder regularly so crud doesn’t collect. Conversely, eating a diet low in fats turns it into a sludgy breeding ground for stones.  So it makes sense that a high-carb diet is risky, while a low-carb diet isn’t—and that’s exactly what science is proving.

What the research shows

Researchers are looking into the effects of diet on gallstone risk, and their results clearly contradict the low-fat advice most doctors hand out. Here are some of the most important findings:

• Yo-yo dieting or very-low-calorie diets put people at higher risk for gallstones. A 2014 study of dieters concluded that in this high-risk group, “Diets high in fat content reduced gallstones, compared with those with low fat content.”
• Pregnant women also are at elevated risk for gallstones. A 2011 study found that eating a diet high in carbohydrates during pregnancy—and, in particular, a diet high in fructose—increases this risk significantly, while eating fats does not.
• A large-scale 2005 study reported that a high intake of carbohydrates increases the risk of symptomatic gallstone disease in men. The researchers concluded, “These results add to the concern that low fat high carbohydrate diets may not be an optimal dietary recommendation.”
• In another study, researchers followed obese patients eating very-low-calorie diets that put them at increased risk for gallstones. They reported that gallstones developed in 6 of 11 participants eating a lower fat diet, “but in none with the higher fat regimen.”

These findings are consistent with an admittedly less scientific but very interesting survey by a Swedish LCHF (low-carb, high-fat) diet group.

Their 2012 survey found that of 145 people with a history of gallstones, 68% said their problems completely disappeared on the LCHF diet and 17% said they had fewer problems. Only 3% said their problems increased. (The remaining 12% experienced no change.)

My advice? Eat fat… but start slow

If you have a history of gallstones, and you’ve been eating a diet high in carbs, I hate to say it—but you’re in a tricky position. Why? Well, here are your two options.

• If you keep eating carbs and avoiding fats, you’ll keep forming stones. Those stones won’t bother you initially, but eventually they’ll get bigger and more numerous and cause a crisis that’s likely to result in surgery.
• If you start eating more fats, your gallbladder will start sending more bile to your small intestine. And in the process, any stones formed during your low-fat phase may pop out and get stuck in the duct. So in the short run, you could have a problem.

My advice? Since the high-carb diet causes the problem, go for the solution that solves it at its source.  Even though there’s a risk that adding fats may precipitate an attack at first, it’ll lower or even eliminate your risk of future attacks. And here’s one more word of advice: Gradually increase fats.

If you’ve been living on carbs, give your gallbladder time to adjust to your new game plan. As I’ve said, your doctor may consider this outright heresy. If so, ask your doctor for actual evidence that a high-carb diet actually helps prevent gallstones, rather than increasing your risk. And then let me know what your doctor says. Frankly, I’m expecting… crickets. This is Part 1 of a two-part series. In Part 2, I’ll talk about how to go low-carb if your gallbladder has been removed.

Keep thinking big and living bold!