After gallbladder removal

Your gallbladder came out. Nobody explained the rest.

Most people are fine after removal. A minority are not, and this page is for them. The symptoms turn up at three weeks for some and twelve years for others, and almost nobody gets told why.

What actually changed What research shows

Read time 4 minutes

A barely-touched breakfast on a kitchen table in mid-morning daylight, the spoon set down beside the plate

500mg per serving, two a day
One ingredient, vegan capsule
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What actually changed

Nothing is broken. The timing changed.

The gallbladder was a reservoir. It held bile, concentrated it, and released a dose when food arrived. After removal the liver carries on making bile at much the same rate. It just trickles into the gut continuously, and more dilute, so less of it is present at the moment a meal is.

01 Before, with a gallbladder between meals meal after A dose arrives with the food, on cue.
02 After removal all day, dilute meal, no dose all day Bile is present constantly and concentrated never. The same total, at the wrong times.
03 A bile acid taken with food own bile pool capsules with meal own pool TUDCA is a bile acid, taken at the meal rather than held for it. That is the idea, stated at its plainest.

Illustrative. The chart shows the timing of bile arriving in the gut, not a measured result.

Why nobody told you

The operation is routine. The aftercare is not there.

Cholecystectomy is one of the most commonly performed operations in the world, and for most people it ends the problem. For the minority whose digestion changes afterwards there is no pathway, no follow-up appointment and no leaflet. So the explanation above tends to arrive years late, from a stranger on the internet, if it arrives at all.

Post-op digestion thread5 months post-op · public forum
Every single doctor I had spoken to before the surgery had recommended removal and now none have answers or seem to want to take me seriously about these symptoms. From functional dyspepsia to IBS. Even told I might just grow out of it.

quoted verbatim 1 of 135 authors

Years later, out of nowhere12 years post-op · public forum
I've had mine out for 12 years now. My digestive system has never been the same. I just wish I knew this could have happened.

quoted verbatim 9 communities read

Tried everything, what now2 years post-op · public forum
I've done every diet in the world, gone with every sort of medication, from allopathic to homeopathic to naturopathic.

quoted verbatim 7,280 threads read

Quoted verbatim from public threads. These are not customers of Dr. Primal and they are not statements about this product.

What people try

The list, and what each thing actually does

Most people arrive having tried several of these. Several are prescribed and entirely appropriate.

Low fat dietLess fat at each meal means less bile needed to handle it. It lowers the demand. It does not change the timing.targets the demand
LoperamideSlows the passage of everything through the gut. Widely used, and aimed at the speed rather than the bile.targets the speed
Digestive enzymesLipase, protease and amylase break food down. Useful work, and a different job: enzymes are not bile.targets the breakdown
Ox bileAnimal-derived bile salts taken with food. The closest like-for-like in the list, and a common next step.adds bile salts
Prescription bile bindersCholestyramine and colesevelam bind bile acid in the gut so it leaves with the stool. Prescribed, appropriate, and the right answer for a lot of people.removes bile acid

What TUDCA is

A bile acid the body already makes

Serving size 2 capsules · 30 servings per pack
Ingredient	Per serving
TUDCATauroursodeoxycholic acid	500 mg
Capsule shellHypromellose	**

** Nutrient Reference Value not established. No magnesium stearate, no rice flour, no colourings, no anti-caking agents.

The protocol: two capsules together, with the largest meal of the day. That is one serving of 500mg daily — not split across two meals, and not on an empty stomach. A bottle is 60 capsules, so 30 servings, so one month. Nobody in this group is usually given a protocol at all, which is the main reason this one is printed here plainly.

TUDCA
Tauroursodeoxycholic acid, present in the human bile pool in small amounts. Sold here as a food supplement that supports bile flow and the digestion of fat. It is a category, not a cure, and the section below says exactly how far the evidence goes.
500mg per serving With food Vegan capsule No fillers
Hypromellose capsule
A plant-based capsule shell. That is the entire rest of the formula — there is nothing else in the bottle.
Vegan No fillers

The research

What research shows

We read the published literature on TUDCA, 66 papers in total, and this is what came back. It is set out on the assumption that the reader will go and check.

Randomised controlled trial Ma et al. 2016, 199 patients, 24 weeksDouble-blind, TUDCA 750mg a day against UDCA 750mg a day, in people with a liver condition. On the primary endpoint the two were statistically the same, 75.97 percent against 80.88 percent, P=0.453. Adverse events were 44 percent against 40 percent, P=0.55, with 93.80 percent judged unrelated to the study drug, and no serious adverse events in either arm. What it says within that trial and that population, TUDCA was statistically no different from UDCA, a licensed prescription bile acid, at the same daily dose over the same 24 weeks. That is the strongest single line in the whole literature. Also says the two arms were tolerated much alike, with no serious adverse events across 199 people taking 750mg a day for six months.
Case series 33 patients, 500 to 750mg a day, three to twelve monthsA separate series of elderly patients given TUDCA orally. It is useful for one thing only, which is establishing that these doses have been given to people for months at a time.

Is this just another supplement?

A highly upvoted post in one of the main communities describes ox bile and TUDCA as voodoo natural healing, and that scepticism is earned. The honest case is the one above and nothing more: TUDCA is a bile acid, the reasoning from physiology is straightforward, and the population-specific research does not exist. For some readers that will not be enough, which is a fair conclusion to reach.

Some people say they tried it and nothing happened.

That is a common report in the same threads, and so is loose stools caused by the bile acid itself. There is no way to know in advance which group any one person falls into, and there is no trial in this population to appeal to. The 30 day guarantee exists for that reason rather than as a flourish.

How much, and when?

Two capsules taken together, with the largest meal of the day, which is one 500mg serving daily. Not split across meals and not on an empty stomach. Sixty capsules per bottle, so thirty servings.

Why is there no timeline on this page?

Because there is no reliable one for this group. Anything sold with a number of weeks attached is extrapolating from other populations. A month of consistent use is a reasonable period over which to form an opinion, and that is as far as this goes.

Can it be taken alongside a bile binder or a prescription?

That is a question for a pharmacist or GP, who has the full list of what is being taken. Nothing on this page is a reason to stop or change a prescription.

Where is it made?

Manufactured and batch tested in the United Kingdom. The certificate of analysis for the current batch is available on request.

Who should not take this. Not suitable during pregnancy or breastfeeding, or under the age of 18. Anyone taking prescription medication, or under care for a liver, bile duct, bowel or heart condition, should speak to a GP or pharmacist before starting. Stop taking it and seek advice if anything unexpected happens. A pharmacist can rule this in or out in about a minute, and that is a better use of a minute than reading more of this page.

TUDCA 500mg

Most people start on the monthly plan and cancel from the account page in two clicks. Buying once costs a little more and is a perfectly reasonable way to find out.