Never Get Your Gallbladder Removed

Berg presents oral bile salts as the primary non-surgical alternative. He describes how concentrated bile can break down cholesterol stones, citing studies where 50% of patients had stone dissolution within 2 years, and another where nearly 80% achieved dissolution within 6–12 months. He emphasizes that this approach has minimal side effects, especially relative to surgery. He mentions TUDCA (transcribed as 'tatka') and purified bile salts as the form to take. While he does not provide a specific dose, the protocol is framed as long-term and meal-dependent, mimicking the natural postprandial release of concentrated bile. He also notes that bile salts can help those who already lack a gallbladder deal with chronic bile insufficiency and that they improve thyroid function by activating thyroid hormones. The underlying concept is that supplementing bile externally can compensate for the liver's low output and the gallbladder's weak ejection, thereby addressing the root deficiency.

Berg identifies insulin resistance as the dominant cause of gallstones. He points to a diet high in carbohydrates, sugars, and seed oils, combined with frequent eating, as the perfect storm that elevates insulin, which in turn suppresses liver bile synthesis and weakens gallbladder contraction. The result is bile stasis and stone formation. The therapeutic shift is to drastically reduce carbohydrate intake and eliminate seed oils, which lowers insulin and allows the liver to produce adequate bile. Intermittent fasting further enhances this by extending the period when bile is not being diluted by constant food intake, allowing it to become super-concentrated and capable of dissolving existing stones. He contrasts this with the standard advice of frequent small meals and low fat, arguing that those practices worsen the condition. He notes that people who fast have more concentrated bile, directly supporting stone dissolution. This protocol is thus a root-cause intervention targeting the metabolic dysfunction, not merely symptom relief.

Berg connects stomach function to gallbladder health, noting that you need strong hydrochloric acid in the stomach to signal the gallbladder to release bile. If acid is low, the gallbladder doesn't receive the proper cue, leading to bile stasis and stone formation. He recommends adding acidic components: apple cider vinegar, betaine hydrochloride, or citrus juices. Additionally, bitter greens like arugula and radish, and fermented foods like sauerkraut, stimulate bile flow through taste receptors and acidic content. He mentions that even celery can help. Herbs such as turmeric, ginger, milk thistle, parsley, and cilantro are also cited as gallbladder contractors. This protocol is designed to be layered on top of dietary changes to ensure that whatever bile is produced actually gets ejected into the intestine when needed, rather than sitting and forming sludge or stones.

Berg argues that surgeons routinely tell patients 'there are no other options,' which he labels a lie. He describes oral bile salts as a low-side-effect alternative, referencing a study where 50% of participants had gallstones dissolve within two years, and another showing nearly 80% dissolution within six to twelve months. He also mentions EDTA, a chelator that binds calcium and other minerals to pull stones out of the body, mechanical extraction of stones while preserving the gallbladder, and lithotripsy using sound waves to break stones. He stresses that surgery should remain an option for life-threatening situations, but patients deserve to know all alternatives and risks. The mainstream system, he argues, fails to provide this transparency.

Berg explains that a gallstone is a super-concentrated cholesterol stone, but the formation equation is high cholesterol plus very low bile salts. So stones result from a lack of bile, meaning the gallbladder isn't contracting properly or the liver isn't producing enough bile. He then connects this to insulin resistance: high insulin from excessive carbs, seed oils, and frequent eating leads to a fatty liver and weak gallbladder contraction, reducing bile output. Therefore, the solution is not lowering cholesterol but addressing the metabolic dysfunction that cripples bile production. He also notes that the gallbladder concentrates bile, and without enough bile, cholesterol precipitates out, forming stones.

Berg states plainly that people on low-fat diets are more at risk for gallstones than those who consume adequate fats. The liver requires cholesterol to manufacture bile; without it, bile production drops. He highlights that fatty fish—specifically the DHA omega-3—has the most potent effect on stimulating bile synthesis, which he suggests makes evolutionary sense. Other helpful fats include those from meat and olive oil, while seed oils are to be avoided for their inflammatory effects. He also points out that cholesterol-rich foods like butter, eggs, shellfish, and liver are essential for bile production, and egg yolks and liver additionally supply choline, a key nutrient for bile. Thus, a low-fat approach sabotages the body's own mechanism for preventing stones.

Berg explains that estrogen directly suppresses bile salt synthesis and gallbladder contraction, creating a temporary environment where stones can form. Once the hormonal spike resolves—after childbirth or stopping birth control pills—bile flow normalizes and the stone may dissolve. He emphatically advises getting a second opinion if surgery is urged under these circumstances. This insight also extends to women on oral contraceptives who develop gallstones, linking the condition to elevated estrogen rather than a permanent gallbladder defect. The underlying principle is that the stone is a symptom of a hormone-driven bile stagnation, not an irreversible organ failure.

Berg states that the biggest reason for gallstones is high insulin, especially with insulin resistance. He has created hundreds of videos on how insulin resistance causes fatty liver, weight gain, and high blood pressure. In the gallbladder, it translates to the liver producing insufficient bile and the gallbladder's smooth muscle failing to contract fully to expel bile. This results in bile stasis and stone formation. He specifically calls out carbohydrates, sugars, seed oils, and frequent eating as the dietary drivers. The antidote is a low-carb diet combined with intermittent fasting, which he says leads to more concentrated bile that helps dissolve stones. He also links antibiotic use to microbially-produced bile disruption and weight gain, further supporting the gut-liver axis. This reframes gallstones from a local plumbing problem to a metabolic syndrome that can be reversed through dietary intervention.