Chronic diarrhea persists after having gallbladder surgery

ANSWER: Probiotics are bacteria that are abundantly found in a healthy colon. They are thought to provide benefit to people in certain circumstances. Unfortunately, there is only proof of benefit in very limited situations. Many trials to help treat or prevent diarrhea due to inflammatory bowel disease — during or after antibiotics — have been done, and the results are mixed. There isn’t an agreement about the “best” type of probiotic.

One that is commonly used, called lactobacillus rhamnosus GG, reduced the risk of traveler’s diarrhea by about half, while other preparations did not. There are reports of infection and even drug resistance being passed through probiotics.

However, diarrhea after gallbladder surgery is not usually due to bacteria. The main job of the gallbladder is to store the bile salts made by the liver and release them when needed after a person eats. Without a gallbladder, the bile salts are released continuously. Bile salts are normally reabsorbed at the very end of the small intestine, but this ability can be overwhelmed with continuous bile salt release. This leads to bile salts getting into the colon, with resultant diarrhea.

A medication to bind the bile salts is usually effective at treating the diarrhea that commonly occurs after gallbladder surgery. I usually prescribe cholestyramine if the diarrhea doesn’t get better, as it should after a few weeks (occasionally months) after surgery. The benefit can be life-changing.

DEAR DR. ROACH: I am a 73-year-old male. I am 5 feet, 9 inches tall, and I weigh 165 pounds. In 2015, I had a kidney removed because of cancer. My remaining kidney works well. I am generally in good health and do resistance training three times a week, plus regular walking and hiking.

My question is, how much protein can I safely ingest to limit muscle mass reduction as I age, while not overworking my remaining kidney? I’ve read that because of the kidney issue, I should limit my daily protein intake to 0.65 grams of protein per kilogram of body weight. I’ve also read that the correct amount should be more in the range of 1-1.2 grams per kilogram.

Can you offer any insight on this? R.D.

ANSWER: If your remaining kidney is working well, I don’t think you need to restrict your protein intake. I do not recommend a protein intake of less than 0.6 grams per kilogram; that’s 45 grams of protein — about 1.5 ounces. I think a 0.8-gram-per-kilogram protein intake (60 grams in your case) is safe for your remaining kidney and adequate for nearly all people’s needs. A limit of 0.8-gram-per-kilogram is recommended for people with moderate to severe chronic kidney disease.

From the kidney’s standpoint, it seems that plant-based protein has less potential for harm than meat-based protein. A typical vegan diet still provides 1 gram of protein per kilogram, compared to 1.3 grams per kilogram found in the typical diet of a person who eats meat. Legumes (peas, lentils, beans) are excellent plant sources of proteins. Some grains, like wild rice and quinoa, are also high in protein. These would be excellent ways of increasing protein intake with the least threat to your remaining kidney — or for other readers who have chronic kidney disease.