Dear Dr. Roach: I’m a 43-year-old mostly healthy woman. After my gallbladder surgery, I had terrible abdominal pain, gas and diarrhea after eating. My doctor treated me with cholestyramine with good results, but now my triglyceride levels are high. I can’t live without the cholestyramine. What should I do? — L.D.V.
Answer: A small proportion of people will develop the symptoms you describe after removal of the gallbladder. In most people, symptoms get better after some months, but they can be persistent in others. Your doctor chose an effective treatment, cholestyramine, which binds the bile acid salts. Unfortunately, a high triglyceride level is a common side effect of bile acid binders.
In general, when a drug causes a side effect, the patient and physician need to discuss whether the benefit is worth the side effect. In your case, the high triglycerides aren’t apparently causing any symptoms, but there is some evidence that high triglycerides increase risk for heart disease and stroke.
Given your young age, you may not need any treatment.
However, it might be worth considering treatment to reduce triglycerides and also reduce risk of heart disease as you get older. If dietary changes alone aren’t helpful — be especially careful to reduce starches and simple sugars — I would suggest consulting with your internist or cardiologist at age 50 or so to consider a statin drug. Perhaps something better that may be available by then.
