I've been eating pseudo-paleo for a while, really starting to ramp up my saturated fats and completely dropping legumes earlier this week. I'm probably eating 150-200 grams of fat a day, mostly coconut oil/milk/cream, eggs, and beef, but do I eat sardines in water, olive oil, a tbsp of cod liver oil, so it's not all saturated. I'm getting some stomach problems, diarrhea, and since last night after eating a bacon/cabbage salad, I've noticed a low, somewhat subtle nauseous feeling that has lasted until this morning and made it impossible to eat more than one bite of my bacon/spinach omelot.
I had assumed it was just my body getting used to the increased fat intake, and this seems like the most likely explanation, but I started wondering if having no gallbladder (removed last summer) is to blame? I know it aids in fat digestion.
Anyone eat paleo without a gallbladder? I'd assume since it's a fairly common procedure (although I'm not sure I'd have it done at this point, I might try to make some dietary changes first) that there's some people out there doing fine on paleo without it.
Dr. Harris talked about this on his forum:
Update: It's been nearly 2 years since this answer, so an update is in order.
Diet is lots of fat during the day, with a few very high carb evenings thrown in. The high fat is from meat (beef,lamb,pig), butter & coconut.
Supplementation is only Vitamin K2 (apparently the gallbladder produces a lot of it), Magnesium & NAC (more so for other issues, but maybe it helps the gallbladder).
Issues: Digestion is still very slow (as expected without a gallbladder) but adding some extra coconut oil clears me out. Need to due this about once a week or I start getting acne due to the toxins from slow digestion. Within 1 day of my gut getting smaller, my skin clears and vice-versa.
My healthy gallbladder was removed in 2005 at the age of 23. Not a typical case for a cholecystectomy. Brain dump below.
After surgery I quickly noticed a slow down in digestion and at times diarrhea. It's still a bit slow but mostly regular.
I had been eating 5-6 mostly paleo meals a day before the surgery and continued that for many years after though didn't go high fat until 2008. The small meals worked but took up too much of my life.
Bile supplements didn't have a noticeable affect, though I wasn't keeping a journal. May try them again while keeping records. Link  below recommends NAC, Glycine and Taurine instead of enzymes.
Earlier this year I switched to 2 large meals a day (lunch and dinner) with absolutely no snacking in between before or in between. It's working wonderfully for me, though I can't explain why. This may explain it, but I'd like a better study to back it up:
The biliary ducts that carry bile from the liver to the small intestine are maintained intact, now bypassing the absent gallbladder. So the good news is the liver is still functioning, the bile is still flowing, and your fatty food gets digested. At this point the choledochal sphincter, which is the sphincter connecting the common bile duct to the duodenal portion of the small intestine, is acting somewhat like the gallbladder did. That is, it stays closed until fatty food is present in the duodenum, and then opens and drops bile onto that food when it is present
Currently the staple of my high fat diet are: butter, coconut (milk, cream, oil), lamb, beef, canned sardines (in water), eggs. A little veg thrown in for flavor and often a small sweet potato. Guessing the MCTs from coconut are helpful. Supplementing with magnesium (helps digestion), VitD when there is no sun and fish oil when diet suffers (normally when traveling).
After food, the other big factors for me are: good posture, eating slowly, and moving around. Saw a big improvement after moving to London. I suspect due to the increased walking.
As mentioned by other hackers, emulsified fats are easier to digest. Some emulsified fats: egg yolk, dairy cream/butter, coconut flesh/cream/milk
p.s. It turns out my gallbladder was fine. The doctor and surgeon mis-diagnosed a minor issue. During surgery, while I was under, the surgeon found the gallbladder to be healthy but took it out anyway since, in their words, "you don't need your gallbladder".
Mileage will vary greatly for people who have had their gallbladder out. Some people have digestive problems for the rest of the lives, even when avoiding fat. Others seem to do fine as long as they don't eat giant hoards of fat all at once. The obvious point is that fat digestion will be impaired to some extent. But if your fat digestion was excellent to start with, you might still be able to get away with a lot of fat consumption. You will just have to experiment to see what your body can handle. Also, after being on paleo for longer periods, you might find your body improves its ability to handle fat as a matter of adaptation. Sounds like you are are already doing a good job of recognizing issues and working out potential solutions. Obviously, if you feel ill, then you will need to make some alterations. Luckily, you don't need to eat a super high fat diet to be healthy on paleo. Many do great with moderate fat intake, as long as all foods are healthy foods. In fact, we really don't know for sure what fat intake is healthiest for most people and there may be such individual variation that to quote specific numbers would be difficult.
Medium chain triglycerides (coconut) is the answer, as you already seem to have discovered. Unique among fats, they can be absorbed without bile. Other than that, and Dr. Harris' suggestion to eat emulsified fats, I don't know of other ways to up your fat intake.
However, despite what some of the newbies in the paleo world believe, you can be very healthy on a high carb diet, provided your metabolism is not already too broken. Make sure to eat the right carbs-- starches are great. High GI starched like potatoes, sweet potatoes, etc are the best unless your metabolism is broken (insulin resistance). If so, concentrate on whole grains as they take longer to digest. Good luck
What to bring to a Paleo Pot Luck? 7 Answers