Following a Ketogenic Diet without a Gallbladder -

Following a Ketogenic Diet without a Gallbladder


The Ketogenic Diet without a Gallbladder

Since the 1920s, ketogenic diets have been used as a therapeutic method to treat obesity, epilepsy, diabetes, neurological disorders, cancer and many other pathological diseases (1). This very low carbohydrate diet that combines moderate protein consumption with high amounts of quality fats puts the body into a state of fat or ketone adaptation.

Following a ketogenic diet without a gallbladder can pose complications because of the body’s inability to adequately secrete bile to break down fatty meals. Fortunately, these 7 strategies will answer your concerns for maintaining ketosis without a gallbladder.


What Is Ketosis?

When net carbohydrate consumption remains less than 50 g/day (in some cases under 30g/day), insulin concentration reduces and the body begins using stored fat for energy via lipogenesis (1). Following 3 to 4 days of this dietary carbohydrate restriction, the central nervous system (CNS) has an inadequate supply of glucose and must seek other fuel.

The alternate energy source the CNS seeks along with tissues and organs is ketone bodies.   These ketone bodies are produced at high concentrations in the liver during the metabolic state of ketogenesis which is also attainable during periods of prolonged fasting.  The 3 major ketone bodies include acetate, acetoacetate and beta-hydroxybutyrate.

Ketosis results in numerous health promoting benefits including: (1)

  • Decreased fatty acid production
  • Increased metabolism of fats and lipids
  • Higher metabolic rate to use ketone bodies
  • Improved mitochondrial function
  • Modified satiety hormones including ghrelin and leptin
  • Regulates blood lipid levels including triglycerides and cholesterol
  • Reduced insulin signaling
  • Improved glycemic control
  • Reduced whole body inflammatory levels

Is a Ketogenic Diet Right for You?

When nutritional ketosis is properly managed, it is an excellent way to improve your quality of life.

Reverse Neurological Dysfunction: Many individuals can benefit from ketosis to improve insulin sensitivity, combat chronic inflammation, reduce the risk of developing chronic disease, prevent muscle fatigue and encourage healthy weight. Ketosis is shown to favor the reversal of neurological decline in patients suffering from neurological disorders affecting sleep habits, causing headaches and those showing symptoms of Alzheimer and Parkinson’s disease as well as multiple sclerosis and autism (7).

Combat Cancer: A diet with normal or high levels of glucose fuels the development of cancer cells. Diminishing your carbohydrate intake will deprive cancer cells of their primary energy source. The state of ketosis has been shown to weaken cancer cells and make them more susceptable to various cancer treatments and the bodies immune attack.  (2).

Contraindication: Due to associated health risks, it may not be appropriate for the following people to enter and maintain a state of ketosis in the body:

  • High performance athletes
  • Children and teenagers
  • Women who are pregnant, nursing or experience irregular menstrual cycles
  • Some individuals with adrenal fatigue or poor thyroid function


Gallbladder and Liver Function as One Unit

If you are still wondering if ketosis is possible, safe and healthy for someone without a gallbladder, the answer is yes.  The gallbladder is an organ that aids in the digestion of fatty foods by storing up bile reserves. Bile is generated in the liver and carried to the gallbladder via the bile ducts. The gallbladder will contract to force bile out when it receives ques that fats have been eaten.

Bile serves four primary functions in digestion:

  1. Breakdown fatty acids
  2. Stabilize blood sugar
  3. Inhibit bacterial overgrowth
  4. Remove toxic waste and cholesterol from the liver for excretion from the body.

If your gallbladder has been removed, the liver still produces bile. However, because bile cannot be stored for efficient fat digestion, it slowly seeps into the intestines. This results in its inadequacy to properly digest a meal with a high amount of fat in it.


Gallbladder and Liver Issues:

Addressing the health of both the liver and gallbladder is vital to improving health. When the bile ducts of the liver harden, they can form a crystallized structure called gallstones that obstruct bile flow and secretion. Gallstones are created from the combination of excessive cholesterol and/or bilirubin.

The liver is responsible for the production of bilirubin. Therefore, the presence of gallstones and gallbladder dysfunction indicates an underlying liver problem. (8)

Common Symptoms:

If fats are not properly digested, someone that has had their gallbladder removed or has a gallbladder disease will experience malabsorption of valuable nutrients. Essential fatty acids like omega-3 and omega-6 fats as well as vitamins that require fat for absorption (vitamins A, D, E, and K) can become deficient. This nutrient loss causes systemic issues including dry skin, thinning hair and even autoimmune symptoms.

Unfortunately, symptoms of gallbladder and liver issues do not disappear with the removal of the gallbladder. Individuals can suffer from digestive distress including nausea and vomiting, abdominal pain, gas and bloating, as well as symptoms distant from the abdominal region such as itchy skin, pain between the shoulder blades, headaches and migraines, fibromyalgia and  hormonal imbalances. (14)


Following a Ketogenic Diet

A ketogenic diet consists of about 75% healthy fats, 20% proteins and 5% carbohydrates. In general, you will want to consume about 20 to 35 grams of protein at each meal depending on your body size and intensity of exercise. Individuals with a sedentary lifestyle only require 10-15% of calories from protein whereas someone with high physical demands requires 20-25% calories from protein.

Although a ketogenic diet will have your body producing ketones within a few days, training your body to stay in a state of ketosis takes about 2 or 3 weeks (6). The following list provides staple foods which promote ketosis.

Fats: Coconut oil, full fat coconut milk, raw nuts and seeds especially pumpkin seeds, chia and flaxseeds, olive oil, avocados, MCT oil, pastured butter, hemp powder, and organ meats such as grass-fed beef and pasture-raised chicken liver.

Proteins: Grass-fed beef, wild game, organic free range poultry, organic and grass-fed raw dairy and fermented dairy.

Carbohydrates: Brussel sprouts, kale, broccoli, asparagus, collard greens, spinach, celery, cauliflower, cabbage, lemons, limes and other non-starchy veggies.

7 Key Strategies:

If you have had liver or gallbladder problems in the past or no longer have your gallbladder than be sure to follow the strategies below.  Many people without a gallbladder are able to thrive when they successfully apply these tips, so give them a shot and see how you respond.

If you feel extremely tired and irritable for more than a few days than try adding back more healthy carbs with your evening meals.  People with liver or gallbladder issues typically do very well with beets, carrots, green apples, squash and berries.  These would be better sources of carbohydrates than grains and sugar sweeteners.


1.) Bile Healthy Foods:

Ginger is a carminative herb and one of the best foods for producing stomach acid and bile (15). Adding apple cider vinegar to your meals and beverages can help thin bile for efficient flow from the liver. Artichokes stimulate bile production in the liver and increase its flow into the intestines (16).

Add plenty of sour foods into your diet like lemons and limes to improve your tolerance of fats. These citrus fruits cleanse the liver and thin bile for improved digestion and nutrient absorption.  Fermented vegetables and drinks such as a low-carb coconut water kefir are excellent for improving digestive juice production.

Fibrous vegetables and fermented foods and beverages are excellent to stimulate a healthy digestive system and prevent the overgrowth of intestinal bacteria that can lead to digestive disturbances (18). Celery and cucumbers are great low carb foods that naturally contain sodium, vitamins B and C and trace minerals for liver health.

Celery as well as asparagus are good foods for detoxifying the liver and improving bile flow. Add radishes to your meals to support the metabolism of fats from increased bile production (17).


2.) Ginger and Dandelion Tea:

Both ginger and dandelion are considered bitter herbs that increase bile production and boost bile flow for a healthy liver.

Ginger has well known carminative properties that can help relieve symptoms of indigestion and prevent nausea and vomiting. Ginger stimulates the secretion of gastric juices like hydrochloric (HCL) acid and bile. It has also been shown to inhibit inflammation of liver tissue aiding in the removal of toxins (10).  Here is my favorite ginger tea and a great green tea and ginger tea combination here.

Traditional Medicinals offers an Organic Dandelion Leaf and Root Tea that is excellent in supporting healthy digestion and enhancing detoxification. Dandelion leaf or greens is also a prebiotic food source that supports a healthy gut microflora and keeps pathogenic bacteria at bay (5).


3.) Good Hydration:

Without plenty of water available to the liver, bile production decreases and the body creates a thick, sluggish bile flow. Aim to drink 32 ounces of purified water within the first hour of waking up and between 32 and 48 ounces of water by noon.

Drinking plenty of purified water is essential to improving gut motility and preventing constipation while maintaining ketosis.  It is also critical for healthy liver function and bile release.

4.) Support Stomach Acid Levels:

Optimal stomach acid levels are necessary for stimulating bile secretion from the liver and destroying pathogenic microbes that can overpopulate the intestines causing inflammation and indigestion. The combination of optimal stomach acid and bile flow is critical to the detoxification process of the liver and digestive tract so that you feel healthy and energized while maintaining ketosis without a gallbladder.

Producing adequate stomach acid will support your body’s ability to metabolize fats, absorb essential nutrients, and prevent feelings of discomfort and digestive problems.

Support stomach acid levels by avoiding water intake within a 30 minute window before and after meals and relaxing to enjoy your meal.  Higher levels of stress block the secretion of stomach acid, so it is very important to relax the body before meals. You may also consider a hydrochloric acid supplement in the form of betaine HCL tablets taken during or immediately following a meal.


5.) Use Digestive Enzymes and Ox Bile:

Supplementing your diet with digestive enzymes and ox bile can significantly support fat metabolism without a gallbladder.

Digestive Enzymes: Digestive enzymes contain natural bile salts, betaine HCL, herbs and a complex of enzymes that support the function of other digestive organs like the pancreas. Finding a good quality digestive enzyme is an effective way to produce adequate stomach acid, inhibit inflammation of the intestines and aid in fat metabolism and the assimilation of fat soluble vitamins (9).

Ox Bile: Ox bile supports the body in breaking down fats without the presence of bile. Some digestive enzymes contain ox bile but it is recommended to be supplemented separately.

Ox bile serves similar purposes in sanitizing or killing off microbes and helping to assimilate fats for absorption. Ox bile can help relieve your symptoms of indigestion and feelings of an upset stomach that you may otherwise experience consuming a high fat diet without healthy bile concentrations. (13)  If you want extra bile support, I recommend using BioGest with your meals.


6.) Avoid High Amounts of Long-Chain Fats:

Long chain fatty acids need bile in order to be metabolized into triglycerides.  Small and medium chain fatty acids do not require bile and are easier on the liver.  In addition, long-chain fats take a longer period of time to break down and require significantly more energy for digestion (3).

We find long-chain fatty acids in avocados, nuts and seeds, olives and olive oil and meats.  We find small and medium chain fatty acids in grass-fed butter and coconut fats.

It is especially critical for individuals without a gallbladder to eat small meals. Inadequate gastric juices and bile secretion will cause digestive distress from the inability to break down long-chain fats. Instead, consume 3 or 4 small meals throughout the day. Substitute liquid nutrition that is easy on the digestive tract with shakes and smoothies to support liver function.


7.) Use MCT Oils:

Medium chain triglyceride (MCT) oils are rapidly metabolized into ketone bodies for efficient energy use. Consuming MCT oil reduces your energy dependence on fats to 60-70% making MCTs easily absorbable by individuals without a gallbladder and those with slow liver function (3).

You may be surprised to know that coconut oil is actually made up of 35% long chain triglycerides, only 15% medium chain triglycerides and 50% lauric acid which is utilized as a long chain fatty acid. (4)

Adding MCT oil to your diet is one of the best ways to increase the medium chain triglycerides that favor maintaining ketosis without a gallbladder. Unlike most fatty acids, MCTs do not rely on the production of bile to be metabolized and begin breaking down immediately from contact with enzymes found in saliva. MCTs have been shown to effectively synthesize ketones and cross the blood-brain barrier for healthy brain function (5).



Greater than 700 toxins are carried by any individual in organs including the digestive tract and liver (11). It is especially critical for individuals without a gallbladder to practice lifestyle habits that support liver function. Preserve nutrition by consuming organic foods and drinking purified water to reduce the toxic burden on your liver and body.

Incorporating a lifestyle of habits that supports your body’s need for detoxification rather than inhibits it will leave you feeling great on the ketogenic diet even without a gallbladder.

Sources for this Article Include:

1. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets.European Journal of Clinical Nutrition. 2013; 67(8):789-796. PMCID: 3826507
2. Klement RJ, Kämmerer U. Is there a role for carbohydrate restriction in the treatment and prevention of cancer?Nutrition & Metabolism. 2011; 8:75.PMCID: 3267662
3. Liu YM, and Wang HS. Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets. Biomed J. 2013 Feb; 36 (1): 9-15. Link Here
4. Page KA, Williamson A, Yu N, et al. Medium-Chain Fatty Acids Improve Cognitive Function in Intensively Treated Type 1 Diabetic Patients and Support In Vitro Synaptic Transmission During Acute Hypoglycemia.Diabetes. 2009; 58(5):1237-1244. PMCID: 2671041
5. Page KA, Williamson A, Yu N, et al. Medium-Chain Fatty Acids Improve Cognitive Function in Intensively Treated Type 1 Diabetic Patients and Support In Vitro Synaptic Transmission During Acute Hypoglycemia. Diabetes. 2009; 58(5). PMCID: 2671041
6. Mitchell GA, Kassovska-Bratinova S, Boukaftane Y, Robert MF, Wang SP, Ashmarina L, Lambert M, Lapierre P, Potier E. Medical aspects of ketone body metabolism. Clin Invest Med. 1995 Jun; 18(3):193-216. PMID: 7554586
7. Stafstrom CE, Rho JM. The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders. Frontiers in Pharmacology. 2012; 3:59. PMCID: 3321471
8. Mayo Clinic: Gallstones Link Here
9. Hulst VDRR, Meyenfeldt MFV, and Soeters PB. Glutamine: an essential amino acid for the gut. Nutrition. 1996 Dec; 12(11-12 Suppl): S78-81. PMID: 8974125
10. Zhou Y, et al. Dietary Natural Products for Prevention and Treatment of Liver Cancer. Nutrients. 2016 Mar; 8(3): PMID: 26978396
11. Department of Health and Human Services: Fourth National Report on Human Exposure to Environmental Chemicals Link Here
12. Prebiotin: How Prebiotics Work Link Here
13. Wang DQ-H, Carey MC. Therapeutic uses of animal biles in traditional Chinese medicine: An ethnopharmacological, biophysical chemical and medicinal review.World Journal of Gastroenterology : WJG. 2014; 20(29):9952-9975. PMCID: 4123376
14. Bateson MC. Gallbladder disease.BMJ : British Medical Journal. 1999; 318(7200):1745-1748. PMCID: 1116086
15. Starwest Botanicals: Improving Digestive Health With Carminative Herbs Link Here
16. Gebhardt R. Anticholestatic activity of flavonoids from artichoke (Cynara scolymus L.) and of their metabolites. Med Sci Monit. 2001 May; 7 Suppl 1: 316-20. PMID: 12211745
17. Lee SW, Yang KM, Kim JK, et al. Effects of White Radish (Raphanus sativus) Enzyme Extract on Hepatotoxicity. Toxicological Research. 2012; 28(3):165-172. PMCID: 3834419
18. Swain MR, Anandharaj M, Ray RC, Parveen Rani R. Fermented Fruits and Vegetables of Asia: A Potential Source of Probiotics. Biotechnology Research International. 2014; 2014:250424. PMCID: 4058509


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33 Responses to Following a Ketogenic Diet without a Gallbladder

  1. Theresa Brown February 20, 2017 at 12:56 pm #

    Dear Dr. Jockers. I follow the clean and unclean diet as set up in the bible. I will not put Pork in my body. Unfortuanetly nearly all digestive aids contain pork. Your suggestion of Bio-Gest is one of them. Pepsin is from Pig guts. I have been living without a gallbladder for many years, and can’t seem to get well. I can’t loose weight, and have had so much trouble with my gut. I keep asking the Lord to show me how to fix this without putting something unclean in my body. I would love it if you could help me find good clean options. Bless you

  2. Vickie Chapel May 3, 2017 at 8:26 pm #

    I’m a 39 yr old woman living without a gall bladder since 2001. Diagnosed a diabetic in 2011. Tried keto had a hard time losing weight. Any suggestions. I would like to get a regiment on how to implement keto. I need your help!!

    • Dr. Jockers May 4, 2017 at 11:13 am #

      Hey Vickie, I’m sorry to hear about this! Without your gallbladder, you would likely need to rely on lots of MCT oils for ketone production and a high quality Enzyme and Ox Bile Supplement to properly digest fats.

      Your case may require some more specific individualized work. You can email if would like some personal consulting on this!

  3. michell June 11, 2017 at 5:50 am #

    I don’t have a gallbladder and I suffer with anaphalactic attacks. I believe I have black mold in my body as well. Most of the food groups for the ketosis diet are bad for a mold free diet. I take organic probiotics. I am suffering. I can’t get better. I need help.

    • Dr. Jockers June 11, 2017 at 12:42 pm #

      Wow that’s a tough situation Michell. You would also probably benefit from a personalized plan if you want to email for that! It would be helpful to perform some lab work to see if you have been reacting to mold.

  4. Reg June 18, 2017 at 7:19 pm #

    Hello Dr Jockers,
    Thank you for sharing this info. I started Keto over a month ago. Lost a quick 15 pounds in the first couple weeks then nothing. I noticed I had a lot of indigestion. I decided to search no gall bladder/keto. I found info on ox bile and ordered. However now I have diarrhea after eating and taking. So then I searched again and found you. 🙂 Would you recommend starting with smaller doses and building up? Thanks

    • Dr. Jockers June 19, 2017 at 12:27 pm #

      Hey Reg! Yes start with the lowest dose and see how you respond. Also make sure to eat plenty of fiber rich leafy greens, cruciferous veggies, and avocados to see if that helps.


  5. Grandma June 26, 2017 at 11:17 am #

    Dr. Jockers,

    I’ve been following a paleo/keto diet for about 2.5 months and have had great success in losing weight. Last week I started getting “phantom” gall bladder pain (right at the bottom of the rib cage in the middle) – I lost my gall bladder 32 years ago (I’m 53). I was using MCT oil in my morning protein shakes but it is causing severe stomach burning and I had to stop. What would be the cause of this? (No stomach burning when I don’t use it)

    • Dr. Jockers June 27, 2017 at 9:48 am #

      What kind of MCT were you using? You may have been using a low quality mct or using too much. You could try a pure C8 mct oil such as Brain Octane from the bulletproof brand as C8 is the easiest to process in the body.


      • Grandma June 27, 2017 at 11:48 pm #

        I was using Viva Naturals MCT Oil. Thank you for the information, I will have to try C8.

        • Elisabeth June 28, 2017 at 8:56 am #

          Hi there! This is Elisabeth from Viva Naturals Customer Care Team.

          I’m sorry to hear that our MCT oil caused you stomach pain! Due to its high saturation, excessive amounts of MCT oil have been shown to cause intestinal discomfort, which is why we recommend limiting your daily serving size to 1 tablespoon per day until your body adjusts. If you experience stomach upset with 1 tablespoon, we recommend reducing to 1 teaspoon per day following a complete meal or blended in a smoothie.

          I just wanted to let you know that we do offer a 90-day satisfaction guarantee on all our products. Please feel free to contact us directly at for further assistance!

          • Grandma July 6, 2017 at 8:27 am #

            Elizabeth I don’t think it was your product as much as my stomach. And it wasn’t “that” kind of upset – it was a burning sensation that lasted a couple hours. And I didn’t consume anywhere near 1 Tablespoon – just a quick squirt in my shakes. We still use it to make fat bombs for my disabled grandson (TBI when he was a baby), so no refund needed.

      • angela Baiza July 2, 2017 at 1:40 pm #

        Can all of these products be taken with high blood pressure

        • Dr. Jockers July 3, 2017 at 11:22 am #

          Yes Angela you can absolutely use MCT oil.

  6. Diane Warne July 5, 2017 at 8:31 pm #

    Hello Dr. Jockers
    I went to the doctor today for pain in upper right quadrant. I am on Ketogenic diet since April and have lost 22 lbs. I have to get an ultrasound tomorrow. I have no other symptoms. Question for you, do you believe in the gallbladder/liver cleanses? I don’t want my gallbladder taken out if I don’t have to. I have never had any digestive issues before, but I do know I have a fatty liver. Thanks for any information.

  7. Shannon Clark August 8, 2017 at 11:30 pm #

    Hello! I have been on a Keto diet for two weeks now. I recently began experiencing a dull ache in my upper back on the right side. I do not have a gall bladder. What could this be? Liver pain? I ate more carbs over the past two days to see if the pain would stop and the pain subsided. Then I limited my carbs again and the pain returned. Should I be concerned in regard to my liver?

    Thank you

  8. Heather Hill-Collis October 1, 2017 at 8:55 am #

    Hello Dr. Jockers,

    Thank you for all of the great information on keto diet without a gall bladder, this explains a lot! You had mentioned eating 3-4 smaller meals and mentioned having a shake for liquid nutrition. I would like to find a protein shake to replace one meal per day that is keto friendly and will support my lack of a gall bladder. Can you recommend a product for me?

    Heather Collis

  9. c king October 2, 2017 at 6:26 pm #

    thanks so much .was on keto and found it didnt work for me .i thinki will take sum advice and get the oxbile .i have no gallbladder

    • Dr. Jockers October 2, 2017 at 7:24 pm #

      Yes you will need the Ox Bile and probably the BioGest as well!

  10. Aisha November 6, 2017 at 1:26 pm #

    Hi Dr. Jockers,

    I’ve been on the keto diet for almost 2 months and have only lost 6 lbs and now I’m stuck right there. I started wondering if the fact that I don’t have a gallbladder might be the problem. I found you surfing the web for a solution. I stick to keto religiously and have become very discouraged as I have about 50 lbs to lose. I am constantly in ketosis from the urine ketosticks. I check a couple time a day. I have been a constant dieter since the age of 16. I eat mainly chicken and turkey, mixed salad greens avocado with ACV and olive on my salads. I was eating beef but gave it up thinking that might be my problem. I was drinking bulletproof coffee daily with the good butter and I stopped that. I added Cacao butter to replace the butter thinking that might be my problem. I feel better looks like I might be losing inches but the scale is not moving. I don’t want to go back to the standard American diet of low calories etc…But I’m at a lost right now. Thanks

    • Dr. Jockers November 6, 2017 at 8:36 pm #

      Hey Aisha, urine strips for ketosis are not very good. You either want to measure blood levels or breath levels:

      If you do not have a gallbladder and you are eating lots of fats, you will probably benefit from using the strategies in this article. If you are still experiencing weight loss problems then I’d recommend you work with one of our health coaches

  11. Aisha November 8, 2017 at 12:49 pm #

    I’m not sure what you where trying to say in part of your reply. “If you do not have a gallbladder and you are eating its of fats”, ??


    • Dr. Jockers November 9, 2017 at 11:57 am #

      Yes, your gallbladder is what helps you digest fats. So if you do not have one and you are eating a lot of fats in your diet, it is going to be hard to digest. Using an Ox Bile Supplement along with the rest of the strategies above will help you have more success following a ketogenic diet without a gallbladder.

  12. Aisha November 9, 2017 at 12:56 pm #

    Got it! Thank you! Today is day 2, I started a liquid fast. I plan to fast for 10 days; chicken bone broth, ACV and lemon water. And then I’ll slowly move back into the Keto diet. I’ll add salad and veggies then meats a few days later. What do you think? Thanks

  13. Kelly Douglas November 19, 2017 at 9:34 am #

    Dr. Jockers,

    I am just getting started with a Ketogenic diet. I am a 43 year old female, I had my gallbladder removed in 2001, I had ERCP with stent placement in 2004 after 6 weeks of hospitalization for acute pancreatitis which occurred due to a bowel obstruction (I do not drink alcohol). I also had RNY gastric bypass in 2011. I experienced some gi distress/dumping and nausea after having coffee with MCT oil and (grass fed) butter. What are your thoughts on someone like me following a ketogenic diet?


    • Dr. Jockers November 19, 2017 at 9:30 pm #

      You will need to make an extra effort to support your liver health to improve fat digestion. It can also be helpful to use an ox bile supplement such as Bio-Gest which we carry. Finally, using MCT oils that only contain capric and caprylic acids will be really helpful.

  14. Julie Martin December 27, 2017 at 6:35 pm #

    Dr. Jockers,

    This video has been so helpful. My gallbladder was removed many years ago and I wish that I had had this info from the doc who removed it. But, I have it now, so…what protein powder would you recommend for the keto meal replacement shakes throughout the day. I am excited to get started.

    Thank you


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