Don’t Forget About Your Bile!

A vital, but often ignored aspect of digestion

What comes to mind when you think about bile? Do you know what it’s for? Where it comes from? If you’re like most of my patients, you probably haven’t given it much thought, and only have a vague idea about the function of bile. I’m on a mission to change that. In my clinical opinion, bile is THE most important aspect of our digestion, and ultimately has an impact on nearly all aspects of your health. That might sound dramatic, but I have a feeling that by the time you finish this article, you may find yourself nodding your head in agreement.

Let’s start with some basic facts about bile. It is estimated that each day, your liver creates approximately one liter of this greenish brown fluid. It flows from the liver into the gallbladder, where it’s concentrated and stored. Every time you eat, your gallbladder releases some bile into your intestine, where it helps with both digestion and detoxification. It enters your small intestine immediately after food leaves your stomach. Here, it’s joined by enzymes from your pancreas. Once the food is mixed with bile and enzymes, it makes its way down the small intestine (all 20+ feet of it) where further digestion, absorption, and assimilation occur.

So why do we even need bile? There are three main reasons. First, bile is in charge of digesting fats – and proper digestion and absorption of fats is vital to our health. We use fats for many functions including energy storage and production, hormone building, temperature regulation, and managing inflammation.Also, every single cell of your body is made of fat. Specifically, the membrane that surrounds each cell is built by phospholipids – a type of fat. So, in order to produce enough energy, create adequate hormones like estrogen, testosterone, and cortisol, keep your body warm, and repair your cell membranes, you must be able to digest and absorb fat. Also don’t forget about the fat soluble vitamins like Vitamins A and E. Bile is how you get those into your body too.

Another vital function of bile has to do with the elimination of toxins. Most people have a general understanding that the liver is a big filter, but what does it do with the toxins that it removes from the blood? These toxins are put into the bile. The body then carries the bile to the intestine so that the toxins can be excreted from the body via bowel movements. Without proper bile flow, toxins that the liver is trying to filter out of the body are not cleared properly. What are these toxins? Well, welive in a world FULL of toxins. They can be chemicals in our environment, like benzene. They can be things we ingest like food dyes or pharmaceutical medication. They can also be waste products from normal physiology. For example, estrogen is processed by the liver and cleared from the body through the bile. Not enough bile or poor bile flow can mean too much estrogen. So keeping hormone balanced must include the bile too.

The final function of bile is its ability to support the immune system by acting as a kind of detergent in the small intestine. When the flow of bile is adequate and strong, it acts to sweep up and move out potential pathogens that could cause health issues. The process of clearing bacteria, mold toxins, viruses, and more can be supported by proper bile flow.

Now you’re likely beginning to see how important bile is for digestive health. And don’t forget, since your digestive system is in charge of breaking down the food you eat, assimilating those nutrients into your body, and keeping out the things that it doesn’t need, the gut truly is the gateway to health. Here’s the problem, though: bile production is difficult. Most of us have poor bile flow. Why? Some of the building blocks of bile are difficult for us to get on a daily basis, no matter how healthy a diet we eat. This creates weak and scanty bile. And bile tends not to flow well because the liver ducts can get plugged up.

So you won’t be surprised to hear that diseases of bile production and flow are surprisingly common. The most common condition is called cholestasis, or stagnant/sluggish bile flow. Symptoms of cholestasis include floating stools, nausea, bloating, and fullness after meals, especially meals high in fat. The next level of concern is the formation of gallstones, also called cholelithiasis. Gallstones range from extremely small sandy particles (called sludge), to large stones that can block ducts and cause significant problems. An inflamed gallbladder, a condition called cholecystitis, is a medical emergency with symptoms of intense pain and nausea. In the US, over 300,000 people have their gallbladder removed each year and it’s estimated that 20 million have gallstones (1).Diagnosis of gallbladder dysfunction and gallstones is typically done by ultrasound; however, in my practice, I’ve seen that many people have gallbladder dysfunction and/or gallstone production that hasn’t reached the level where it would be detected with ultrasound. While digestive distress and abdominal pain are the most obvious symptoms with bile flow issues, other symptoms are often present as well. Migraines, painful periods, fatigue, and anxiety are common symptoms that I’ve seen with sluggish bile and they almost always improve with improved bile flow.

Supporting bile creation and bile flow requires a few specific nutrients that are unfortunately scarce in our modern diet. When we supplement small amounts of these nutrients every day, we start to build better quality bile. Once we have quality bile, we can then support it to flow more easily and effectively. The two supplements I recommend to improve the quality of bile are Taurine and Phosphotidylcholine. Once those are in place, stimulation of bile flow can be accomplished with cholagogue herbs, AKA bitters.

Taurine, an amino acid, is a key ingredient in the formation of bile. It is found in high amounts in raw eggs, raw milk, and raw meat. We don’t eat these foods raw typically, so we have a hard time making quality bile. The liver binds taurine to cholesterol to create something called a bile acid. Bile acids keep the cholesterol, which is a fat, dissolved in the bile, and assists in the binding or emulsification of fats in the intestine. Without enough taurine, cholesterol will form sludge and stones which block bile flow and impede proper digestion and elimination. As a bonus, Taurine also plays a major role in stabilizing the heart beat and electrical activity of nerves.

Phosphatidylcholine is a one of the most important phospholipids (fats) in our body. In the bile, phosphatidylcholine acts as an emulsifier of the fats, allowing them to be absorbed into the body and utilized. Our body needs these essential phospholipids for building cell membranes (remember you have around 100 trillion cells!), which act like the “bouncers” of the cell, ensuring only the good stuff enters and keeping the not so good stuff out. Phospholipids also support the nervous system and brain function.

Bitter herbs or cholagogues, have been used for liver, gallbladder, and digestive complaints for centuries. Their therapeutic action is due to their ability to increase the amount of bile that’s made by the liver and increasing the speed for bile movement into the intestine. Common bitter herbs are chamomile (Chamomillarecutita), elecampain (Inulahelenium), dandelion (Taraxacum officinalis), St. John’s wort (Hypericumperforatum), Artemisia sp, yarrow (Achilleamillefolium), rosemary (Rosmarinus officinalis), chelidonia (Chelidoniummajus), and Gentian (Gentianalutea).

Digestive complaints are often complex and multifaceted. Addressing bile production and flow provides a strong foundation upon which all other contributing factors can be properly assessed and addressed. So don’t forget about the bile!

CASE STUDY:

A 38 year old male patient came in to my office with severe fatigue and digestive trouble. His symptoms started in 2013 after what he reported was a bad case of food poisoning; over the following six months, he lost around 30 pounds. His symptoms included gas, bloating, diarrhea, brain fog, poor sleep, fatigue and trouble regulating his body temperature. He eventually was diagnosed with IBS and prescribed a probiotic. In the five years since his symptoms began, he found some relief from acupuncture and Chinese herbs, but was never able to heal completely. In the last two years, my patient had identified certain foods made his symptoms worse, as well as foods that he tolerated. This gave him some relief, but the list of tolerated foods was getting smaller and smaller. He was extremely sensitive to any changes to his diet, and lifestyle stressors impacted his symptoms greatly. His extreme fatigue meant that it took him days to recover from any exertion, so his life revolved around managing his tasks in order to account for his recovery time. As you can imagine, he was frustrated and miserable.

As with most of my patients with digestive issues, I started him on a treatment plan to improve his overall digestive function, with special emphasis on his bile production. We ran a SIBO (Small Intestinal Bacterial Overgrowth) test. Within two weeks of being on my initial recommendations, my patient reported feeling better than he had in years. His uncomfortable bloating started to subside, and he noticed more energy and better sleep. He was ecstatic! We hadn’t even received the SIBO test results at that point. He did end up testing positive for SIBO, so we are currently addressing that; however, nothing we’ve done in the SIBO protocol has had the same impact as our initial protocol. At this point he and I have been working with for six months and I’m convinced that poor bile production and flow are the root causes of his SIBO and other digestive issues. As his liver, bile production, and bile flow continue to improve, he’s getting his life back. The foods he can tolerate continue to expand, his bloating is non-existent, his energy and motivation have significantly improved, and he is able to exert himself and recover normally. Amazing what a little bile can do.

1 – https://www.ncbi.nlm.nih.gov/books/NBK448145/
Kenneth R. Hassler; Mark W. Jones.Gallbladder, Cholecystectomy, Laparoscopic. Last updated October 217

Dr. Matt Reddy runs Reddy Natural Medicine in Lafayette Colorado. He is a Colorado native, graduate of the University of Colorado, and proud alumnus of the National University of Natural Medicine in Portland, Oregon where he graduated in 2002. While Dr. Reddy works with all sorts of health concerns, he specializes in digestive issues (gas, bloating, candida, diarrhea, etc), liver and gallbladder disease, hormone imbalances and immune system issues. Dr. Reddy can be reached at drmattreddy@gmail.com or by calling (303) 200-0234.