WHAT IS BILE?

Bile is that strange-looking greenish digestive fluid produced by your liver and stored in your gallbladder. It's a soap-like substance that helps in the emulsification of fats. But as you'll see, it does a lot more than that!

Bile consists mainly of bile salts, phospholipids, cholesterol, conjugated bilirubin, electrolytes, and water.

Let's point out here that 70%-80% of cholesterol is used for bile acid production. Cholesterol gets such a bad press, but it's not the evil... it's actually a building block for many important functions in the body. However, if there are issues with bile production, it could potentially lead to high cholesterol (as it's not being used).

The production of bile requires amino acids taurine and glycine , cholesterol, vitamin C, and lecithin - aka phosphatidylcholine.

* Bile acids are conjugated by the liver with an amino acid, either glycine or taurine. Conjugated bile acids are known as bile salts.

When you eat fat, the hormone cholecystokinin (CCK) stimulates the gallbladder to contract, pushing bile into your duodenum (the first part of your small intestine) through the bile duct. A muscular valve called the sphincter of Oddi controls the release of bile into your duodenum.

Approximately 95% of bile acids are recycled and transported back to the liver through the portal vein, while the remaining 5% is deconjugated by the gut microbiota and excreted in your stools.

It's interesting to know as well that bile is what gives stools its dark brown color... light yellow stools indicate poor bile flow.

SIBO CONNECTION: because bacteria can deconjugate bile (making it unable to do its job), many people with SIBO end up with fat malabsorption issues. Interestingly, as you'll see below, bile insufficiency is also a cause of SIBO!

WHAT CAUSES POOR BILE FLOW/BILE INSUFFICIENCY?

Some people have bile insufficiency due to:

• a sluggish gallbladder
• gallbladder stones
• a blockage in any of the bile ducts
• sphincter of Oddi dysfunction
• genetics (especially snps in the PEMT gene)
• having their gallbladder removed
• liver disease
• nutrients deficiency (especially taurine and lecithin/phosphatidylcholine)
• low cholesterol (as cholesterol is a major building block for bile)

WHY IS IT IMPORTANT TO IMPROVE BILE FLOW

The purpose of bile in the digestive process is to emulsify fats from the diet. Those fats can then be further broken down by lipase (one of your pancreatic enzymes) and absorbed.

This means that improving bile flow will ensure that you can digest your fats properly. This is crucial for:

• Energy production.
• Absorption of fat-soluble vitamins (such as vitamins A, D, E, and K)
• Balancing cholesterol levels

* Supplementing with digestive enzymes containing lipase will help with fat digestion, but it's not enough on it's own.

Apart from helping you digest fats, bile has a few other really important roles:

1- Bile is antimicrobial.

This antimicrobial effect prevents bacteria from growing in the small intestine. This is so important! It means that optimising bile flow is key to maintaining an environment in the small intestine where SIBO cannot thrive.

Good bile flow = SIBO Prevention

2- Drainage / detoxification.

Good bile flow is part of your body's drainage pathway - aka - a way to flush the toxins out.

Bile binds to fat-soluble toxins (the hardest toxins to get rid of) to carry them out of the body through our stools. This is a major mechanism for moving fat-soluble toxins out of the body.

If you don't have good bile flow, the toxins stagnate in your body.

* One of the treatments for mould toxicity involves binding the bile. Remember that, normally, only five percent of your bile is excreted through your stool, the rest is recycled. By binding it, more bile is excreted through your stool, hence more toxins are flushed out.

Good bile flow = Less Toxins

3- Supporting healthy bowel movements

Bile helps to stimulate peristalsis in the intestinal tract as well as promote the movement of water and electrolytes from your colon. If someone has poor bile flow, the bowels are often sluggish leading to constipation.

* Too much bile (another potential issue which we won't discuss here) will lead to loose stools.

4- Bile neutralises acidity in the small intestine

If there isn't enough bile in the small intestine to neutralise the acidity of the stomach contents that gets dumped into the small intestine , which is extremely acidic, the body decreases stomach acid to compensate. Read more about why that's a bad thing here.

HELPFUL SUPPLEMENTS

Ox bile/Bile salts/Bile acids:

One of the most common bile supplement as it's very similar to what our bodies naturally produce.

We recommend Seeking Health's Ox Bile. Start with 125mg with every meals. If you feel like you need more, you can increase to up to 3 capsules per meal.

Tudca

TUDCA is a rising star in the natural medicine world, even though it's been used in traditional Chinese medicine for millenia.

Tauroursodeoxycholic acid, or TUDCA, is a bile acid derivative that occurs naturally in the body. When bile salts reach the large intestine, they can be metabolised by bacteria into ursodeoxycholic acid (UDCA). TUDCA is formed when taurine binds to UDCA. We only make small amounts of this health-giving compound in our body, but it actually influences many bodily functions.

TUDCA has been shown to increase bile flow by as much as 250 percent!

TUDCA can also help to dissolve gallstones, reducing them to a size in which they may be passed.

On top of helping with bile flow, Tudca has also shown to support brain, immune, kidney, eye and mitochondria function, as well as a healthy gut microbiome.

Overall, it's a win-win supplement with very little side effects.

We recommend Advanced Tudca by Cellcore.

Bitter herbs/cholagogue herbs

These will naturally stimulate a stronger and healthier bile flow. Globe artichoke, milk thistle, dandelion, gentian and burdock are all good options (usually coming as a blend). However, this might not be enough if you have a severe bile insufficiency/clogged up bile flow.

* Not recommended for people with salicylate sensitivities, multiple chemical sensitivities or MCAS.

Taurine

Because bile acids are conjugated by the liver with either glycine or taurine, supplementing with those amino acids, especially taurine, can be very helpful.

Lecithin or Phosphatidylcholine

Your bile must be 10 parts phosphatidylcholine (PC) and 1 part cholesterol or the bile won't flow properly. This means that phosphatidylcholine/lecithin is essential for good bile flow.

PC is also really important for methylation and cell membrane health (and brain health!).

It's especially important for people with a snp in the PEMT gene.

* Egg yolks and liver are good sources of lecithin/choline (Phosphatidylcholine is a metabolite of choline).

A FEW MORE THINGS

Thyroid hormones: If you have low thyroid function, correcting this (you might need thyroid hormones) can be a big factor in improving bile flow. Interestingly, the sphincter of Oddi not only controls the release of bile into the small intestines, but it is also a receptor site for your thyroid hormones. This means that healthy thyroid hormone levels are also important to ensure that the sphincter works properly.

Coffee enemas are also a great way to improve bile flow.