Eyes on bile

Bile does much more than digest and help to absorb fat. It often gets overlooked and it is more interesting than it seems. Looking at the bile acids in your poo can help us to determine to state of your digestive health so it is an important aspect to consider.

Bile acids also support the regulation and excretion of cholesterol, it exerts antimicrobial effects and eliminates bilirubin and fat soluble wastes from the body.

Bile is made up of water, oil, acids, cholesterol, bilirubin and waste products. It is created in the liver, stored and concentrated in the gall bladder and it is released when the gall bladder contracts when fat is identified in the small intestine.

The acids help to emulsify fats in the small intestine and they can then be recycled. It is said they can be recycled up to four times in one meal.

About 5% doesn’t get recycled and it ends up towards the large intestine. Bile acids are worked on by the gut bacteria and can be transformed into around 40-50 different types of metabolites.

Some of these are helpful to health (e.g. neuroprotective, preventative of bacterial overgrowth and damaging effects, anti-inflammatory and supportive of glucose control) and some are detrimental (pro-inflammatory and may increase colorectal cancer development). What determines if they are transformed to be helpful or detrimental is the balance of the intestine. An imbalance of the gut bacteria (dysbiosis) and conditions such as SIBO can have negative consequences and these more harmful metabolites can further worsen these conditions.

Some of these metabolites are repaired back in the liver and some are excreted in the faeces.

As well as SIBO/dysbiosis. What other factors that can have a negative effect on bile?

-Lack of fibre in the diet can reduce the excretion of fat soluble toxins

-Dehydration and high cholesterol can lead to bile that is too thick which also increases the risk of gall stones

-Liver damage and inflammation can impair the production of bile acids and their flow

Testing and why it is useful

It is important with any testing or when you are considering supplements to work with health professionals such as a Nutritional Therapist. It may also be necessary to contact your doctor as well.

Theoretically you shouldn’t see many bile acids hit the stool because we should have the re circulation process happening effectively.

Really low levels can be because you’re not producing enough bile which can be down to various factors that need identifying my a professional. Low levels of bile salts might also be associated with changes in the environment of the small intestine to be more favourable for bacterial growth so therefore it could help to indicate SIBO and low levels can show poor mucosal immunity of the intestine. Bile acids also act as an important way of regulating movements of the small and large intestine so a lack of them may result in constipation or be a contributing factor towards SIBO which in turn can lead to diarrhoea.

Raised levels mean the resorption process isn’t happening very well and generally it is down to significant damage in the small intestine-such as from coeliac disease or IBD.

Again I can’t stress enough the importance of working with a professional but here are some dietary interventions for both low and high bile acids that would be considered as part of a larger programme because as with every case it is never as simple as just looking at bile. There will be a complex series of events happening and a Naturopathic Nutritionist can help address the root causes.

Dietary interventions to support bile

-There are various herbs such as Cholertetic and cholagogue herbs (e.g milk thistle and dandelion) that can help to regulate bile production, flow, secretion and resorption. It is also important to support the pancreatic enzymes.

-Increasing fibre help to promote excretion

-Ensuring that you are drinking enough water and that the body is holding onto it correctly is essential for creating quality bile

-Too much fat especially too much saturated fat from meat for example and trans fats can overload the bodies capacity to break down fat

-There are many ways we can support the health of our liver so it is important to address this and ensure that detoxification is happening effectively

-The state of the microbiome and digestion is essential to address

It is also worth noting the importance of addressing deficiencies in fat soluble vitamins like A,D.K and E as if you are not digesting fats properly you can become deficient in these vitamins.