Bile & the Greater Good: are you missing this link?

Bile gets little credence in the health & wellness world; or worse, relegated to the useless and pesky. I get it though – like anyone else who has vomited and dry-heaved so hard bile came up – I can attest that it is quite bitter and leaves an undeniable sting on the palate.

These days I view bile as an unsung hero of the digestive system, with impacts reverberating far beyond the gut. In this post I’d like to make the case for bile, to help it earn well-deserved respect.

What is bile?

Bile is a liquidy digestive aid produced by the liver. It is made of bile acids and bile salts, cholesterol, phospholipids (including phosphatidyl choline), bilirubin & other bile pigments, electrolytes and water.

After production, it travels to the gallbladder through a ductal system. Safely tucked under the liver, the gallbladder stores bile & waits for the right time to release it. Upon a meal, and in the presence of fats (and the right amount of stomach acid), the gallbladder contracts and delivers its biliary contents to the very beginning of the small intestine, just as food is exiting the stomach on its path of digestion.

Your body is so thrifty!

By the time bile has traversed the entire length of your small intestine – all 20-25 feet of it – your body has resorbed about 95% of your bile. It is brought back to the liver where it is recycled and rebuilt into new bile. This cycling happens four to twelve times daily. The remaining 5% bile that is not resorbed goes on to your large intestine, ultimately to be pooped out.

The many roles of bile

Digestion of fats: bile’s most famous and obvious role is to aid in fat digestion. Bile acts as an emulsifier for fats, spreading them out so that fat-digesting enzymes (like lipase) and clip them up for absorption and so they don’t give you diarrhea.

Absorption of fats: fats are absorbed by the small intestine in a tiny globular form called a micelle. These little packages are sculpted by bile. You didn’t know your bile was a potter, did you? Bile helps create ready-to-be-absorbed micelles.

Absorption of fat-soluble vitamins: vitamins A, D, E & K require fats for absorption. They ride in to your body ensconced in micelles.

Defense: bile acids are antimicrobial, conferring killing power against bad bacteria, fungus and yeast. Healthy, thin bile is a major barrier to the overgrowth of bacteria & other pathogens in the small intestine.

Bile helps to maintain the integrity of the lining of the small intestine, helping the small intestine do its job of bringing the good in and keeping the bad out.

Beneficial bacteria residing in your gut are encouraged by bile to make additional antimicrobial compounds to kill off invaders and potential pathogens. It acts like a life coach for your good guys, helping them to fulfill their purpose and be the best bacteria they can be.

Detoxification: the 5% of bile that makes it to the large intestine contains toxicants that your body has bound there as a way to remove them and detoxify your system. The gastrointestinal system carries a lot of responsibility in the detoxification process of your body.

The liver is perhaps the most famous detoxification organ with a plethora of enzyme systems that help scrub you down, and as it makes bile, it will wrap drug metabolites and other fat-soluble harmful compounds within, and send them on their merry way.

Bowel regularity: ask anyone who struggles with constipation or diarrhea – there is a sweet spot for how fast the gut moves. Bile helps to keep the small and large intestine moving at just the right pace. If bile becomes bound up in stones or sludge, things slow way down.

Bile needs to be the right consistency to assist with the MMC (migrating motor complex) in the small intestine. The MMC helps keep the small intestine moving at the right pace. Too slow, and SIBO/SIFO (small intestine bacterial/fungal overgrowth) can settle in. There is a distinct link between sludgy bile, gallstones (and gallbladder removal), SIBO and constipation.

When the MMC is too fast nutrients are not well absorbed. More than the usual 5% of bile acids enter the large intestine, and create diarrhea. Bile acid malabsorption and bile acid diarrhea accounts for half of all functional diarrhea, and up to a third each in IBS-D and microscopic colitis.

Microbiome support: bile as life coach for bacteria, again. Bile encourages a diverse, robust and vigilant microbiome. The trillion-plus bacterial colony that resides in your large intestine and performs innumerable functions for you is shaped for the better in part by bile’s influence.

Bile thus protects against dysbiosis directly and indirectly.

Metabolic balance: fat cells were once thought of as an inert depot for extra calories. Man, did we get that wrong. Fat is metabolically active, producing a wide array of signaling molecules. The more we examine bile, the closer we see that bile is on this track as well.

Bile acids are metabolic instigators and communication molecules and participate in the conversation of biochemistry and physiology in the body. They play a part in sugar metabolism, insulin sensitivity and thus insulin resistance. Healthy bile as a defense against diabetes and metabolic syndrome? You’ve got it.

Biliary compounds influence energy production. They protect the liver and large intestine from inflammation. By protecting against immune activation and an inflammatory response from the liver, the portal to systemic circulation, bile protects the whole body from inflammation.

Bile and Metabolic Syndrome

Diseases and distress of the biliary system (gallstones, sludgy bile, fatty liver) are slowly being identified as facets of metabolic disease. Harbingers of metabolic syndrome. Metabolic syndrome isn’t a disease itself, it’s a collection of signs that when taken together, increase risk for type two diabetes and cardiovascular disease. Three out of the five following factors indicates metabolic syndrome:

  1. High triglycerides (greater than 150)
  2. High fasting blood sugar (greater than 100)
  3. High blood pressure (130/85 or above)
  4. Low HDL (less than 50 for women; less than 40 for men)
  5. Waist circumference greater than 35 inches in women; 40 inches for men

It’s time we started paying attention to our bile, the organs that make and store it, the ducts that carry it, the parts of us that resorb and recycle and remove it.

Quality matters

Just as healthy poops are defined in part by their consistency, bile functions best when thin. A thin, viscous bile coats the lining of the small intestine, mixes thoroughly with food leaving the stomach, and perform its duties with ease.

Bile tied up in stones or sludge lacks these flexible abilities. It is no wonder that sludgy bile and stones are found hand in hand with SIBO, slow transit, constipation and fatty liver. In women, gallbladder removal is an independent risk factor for fatty liver.

Gallbladders are removed due to stones (750,000 times a year in the US). Before the stones, comes sludge. If we remove the storage tank – and the stones – it is still entirely possible for bile to be sludgy.

We blame the gallbladder for what is truly a bile issue. This is a facet of what drives these risks and associations.

Want more?

I must confess, I’ve been singularly obsessed with bile and the biliary system. As such, I have created a free training, the Gallbladder & Liver School specifically for those with gallstones, sludgy bile, those without gallbladders, Those looking to improve their biliary system and detoxification capacities, those with fatty liver, IBS-D, or BAD/BAM.


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