Medical theories dating back to the time of Hippocrates have focused on the importance of balancing the “four humors”: blood, phlegm, black bile, and “yellow bile.” When these four fluids fall out of balance, it is said that illness is imminent. Among these four humors, the importance of yellow bile is often neglected. So what is this important “yellow bile”, and where does it come from? It all starts with your liver and gallbladder.
So what is bile? Bile definition
Bile starts with the liver
The liver is arguably the most dynamic and versatile organ within the human body. The liver is the largest organ within the body—surpassing even the human brain—accounting for just over 2% of the average human’s body weight. It lies in the right upper quadrant just under the rib cage and below the diaphragm. It has the capacity to regenerate itself from only one fourth of its mass if an illness warrants a partial removal.
The liver is critical for a list of functions like:
- cleansing of blood,
- digesting and absorbing fats,
- helping to stabilize blood sugar,
- storing fat-soluble vitamins,
- synthesizing and breaking down cholesterol,
- recycling iron,
- and so much more!
Needless to say: the liver is noteworthy. However, it wouldn’t be able to execute all of these tasks without the important “yellow bile” that Hippocrates was referring to.
Bile and liver function
Let’s begin with some anatomy and physiology. The liver is predominantly made up of cells known as hepatocytes. These cells have many biological functions, but their primary role is to process blood as it comes into the liver. As blood passes in and around them, hepatocytes skim it for toxic substances like drugs, xenobiotics, and hormones, and these substances undergo several stages of transformation.
These “transformations” refer to the infamous phases of liver detoxification which prompts substances to be oxidized, neutralized, and secreted by cells into a substance known as bile. Bile is composed of water, bile acids, bile salts, electrolytes, fatty acids, phospholipids, toxins, cholesterol, and bilirubin. We’ll talk a bit more about bile and its components later. Bile is accumulated from hepatocytes into ducts where they eventually move this substance into the gallbladder to be stored until needed for use.
What else does bile do?
Aside from serving as the body’s trash service, bile has another important role: fat breakdown. As mentioned above, bile goes into storage in the gallbladder until it’s called into action to break lipids down. But how does the body know if it’s eating a snack that’s free of fat that doesn’t warrant bile? Special cells within the lining of our small intestine signal that fat is present to ramp up production and release bile. Without the presence of fat in the diet, there is nothing to signal for the release of bile. Keep this important point in mind for later.
As we take a closer look at bile’s role in digestion, it’s important to note that it doesn’t directly break fats down. Given its pH as a base, bile serves as a detergent-like substance that prepares fats to be broken down.
Thinking of soap being placed in a greasy frying pan is a good analogy: bile “spreads” fat molecules apart for the pancreatic enzyme lipase to actually carry out lipid breakdown. It’s a two man effort, and this allows fats to be broken down into small enough particles to be absorbed by the villi of the small intestine.
If bile flow is impeded, biliary insufficiency contributing to maldigestion of lipids can result. This can contribute to dysbiosis and intestinal permeability as undigested foods are a) inflammatory to the lining of the small intestine and b) serve as food for pathogenic microbes. We also can see deficiency in fat-soluble vitamins like A, D, E, and K over time which can contribute to irregularities in the inflammatory response, immunity, bone health, skin vitality and eye function... among other things. Talk about one problem turning into another!
Bile also serves as an antimicrobial. While most would assume that bile may be acidic, it’s actually a base (roughly 7-8 on the pH scale). This pH aides in its ability to breakdown fats as described above. Given its pH, bile makes the environment of the small intestine inhospitable for aggressive pathogens like Staphylococcus aureus when present in adequate amounts.
The failure of bile to be healthily present has been correlated to varying chronic GI pathologies, most notably Small Intestinal Bacterial Overgrowth (SIBO). Higher incidences of duodenal ulcers have been linked to biliary insufficiency as bile regularly inhibits the growth of pathogens like Helicobacter pylori. Overall, optimal biliary function can help to restore immune function to balance out chronic and persistent infections.
Bile also assists in the breakdown of cholesterol. Cholesterol gets a bad reputation, but it’s really not the menace we’ve made it out to be. Oftentimes there’s underlying dysfunction relating to bile synthesis that can contribute to high numbers of cholesterol seen on bloodwork.
To bring these numbers down, conventional medicine might put someone on a drug to sequester bile acids (like WelChol or Cholestyramine). This will fix the topical problem of elevated cholesterol, but it doesn’t address the root of the problem of why the cholesterol is high. Supporting the body to optimize biliary output can allow these numbers to normalize on their own.
Finally, bile serves as a lubricant. By contributing to the breakdown and metabolization of fats, adequate bile keeps the digestion process moving along smoothly. Incomplete or partial breakdown of foods—not just limited to fats—can inhibit successive digestive processes. This can contribute to constipation and infrequent bowel movements. Infrequent bowel movements can contribute to dysbiosis and one’s toxic burden as your body’s trash isn’t being healthily eliminated. Ultimately, normalizing bile function can regulate motility of the gastrointestinal system.
The Absence of Bile Can Cause Disease
Theoretically, a major cause of disease could be blamed on impaired bile function. Keeping in mind that bile is a detox portal, an antimicrobial, necessary for fat digestion, and a player in gastric motility... if bile is not flowing, our bodily systems may not work optimally. Consider that we can manifest disease…
- …If our detox portal is blocked, as toxins that have been accumulated are being reabsorbed and stored within the body. Too many toxins can contribute to oxidative stress. Oxidative stress can contribute to things like systemic inflammation and mitochondrial damage.
- …If antimicrobial activity is low or absent, as we can set ourselves up for higher incidences of chronic infection. Chronic infection leaves the immune system on high-alert and can deplete our nutrient reserves. This can further tax the immune system over the long term.
- …If fat digestion is hindered, as we can see inflammation within the small intestine contributes to intestinal permeability and immune up-regulation. Maldigested foods can also feed pathogenic infections. If digestion of fats is subpar, absorption of fat-soluble vitamins is also subpar. Fat-soluble vitamins like A, D, E, and K are critical for so many functions within the body, especially the immune and inflammation responses!
- …If peristalsis is not optimal, as we’re often backed up and constipated. This can contribute to toxicity levels and problems with bacterial overgrowth.
Fat free tastes as bad as it is for you
The regular release of bile into the small intestine relies on one major delicious factor that mainstream medicine tells us to avoid: eating fats. Remember how we mentioned earlier that bile is released in the presence of fats when sensory cells of the small intestine signal that they’re present? Your body is extremely energy efficient and tries to only do what is essential. If fats aren’t being eaten, the body won’t take the energy to release that labor-intensive resource to break it down. This allows for bile to sit within the gallbladder for extended periods on end which can contribute to cholestasis.
Think of bile in this situation like the oil in a car. When you’re driving the car everyday—like eating your healthy fats regularly—things are fine and flowing. However, when you stop driving that car in fear of damaging it, that oil can sludge up (much like your bile and gallstones).
Cholestasis refers to a condition in which bile flow is reduced or blocked. When cholestasis occurs, we can see an onset of conditions like gallstones. This can warrant the removal of the gallbladder if enough stones accumulate. Fats can be irritating for many people with biliary insufficiency because bile is trying to flow through these blocked ducts. It becomes a vicious cycle–-those who would benefit from eating fats to get bile moving end up avoiding it and the problem compounds. This is why it’s all too important to “change your oil” regularly... AKA eat your healthy fats and nutrient cofactors for healthy bile!
Reduce, reuse, recycle: bile enterohepatic circulation
Bile is extremely laborious to make. Your body—being the fuel efficient machine that it is—likes to recycle bile as much as possible (about 95% of it, actually). Bile is produced by the liver, stored by the gallbladder, and released into the first part of the small intestine known as the duodenum.
It hangs around and participates in digestion until reaching the last part of the small intestine known as the ileum. It is here that reabsorption into the portal venous system occurs in a process known as enterohepatic circulation.
“Dirty” bile—or bile that hasn’t been cycled out regularly—can be reabsorbed and contribute to the body’s toxic burden. Considering a fibrous matrix is needed to bind and excrete toxins within bile, autointoxication can compound in this manner if one’s diet is low in fiber.
If you’re struggling with relentless infections, toxicity issues, immune dysregulation, or constipation, ask yourself... have you checked your bile flow?
Check your bile flow: Is this thing on?
So now the big question is... how do we know if our bile is flowing? Well, there are a laundry list of indicators that can tell you that it might need some work. Grey, white, clay-colored, or floating stools can visually indicate some problems with fat digestion. Altered bowel movements (too fast or too slow), stubborn weight gain that won’t go anywhere, gallstones, cholestasis, gallbladder attacks, discomfort and onset of symptoms when eating fats, known bacterial overgrowth in the small intestine, and a known toxin burden from pharmaceuticals, drugs, alcohol, smoking, or other substances can also hint that some biliary aide might be helpful.
Long term adherence to a low-fat diet often calls for bile support as bile flow will have been lowered for some time. Finally, if you’re dealing with symptoms like autoimmunity, cancer, diabetes, chronic fatigue, IBS, IBD, high blood pressure, dysbiosis, Lyme, chronic infections (viral, bacterial, fungal), SIBO, candida, histamine intolerance or excessive sensitivities to food and the environment, your bile might be a little sluggish.
Because most of these symptoms often arise from either from a toxic burden or from microbial overgrowth—two problems that we’ve linked to biliary insufficiency—support might prove to be beneficial.
How do you make bile? Bile composition
We’ve come to the point in the article where I’m sure you’re hanging on the edge of your chair waiting to see how to solve your biliary problems. Bile has many components, although it is predominantly water. In terms of organic constituents, bile is composed of acids, bile salts, electrolytes, water, fatty acids, phospholipids, cholesterol, and bilirubin.
There is also a large amount of bile that’s composed of toxins that we’re trying to eliminate: drugs, old hormones, byproducts of cell metabolism, old cells, environmental toxins, and heavy metals. Ensuring that the components you have control over are well-supported and that any cofactors that you may need are provided for can best support your quest on achieving healthy bile flow.
Hydration for bile support
There are two key components to adequate hydration: water and electrolytes. Both have importance in bile synthesis, flow, and function.
Bile is about 95% water. If you’re chronically dehydrated, chances are the body is operating
from a deficit to start with. Ensuring that you’re properly hydrated with clean water can be a sure way to support healthy bile flow. Avoiding drinks that are high in sugar, flavorings, and dyes like sodas, alcohol, and other artificial beverages can also support healthy bile flow; these beverages can contribute to our toxic burden and can inhibit hydration.
A person is not adequately hydrated with water alone; electrolytes are needed for conduction
and transmission of electrical signaling to and from the central nervous system. Electrolytes consist of sodium, potassium, chloride, calcium, and magnesium. Not only do these minerals make up a small portion of bile but they also are needed for processes like active transport of bile acids and the adequate opening and closing of valves associated with biliary output.
Unfortunately in the modern diet (especially if we’re coming from a processed lifestyle) electrolytes are typically out of balance. Sodium intake is commonly far too high and magnesium is often deficient. Those who are dairy free run the risk for low calcium intake. Stress, low carbohydrate diets, and exercise run the risk of exacerbating mineral loss. Supporting electrolyte levels with mineral-rich foods or a mineral supplement like BodyBio E-lyte can support hydration and biliary output (among many other things!).
Diet and foods for bile support
When food is eaten, all macro and micronutrients are taken up by the body to be used as resources. These raw materials go into making various components of the body: cells, tissues, organs, and secretions like bile. Eating a nutrient-rich, healthful diet supplies our bodies with the cofactors it needs to carry out its functions.
When looking at bile specifically, it’s very important to make sure we’re getting adequate amino acids like glycine and taurine. Glycine and taurine are essential in the conjugation of bile acids to bile salts. When we’re deficient in these amino acids, this conversion does not occur.
Foods that are rich in glycine include:
- bone broth or meat stock,
- cuts of meat or poultry with more connective tissue,
Foods with higher levels of taurine include:
- shellfish like scallops, mussels, and clams,
- dairy products,
- dark meat of poultry,
- sea vegetables.
The importance of dietary fats within the diet for bile flow has been discussed, but it’s worth
mentioning again: lipids are important to have within the diet to signal for bile release. If one is
not consistently eating fats, bile is not regularly being cycled out. When bile is not regularly being cycled out, one is more prone to conditions like gallstones.
Not all fats are created equal, though: healthy fats should be prioritized. Avoid cheap seed oils as they’re prone to oxidation and can contribute to inflammation. Oils like canola and soy have actually been shown to contribute to conditions like Non-Alcoholic Fatty Liver Disease (NAFLD) and can be a cause of biliary stasis. Instead, look to get fats from a variety of sources like:
- olive oil,
- coconut oil,
- grass-fed butter,
- soaked and sprouted nuts,
- fatty meats
- dark chocolate.
Eating a diverse range of these fats will ensure a well-balanced intake of different fatty acids. Our BodyBio Balance Oil is a great mix of multiple fat sources that can be easily added atop a salad or in your smoothie or protein shake.
Vitamins and minerals serve as the catalysts to all biological reactions and processes within the body. Vitamin C stimulates the metabolism of cholesterol into bile acids by influencing an enzyme known as 7-alpha-hydroxylase.
Failure to take in adequate vitamin C through diet can affect biliary sufficiency and can contribute to higher cholesterol levels as the cofactors needed to transform them into bile acids are not present.
Great sources of dietary vitamin C can be found in:
- in-season fruits,
- dark leafy vegetables,
Vitamin C is a major antioxidant that is used up readily when there is excessive oxidative stress. If you’re dealing with chronic inflammation, supplementing with Vitamin C can be helpful until things get back to normal.
Phospholipids make up a large proportion of the organic components of bile. About 95% of these phospholipids come from phosphatidylcholine. Phosphatidylcholine is a metabolite of choline which can be taken in through diet.
Because of its high demand within the body, consuming enough dietary phosphatidylcholine can be tough. It can be found readily in:
- egg yolks,
Because of its role in cholesterol solubility, increasing phosphatidylcholine within the diet or as a supplement can also be helpful for high cholesterol and gallstone formation. Taking advantage of a high-quality supplement like our PC could be helpful to get bile production back on track.
Bile acids are another key constituent of bile. Bile acids are synthesized in the liver from cholesterol. In someone with a balanced digestive system, they are then transformed into secondary bile acids from microbes within the colon. In instances of prolonged low fat intake, biliary insufficiency, or microbial imbalance, the body may have a hard time producing enough of its own bile acids.
To get the body up and running again, one could look to supplement with an exogenous bile acid supplement like Tauroursodeoxycholic Acid (TUDCA). TUDCA is the conjugated form of ursodeoxycholic acid (UDCA), meaning it already has a taurine molecule added to it. Essentially, it’s armed and ready for action!
TUDCA is recommended to use when getting the body back into balance. It can reduce bile oversaturated with cholesterol and can slowly support dissolution of cholesterol-derived gallstones.
TUDCA has been used for thousands of years in Chinese medicine on conditions associated with the liver, biliary insufficiency, and cholestasis. It has also been used in evidence-based medical studies to counter conditions like cholelithiasis and other forms of biliary stasis. If used for too long, however, it can disrupt the body’s natural production of its own bile acids. Try cycling it on and off in thirty day periods for best results.
Bitter foods are helpful in getting bile to flow and have been used as traditional medicines for thousands of years to address digestive disorders.
Bitter foods include:
- bitter greens (arugula, dandelion),
- herbs (wormwood, gentian, burdock),
- citrus (warm lemon water),
- and other plant foods and food derivatives (coffee).
These foods have the ability to act upon the central nervous system by stimulating gustatory cells within the mouth. Sensory information is transmitted to the brain where it is communicated to increase the output of gastric secretions. This is not limited to just bile; bitter foods have been shown to increase production of saliva, stomach acid, and pancreatic enzymes, too.
Bile is a an essential multidimensional and multifunctional component of digestion produced by the liver and stored in the gallbladder for digestion. It has major roles in fat breakdown, detoxification, mediating microbial activity within the microbiome, and breaking down cholesterol. When bile flow slows or stops—often from some form of deficiency which we’ve discussed—we can see onset of disease.
Optimizing bile flow can help to manage and optimize SO many conditions, but it’s often overlooked. Take care of your bile, and be kind to your liver!
NAFLD - seed oils
PC in bile
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