I suspect that most of you do not spend much time thinking about your bile flow. Perhaps if you have ever had gallbladder symptoms it may have crossed your mind once or twice, but otherwise not. And yet strangely bile issues are one of those hidden core health issues that are the root cause behind so many other health concerns. As with most bodily issues, we have to look at problems of both too much and too little. Everything in the body is about balance. Bile is one of those initiating issues that starts a chain of events, so the final result is several steps away from the initial cause. So what kind of issues are we talking about here? Excess bile can cause:

Diarrhea

Excessive gas

Bloating

Abdominal pain

Leaky gut >causing-

Autoimmune diseases

Dehydration

Electrolyte deficiencies >causing-

Fatigue/muscle weakness

Dizziness

Heart arrhythmia

Muscle cramps

Deficiency of bile can cause:

Hormone deficiencies

Constipation

Systemic toxicity

Low vitamins A, D, E, & K >causing

Osteoporosis

Rickets

Night blindness

Immune deficiencies

Inflammation

Bruising

Poor blood clotting

Muscle cramps

This list is just a sampling since the list of all the things that can go wrong with hormonal disturbances, electrolyte disturbances, autoimmune diseases, and systemic toxicity would take pages and pages to write out. All this can come from something as simple as poor bile flow. So bile is pretty important.

What is bile? The primary job of bile is twofold. Bile is the direct way that the body eliminates poisons and waste products. The liver is the primary organ for breaking down toxins and filtering out poisons, and it dumps these nasties into the bile to be carried out through the digestive tract and out the back door. Some water-soluble poisons are removed by the kidneys, but the vast majority of toxins are handled by the liver and carried away in the bile. The other primary job of bile is to enable us to absorb fats from our diet. Those fats include our fat-soluble vitamins A, D, E, and K which we can't live without and which do all sorts of things. All of our hormones, our brain neurotransmitters, and even the bile itself are made from the base substance cholesterol. We get that from our food when bile emulsifies it so we can absorb it. Other fats bile helps us absorb go on to form all our cell walls, and nerve sheaths, and provide the energy to keep our heart beating and our muscles functioning.

Bile is formed in the liver from cholesterol. Initially, it is formed as a bile acid which then combines with the electrolytes sodium and potassium to form bile salts. Some of these then combine with the amino acids glycine and taurine to form the conjugated bile salts that are responsible for emulsifying fats so they can be absorbed. Bile is 95% water, so dehydration can make the bile thick and cause it to flow poorly causing bile deficiency. Likewise, electrolyte deficiency or poor availability of the free amino acids glycine and taurine will also create a deficiency. When that happens we poorly absorb fats and fat-soluble vitamins. We can not survive without fat absorption. We can't make our hormones without cholesterol being absorbed. The same is true for the brain neurotransmitters which are also made from cholesterol. The crazy thing is that we can't even make bile without already having bile to help us absorb cholesterol since bile is made from cholesterol after 17 different chemical steps in the liver.

Bile flow is one of the reasons why we need to stay hydrated and take our electrolytes — particularly potassium since we usually get enough sodium in our American diet. When we do not stay hydrated, the bile gets thick and sticky and it does not flow down to the duodenum below the stomach to do its job. 

An extra job of bile salts is to serve as signaling molecules to trigger hormone receptors in the gut that regulate both our blood sugar levels and our blood fat levels. Without sufficient bile salts, we develop insulin resistance, high triglycerides, and dysfunctional glucose metabolism. I am not seeing anybody out there right now talking about poor bile flow as a cause of these hot-topic concerns. It is like good digestion is too simple for anyone to pay attention to as a source of our ills.

Excess bile flow can happen in several ways. Some of the control feedback circuits get messed up that regulate bile production, so too much is produced. Most of the bile that is dumped into the small intestine is supposed to be reabsorbed and sent back to the liver and the wrong bacteria in the microbiome can interfere with the absorption. Certain meds like metformin cause excess bile in the colon by the direct effect of causing diarrhea. The list goes on, but the end result is concerns like Crohn's disease and Irritable Bowel Syndrome without the usual causes being found. Part of the issue is too much bile acid actually “burning” the colon causing inflammation. This damages the colon wall which sets up a leaky gut and the whole line of autoimmune diseases that follow from that. Normally very little bile acid or salt ever makes it into the colon.

Aside from the chronic diarrhea excess bile flow can create, there is a whole list of issues that come with diarrhea from any cause. The main concerns come from electrolyte depletion affecting heart and nerve function as well as the impact of dehydration due to water loss from the colon. These concerns are not insignificant. The disease typhoid basically kills you because of the level of diarrhea it causes.

What can we do for excess bile flow? Well obviously if medications are the cause then you need to switch to different meds. If the problem is bad bacteria in the small intestine, typically you are dealing with a backup of bacteria from the colon through a problem with the ileocecal valve creating what is now called SIBO (small intestinal bacterial overload). I treat that with diet and adjustment. You also need to up your electrolytes and water to compensate for loss from the diarrhea. I don't have a fix for malfunctioning feedback loops.

How about deficient bile flow? What can we do there? As already mentioned, make sure you are hydrated, are getting enough electrolytes, and getting enough glycine and taurine. The bitter element in herbs is great for thinning the bile, particularly the juice of beet tops (not the root). Dried beet juice tablets are my way to go. Swedish bitters and dandelion greens also work. As a final alternative, you can actually take bile salts as a supplement, usually from ox bile.

It is weird to think of something as simple as the bile flow from your liver as being so important, but it really is. Aside from fancy lab tests, what would make you suspect you had poor bile flow? The most basic is when your bowel movements are light, like the color of cardboard. Stools should be dark, not light. Nausea when eating fatty foods is another clue. Floating stools indicate undigested fat in the stool, another sign of poor bile production. Excess bile flow does take fancy lab tests to assess, but it may be the case if you have chronic diarrhea.

What causes these issues in the first place? You are going to hate this answer. The usual cause is the typical American diet — too many processed foods, grains, inflammatory seed oils, and sugar. Basically, a crap diet produces a crap liver function. Various exotic other causes also can cause these problems, but they are not the usual cause. So if you simply want to avoid poor bile flow then eating a good healthy diet is the way to go. Eat whole fresh natural foods minimally processed and raised organically. It can be done!

Take care,

David