Bile and healthy bile flow is really an unsung hero of overall health, proper digestion, regular poops, and even clear skin. Its impacts stretch far beyond the gut. Bile plays a major role in detox; it’s an antimicrobial; it’s necessary for fat digestion; and it plays a major player in gastric motility. It’s kind of hard to make bile sexy, but I’ll do my best. Why is bile important for digestion and detox?
What is Bile?
It’s a digestive aid produced in the liver (approx 1 liter per day!). It’s made of water, bile acids, bile salts, electrolytes, fatty acids, phospholipids, cholesterol, and bilirubin. Aside from digestion, one of bile’s main functions is to carry out toxic substances like drugs, xenobiotics, and hormones the liver has processed for removal. It’s kind of like the trash guy.
After production in the liver, bile travels to the gallbladder through a ductal system for storage. Safely tucked under the liver, the gallbladder stores bile and waits for the right time to release it. This happens when you’re eating a meal with fats: The gallbladder contracts in response and delivers bile to the very beginning of the small intestine, just as food is exiting the stomach on its path of digestion. It helps you break down fats and absorb fatty acids.
Interestingly, 95% of bile is recycled after use back to the liver. The other 5% is the trash guy that carries toxins out via stool in the colon.
Why Bile is Crucial for Digestion & Detox
Bile is the unsung hero of digestion and detox. If bile isn’t produced or flowing properly, many different body systems can suffer. For example, if you have poor bile flow, you’ll be constipated, which leads to bacterial overgrowth in the gut and toxins reabsorbed into your system, causing mitochondrial damage, oxidative stress, and inflammation. Poor bile flow or production means you won’t get the antimicrobial action you need to keep bad bacteria in the gut in check. And if fat digestion is hindered via poor bile production, you experience fat soluble nutrient deficiencies and greasy stool. SO: bile plays a huge role in preventing dysbiosis, supporting detox, healthy poops, and absorption of nutrients.
Bile secretion is one of the major functions of your liver, and it serves two major purposes: excretion of hepatic metabolites—including bilirubin, cholesterol, drugs, and toxins—and to help you metabolize fats. What else does it do, and why is it so important?
- I’ll just put this at #1 since it’s bile’s most famous role: Digestion of fats. Bile aids in fat digestion. It acts as an emulsifier for fats, spreading them out so that fat-digesting enzymes (lipase) can assimilate them for absorption and so the fats don’t give you diarrhea. It’s a two man effort, and this process 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 (and we’ll discuss how and why in a bit), biliary insufficiency and fat maldigestion can result. This can contribute to dysbiosis and intestinal permeability (AKA leaky gut) as undigested foods are a) inflammatory to the lining of the small intestine and b) serve as food for bad bacteria.
You may also see deficiencies in fat-soluble vitamins A, D, E, and K over time which can contribute to irregularities in the inflammatory response, immunity, bone health, skin vitality, and eye function. If you see an oil slick in the toilet after you poop, you probably have a problem absorbing fats, and low production of or slow moving bile may be the culprit.
- Antimicrobial: bile makes the environment of the small intestine inhospitable for pathogens. This is a very good thing. Healthy, thin bile is a major barrier to the overgrowth of bacteria & other pathogens in the small intestine. Poor bile flow/production is correlated with Small Intestinal Bacterial Overgrowth (SIBO) and h. pylori. Improving bile flow is a crucial part of healing the gut and maintaining a healthy gut.
- Detox: you wouldn’t think it, but your digestive system is an important part of detox. Your liver & digestive system work together, and bile is one liaison. The liver dumps toxicants into some of the bile it produces that are then carried to the large intestine so you can poop it all out.
- Bowel regularity: healthy bile production and flow is a key piece of digestion that I work on with my constipated clients. If bile doesn’t flow smoothly or is “sludgy,” you’ll be constipated and more prone to SIBO, candida, and gallstones. (source) Bile needs to be the right consistency to assist with the MMC (migrating motor complex) in the small intestine (a key player in preventing SIBO). When the MMC is too fast, nutrients are not well absorbed. If more than the usual 5% of bile acids enter the large intestine, diarrhea happens. 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. (source)
- Bile assists in cholesterol breakdown. High cholesterol (LDL especially) can signal bile flow issues.
- Healthy microbiome and bacterial balance: Bile encourages a diverse and vigilant microbiome and protects against dysbiosis.
How Do You Know if You Have Poor Bile Flow?
A thin, viscous bile coats the lining of the small intestine, mixes thoroughly with food leaving the stomach, and performs its detox and digestion duties with ease. So how do you know if you have healthy bile flow? Cholestasis is the technical term for stagnant/sluggish bile flow, and here are some symptoms:
- Grey, white, or floating stools that visually indicate problems with fat digestion
- Greasy, foul smelling stool
- Nausea, esp after high fat meals
- Altered bowel movements: too fast or too slow
- Gallstones or gallbladder attacks. Issues of the gallbladder are truly bile issues!
- SIBO and/or chronic gut infections like dysbiosis, candida, h pylori
- Reflux, GERD
- elevated steatocrit marker on the GI MAP
How to Get That Good Bile Flow
So how do you cultivate good bile flow? Remember that bile is produced from acids, bile salts, electrolytes, water, fatty acids, phospholipids, cholesterol, and bilirubin. So you need to make sure you have those raw materials so the liver can produce adequate bile.
The 2 most important components are water and electrolytes. You need to have plenty of both. Ensuring you are properly hydrated is key #1. Note that 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. (source)
We as a nation have poor electrolyte and mineral reserves because we drink dehydrating and mineral-depleting beverages like soda, coffee, and booze. And we eat mineral poor diets with too much processed table salt (always use sea salt!) that throws off electrolyte balance. Stress, low carb diets, and keto diets cause electrolyte imbalance too. If you struggle with bile production, consider an electrolyte like this one or this one (which tastes saltier). If you are keto, low carb, or have high blood pressure, you need electrolytes.
Bitter foods are also great bile movers: radicchio, kale, endive, arugula, celery, and radish. Celery juice first thing in the AM can work. Hot water with lemon activates the liver and stimulates digestion. Though not bitter, beets and beet juice are excellent for bile flow. This supplement is great for both liver and bile support.
If you’ve had your gallbladder removed, you will need digestive enzymes and/or bile salts, as unfortunately while gall bladder removal alleviates symptoms, it doesn’t address the underlying dysfunction. 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. (source) Try Cholecal bile salts and an enzyme like this one.
For Healthy Bile Flow
- bitter foods, bitter greens, bitter herbs
- apple cider vinegar, a shot in some water prior to meals
- cooked beets, beet juice
- raw sauerkraut
- liver gall bladder support supplement
- hot water with lemon (usually best first thing in AM)
- celery juice (best in AM on empty stomach)
- bile salts like Cholecal
- stay hydrated
- add flax oil to smoothies
- Taurine, an amino acid and key ingredient in bile formation.
- Phosphotidylcholine, an important phospholipid (fat)
You need healthy bile flow for digestion of fats, detox support, good poops, and prevention of dysbiosis and gut infections. You can improve bile quality and flow with food and specific bitter herbs to support the liver, gall bladder, and fat digestion.
If this post resonated with you, I would recommend a stool test like the GI MAP (find in this test menu) to get a picture of what’s going on in the gut so you can optimize your good and bad bacteria and eliminate any gut infections. You can work on healthy bile flow while cleaning up the gut.
Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. She combines a science-based approach with natural therapies to rebalance the body. In addition to her 1:1 coaching, she offers courses to help you heal your gut and improve your health. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.
What are your thoughts on using the supplement TUDCA to improve liver/bile health?
Jessie: I have personally never used nor recommended this but have heard positive reviews.