Bile insufficiency

Question 1

Bile insufficiency

Answer 1

Bile insufficiency = a condition whereby bile synthesis and / or bile flow (note — bile should be quite ‘thin’) is compromised affecting one’s ability to digest, absorb and utilise fatty acids from the diet.

Question 2

Bile insufficiency: Key signs and symptoms

Answer 2

• Steatorrhoea: Constipation or diarrhoea.
• Intolerance to fatty foods / nausea when eaten.
• Bloating, excess flatulence and cramping.

Question 3

Bile insufficiency: Stool test indicators

Answer 3

• Low / absent bile acids (accompanied by key signs / symptoms as zero can be normal if very efficient at resorbing bile salts).
• High faecal fats (steatocrit) — indicates fat malabsorption

Question 4

Common causes of bile insufficiency

Answer 4

• Low dietary fat intake.
• Impaired liver function and obstructed bile ducts.
• Obesity (shown to have ↓ postprandial bile acid response).
• Oestrogen dominance (↑ liver production of cholesterol which thickens bile and also slows the excretion of oestrogen — a viscous cycle!).
• Other GI conditions e.g., cholecystectomy (gall bladder removal), coeliac disease, Crohn’s disease, chronic pancreatitis, SIBO.
• Low HCl (reducing CCK and hence bile release).

Question 5

Implications of long-term bile insufficiency

Answer 5

• Deficiency of fat-soluble nutrients:

– Vitamins A, D, E, K; essential fatty acids, phytonutrients (e.g., beta-carotene).

• Hormone imbalances (i.e., associated with poor oestrogen clearance).
• Hypercholesterolaemia.
• Compromised liver detoxification.
• SIBO and dysbiosis (bile has antimicrobial effects, detoxifies bacterial endotoxins and stimulates peristalsis).
• Gallstones or inflammation of the liver or pancreas

Question 6

Natural approach to bile insufficiency

Answer 6

• Getting the basics right:

– Adequate hydration — at least 6‒8 glasses per day.
– Avoid processed food, trans fats and refined sugar.
– Chew slowly and thoroughly (until food is liquid).
– Diaphragmatic breathing — massages the liver, ↑ bile production.
* ↑ taurine and choline foods (key bile components), or supplement.

Taurine-rich foods: Seaweed, scallops, clams, tuna, salmon, turkey / chicken thighs
Choline-rich foods: Wheat germ, kidney beans, broccoli, Brussel sprouts, quinoa, beef liver, eggs

• Support liver detoxification with cruciferous vegetables and fibre.
• Consume choleretic and cholagogue-rich foods and herbs:
  Choleretics (↑ bile production):
  Foods: Radish, cucumber, bitter melon, onion, kidney beans, ACV.
  Herbs: Gentian, artichoke leaf, barberry bark, dandelion root.
  Cholagogues (↑ bile flow):
  Foods: Apples, artichoke, beets, bitter greens, celery, fennel.
  Herbs: Milk thistle, turmeric, ginger, dandelion greens, fenugreek (fenugreek removes cholesterol from bile to ↑ bile acid concentration by 4 x)