Symptoms of low bile. Understanding Bile Salts: Functions, Benefits, and Symptoms of Deficiency
What are bile salts and how do they function in the body. How do bile salts aid in digestion and nutrient absorption. What are the symptoms of bile salt deficiency. Can bile salt supplements help with digestive issues.
The Vital Role of Bile Salts in Digestion
Bile salts are crucial components of bile, a greenish-yellow fluid produced by the liver and stored in the gallbladder. These salts play a pivotal role in various bodily functions, particularly in the digestive process. But what exactly are bile salts, and how do they contribute to our overall health?
Bile salts are formed when bile acids bond with potassium or sodium ions. This transformation gives them specific properties that make them highly effective at breaking down fats. The primary functions of bile and bile salts in the body include:
- Aiding digestion by breaking down fats
- Helping absorb fat-soluble vitamins (A, D, E, and K)
- Eliminating waste products
The Bile Production and Release Process
How does the body produce and release bile salts? The process begins in the liver, where bile is manufactured and then stored in the gallbladder between meals. When we consume foods containing fats, hormones signal the gallbladder to release bile into the duodenum, the first part of the small intestine. Here, bile salts get to work, breaking down fats and aiding in their digestion.
Types of Bile Salts and Their Specific Roles
Not all bile salts are created equal. There are several types, each with a unique role in the digestive process. Understanding these differences can provide insight into the complexity of our digestive system.
Primary Bile Salts
Primary bile salts are the original form, consisting of cholesterol-derived bile acid bound to potassium or sodium ions. Some of these travel directly to the duodenum without undergoing any changes.
Secondary Bile Salts
When primary bile salts encounter intestinal bacteria, these microorganisms can remove a group of atoms from the bile salt molecule, creating secondary bile salts.
Conjugated Bile Salts
Some bile salts gain additional taurine or glycine amino acids, forming conjugated bile salts. These are considered the most important for fat breakdown in the digestive process.
The Crucial Link Between Bile Salts and Nutrient Absorption
Why are bile salts so important for nutrient absorption? Their role extends beyond just breaking down fats. Bile salts are essential for the absorption of fat-soluble vitamins, including vitamins A, D, E, and K. Without sufficient bile salts, these vital nutrients may pass through the digestive system without being properly absorbed, potentially leading to deficiencies.
Moreover, bile salts play a role in the formation of hormones. According to research from 2014, a deficiency in bile salts can disrupt hormone production, as all hormones are derived from broken-down fats.
Recognizing Symptoms of Bile Salt Deficiency
How can you tell if you’re experiencing a bile salt deficiency? Several symptoms may indicate a lack of bile salts in your system. These can include:
- Diarrhea
- Trapped gas
- Bad-smelling gas
- Stomach cramps
- Erratic bowel movements
- Weight loss
- Pale-colored stools
These symptoms often occur in individuals who don’t produce and store enough bile salts, which can happen after gallbladder removal surgery. If you’re experiencing these symptoms consistently, it’s crucial to consult with a healthcare professional for proper diagnosis and treatment.
The Detoxifying Power of Bile Salts
Beyond their role in digestion and nutrient absorption, bile salts serve another vital function: detoxification. How do bile salts contribute to the body’s natural detox process?
Bile salts aid in the removal of toxins from the body. These toxins are secreted into the bile and subsequently eliminated through feces. When there’s a deficiency of bile salts, it can lead to a buildup of toxins in the body, potentially causing various health issues.
The Liver-Bile Connection
The liver plays a central role in the production of bile acids, which are the precursors to bile salts. Hepatocyte cells in the liver derive bile acids from cholesterol. This process underscores the intricate relationship between liver health and bile salt production.
Bile Salt Supplements: A Potential Solution?
For individuals experiencing bile salt deficiency, supplements may offer a potential solution. But how effective are these supplements, and who might benefit from them?
Bile salt supplements are designed to counteract the symptoms associated with bile salt deficiency. They can be particularly helpful for people who have had their gallbladder removed or those with conditions that affect bile production or storage.
Natural Ways to Support Bile Production
In addition to supplements, there are natural ways to support bile production and function:
- Stay hydrated: About 85% of bile is composed of water, so adequate hydration is crucial.
- Consume beets and beet greens: These vegetables are rich in betaine, a powerful liver detoxicant.
- Eat a balanced diet: A diet rich in healthy fats can stimulate bile production and release.
The Consequences of Untreated Bile Salt Deficiency
What happens if bile salt deficiency is left untreated? The consequences can be significant and may include:
- Increased risk of kidney stones
- Higher likelihood of gallstone formation
- Potential nutrient deficiencies, especially of fat-soluble vitamins
- Digestive discomfort and irregularities
Moreover, certain conditions are associated with a higher risk of bile salt malabsorption. These include Crohn’s disease and irritable bowel syndrome (IBS). Individuals with these conditions should be particularly vigilant about their bile salt levels and discuss potential treatments with their healthcare providers.
The Future of Bile Salt Research and Treatment
As our understanding of bile salts and their functions continues to evolve, what does the future hold for bile salt research and treatment options?
Ongoing research is exploring the potential uses of bile salts in treating various conditions, including certain types of liver disease and metabolic disorders. Scientists are also investigating the role of bile salts in the gut microbiome and their potential influence on overall health.
Emerging Therapies
New therapies targeting bile salt metabolism are in development. These include:
- Bile acid sequestrants: Medications that bind to bile acids in the intestine
- FXR agonists: Drugs that activate the farnesoid X receptor, which regulates bile acid synthesis
- Microbiome-based treatments: Therapies that aim to modulate gut bacteria involved in bile salt metabolism
As research progresses, we may see more targeted and effective treatments for bile salt-related disorders in the future.
Maintaining Optimal Bile Salt Levels for Overall Health
Given the crucial role of bile salts in digestion, nutrient absorption, and detoxification, maintaining optimal levels is key to overall health. But how can individuals ensure they’re supporting their body’s bile salt production and function?
Dietary Considerations
A diet that supports healthy bile production and function includes:
- Adequate fiber intake to promote regular bowel movements
- Healthy fats from sources like avocados, nuts, and olive oil
- Bitter foods like arugula and dandelion greens, which can stimulate bile production
- Probiotic-rich foods to support gut health and bile salt metabolism
Lifestyle Factors
Beyond diet, certain lifestyle factors can influence bile salt levels and function:
- Regular exercise to promote healthy digestion and liver function
- Stress management, as chronic stress can impact digestive processes
- Avoiding excessive alcohol consumption, which can strain the liver
- Maintaining a healthy weight to reduce the risk of gallbladder issues
By incorporating these dietary and lifestyle strategies, individuals can support their body’s natural bile salt production and function, promoting better digestion, nutrient absorption, and overall health.
The Interplay Between Bile Salts and Gut Health
The relationship between bile salts and gut health is complex and bidirectional. How do bile salts influence the gut microbiome, and conversely, how does the gut microbiome affect bile salt metabolism?
Bile salts play a crucial role in shaping the gut microbiome. They have antimicrobial properties that help control bacterial populations in the intestine. At the same time, certain gut bacteria are involved in the transformation of primary bile salts into secondary bile salts.
The Gut-Liver Axis
The interplay between bile salts and gut health is part of a broader concept known as the gut-liver axis. This refers to the bidirectional relationship between the gut and the liver, mediated in part by bile acids and bile salts. Disruptions in this axis can lead to various health issues, including:
- Non-alcoholic fatty liver disease (NAFLD)
- Inflammatory bowel diseases
- Metabolic disorders
Understanding this relationship underscores the importance of maintaining a healthy gut for optimal bile salt function, and vice versa.
Bile Salts and Cholesterol Regulation
Another critical function of bile salts is their role in cholesterol regulation. How do bile salts help manage cholesterol levels in the body?
Bile salts are synthesized from cholesterol in the liver. This process is one of the primary ways the body eliminates excess cholesterol. When bile salts are excreted from the body, they take cholesterol with them, helping to maintain healthy cholesterol levels.
The Cholesterol-Bile Salt Cycle
The relationship between cholesterol and bile salts forms a cycle:
- Cholesterol is converted to bile acids in the liver
- Bile acids combine with other substances to form bile
- Bile is released into the intestine to aid digestion
- Most bile salts are reabsorbed in the ileum and returned to the liver
- A small portion is excreted, taking some cholesterol with it
This cycle plays a crucial role in maintaining cholesterol homeostasis in the body.
Bile Salts in Different Life Stages
The production and function of bile salts can vary throughout different life stages. How do bile salt levels and functions change from infancy to old age?
Bile Salts in Infancy
Newborns have immature bile salt synthesis and transport systems. This can lead to:
- Reduced fat absorption in early infancy
- Increased risk of jaundice in some newborns
As infants grow, their bile salt production and function mature, improving their ability to digest and absorb fats.
Bile Salts in Aging
As we age, changes in bile salt metabolism can occur:
- Reduced bile acid synthesis
- Alterations in bile acid composition
- Increased risk of gallstone formation
These changes can contribute to age-related digestive issues and highlight the importance of supporting bile salt function throughout life.
The Role of Bile Salts in Medication Absorption
Beyond their role in nutrient absorption, bile salts also play a crucial part in the absorption of certain medications. How do bile salts interact with pharmaceuticals?
Many drugs, particularly those that are lipophilic (fat-loving), rely on bile salts for proper absorption in the intestine. This is why some medications are recommended to be taken with food, as the presence of food stimulates bile release.
Implications for Drug Development
Understanding the role of bile salts in drug absorption has important implications for pharmaceutical development:
- It can inform the design of new drug formulations
- It may help improve the bioavailability of existing medications
- It underscores the importance of considering bile salt function in patients with digestive disorders
This knowledge can lead to more effective and targeted drug therapies, potentially improving treatment outcomes for various conditions.
Bile Salts and Their Connection to Liver Health
The liver plays a central role in bile salt production and metabolism. How does liver health impact bile salt function, and conversely, how do bile salts influence liver health?
A healthy liver is crucial for proper bile salt production and function. Liver diseases can disrupt bile salt metabolism, leading to various complications:
- Reduced bile flow (cholestasis)
- Altered bile composition
- Impaired fat digestion and absorption
Bile Salts as Liver Protectors
Interestingly, bile salts also play a protective role in liver health:
- They help remove toxins from the liver
- They have anti-inflammatory properties
- They may help regulate liver cell regeneration
This dual relationship underscores the importance of maintaining both liver health and proper bile salt function for overall wellbeing.
The Future of Bile Salt Research
As our understanding of bile salts continues to grow, what areas of research hold promise for the future?
Emerging Areas of Study
Several exciting areas of bile salt research are emerging:
- The role of bile salts in gut-brain communication
- The potential use of bile acids in treating metabolic disorders
- The impact of bile salts on the immune system
- The development of targeted bile salt therapies for various conditions
These areas of study could lead to new treatments and a deeper understanding of the complex roles bile salts play in our bodies.
Potential Clinical Applications
Future research may lead to novel clinical applications of bile salt knowledge:
- Personalized nutrition plans based on individual bile salt profiles
- Targeted probiotic therapies to modulate bile salt metabolism
- New treatments for bile acid-related disorders
- Improved strategies for managing digestive and liver diseases
As research progresses, our ability to leverage bile salt function for better health outcomes is likely to expand significantly.
Bile Salts in Your Body: Function, Benefits, and More
Bile Salts in Your Body: Function, Benefits, and More
- Health Conditions
- Featured
- Breast Cancer
- IBD
- Migraine
- Multiple Sclerosis (MS)
- Rheumatoid Arthritis
- Type 2 Diabetes
- Articles
- Acid Reflux
- ADHD
- Allergies
- Alzheimer’s & Dementia
- Bipolar Disorder
- Cancer
- Crohn’s Disease
- Chronic Pain
- Cold & Flu
- COPD
- Depression
- Fibromyalgia
- Heart Disease
- High Cholesterol
- HIV
- Hypertension
- IPF
- Osteoarthritis
- Psoriasis
- Skin Disorders and Care
- STDs
- Featured
- Discover
- Wellness Topics
- Nutrition
- Fitness
- Skin Care
- Sexual Health
- Women’s Health
- Mental Well-Being
- Sleep
- Product Reviews
- Vitamins & Supplements
- Sleep
- Mental Health
- Nutrition
- At-Home Testing
- CBD
- Men’s Health
- Original Series
- Fresh Food Fast
- Diagnosis Diaries
- You’re Not Alone
- Present Tense
- Video Series
- Youth in Focus
- Healthy Harvest
- No More Silence
- Future of Health
- Wellness Topics
- Plan
- Health Challenges
- Mindful Eating
- Sugar Savvy
- Move Your Body
- Gut Health
- Mood Foods
- Align Your Spine
- Find Care
- Primary Care
- Mental Health
- OB-GYN
- Dermatologists
- Neurologists
- Cardiologists
- Orthopedists
- Lifestyle Quizzes
- Weight Management
- Am I Depressed? A Quiz for Teens
- Are You a Workaholic?
- How Well Do You Sleep?
- Tools & Resources
- Health News
- Find a Diet
- Find Healthy Snacks
- Drugs A-Z
- Health A-Z
- Health Challenges
- Connect
- Breast Cancer
- Inflammatory Bowel Disease
- Psoriatic Arthritis
- Migraine
- Multiple Sclerosis
- Psoriasis
Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — By Becky Young — Updated on April 8, 2022
Bile salts are one of the primary components of bile. Bile is a greenish-yellow fluid made by your liver and stored in the gallbladder. In addition to bile salts, bile contains cholesterol, water, bile acids, and the pigment bilirubin.
Bile salts help with the digestion of fats. They also help the body absorb fat-soluble vitamins, like vitamins A, D, E, and K.
Bile and bile salts are made in the liver and stored in the gallbladder between meals.
The role of bile and bile salts in the body is to:
- aid digestion by breaking down fats
- help absorb fat-soluble vitamins
- eliminate waste products
After you eat and there are fats present in your digestive tract, your hormones send a signal to the gallbladder to release bile.
The bile is released directly into the first part of the small intestine, called the duodenum. This is where most of the process of digestion happens. The bile helps break down and digest the fats present in food.
Another primary function of bile that bile salts help with is the removal of toxins. Toxins are secreted into the bile and eliminated in feces. A lack of bile salts can cause a buildup of toxins in the body.
According to 2014 research, bile salt deficiency can cause problems with the formation of hormones, since all hormones are made from the broken-down parts of fats.
Bile acids are made by the hepatocyte cells in the liver and derive from cholesterol. Bile salts are similar to bile acids and form when bile acids bone to molecules of potassium or sodium. This process allows bile salts to take on specific properties that make them effective at breaking down fats.
Types of bile salts
All bile salts start as primary bile salts. These consist of cholesterol-derived bile acid bound to potassium or sodium ions. From there, there are a few different paths bile salts can take.
Some bile salts stay unaltered and travel to the duodenum as primary bile salts. Others encounter intestinal bacteria that remove a group of atoms from a molecule of bile salt. This creates what is known as a secondary bile salt.
Other bile salts gain further additions in the form of taurine or glycine amino acids, creating conjugated bile salts.
Each type of bile salt plays a slightly different role in the digestion process, with conjugated bile salts being the most important for fat breakdown.
If the fat-soluble vitamins and fatty acids that you eat can’t be absorbed, they pass into the colon, which can cause complications.
People who don’t produce and store enough bile salts, possibly because they’ve had their gallbladder removed, can experience:
- diarrhea
- trapped gas
- bad-smelling gas
- stomach cramps
- erratic bowel movements
- weight loss
- pale-colored stools
Bile salt supplements
People with bile salt deficiency may try bile salt supplements to counteract these symptoms. It’s also important to stay hydrated since about 85 percent of bile is made up of water.
It can also be helpful for people who don’t produce enough bile salts to eat a lot of beets and beet greens. This is because they contain a lot of the nutrient betaine, which is one of the most powerful liver detoxicants.
Untreated bile salt deficiency
If a bile salt deficiency is left untreated, it can increase your risk of forming kidney stones and gallstones.
There are two conditions that are associated with higher risks of bile salt malabsorption. These are Crohn’s disease and irritable bowel syndrome.
Bile salts are a primary component of bile and are needed by the body to help break down fats, aid digestion, absorb important vitamins, and eliminate toxins.
Bile salts are stored in your gallbladder when they’re not being used. If your gallbladder is removed, it can lead to a bile salt deficiency. This condition can also be caused by other diseases of the bowel.
If you experience any of the symptoms of a bile salt deficiency, it’s important that you see your doctor. They’ll be able to talk you through your options. They’re likely to suggest that you stay properly hydrated at all times, increase your consumption of beets, and begin taking bile salt supplements.
Last medically reviewed on April 8, 2022
How we reviewed this article:
Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
- Boyer JL, et al. (2021). Bile formation and secretion: An update.
pubmed.ncbi.nlm.nih.gov/33617926/ - Macierzanka A, et al. (2019). Bile salts in digestion and transport of lipids.
sciencedirect.com/science/article/abs/pii/S0001868619302623 - McEvoy M. (2011).
Bile deficiency: Heartburn, poor digestion, toxicity.
metabolichealing.com/bile-deficiency-heartburn-poor-digestion-toxicity/ - Zhou H, et al. (2014). Bile acids are nutrient signaling hormones.
ncbi.nlm.nih.gov/pmc/articles/PMC4073476/
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
Current Version
Apr 8, 2022
Written By
Becky Young
Edited By
Haley Weiss
Medically Reviewed By
Alisha D. Vassar-Sellers, BS Pharmacy, PharmD
Copy Edited By
Ahmed Fara
Jun 16, 2018
Written By
Becky Young
VIEW ALL HISTORY
Share this article
Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — By Becky Young — Updated on April 8, 2022
Read this next
- Gallbladder Disease
Medically reviewed by Judith Marcin, M.D.
The term gallbladder disease refers to several types of conditions that can affect the organ.
Here are the various symptoms, treatments, and potential…
READ MORE
- What Is Open Gallbladder Removal?
Medically reviewed by Stacy Sampson, D.O.
Doctors perform gallbladder removal to provide permanent relief from gallstones and other problems associated with the gallbladder.
READ MORE
- Identifying Gallbladder Problems and Their Symptoms
Medically reviewed by Saurabh Sethi, M.D., MPH
Learn the signs and symptoms of gallbladder problems here. Also discover how they’re treated, foods to eat and avoid, when to see your doctor, and…
READ MORE
- Gallbladder Diet
Medically reviewed by Jillian Kubala, MS, RD
The gallbladder is a sensitive organ, and maintaining a diet full of nutrient-dense foods helps keep it healthy. Here’s the lowdown on following a…
READ MORE
- Why Is Jackfruit Good for You? Nutrition, Benefits and How To Eat It
By Brianna Elliott, RD
Jackfruit is a versatile tropical fruit with a sweet flavor.
Here’s a look at why jackfruit is healthy and how to eat it.
READ MORE
- Is Honey Vegan?
By Alina Petre, MS, RD (NL)
Vegans avoid eating animal products, but many people wonder if this extends to foods made from insects, such as honey. This article discusses whether…
READ MORE
- Is Catfish Healthy? Nutrients, Benefits, and More
By Cecilia Snyder, MS, RD
Catfish is a ubiquitous species eaten worldwide, but you may wonder whether it’s healthy. Learn more about nutrients, benefits, and downsides.
READ MORE
- Are Instant Noodles Bad for You?
By Rachael Ajmera, MS, RD
Instant noodles are a popular and inexpensive convenience food. However, serious concerns have been raised about whether they’re good or bad for…
READ MORE
- 11 High-Calorie Vegan Foods for Healthy Weight Gain
By Rachael Ajmera, MS, RD
Gaining weight can be difficult, especially if you’re following a vegan diet. Here are 11 high-calorie vegan foods that can help you gain weight.
READ MORE
- 7 Effects of Greasy Food on Your Body
By Elise Mandl, BSc, Msc, APD
Greasy food is scrumptious and quick, but you may wonder what effect it has on your body. Here are 7 reasons to avoid greasy food.
READ MORE
Bile Acid Malabsorption Guide: Symptoms, Diagnosis, And Treatment
Bile acid malabsorption is a little-known condition, yet a 2014 study found that 1 in 3 people diagnosed with IBS-D and functional diarrhoea have bile acid malabsorption.
Bile is an acidic digestive juice that helps the body break down fats. Typically, the body reabsorbs the bile and recycles it. When it doesn’t, it causes a condition called bile acid malabsorption, with diarrhoea as the primary symptom.
Crohn’s disease, gallstones, coeliac disease, and other diseases of the digestive system may cause bile acid malabsorption. It can also disturb the delicate equilibrium of the gut microbiome in the colon. Find out the symptoms of bile acid malabsorption, how it is diagnosed, and how it is treated in this article.
☝️DISCLAIMER☝This article is for informational purposes only. It is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment.
Table of contents
- What is bile?
- Bile acid malabsorption
- Causes of bile acid malabsorption
- Symptoms of bile acid malabsorption
- Bile acids and the gut microbiome
- Diagnosing bile acid malabsorption (tests)
- Treating bile acid malabsorption
What is bile?
Bile is essential for the digestion of fats. It is made by the liver and stored in the gallbladder, where it is released into the small intestine during digestion.
Bile acids are made from cholesterol, and they are vital for the absorption and transportation of fats, nutrients, and vitamins. Primary bile acids, like cholic acid and chenodeoxycholic acid, participate in a few critical processes:
- the breakdown and absorption of fats and fat-soluble vitamins
- the removal of waste products from the body that are secreted into bile
Bile acids are detergent molecules that perform two functions. One end of the molecule loves water while the other likes fat, grease, or dirt, making them perfect for emulsifying dietary fats. Emulsified fats have a greater surface area, which makes it easier for digestive enzymes to them break down.
What is bile acid malabsorption?
Around 95% of bile acids are reabsorbed in the ileum, the final part of the small intestine, and are restored back to the liver.
This cycle is known as enterohepatic circulation. When this cycle is disrupted, it causes bile acid malabsorption. This condition is also known as bile acid diarrhoea (BAD), and bile salt malabsorption.
In bile acid malabsorption, too much bile acid enters the colon, which causes the large intestine to release more water. The increase in fluids results in a faster transit time of waste through the gut and chronic watery diarrhoea.
Causes of bile acid malabsorption
There are three types of bile acid malabsorption, and many potential causes, most of which are linked to digestive diseases and conditions.
Type 1 | Problems affecting the ileum (small intestine) where bile acid is reabsorbed, such as surgical removal of the ileum, Crohn’s disease, or cancer treatment. |
Type 2 | Idiopathic – no known cause. |
Type 3 | Caused by other diseases or conditions affecting the stomach or gut. Examples include removal of the gallbladder, chronic pancreatitis, coeliac disease, or small intestine bacterial overgrowth (SIBO). |
Gallstones, fatty liver disease, and bile acid diarrhoea
Bile acids are produced by the liver and stored in the gallbladder. A 2017 study that studied the files of 578 patients found that bile acid diarrhoea was associated with gallstones and fatty liver disease.
Research shows that the idiopathic form (type 2) of bile acid diarrhoea may be caused by low serum fibroblast growth factor 19 (FGF19), which impairs the normal bile acid cycle. There is also evidence of increased weight being associated with bile acid malabsorption and low FGF19 levels.
☝️Find out if you are genetically predisposed to gallstones with the Atlas DNA Test.
Crohn’s disease
Basic differences between Crohn’s disease and ulcerative colitis
Bile acid malabsorption is a common sign of inflammatory bowel disease (IBD), especially Crohn’s disease. This serious lifelong condition can damage any area of the digestive tract lining from the mouth to the anus. Type 1 bile acid malabsorption is especially prevalent in people who have Crohn’s Disease and have experienced:
- ileal-resection (surgical removal of the ileum)
- ileitis (chronic inflammation of the ileum)
Discover whether you are genetically predisposed to inflammatory bowel disease and how your gut bacteria can influence your protection from this disease with the Atlas Microbiome Test.
Coeliac disease
Coeliac disease, a hereditary form of gluten intolerance, is an autoimmune condition in which gluten triggers the immune system, which starts to attack the cells in the small intestine. It causes many digestive-related symptoms including diarrhoea, constipation, weight loss, and pain.
Type 3 bile acid malabsorption affects coeliac patients because this disease can interfere with the bile acid reabsorption cycle. Coeliac disease also affects the absorption of nutrients, such as iron and zinc, when the digestive lining is inflamed.
☝Find out what your DNA and gut microbiome say about gluten intolerance with the Atlas Microbiome and DNA Tests.
Symptoms of bile acid malabsorption
The most common symptom of bile acid malabsorption is watery diarrhoea, which can also be present with or without steatorrhoea (excess fat in stools). Although the condition is not life-threatening, it can have a negative impact on an individual’s quality of life.
That’s because it causes an increased frequency of needing to go to the toilet which can dictate a person’s day-to-day life, and in severe cases, prevent them from leaving their home. Sometimes diarrhoea can be pale and greasy in appearance and may be difficult to flush.
Bile acid malabsorption symptoms
- watery diarrhoea – often yellow and greasy in appearance
- needing the toilet often
- bloating
- abdominal cramps
- excessive, smelly wind
Other symptoms can be similar to those of Irritable Bowel Syndrome (IBS), like bloating, excessive wind, and abdominal cramps. People who have bile acid malabsorption may also be at risk of vitamin B12 deficiency because the nutrient is absorbed in the ileum, the same place as bile acids.
So, if this section of the small bowel is damaged or diseased and vitamin B12 absorption is affected, it can cause symptoms like shortness of breath and feeling tired all the time. Therefore, in some people with bile acid malabsorption, fatigue may be a symptom. Bile acid malabsorption and joint pain are also reported by some patients.
Bile acids and the gut microbiome
The human gut is home to trillions of bacteria that help maintain a healthy colon, support immune health, and participate in metabolic processes. A balanced and diverse microbiome is associated with good health, but a fragile and unbalanced one is linked to many diseases.
In healthy people, small amounts of primary bile acids travel to the colon where specific gut bacteria transform them into secondary bile acids, like deoxycholic acid (DCA). These secondary bile acids regulate both the composition of the gut microbiome and the health of the host.
A 2020 study into the relationship between gut bacteria and bile acid diarrhoea found that patients with this condition had a less diverse microbiome. The authors also noted changes in short-chain fatty acid profiles and the composition of the gut microbiome. It is likely that, in the coming years, more will be known on this topic.
Bile acid malabsorption diagnosis
The gold standard bile acid malabsorption test is the selenium homotaurocholic acid test (SeHCAT). The patient takes a capsule containing radiolabeled bile acids and several images are taken at various time periods to monitor the bile acid cycle.
The test measures how many radiolabeled bile acids are still in the abdomen after several days. If the results show fewer radiolabeled bile acids, then it indicates that bile acids are not being retained normally, which is a sign of bile acid malabsorption.
Other diagnostic tests that may be used to diagnose bile acid malabsorption are serum biomarkers of bile acid synthesis in the liver, like fasting serum C4 and FGF19. Total and individual faecal bile acids may also be used.
Bile acid malabsorption treatment
The main treatment options available for bile acid malabsorption are medication and diet changes. Because type 1 and type 3 are caused by underlying health conditions, it may be necessary to treat them first, which may improve the symptoms associated with bile acid malabsorption.
Medication
Bile acid binders are prescribed to people who are affected by the malabsorption of bile acids. They work by binding to bile acids in the small intestine, preventing them from irritating the lining of the gut as they move through the gastrointestinal tract.
These fat reducing agents aren’t always well-tolerated. There is also a risk of gastrointestinal side effects like constipation, upset stomach, diarrhoea, and loss of appetite when taking them.
Low-fat diet
Individuals diagnosed with bile acid malabsorption may be referred to a dietician to help control their symptoms. In many cases, it is advised to eat less than 40g of fat per day and make healthy swaps, such as whole milk for skimmed or semi-skimmed varieties.
Bile acid malabsorption foods to avoid
- butter and margarine
- cream cheese
- fatty meats or meat with visible fat
- frying oil
- hard (full fat) cheese
- pastry (especially puff and shortcrust)
- skin on meat (e.g. chicken or pork crackling)
- whole milk
A 2015 study of 40 patients with bile acid malabsorption demonstrated that a low-fat diet could significantly reduce symptoms such as bloating, frequency of going to the toilet, and urgency. The participants also reported a reduction in gas, abdominal pain, and greasy poops.
Living with bile acid malabsorption
Bile acid malabsorption can have a severe impact on your quality of life, particularly if it is left undiagnosed or untreated. The most common symptom is diarrhoea, and some people may need to go in excess of 10 times per day.
This can significantly decrease a person’s quality of life and socialisation. Treatment such as medication or treating the underlying cause can help to relieve symptoms. Dietary changes may also be beneficial.
☝REMEMBER☝ If you suffer from prolonged diarrhoea, or severe gastrointestinal symptoms, don’t wait. Ask your doctor for help!
Biliary dyskinesia – Symptoms and treatment in adults
Biliary dyskinesia is a violation of the flow of bile from the liver through the biliary tract (gall bladder and cystic duct).
There is either too much or too little contraction of the gallbladder. As a result, an insufficient amount of bile enters the duodenum. The disease is 10 times more common in women than in men.
Symptoms
Pain in the right hypochondrium
- In case of hyperkinetic variant of dyskinesia (that is, with increased contractile activity of the biliary system), the pain is acute, paroxysmal, short-term, can radiate to the right shoulder or right shoulder blade. As a rule, pain occurs after physical or emotional stress, eating fatty foods
- In case of hypokinetic variant of dyskinesia (that is, with reduced contractile activity of the biliary system), the pain is dull, aching, almost constant, with rare episodes of pain absence, accompanied by a feeling of fullness in the right hypochondrium
- Attacks of biliary colic – severe pain in the right hypochondrium, occurring suddenly, accompanied by palpitations or a feeling of cardiac arrest, fear, numbness of the limbs
Cholestatic syndrome
This is a whole complex of symptoms resulting from a decrease in the flow of bile into the duodenum – the initial section of the small intestine. Develops in less than half of the cases.
Manifestations of cholestatic syndrome:
- jaundice (yellow discoloration of the skin, mucous membranes (e.g. oral cavity), body fluids (e.g. saliva, lacrimal fluid, etc.)
- lighter than usual, cal
- urine darker than usual
- hepatomegaly (enlargement of the liver)
- pruritus
Dyspeptic manifestations (digestive disorders) :
- loss of appetite
- nausea and vomiting
- bloating
- bitterness and dry mouth in the morning
- bad breath
Manifestations of neurosis :
- increased fatigue
- irritability
- increased sweating
- recurrent headaches
- reduced sexual activity
Reasons
Causes of primary biliary dyskinesias associated with congenital malformations of the biliary tract:
- duplication of the gallbladder and bile ducts
- constriction of the gallbladder
- Constrictions and septa in the gallbladder
Causes of secondary biliary dyskinesias (developing throughout life) – various diseases, for example:
- gastritis (inflammation of the gastric mucosa)
- duodenitis (inflammation of the mucous membrane of the duodenum)
- peptic ulcer (formation of ulcers – deep defects) of the stomach or duodenum
- pancreatitis (inflammation of the pancreas)
- cholecystitis (inflammation of the gallbladder)
- viral hepatitis (systemic disease with predominant liver damage caused by viruses)
- neuroses (treatable mental disorders conscious of patients)
- hypofunction of the endocrine glands (reduced production of hormones), e.
g. hypothyroidism – hypofunction of the thyroid gland
Risk factors
- Genetic predisposition
- Unhealthy diet (eating a lot of fatty, fried and spicy foods)
- Worms (flat and roundworms) and Giardia (single-celled organisms with flagella).
- Intestinal infections (infectious diseases primarily affecting the digestive system)
- Hormonal disorders (disturbances in the ratio of hormones – biologically active substances that regulate all types of body activity). For example, increased or decreased production of hormones, violation of their composition or transportation
- Vegetovascular dystonia (VVD), or neurocirculatory dystonia (NCD) – disorders of the autonomic nervous system (part of the nervous system that regulates the activity of internal organs)
- Psycho-emotional stress (psycho-emotional stress)
- Excessive exercise
- Sedentary lifestyle
Diagnosis at the Medline clinic
Analysis of the anamnesis of the disease, complaints, life and physical examination . On examination, the normal color of the skin or its yellowness, reduced or increased nutrition is determined. On palpation (palpation), pain in the right hypochondrium is assessed, aggravated by inhalation. When tapping, the size of the liver and spleen is determined.
Laboratory tests :
- Complete blood count may not reveal abnormalities. In the presence of inflammatory diseases, leukocytosis appears (an increase in the number of leukocytes – white blood cells), an increase in the erythrocyte sedimentation rate – red blood cells (ESR – a non-specific laboratory indicator that reflects the ratio of blood protein varieties)
- Urinalysis reveals darker urine than normal and may contain bile pigments (coloring matter secreted by bile).
- Biochemical blood test. The level of creatinine (protein breakdown product), uric acid (decomposition product of substances from the cell nucleus), total protein and its fractions (varieties), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (AlAT or ALT), aspartate aminotransferase (AST or AST), bilirubin (a bile pigment – a coloring matter, a breakdown product of red blood cells), electrolytes (potassium, sodium, calcium, magnesium)
- Lipidogram (analysis of lipids, fat-like substances in the blood).
Can reveal abnormalities in the normal content of various lipids.
- Viral hepatitis markers (signs of the presence of viruses in the body that can damage the liver)
- Examination of feces for the presence of flat and round worms, as well as protozoa (single-celled organisms)
Instrumental methods of research :
- Ultrasound examination (ultrasound) of the abdominal organs reveals changes in the size and shape of the gallbladder, the presence of stones, kinks or constrictions in it
- Ultrasound examination of the gallbladder with trial breakfast. After performing an ultrasound examination of the gallbladder on an empty stomach, the patient is given a trial breakfast containing a large amount of fat (for example, a glass of sour cream or two egg yolks). After 30 and 60 minutes, an ultrasound examination of the gallbladder is performed again. The doctor evaluates how timely and completely the gallbladder was reduced after eating.
This study allows you to evaluate the form of biliary dyskinesia – hyperkinetic (that is, with increased contractility of the muscles of the biliary tract) or hypokinetic (that is, with reduced contractility of the muscles of the biliary tract)
- Duodenal sounding. In this study, a probe (tube) is inserted into the duodenum through the nose or mouth for a long time. Periodically, portions of bile are taken through the probe for research. The study of bile reveals signs of inflammation, stone formation, etc.
- Fibroesophagogastroduodenoscopy (FEGDS) – examination of the surface of the esophagus, stomach, duodenum using endoscopes (optical instruments). It is carried out if a disease of these organs is suspected as the cause of biliary dyskinesia
- Oral cholecystography is a method of examination in which the patient drinks a contrast (that is, makes the places of its accumulation visible on the x-ray) substance that accumulates in the gallbladder. Allows you to assess the size and shape of the gallbladder, the presence of anomalies (disorders) of its development
- Intravenous cholecystography is a method of examination in which a contrast agent is injected intravenously, which accumulates in the gallbladder.
Allows you to assess the size and shape of the gallbladder, the presence of anomalies (violations) of its development. Contraindicated in case of allergy (individual hypersensitivity) to iodine preparation
- Endoscopic retrograde cholangiopancreatigraphy (ERCP) – a combination of endoscopic and radiological methods that gives an image of the biliary tract
- Hepatobiliary scintigraphy – a radioisotope method of research, in which a radioactive drug is administered intravenously, selectively accumulates in the liver and biliary tract, which allows you to get an accurate image of them
Treatment of biliary dyskinesia
The purpose of therapeutic measures for biliary dyskinesia is to normalize the outflow of bile and prevent its stagnation in the gallbladder.
Compliance with the regime of work and rest
Diet therapy: Diet No. 5.
- Feed 5-6 times a day in small portions to improve bile excretion
- Exclusion from the diet of spicy, fatty, fried, smoked foods, canned food
- Reduced salt content in food (up to 3 grams per knock) and spices to reduce fluid retention in the body
- Mineral water intake:
- high mineralization (that is, with a high content of salts) with hypomotor biliary dyskinesia (with reduced contractile activity of the biliary system)
- low mineralization (that is, with a low salt content) with hypermotor biliary dyskinesia (increased contractile activity of the biliary system)
Conservative (non-surgical) treatment.
- Choleretics (cholagogues) facilitate the flow of bile
- Cholespasmolytics (drugs that reduce the increased tone of the muscles of the biliary tract) are used in the hypermotor variant of dyskinesia
- Enzyme preparations facilitate the digestion of food in case of hypomotor dysfunction
- Collections of medicinal herbs are appointed courses 2 times a year.
The composition of the herbal collection depends on the type of dyskinesia (hyperkinetic or hypokinetic)
- Duodenal sounding – removal through a probe (tube) of the contents of the duodenum after the introduction of drugs that stimulate the release of bile from the gallbladder
- Closed tubes (cleansing) of the gallbladder, or “blind” probing – taking cholagogues under conditions that facilitate the outflow of bile (in the position on the right side, with a warm heating pad on the right hypochondrium)
- Treatment with neurotropic (affecting the nervous system) drugs on the recommendation of a psychotherapist
Physiotherapeutic treatment :
- Diadynamic therapy (therapeutic effect of electric current of different frequencies on the area of the right hypochondrium)
- Electrophoresis (impact on the body of direct electric current and medicinal substances administered with its help) with magnesium preparations on the liver area
Acupuncture (acupuncture) – a method of treatment in which the impact on the body is carried out by introducing special needles into specific points on the body
Massage (especially acupressure) – that is, with the impact on certain points of the human body that affect the activity of the gallbladder
Prevention of biliary dyskinesia
Primary prevention of biliary dyskinesia (that is, before it occurs)
- Compliance with the regime of work and rest
- Wholesome nutrition with restriction of fatty, fried, smoked, salty foods, with sufficient content of vegetables and fruits
- Exclusion of psycho-emotional (stressful) situations
- Timely treatment of neuroses
Secondary prevention (that is, after the onset of biliary dyskinesia) consists in its earliest detection – with regular preventive examinations.
Primary appointment with a gastroenterologist (taking an anamnesis, prescribing the necessary examination for making a diagnosis, (setting a primary diagnosis) PRICE: 1700 |
Repeated examination by a gastroenterologist (diagnosis, appointment of the necessary course of treatment) PRICE: 1700 |
come back
Treatment of biliary dyskinesia in Moscow, prices at the MedEx clinic
Gallbladder motility disorder is the most common pathology of the gastrointestinal tract. Both adults and children are susceptible to biliary dyskinesia. Women suffer more often; their provocateurs of this condition are periods of pregnancy.
Clinic of personal medicine MedEx invites you to the diagnosis and treatment of the disease, taking into account the general health of patients.
Causes of development
A healthy gallbladder is a natural reservoir that stores a small amount of bile. After eating, when food enters the duodenum, it contracts, pushing bile into the intestine, where it participates in the further digestion of the food bolus. If the organ and its ducts are compressed too weakly or excessively, the necessary supply of bile is not collected on time, digestion is disturbed.
The causes of a functional disorder are varied and not always obvious. These include:
- inaccuracies in nutrition: passion for fatty foods, smoked and fried foods, occasional starvation diets, irregular meals;
- stressful situations, acute and chronic nervous overload;
- hormonal disruptions;
- parasitic and infectious diseases;
- systemic pathologies: diseases of the thyroid gland, adrenal glands, pituitary gland, diabetes mellitus, gastritis, chronic inflammation of the intestinal mucosa;
- lack of physical activity;
- overweight;
- malformations of the anatomical structure of the gallbladder and ducts;
- cholelithiasis.
Dyskinesias formed by factors that directly affect digestion (malnutrition, excess weight, physical inactivity) are called primary. Those that appeared as a result of hormonal and other systemic disorders are classified as secondary.
Symptoms of biliary dyskinesia
The most common signs of the disease:
- heaviness and physical discomfort in the abdominal cavity, worse after a heavy meal;
- pain spasms in the right hypochondrium;
- belching;
- bitterness in the mouth;
- occasional bouts of nausea.
In severe cases, the pathology is accompanied by disorders in the functioning of the lungs and the cardiovascular system. Frequent mood changes and asthenic syndrome are possible: dizziness, weakness, numbness of the arms or legs. The lack of bile acids in the intestine due to cholestasis (bile stasis) leads to a persistent disorder of the digestive system, the absorption of many important nutrients and vitamins.
Biliary dyskinesia in children is also manifested by lack of appetite and dyspeptic disorders. Toddlers complain of abdominal pain, nausea, are picky eaters, and may experience a physical aversion to certain foods.
Types of biliary dyskinesia
With hypertonic dyskinesia, the intensity of contractions of the bladder walls increases. In this case, there are sharp paroxysmal pain in the side. Cramps are usually short-lived, lasting from a few minutes to an hour, appear after meals and on an empty stomach. They usually develop after some annoying situation and may be accompanied by severe tachycardia, sweating, increased heart rate, headache, sleep disturbance. This dysfunction is more common in young and middle-aged women. The provoking factor is hormonal changes that occur in the body every month and during pregnancy, nervous disorders.
Dysfunction of the hypotonic type is associated with insufficient contractile function of the gallbladder. Manifested by frequent or constant aching pains, indigestion:
- nausea after fatty and heavy meals;
- diarrhea or constipation;
- bloating;
- loss of appetite.
This type of biliary dyskinesia in adults is typical for elderly people suffering from obesity, thyroid insufficiency. Sometimes prolonged stagnation of bile can provoke the appearance of icteric symptoms: yellowing of the sclera of the eyes, tongue and mucous membranes, a change in the normal color of urine and feces.
Due to prolonged stagnation of bile, enlargement and changes in the boundaries of the liver are possible.
Diagnostics of the disease
In addition to studying the patient’s complaints, instrumental and laboratory methods of examination are used to establish the diagnosis.
- Ultrasound of the liver and gallbladder is the fastest and most painless way to obtain preliminary information about dysfunction. During the study, the condition, shape and size of the organ, the possible presence of stones in the cavity and ducts are determined. With dysfunction of the hypotonic type, the organ is enlarged and somewhat lowered; the hypertonic type is characterized by a decrease in the size of the bladder, tension, and periodic contractions of the walls.
Studied homogeneity and movement of bile.
- Duodenal examination. A special probe is inserted into the patient on an empty stomach, through which an enzymatic fluid containing bile is taken. According to its quantity and properties, the state of the motor functions of the biliary system is established, the diagnosis is specified. Sounding helps to get rid of stagnant bile. If necessary, a solution washing the ducts is injected through the probe.
- Cholecystography. X-ray examination of the biliary system is performed using contrast agents after preliminary preparation. According to the degree of staining of the ducts and the cavity of the gallbladder, congestion and mechanical obstacles are revealed.
- Blood test for biochemical parameters. With dysfunction of the gallbladder, this type of examination is informative only in cases of advanced forms of the disease, but its result allows you to find out the condition of the liver, to differentiate dyskinesia from other pathologies.
Examine the presence of bile acids, bilirubin, liver tests, cholesterol.
At the MedEx clinic, all scheduled diagnostic procedures are performed within one day using high-precision medical equipment.
Treatment of biliary dyskinesia
In the absence of a complicated course, the disease is treated on an outpatient basis. Methods of therapy depend on the causes of the pathology:
- To cope with the secondary dysfunction caused by endocrine disorders, it is necessary to deal with the underlying disease.
- If the condition is psychosomatic: caused by mental changes, nervous disorders, one cannot do without psychotherapeutic help, a psychologist’s consultation. It will require a revision of negative character traits, the development of a calm, adequate attitude to problems.
The disease is not cured in a few days. An integrated approach to solving this problem and a lot of patience are required.
Correction of nutrition
Whatever the causes of gallbladder dysfunction, the first step for successful treatment is the right diet. Regular meals in a calm environment are required. You can’t eat up “to satiety” or endure hunger for a long time – it is this eating behavior that contributes to disruption of the gallbladder.
Eat more often than usual. In addition to breakfast, lunch and dinner, you need 2 or 3 small additional snacks.
Foods that provoke bile stasis or are rich in cholesterol are excluded from the diet:
- heavy animal and synthetic fats;
- any kind of smoked meats, marinades;
- canned food;
- muffin;
- fast food;
- foods that increase gas formation in the intestines: cabbage, peas, corn, unripe apples, rhubarb, sorrel.
Preferred vegetable and dairy food, lean meats and fish, fruits, raw, stewed, baked vegetables, dairy cereals and soups, vegetable or meat secondary broth, natural butter and vegetable oils, low-fat cottage cheese, sour-milk drinks.
Useful vegetable salads dressed with olive oil, fresh juices without salt and sugar.
Diet therapy is comparable in effectiveness to drug treatment, helps to control weight, establish healthy bile secretion, and prevent the formation of calculi in the bladder.
Medications
It is impossible to prescribe drug therapy on your own – aggravation of painful conditions is possible. The attending physician should select drugs.
In case of hypotonic pathology, choleretics are used that increase the production and separation of bile:
- Cholenzim;
- “Deholin”.
Hypertensive dysfunctions are treated with drugs that regulate and relieve spasms:
- Bellalgin;
- “Drotaverine”;
- “Papaverine”.
In addition, enzymatic preparations are prescribed to facilitate digestion:
- “Mezim”;
- “Festal”;
- “Allohole”.
“Cerucal”, “Motilium” are used for mixed types of dysfunctions.
Complementary therapies
Various types of physiotherapy are useful for dyskinesia:
- magnesium sulfate electrophoresis;
- low frequency impulse currents;
- ultrasound.
The course intake of mineral medicinal waters has an excellent effect on the health of the gallbladder:
- “Essentuki” No. 4, No. 17, No. 20;
- “Narzan”;
- “Borjomi”;
- Slavyanovskaya.
Considering that mineral water contains a large amount of various salts, before treatment it is necessary to make sure that the kidneys are healthy and there is no risk of edema.
Tubage or “blind probing” helps to get rid of excess stagnant bile. The procedure is prescribed 1 or several times a week. In the morning after a bowel movement, you need to take a choleretic agent. Then it is necessary to rest, lying on the left side for 2-3 hours with a heating pad applied to the area of the right hypochondrium. During this time, the accumulated bile completely leaves the bladder.
Breathing exercises are also used in the treatment. The basis of the method is diaphragmatic breathing. It has a massaging effect on the internal organs, prevents stagnation of bile.