The body’s primary job is to make sure that each organ system works correctly and does its job. One of the systems in the body is the gut system, and its position is to make sure that the food is being consumed and digested to be turned into nutrients and transported throughout the entire body. The gut system makes sure that the food is being digested and excreted out of the body to be functional. The digestion of the food being turned into particles is done through the bile acids in the stomach and the intestines (both large and small) to help turn the foods into nutrients and help regulate the entire digestive system. In this 2 part series, we will be looking at what bile acids are, their role in the gut, and what gall sludge is. Part 2 will look at how bile acids are hormones, sterolbiome, and bile reflux. By referring patients to qualified and skilled providers who specialize in gastroenterology services. To that end, and when appropriate, we advise our patients to refer to our associated medical providers based on their examination. We find that education is the key to asking valuable questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
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Since the human body is a complex ecosystem that is predominantly bacterial on a cellular and gene level, the various surfaces of the body are an interconnected network of ecosystems made up of human cells, bacteria, and archaea. These include:
As research studies have found, the gut microbiota is home to a complex community of over trillions of microbial cells that help influence the human body’s physiology, metabolism, nutrition, and immune function to ensure that everything is working and functioning correctly. Through their capacity, the gut microbial community can also produce bile acid metabolites that are distinct from the liver. The produced bile acids from the liver can be thought of as an endocrine organ with the potential to alter host physiology, perhaps to their favor.
Bile acids are produced from the liver to help with the aid of digestion of foods to be absorbed into the body. The liver synthesizes and secretes water-soluble primary bile acids, converted by intestinal flora into numerous fat-soluble compounds. Research studies show that bile acids are large molecules synthesized from cholesterol in the liver and are secreted out to the intestines. After that, these bile acids are absorbed into the blood, returned to the liver, and accumulate in the biliary pool. It takes about 16 enzymes needed to convert cholesterol to bile acids.
Other research studies have also found that the composition of the bile pool is being mediated by the bacterial metabolism in the intestinal tract, thus linking to the body’s physiology. When this happens, the liver cells also attach bile salts to glycine, taurine, sulfate, or glucuronide, forming a conjugation. However, flora in the ileum and colon may undo this process, causing a deconjugation as Bilirubin pigments are conjugated with glucuronic acid. Gilbert’s syndrome occurs if this does not happen as well as it should due to a genetic enzyme deficiency. For the bile pool, the primary mechanism for removing cholesterol from the blood is excretion into the bile. About 5% of the bile gets into the large intestine and is eliminated in the stool. Although with increasing levels, these bile acids can cause diarrhea. It is hypothesized that if these bile acids are deficient, functional constipation may occur in the body.
Primary bile acids form micelles with lecithin and cholesterol to mix fat and water, allowing the absorption of fats and fat-soluble vitamins. Research studies have shown that the two primary bile acids are synthesized from cholesterol in the liver, which are:
The primary bile acid chenodeoxycholic acid (CDCA) and the secondary bile acid deoxycholic acid (DCA) function as laxatives for the gastrointestinal tract. They do this by increasing water secretion from the blood into the bowel, causing the bile to be turned into a stool and being excreted out of the body. Primary bile acid also ensures that it is being secreted into the intestines, thus undergoing bacterial biotransformation that will generate the primary bile acid into secondary bile acid.
Secondary bile acids are metabolites that influence nuclear receptors in the body as they can be carcinogens. The two secondary bile acids are made when intestinal flora act on the primary bile acids as:
Since the biliary system is a route of detoxification for the liver, bile acids can be therapeutic agents for the body. Research studies have shown that the enterohepatic circulation of bile acids (both primary and secondary) from the liver to the intestines and back to the liver plays a vital role in nutrient absorption and distribution and provides metabolic regulation and homeostasis to the liver and the body.
Bile acids are essential to the body’s overall health and wellness as they help break down food particles into nutrients so the body can use them for energy, growth, and metabolism. Studies have found that bile acids have been long known to facilitate digestion and absorption of lipids in the intestines and regulate cholesterol homeostasis. Since bile acids are produced from the liver, bile acids must regulate the endocrine and digestive systems for optimal health and wellness.
Biliary sludge (microlithiasis) is a reversible suspension of precipitated particulate matter in bile in a viscous mucous liquid phase. The most common precipitates are cholesterol monohydrate crystals, calcium-based crystals, granules, and salts. Research studies have shown that gall sludge is when there is a collection of particles from the bile acids that are remaining in the gallbladder for too long. Individuals with biliary sludge or microlithiasis are believed to be gallstone patients at an early stage of their disease. The best way for many individuals to treat gall sludge is to go for oral bile-acid therapy. This therapy is for mildly symptomatic individuals with small radiolucent stones who cannot or do not want to undergo surgery. Other research studies have found that medical treatment can help prevent sludge formation and recurrent acute pancreatitis.
Overall, the gut system needs bile acids to aid in the progress of digestion and absorb the nutrients from food particles in the stomach. The food particles then go through biotransformation as they are broken down further from the primary bile acids and then transformed to become secondary bile acids. Since the bile acids are produced from the liver, it is considered a hormone with an essential function by ensuring that the entire body functions correctly and excreting out. When the bile acids have stayed in the gallbladder for long periods, it can create gall sludge and cause unwanted diseases in the body. Incorporating proper gut health protocols can provide beneficial results in producing bile acids and ensuring a healthy body.
National Institute of Diabetes and Digestive and Kidney Diseases; 2012-., Bethesda (MD). “Bile Acids.” LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]., U.S. National Library of Medicine, 25 Sept. 2017, www.ncbi.nlm.nih.gov/books/NBK548626/.
Chiang, John Y L. “Bile Acid Metabolism and Signaling.” Comprehensive Physiology, U.S. National Library of Medicine, July 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4422175/.
Guinane, Caitriona M, and Paul D Cotter. “Role of the Gut Microbiota in Health and Chronic Gastrointestinal Disease: Understanding a Hidden Metabolic Organ.” Therapeutic Advances in Gastroenterology, SAGE Publications, July 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3667473/.
Jain, Rajeev. “Biliary Sludge: When Should It Not Be Ignored?” Current Treatment Options in Gastroenterology, U.S. National Library of Medicine, Apr. 2004, pubmed.ncbi.nlm.nih.gov/15010024/.
Staels, Bart, and Vivian A Fonseca. “Bile Acids and Metabolic Regulation: Mechanisms and Clinical Responses to Bile Acid Sequestration.” Diabetes Care, American Diabetes Association, Nov. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2811459/.
Staley, Christopher, et al. “Interaction of Gut Microbiota with Bile Acid Metabolism and Its Influence on Disease States.” Applied Microbiology and Biotechnology, U.S. National Library of Medicine, Jan. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5203956/.
Taylor, Sarah A, and Richard M Green. “Bile Acids, Microbiota, and Metabolism.” Hepatology (Baltimore, Md.), U.S. National Library of Medicine, Oct. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6173626/.
Villines, Zawn. “Gallbladder Sludge: Symptoms, Causes, and Treatments.” Medical News Today, MediLexicon International, 18 Nov. 2017, www.medicalnewstoday.com/articles/320057.
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The information herein on "How Bile Acids Help Regulate The Gut | Part 1" is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.
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Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*
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Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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