Low Bile Throughput.

Bile is the unsung hero of digestion and detox. When it's sluggish, everything backs up.

"You can't detox without bile. You can't absorb fat-soluble nutrients without bile. You can't clear hormones without bile."

Why bile matters.

Bile isn't just for fat digestion. It's a critical elimination pathway that most people ignore.

Bile's jobs

Emulsify dietary fats for absorption
Absorb fat-soluble vitamins (A, D, E, K)
Eliminate used hormones (especially estrogen)
Remove heavy metals and toxins
Kill pathogens in the small intestine
Regulate cholesterol levels

When bile is low

Fats pass through undigested
Fat-soluble vitamins become deficient
Hormones recirculate instead of clearing
Toxins get reabsorbed (enterohepatic recirculation)
SIBO risk increases
Cholesterol stays elevated

Genes in this pattern.

These genes affect bile production, composition, flow, and the recycling of bile acids.

UGT1A1

UDP Glucuronosyltransferase 1A1

Conjugates bilirubin and toxins for excretion

Key variants: Gilbert's syndrome variant reduces activity by ~70%

Impact: Elevated bilirubin, slower drug clearance, jaundice risk

ABCB4

ATP Binding Cassette B4 (MDR3)

Pumps phospholipids into bile to protect bile ducts

Key variants: Multiple variants affect bile composition

Impact: Gallstones, cholestasis, bile duct damage

SLCO1B1

Solute Carrier Organic Anion Transporter 1B1

Transports bile acids and drugs into liver cells

Key variants: *5 and *15 variants reduce transport

Impact: Statin intolerance, altered drug metabolism

CYP7A1Cytochrome P450 7A1

Rate-limiting enzyme for bile acid synthesis from cholesterol

Key variants: Variants affect cholesterol-to-bile conversion

Impact: High cholesterol, reduced bile acid pool

FXR (NR1H4)

Farnesoid X Receptor

Master regulator of bile acid homeostasis

Key variants: Affects bile acid feedback loops

Impact: Bile acid dysregulation, metabolic issues

BSEP (ABCB11)

Bile Salt Export Pump

Exports bile salts from liver into bile ducts

Key variants: Mutations cause progressive familial intrahepatic cholestasis

Impact: Bile salt accumulation, liver damage

Signs of low bile throughput.

These symptoms suggest your bile flow may need support.

✓Nausea or discomfort with fatty meals

✓Pale or clay-colored stools

✓Floating, greasy stools (steatorrhea)

✓Right upper quadrant discomfort

✓Gallstones or gallbladder removal history

✓Fat-soluble vitamin deficiencies (A, D, E, K)

✓Hormone imbalances (estrogen dominance)

✓Chemical sensitivity

✓Elevated bilirubin (Gilbert's)

✓Statin intolerance

The gallbladder question.

Had your gallbladder removed? You still make bile—but now it drips continuously instead of being stored and released in a concentrated burst.

Post-cholecystectomy considerations:

✓Ox bile with meals becomes essential, not optional
✓Smaller, more frequent meals work better than large ones
✓Fat-soluble vitamin supplementation may be necessary
✓Bile acid sequestrants can help with diarrhea
✓SIBO risk increases without concentrated bile release

Support strategies.

Bile Flow Support

•Ox bile with fatty meals
•Bitter herbs (gentian, dandelion, artichoke)
•Phosphatidylcholine (lecithin)
•Taurine (conjugates bile acids)
•Beet root (betaine support)

Liver Support

•Milk thistle (silymarin)
•NAC (glutathione precursor)
•B vitamins for methylation
•Adequate protein intake
•Coffee (stimulates bile flow)

Lifestyle

•Eat fat with meals (stimulates release)
•Don't fear healthy fats
•Fiber for bile acid binding
•Regular meal timing
•Address constipation promptly

Testing

•GGT (gamma-glutamyl transferase)
•Bilirubin (direct and indirect)
•Bile acid panel
•Fat-soluble vitamin levels
•Comprehensive stool analysis

The bile-gut connection.

Bile and gut health are deeply interconnected. Problems in one affect the other.

SIBO and bile

Bile is antimicrobial. Low bile flow allows bacteria to overgrow in the small intestine. SIBO then further impairs fat absorption, creating a vicious cycle.

Enterohepatic circulation

95% of bile acids are reabsorbed in the ileum and recycled. Disrupted gut function (inflammation, dysbiosis) impairs this recycling, depleting your bile acid pool.

Hormone clearance

Used estrogen is conjugated by the liver and excreted via bile. If gut bacteria produce beta-glucuronidase, they deconjugate estrogen, allowing reabsorption. This drives estrogen dominance.