Resolve IBS and IBD Naturally
This podcast is for you if you are struggling with symptoms of IBS and IBD and want to get to the root cause of your symptoms so you can take back your health through a holistic, whole-person approach.
Resolve IBS and IBD Naturally
Episode 55: Your Digestive Health Depends on Quality Bile Production
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Bile plays a critical role in digestion, serving as an emulsifier for fats much like dishwashing detergent breaks down grease. Understanding bile quality issues can explain why many people struggle with either constipation or loose stools despite trying various remedies.
• Bile breaks down dietary fats into fatty acids, essential for hormone production and blood sugar regulation
• Poor bile production or quality can lead to undigested fat, causing inflammation, bloating, and bowel irregularity
• Common signs of bile issues include floating stools, pale/chalky colored stool, and unusually strong-smelling bowel movements
• Steatocrit testing in comprehensive stool analysis can objectively measure undigested fat
• Two main bile problems: insufficient production and poor quality ("sludgy bile")
• Chronic low-fat diets and consumption of low-quality processed oils contribute to bile issues
• Conventional treatments like bile acid sequestrants (Welchol, cholestyramine) may provide symptom relief but don't address root causes
• MCT oil can be helpful for those with fat digestion issues as it doesn't require bile for absorption
• Start with small amounts of MCT oil (½ teaspoon) and increase slowly based on tolerance
To get my free guide "IBSD and IBD Relief: a three-step solution to end bowel urgency and loose stool," click the link in the show notes below.
Link to a free 30 minute Gut Check Call
Disclaimer: None of the content discussed is meant to be taken as medical advice. All information presented is for educational purposes only and listeners and viewers assume all responsibility around implementing any changes to their health and medical regimen.
Introduction to Bile's Role in Digestion
Speaker 1Welcome to Resolve IBS and IBD. Naturally, I'm Courtney Cowie, a nutrition therapy and functional diagnostic nutrition practitioner. If you are struggling with the symptoms of IBS or IBD and want to get to the root cause of your symptoms so you can take back your health through a whole person approach, this podcast is for you. Just a disclaimer that the information I'm presenting in this podcast is for educational purposes only and should not be taken as medical advice. You should always consult a qualified practitioner before making any changes to your health or medical regimen. That being said, let's get on with the show.
Speaker 1My goal is to walk you through the role that bile plays in digestion, all the things that can go wrong with bile quality or bile production, and why. It's a really key piece to understanding why some people struggle with either sluggish bowels or loose stools. Right, those are just two ends of the spectrum. Both of those symptoms 100 have a component of potentially bile quality issues, so I sort of alluded this. But bile is essentially a digestive fluid that's meant to break down the healthy fats you eat and, in simple terms, I describe this all the time to my clients. It works just like your dishwashing detergent breaks down grease on dishes. It's an emulsifier and my clients that work with me. I spend quite a bit of time educating them about the different macronutrients, which would be the proteins, fats and carbs. Those are the three major types of, you know, fuel sources that all foods fall into, and they have very different components structurally, if you've spent any time learning about these different macronutrients. Fat, particularly, is a very large molecule. It does take some digestive firepower to break down, hence why bile is so important. It needs to be kind of like cleaved into these smaller components called fatty acids, and that's exactly what bile does. So in that manner, if you can imagine, you're either not producing enough bile or the bile you're producing isn't able to do its job well enough to break down healthy fat.
Speaker 1That can lead to all kinds of issues. First of all, having enough fatty acids to build things like hormones, especially thyroid hormones, sex sex hormones all types of hormones are built from fat. It can be very hard for people who aren't getting enough essential fatty acids to make it meal to meal without feeling like they get really hungry within a couple hours. Mentally foggy, crashing and burning, jittery because they're not eating. Those can all be signs of blood sugar handling issues, which is a foundation of health that I assess with all of my clients and a big piece of the work I do to help balance my clients out holistically. Beyond just supporting their digestive function, believe it or not there's these other key functions that have to be working right for the GI system to work right, one of which is sugar handling, and so we need to have enough fatty acids to make sure that we can go the long haul meal to meal as well as overnight without having signs of just basically crashing and burning right. So fats are really important for that. They're a cushion for the body, they help to support cells and tissues. They're just a really, really essential piece of the puzzle when it comes to diet, and so I won't go into this topic today.
How Bile Functions Like Dishwashing Detergent
Speaker 1This is a topic I will sometimes go in depth with with some of my female clients that were raised in the Weight Watchers and Jenny Craig heyday, where fat was kind of vilified and low-fat diets were all the rage. But I do sometimes find that people have confusion around fat actually making a person fat, which is totally not true. We won't talk about that today. I want to just bust that myth and say that we absolutely need enough healthy fat for the body to run well and particularly for fat to actually help feed back into building high quality bile, and the same is true for cholesterol. So neither fat nor cholesterol is a bad substance in and of itself, even though these are both things that have been vilified in kind of the media and just food pop culture, right Like even today. On food culture or food labeling it's common to see things like you know low fat or you know no cholesterol or whatever it is. That's a whole nother topic. Again, like I said, I don't want to dive into that, but realize that they're both very much needed to build bile, and bile, as I mentioned, is critical to breaking down fat.
Speaker 1And also bile has other roles in the body as well. It's one of the main ways that our body gets toxins out of the system, believe it or not, and whether you know it or not, you're being exposed to a certain amount of toxicity, whether that's through chemical sources. You know air quality issues. Especially if you live in a bigger city environment, you're probably being exposed more so than people who live more rurally, just because of the population density and all of the different vehicle emissions and just chemicals that are more present in those types of environments. But certainly I've worked with some pretty ill clients who have even had things like mold toxicity or Lyme disease, which are considered biotoxins, right, and so all of these different toxic inputs have to get detoxified through the liver, and the liver's way of packaging and getting these things out is by attaching them to bile as the main substrate to actually move them out through the gut. We won't go into the whole toxicity piece of bile today.
Speaker 1I want to focus more so on its role in digestion, but just realize it's an incredibly important fluid that has different purposes in the body. So what are the two main issues I see with bile and bile quality when I'm working with clients? These are the two most common things I see happen. Number one clients aren't producing enough bile, which then can make it hard to break down their fat. Undigested fat in the digestive system can put a burden on the intestines. It can cause a lot of inflammation. It can cause symptoms like bloating, flatulence, stomach cramping, bowel alterations. Undigested fat moving through the digestive system is not a good thing and it can really lead to a lot of GI symptoms Some of the common signs that I actually will ask clients about if they're unsure if they're able to digest their fat is do they see floating stool in the toilet after they have a bowel movement?
Speaker 1That could be a sign that they're not digesting their fat very well. If their stool is pale or chalky colored, that could be another sign that they're not digesting their fat very well and that they're having some bile quality issues. Things like mucus or grease, or even unusually strong smelling bowel movements could all be signs that fat is not breaking down very well and point back to bile quality issues. Now, more objectively, we can get clues as well from specialized root cause testing, in other words functional lab testing, and I'll talk about that in just a second.
Speaker 1Let me circle back to the other most common bile quality issue. I see and that would be just poor quality bile, and sometimes we describe that as sludgy bile In extreme form this is bile that can actually harden and calcify and become literal gallstones in the gallbladder. So if you yourself have ever had gallstones, or you know someone who's had gallstones, or especially if you've had gallstones that have led then to a gallbladder attack or removal of the gallbladder, what I want you to realize is, leading up to that event, the bile that your body was creating was on this track where it was actually becoming poor and poor quality to the point where it actually wasn't able to properly release and break down fat. It was accumulating and getting all hard and calcified in the gallbladder and that is not functional quality bile that can do what it's meant to do. And there's a lot of reasons why that can happen as well.
Two Common Bile Quality Issues
Speaker 1Probably the two biggest culprits that I've seen in my practice over time is a chronic low-fat diet, which makes it hard then for the liver to have the the necessary components or ingredients to build quality bile. So it's kind of trying, but bile quality and creation just isn't very good and then over time that leads to really poor quality bile that can then turn into gallstones, right right. Another big reason is just the standard American diet and a lot of people I find just aren't aware that one of the biggest problems with packaged and processed foods in our supermarkets nowadays isn't necessarily like the sugar although, yes, excess sugar is a problem it's the quality of the oils and fats that are in those foods. And again, I'm not going to do a deep dive on that. But people I just find are not as aware of how to properly read product labels and discern whether or not the products are selecting from the grocery store are going to have some of these really low quality, toxic fats that then put this inflammatory burden on the body and are definitely not the fats the body can use to make high quality bile. And so, you know, lacking the actual healthy fats that we do want to be focusing on in our diet, that will then ultimately, over time, lead to bile quality issues. And so, again, this is another skill set I'm really passionate about teaching my clients is I want them to be able to go into the grocery store, walk into any grocery store, any aisle, be able to make a very clear decision around whether or not any food they pick up off the shelf is going to help or hurt their health and especially, you know, relative to their issues and their chronic health issues they're dealing with. I mean, the things I might tend to emphasize for certain clients over others might look different person to person, but generally speaking, I find this is a big area of confusion is, you know, foods that people think are healthy aren't necessarily so, depending on what they deem healthy right, and this is a very big, open, you know, topic. We could talk a lot on that. We won't today. But just understand that usually with bile we're looking at either low quality bile, not enough of it being produced, or just really poor quality bile. Those are kind of the two ends of the spectrum.
Speaker 1Now, in terms of how do we actually quantitatively discern whether or not a client has good quality bile? So one of the best factors that we can look at from specialized testing and this is something that I get on the stool testing that I run on my clients is a marker called steatocrit, and Steatocrit is actually a marker that any regular GI doc could run as well in their conventional stool testing. Sometimes they do, sometimes they don't. But what's important about looking at this marker is it'll give us an actual indication of whether or not we're seeing undigested fat come out in the stool. And, generally speaking, in optimal gut function we don't want any undigested fat showing up in the stool. So on the stool test I run, for example, we want to see that value nothing right, zero, less than detectable. We don't want anything detected fat-wise in the stool than detectable. We don't want anything detected fat-wise in the stool. However, what we'll often see is some kind of a number show up and depending on how elevated that value is, that will correlate directly with how much of a bile quality or, you know, lack of bile issue we have going on. We can't necessarily, with steatocrit, tell whether it's just not enough bile or poor quality bile, but at the end of the day, we know that if we're seeing a number there, there's some degree of fat maldigestion happening and in the context of what that client's presenting with, if they have loose stool, if they have constipation, if they have bloating, if they have floating stools, stomach cramping, any of those things that could all then relate back to not digesting their fat. Very well.
Speaker 1So this is this is a piece just to understand, and again a piece as to why I feel getting good quality data when you're trying to really get to the root of your problem is so important, because otherwise we're throwing a spaghetti at a wall and hoping it's gonna stick. And just if you've been watching these lives, you'll know that I just went through a series on pancreatic enzymes and why they're so important. Enzyme deficiencies could lead to some of these symptoms, right, and so to really get clear on, okay, what is all going on here and what do we need to address, is super, super helpful. So we're not just randomly trying a supplement or randomly trying a diet without really understanding is this getting to the actual root imbalance that's at play? And just understand that in any 10 people with IBS symptoms there could be 10 different combinations of things going on. That could all explain those symptoms and the approach that I might take as a functional practitioner could look actually quite different person to person. And that's kind of the art and science of doing this work and why I think it's so hard to try to troubleshoot this as a regular person out there putting the pieces together and trying to gather all the info, and why it gets so overwhelming for the majority of people on this journey. So so steatocrit is super important. There are, of course, other markers that we can look at, but for the purposes of today I'm going to keep this ultra, ultra simple. I couldn't even go for a walk without planning my bathroom breaks. If you have IBSD or IBD and feel trapped by your gut, you're not alone. I used to plan my life around bathroom breaks until I found a three-step solution that finally worked To get my free guide IBSD and IBD Relief a three-step solution to end bowel urgency and loose stool. Click the link in the show notes below.
Testing for Bile Issues
Speaker 1Now just back to the GI doc side of things. I did mention that they can also take a look at steatocrit on their testing as well. What I find is a weakness in the conventional medical system as far as especially like GI testing is a lot of times these doctors and practitioners don't necessarily want to go run testing and get a ton of data, or they might do just some preliminary simple testing up front. But what I just tend to find more and more is that, right from go, they're going to often recommend, tend to find more and more is that, right from go, they're going to often recommend either some medications or some simple over-the-counter solutions, whether that's probiotics or fiber, which sometimes may work somewhat to a point, but often, if it's a more complicated case or there's a lot more going on, that beneath the surface which is a lot of the people I work with that's really not going to touch it.
Speaker 1And then, after those things don't work, they might start to jump to typical medications that will either slow down motility, in the case of diarrhea, or speed it up in the case of constipation. And some of the medications they use are actually bile acid sequestrants, things like Wellcol or cholestyramine, and so if those terms sound familiar, if you feel like that's something that your doctor has tried with you, just know that that's another common way that they might try to address bringing symptom relief. But again, here's the rub like using a bile acid sequestrant willy-nilly, without checking whether or not this person actually has excess bile production, and just know that kind of the assumption with these meds is that one of the driving factors of, say, the diarrhea because this is typically when they are prescribed is an excess production or a dripping out of the bile. That shouldn't be happening and this sequestrant is coming in to kind of bind that up and essentially stop that. So it's not stimulating lots of bowel movements.
Speaker 1The thinking here is that bile is actually an agent that stimulates bowel movement in the body and that is one of its biological functions in a healthy way, right like we want to have good bile flow so that we're optimally having one to three bowel movements a day. That's kind of that healthy average we're looking for well-formed, healthy, easy to pass bowel movements. Bile does certainly help to produce that urge to go to the bathroom in a physiologically healthy way, but where doctors will often try things like cholestyramine. The assumption is, well, you're having the urge to go all the time, so that could be because of a bile excess will give you this binder that'll kind of help to like, mop up this bile acid and then that should help to reduce the diarrhea and sometimes it can have an effect. But there too I often find that it's not a very good solution and even if it's lowering the frequency of bowel movements, sometimes people can actually get backed up and then when they do have a bowel movement, it's still quite urgent and sometimes even explosive, because now there's been this kind of stoppage happening from the medication. So again, if this all resonates and you've had these experiences with these types of meds, just know that this is pretty common and, in my opinion, not doing testing to really check what is going on with this person's bile is it low, is it, you know, poor quality You're really kind of empirically just trying something without really knowing, and so to that end it may work well, but often it won't, because you just don't know what you're dealing with right.
Conventional Approaches vs. Root Causes
Speaker 1The other thing I want to mention about bile sequestrants, just in terms of like how they're used to help with things like loose stool is that they do tend to grab bile and bring it out more so through the gut and in a healthy gut what will actually happen is when bile is created like a large amount of that will get reabsorbed at the end of the small intestine and recycled back to the liver to be used again and again and again. And you know one thing a lot of people aren't aware of is that bile is a relatively expensive digestive fluid for the body to make. It takes some resources to make bile, and so one of the sort of downsides of using bile sequestrants long-term and this can even be natural bile binders, because we have those in our holistic health slash functional medicine side as well, because we have those in our holistic health slash functional medicine side as well is that we're pulling a lot of bile out of the body, not allowing it to recycle back the way it would be in a healthy, optimal state, right. And so, as this bile kind of gets pulled out along with whatever's in that bile toxins and whatnot, right? One of the side effects of that is it can tend to deplete a little bit of those energetic resources needed to build more bile, and so it will then call on the body to use more energy to build bile and truly I've actually worked with some people who have been on prescription bile acid sequestrants that have felt pretty drained and like, literally felt that energy you know dump, if you will just from being on that type of medication long-term. So you know that is kind of a downside of using that type of approach as a band-aid for something like chronic loose stool long-term.
Speaker 1Ultimately, what we want to try to do is get to the root of what's driving these symptoms in the first place and that's where using root cause testing really hits the nail on the head and helps us get clear on what's going on. So I want to leave you with a little bit of an action tip that's related to bile and helping to support bile production. So one thing I find with people who have struggled historically with quality issues is that if they're tuned into their body, they actually notice that they struggle to digest meals that have a lot of high fat foods or just a lot of fat in the meal. Like they'll actually feel really sluggish or kind of gross or just like things aren't moving through very well and it can be kind of hard to get the fat digestion back on track. If someone's been in a state of bile quality for a long time or if, prior to that, they had a low-fat diet, that led to this issue right. And so one of the little hacks or tricks that I like to give my clients that I see are struggling with fat digestion in the very beginning is to start working with small amounts of MCT oil.
Speaker 1Mct strain stands for medium chain triglycerides. It's derived from coconut oil. You can get it in liquid form. You can even find it at most grocery stores nowadays if they have like, especially a natural aisle or a supplement aisle. And what's great about this is MCT oil is very easily absorbable by the body. It doesn't actually need bile to break it down and emulsify it like other fat structures do, and so for the person who has trouble digesting fat and might have more of a propensity to fatty acid deficiencies, starting with MCT oil, getting little amounts in once or twice a day, is a great way to start to get a little bit of like easily absorbable fat into the body and build them back up and help to give the liver a little bit more substrate fat wise to start to build higher quality bile.
Speaker 1Now, just know, with MCT oil. It can be bowel stimulating. It can definitely cause people to go to the bathroom, especially in larger amounts. So if you're in the camp where you're already struggling with, say, like IBSD or IBD symptoms, I would tread very carefully and cautiously with MCT oil. If you're taking it in large amounts and you've got that going on, that would be a red flag to stop that right and see if the issue gets better.
Speaker 1However, if you want to try it, I usually have clients start with like half a teaspoon a day with a meal right, and then you can slowly increase from there. You could go up to as high as a tablespoon, or maybe even a tablespoon and a half right. I wouldn't do it all at once, I would still divide that dose out throughout the day. But this is definitely one of those things where, person to person, it's a bowel tolerance issue and if you start low and you're doing well and you hit a point where you're noticing you have to run to the bathroom, you're having some urgency. It's probably because you hit your ceiling for what your body can handle for MCT oil.
MCT Oil: A Solution for Bile Support
Speaker 1However, in small amounts it still can be very helpful, very effective. It is very supportive of helping the metabolism to run on fat and become more fat burning. It's one of the supplements that can be used in the ketogenic communities as just kind of something to look into. If you suspect or know that you have some fat digestion issues and you've been avoiding high fat foods or afraid to eat them because you know you're not going to feel great, I would start with a little MCT oil and slowly kind of build from there and see how that goes. Did you find this episode informative and helpful? I'd love to have you leave me a five-star rating. Do you have questions about holistic approaches to optimizing gut health that you'd like to ask? Please leave your question or comment below and I will be sure to address it personally or cover it in a future episode. Be sure to check the show notes for any resources mentioned in today's episode. See you next time.