September Views of the Vis from WellSpring Naturopathic

Usually I try to mix up the "Of the Month" section so you get a little variety here. But, for those of you who have been in dreadful suspense from the bile cliff-hanger of last month, I decided to let you off the hook. So where else would you find a body fluid of the month column?! And who knew you'd even care? We'll do pumpkins next month for October.

Bile is a remarkable body fluid, actually. It serves two very important functions in the body. One, it plays a role in fat digestion and absorption and two, it is a means for excretion of several important waste products from the blood.

What is bile and where does it come from? You might recall from last month that bile is continually made in the liver - to the tune of 600-1000 ml/day. From the liver it goes mostly to the gall bladder, though some goes directly through to the duodenum of the small intestine. Once in the gall bladder, bile is highly concentrated as the gall bladder's mucosal lining reabsorbs water and many small electrolytes. Remember the capacity of the average gall bladder is only 30-60 ml.
Once concentrated, about one half of the solutes in bile are bile salts, making them the single largest component (besides water). Cholesterol is the building block of bile salts (and other things, like your steroid hormones and Vitamin D), so take note that cholesterol is an essential part of your biochemistry and physiology! About 500 mg of cholesterol is used each day making bile salts. Most of the rest of bile is made of bilirubin, cholesterol, lecithin and other fatty acids. Odds and ends of electrolytes round out the composition.

What does bile do? Fat digestion and absorption. The gall bladder empties bile into the duodenum on signals sent when we eat a meal. Since it is primarily involved with the digestion of fat, fat in the meal triggers this emptying most effectively. (Indeed, when there is no fat in the meal, the gall bladder empties poorly which can lead to problems there.) Bile salts are the primary workers in this task, completing two important actions. First, they have a detergent action on fat particles in food that helps break down fat into tiny sizes. Then, they form complexes called micelles with these fats (fatty acids, cholesterol, monoglycerides and other lipids). Micelles are then soluble in chyme (the lovely mix of partly digested food and digestive juices found in the stomach and small intestine) and serve as a taxi service for the various fats in them to the lining of the intestines where they can be absorbed for use. Once the micelle delivers its fat component to the intestinal lining cells, the remaining bile salts are available again to make more micelles with more fats for more taxi-ing to more intestinal lining cells. And so it goes. Without bile salts, up to 40% of ingested fats are never absorbed and are excreted in the stool. This is why many people without gall bladders have trouble with diarrhea and fatty meals. (You might think it sounds good to not be able to absorb fat, but fats are a vital nutrient to our bodies and the inability to absorb them can result in metabolic deficits that compromise our overall health. There are, in fact, pharmaceutical drugs that bind up bile salts so they cannot perform this function. They can be helpful in some ways, but may be disastrous long-term.) By the way, our bodies are the original recyclers! When the digestion is largely done, about 94% of bile salts are absorbed into the blood and shunted back to the liver to be re-secreted into more bile. This is called enterohepatic circulation. It is estimated that the average bile salt makes this loop 18 times before it's excreted in the stool.

Excretion of Waste Products. The liver is our primary waste filter. Blood comes into the liver carrying all kinds of stuff - good and bad. Some of the used up, unhealthy, or unnecessary stuff gets screened out and put into the bile. The bile goes into the duodenum, either directly or through the gall bladder. The garbage parts of the bile (for the most part) continue through the rest of the small intestine, into the large intestine and are incorporated into feces for elimination. Excess cholesterol is one of those components destined for flushing. See, even before our current low cholesterol obsession, the liver quietly went about its business in helping to maintain appropriate levels of this important substance! Another important waste product in bile is bilirubin.
Now, here I digress from talking about actual bile. But bilirubin is also interesting and I don't want to have another cliff-hanger this month, so I'm just going to tell you a little about it now! Bilirubin is an end product of the destruction of our red blood cells. It is a greenish yellow pigment that gives bile its color. (After some chemical conversions in the gut with the help of our gut bacteria, it's also what gives the stool its normal brown color.) Under normal circumstances, we don't notice bilirubin - which is a good thing! But under abnormal circumstances, we might end up with jaundice - a yellowing of the skin caused by an excess of bilirubin (which, remember, is greenish yellow!) in the blood & extracellular spaces. There are a number of causes of jaundice that basically all boil down to one thing -- for some reason, bilirubin is not being put into the bile and/or into the gut for proper elimination.

Loving Your Bile. Without healthy bile, we might be sickly, yellow people with high cholesterol, chronic diarrhea and numerous maladies related to lack of healthy fats to build cell membranes, speed nerve impulses, insulate and pad organs, provide energy and the list goes on! Healthy bile comes from a healthy liver. A healthy liver comes from a good diet, minimizing toxin exposure and maximizing toxin elimination, and other good lifestyle habits. It likes beets! Beets are still in at the Farmer's Market.... Enjoy!