129 E 90th Street #1W,
New York, NY,

(646) 609-4250

For the Love of Bile

By Dr. Andrea Vannelli


We tend to hear a lot about the liver in functional and traditional Asian medicine arenas these
days. And with good reason: just to name a few of its key roles, this organ is paramount in
helping the body manage blood glucose and energy production, process and store nutrients,
conjugate cholesterol and hormones, repair and recycle blood cells, de-fuse and metabolize
toxins, and regulate all of the above. In many ways it acts as an over-seer that continuously
sieves, monitors and modulates the blood, taking on the broad role of keeping us balanced.


When things aren’t running smoothly with the liver for whatever reason, we feel it—even if only
in indirect ways such as an agitated mood or increased anxiety. In our modern era of fast-paced
lives, processed foods and environmental toxins, supporting the liver is a key part of staying
healthy. All of these aspects and more are integral to a TCM understanding of the liver’s role as


The liver’s small side-kick, the gallbladder, typically gets less attention. Still, like a good
assistant, it works behind the scenes to help the liver function optimally, and that translates to
health and metabolic benefits. The gallbladder is commonly known as a storage pouch for
concentrated bile. It’s nestled amidst the lobes of the liver and is integrated with the network of
biliary vessels that transport bile from the liver into the gallbladder and eventually out to the
digestive tract.


Bile is a complex fluid containing inorganic salts, bilirubin, and fats. A healthy liver & spleen will
produce 1-2 quarts of bile per day, which is stored in the gallbladder for release as needed. Bile
salts emulsify fats into smaller fatty acids that can then be properly digested and assimilated.
This is bile’s most commonly-known function, but the secondary functions are also quite


For starters, bile’s role in good fat absorption is key for blood sugar stability. Having relatively
stable blood sugar avoids unnecessary stress on other glands, including the liver and adrenals,
which help keep us grounded and clear-headed. When we eat a fatty meal, a hormone called
CCK triggers the release of bile from the gallbladder, which then flows into the duodenum to
emulsify the lipids. Eating sufficient fats on a regular basis helps to keep the bile flowing
consistently. Bile stored in the gallbladder is concentrated to begin with, and if it isn’t used
regularly, it can thicken and coagulate, or even form stones that can block the flow.


Bile thickening may also happen as a result of eating too many inflammatory trans-fats, or from
long-term calorie restriction. When bile flow is insufficient, the fats we need to nourish our
endocrine system go undigested, eventually leading to deficiencies and dysregulation. Important
fat-soluble vitamins include A, D, E and K—which are key to hormonal and immune health. Bile
also converts thyroid hormone to its active state and neutralizes stomach acid as the digested
material transitions to the small intestine.


Our current understanding of bile includes evidence that it also plays a role in preventing insulin
resistance via signaling molecules that help to regulate carbohydrate and lipid metabolism,
including helping the body get rid of excess cholesterol.


As the liver filters blood, many of the toxins that get flagged for removal are put into the bile so
they can then be released into the digestive tract and properly eliminated. In this way, the gallbladder helps purify the body of numerous environmental toxins such as heavy metals, drug
metabolites, xenoestrogens and steroid hormones. Sufficient soluble fiber must be present in
the diet to keep these toxic wastes moving out rather than being reabsorbed. Fortunately, bile
functions as a laxative for the large intestine. This keeps the colon moist and moving regularly.


The nature of bile is antimicrobial, and it thus helps us to keep irritants such as parasites, fungi
/mold and other unfriendly microbes in check. When bile flow is poor, we often see a
microbiome that is out of balance. If this process is inadequate, our garbage can end up
recirculating, which may contribute to problems such as estrogen dominance, SIBO and H.
Pylori. Excess estrogen may even cause viscous bile, which might be why women on oral
contraceptives are known to have an increased risk of gallbladder disease.


Ideally, we are looking for good bile flow, bile ducts that are clear of bile sludge or gallstones,
adequate concentration and efficient recycling. When bile gets congealed, the flow becomes
sluggish and its effect suboptimal. Some symptoms of low bile flow are digestive pain, bloating,
constipation, stool that is pale and/or floats, vitamin deficiencies, low thyroid function, and poor
absorption of fatty acids.


Obviously, keeping the bile thinned and free-flowing is good preventive medicine. To support
bile flow, be sure you’re daily nutrition includes the proper raw materials, including magnesium,
whole food vitamin C, choline and taurine (both of which are made in liver). Avoid inhibiting
factors such as refined foods, trans fats, and alcohol. Incorporate bile-friendly foods into your
diet on a regular basis, such as:


– Ginger, celery, daikon radish, horseradish, garlic, fennel
– Lemon, lime, seaweeds
– Digestive bitters such as globe artichoke and dandelion root
– Beets & beet greens, or supplements that contain beets


Last but not least, chew food thoroughly to prime digestion before food hits the stomach. (Be
wary of over-doing foods that boost bile production if you have chronically loose stool or a
hyper-active thyroid condition.)


Another way to promote good bile flow is to practice diaphragmatic breathing. The liver is
positioned on the right side, just below the diaphragm. With deep belly breathing, the action of
the diaphragm pushes down on the organ, providing a gentle massage that helps stimulate bile
production and activate the liver’s detoxification functions.


Some people have had their gallbladder removed. This puts an extra burden on the liver but it’s
not insurmountable. The liver still produces bile but it can’t be stored up, so being more careful
to moderate fat intake is usually a good idea. Lacking a gallbladder, a meal heavy in fat can be
difficult to properly digest and often results in uncomfortable symptoms such as nausea,
stomach cramps or greasy stool. This can be remedied by supplementing with bile salts, and in
fact is recommended for all the reasons described above.


Hoffmann, A. F., & Eckmann, L. (2006). How bile acids confer gut mucosal protection against
bacteria. Proceedings of the National Academy of Sciences, 103(12), 4333–4334.
Housset, C., Chrétien, Y., Debray, D., & Chignard, N. (2016). Functions of the Gallbladder.
Comprehensive Physiology, 6(3), 1549–1577. https://doi.org/10.1002/cphy.c150050
Itoh, M., Wada, K., Tan, S., Kitano, Y., Kai, J., & Makino, I. (1999). Antibacterial action of bile
acids against Helicobacter pylori and changes in its ultrastructural morphology: effect of
unconjugated dihydroxy bile acid. Journal of gastroenterology, 34(5), 571–576.
Khan, M. K., Jalil, M. A., & Khan, M. S. (2007). Oral contraceptives in gall stone diseases.
Mymensingh medical journal : MMJ, 16(2 Suppl), S40–S45.
Liu Z, -W, Shu J, Tu J, -Y, Zhang C, -H, Hong J: Liver in the Chinese and Western Medicine.
Integr Med Int 2017;4:39-45. doi: 10.1159/000466694unconjugated dihydroxy bile acid. Journal
of gastroenterology, 34(5), 571–576. https://doi.org/10.1007/s005350050374