August 26, 2024 • 19 mins
Can you imagine that a substance as overlooked as bile could be a powerhouse in your body's defense mechanisms? In this episode of the Inflammation Nation podcast, Dr. Steve Noseworthy unveils the hidden marvels of bile, produced by the liver and stored in the gallbladder. Often recognized merely for its role in digesting fats and absorbing vital fat-soluble vitamins, bile is also a key player in detoxification and maintaining a balanced microbiome. Dr. N dives into how bile and its secondary metabolites, produced by gut bacteria, are essential in inhibiting harmful bacteria like C. diff and enhancing gut immunity through the modulation of dendritic cells. This episode will change the way you think about bile and its importance in your overall health.
As we bring our Miracle Molecules series to a close, get ready for the upcoming mini-series, "The Better Brain Equation." Dr. Noseworthy will be setting the stage for a rich two-part interview with experts on neurobehavioral disorders such as ADD, ADHD, and autism spectrum disorders. This series is designed to offer insights into enhancing brain health and function, providing a foundational understanding of brain development. Whether you're looking for ways to optimize your cognitive well-being or seeking to comprehend neurobehavioral conditions better, the next series promises to be enlightening and indispensable. Stay tuned to the Inflammation Nation podcast for valuable insights that could make a significant difference in your wellness journey.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hey everyone, welcome to the Inflammation Nation
podcast.
I'm your host, Dr SteveNoseberg.
Speaker 2 (00:08):
One of the greatest obstacles to crafting health and
wellness is identifying andcontrolling inflammation.
It's at the core of all complexand chronic diseases and it's
the driving mechanism thatunderlies the most common
symptoms that people like youstruggle to overcome.
Join us as we explore cuttingedge science and research to
give you the information andtools you need to create the
(00:28):
quality of life you want anddeserve.
And now here is the host ofInflammation Nation, dr Stephen
Noseworthy.
Speaker 1 (00:37):
Hey guys, welcome back to the podcast.
This is part two of the stomachacid and bile part of our
Miracle Molecules series, andwe're going to be talking about
bile today.
Last episode we talked abouthydrochloric acid and how it
functions to activate pepsin,which is actually what does the
(00:58):
digesting of protein in yourdiet.
It's not the hydrochloric acid,but it's the pepsin that comes
from that.
But what we focused on in thecontext of this idea of miracle
molecules was the fact thathydrochloric acid is used to
lower the pH of the stomach,which increases the acidity, in
order to kill potentialinfections hidden in your food,
(01:21):
and given that this isessentially the first line of
defense against ingestedmicrobes.
Hydrochloric acid is part ofyour what's called your innate
immune system and it plays a keyrole in immune competence.
Today we finish off by talkingabout bile, which, in addition
(01:41):
to its function in digestion,plays key roles in immune
competence, detoxification, aswell as balancing the microbiome
.
Now I did mention a fewfunctions of bile the last time
in my introduction, so I'll justgo through those quickly.
First of all, bile acids aid inthe digestion of fat from your
(02:03):
diet through a process calledemulsification, and that's
basically breaking down largefat droplets into smaller ones
that are easier to break downeven further by pancreatic
lipases for eventual absorption.
And because vitamins A, d, eand K are fat soluble and not
water soluble, you need bile tobreak down the fat from your
(02:26):
diet so that you can extract andabsorb vitamin A, vitamin D,
vitamin E and vitamin K.
Bile is also used to metabolizeand get rid of excess
cholesterol, and it neutralizesthe acidic pH of the food that
comes from the stomach into thesmall intestine.
It also provides bactericidalactivity or antimicrobial
(02:49):
activity against organisms againpresent in the food that you
eat, and it's part of thedetoxification system which you
know.
I've spoken aboutdetoxification system at length
in other episodes.
We probably won't revisit thatparticular topic, but I do want
to focus on a couple of things.
While hydrochloric acid killsbacteria by creating a very
(03:13):
acidic environment that somebacteria can't live in, bile
contributes to immunity througha different mechanism.
In fact, bile is not an acidlike hydrochloric acid is, but
it's what we call a base, whichis what neutralizes acid.
And you might think well, sinceinfections don't thrive in an
acid environment, then that'spart of the point of
(03:34):
hydrochloric acid.
Maybe if you neutralize theacid in the small intestine by
secreting bile.
Maybe that would encouragethings to grow?
Wouldn't that promoteinfections?
And the thought is, let's say,partially correct.
The reality is is that, as goodas stomach acid is at
(03:54):
sterilizing your food, somemicrobes that are in the food
that you eat are actually acidresistant and they will slip
through the stomach into thesmall intestine, right at the
spot where your liver and yourgallbladder release bile.
And while bile itself isn'tnecessarily directly
antimicrobial and that's kind ofa somewhat untrue statement,
(04:17):
but let's just for the momentsay bile itself isn't directly
antimicrobial, isn't directlyantimicrobial the secondary bile
metabolites that are the resultof good bacteria in your gut
metabolizing bile areantimicrobial.
So let me explain that.
Most people I think includingmany doctors think that bile is
(04:42):
actually made in the gallbladder.
Right, but bile is actuallymade in the liver, which uses
cholesterol as a base moleculeto make it, and the bile made in
the liver is then exported tothe gallbladder where it
accumulates, it getsconcentrated and then is
released, somewhat on demand, inlarge quantities when you eat
(05:03):
food that has fat in it.
And, as I said before, the bileemulsifies the fat, it breaks
it down, helps us get thosefat-soluble vitamins out of it.
But as the bile travels throughthe small and the large
intestines, the bacteria in yourgut, your probiotics gobble up
some of the bile and they makethese things called secondary
(05:24):
bile metabolites or secondarybile acids.
And there are many of them, butthe primary ones that we know
about that are, you know, prettyroutinely studied are called
deoxycholic and lithocholic acid.
Not that you need to know thosethings Now, this is a fairly
new area of research, but here'swhat I think we can say for now
(05:45):
with some certainty.
Number one bile itself, as wellas the secondary bile acids, can
directly inhibit certain typesof bacteria.
Bacteria like C diff and youmay have heard of that quite
often causes diarrhea in peoplewho use multiple rounds of
antibiotics or even a singlecourse of a very powerful
(06:08):
antibiotic like Cipro.
It also turns out that someimmune cells have bile acid
receptors, and so when thesesecondary bile metabolites
interact with immune cells, theyincrease immune activity in the
gut, making these immune cellsmore effective and more
efficient, and this includescell types like monocytes or T
(06:30):
cells, b cells, even what wecall natural killer cells, which
all coordinate together tocreate efficient immunity.
Bile acids also modulate thefunction of a very special type
of cell called dendritic cellsalso modulate the function of a
very special type of cell calleddendritic cells, which are
critical for immune competence,through the process of
surveillance.
Basically, these dendriticcells in your gut patrol the gut
(06:55):
environment and they pick upand examine potential infections
, even toxins, and essentiallyhelp your immune system decide
if it needs to deal with it, todecide whether or not it should
activate against whatever itfinds.
And then, finally, bile acidshelp to control the
over-activation of immune cellsthat are very specific to hollow
(07:17):
or open spaces, meaning yourgut, your Th17 system again,
which is necessary for openspace immunity or what we might
(07:37):
call mucosal immunity, referringto the lining of these open
spaces.
That Th17 system is veryimportant so that you can fight
off infections that target yourlungs, your gut, your sinuses,
your bladder.
But the Th17 system is alsowhat gets out of control when
you have autoimmunity, whichmeans that you want controlled
(08:00):
and balanced activation of Th17cells.
You don't want to lose controlof that and part of that control
comes from how your probioticsprocess bile into the secondary
metabolites which then modulateand help keep control and keep
balance of that Th17 system.
And all of this points tosomething that I've said many
(08:23):
times before, and that is thatwe tend to learn something about
how our body works and then wepigeonhole that thing and we
think that that's all that thatthing does.
So if you randomly asked peoplehow bile affects your immune
system, you would probably get apuzzled look, because almost
everyone thinks that the onlything that bile does is help you
(08:45):
to digest your dietary fats.
So I'm fairly sure that whatI've shared about the role of
bile in gut-based immunity isprobably new information, and I
hope it raises some otherquestions as well.
So, for example, if someonegoes on a low-fat diet, does
that have an impact on gutimmunity?
(09:06):
After all, a low-fat diet meansthat less bile is being
released into the intestines toemulsify the fat you eat,
because there's less fat there.
But less bile means lesssecondary bile acids and a
potential impact on gut-basedimmune capacity, meaning a
(09:27):
low-fat diet with low biliaryoutput or bile output could
result in decreased gut immunity.
Now someone might adopt alow-fat diet because they
mistakenly think that eating fatmakes you fat and maybe they're
trying to lose weight, or maybethey have a gallbladder problem
and every time they eat fattyfoods they get right shoulder
(09:47):
pain or they get this kind ofcolicky pain in the right upper
quadrant of their abdomen, maybethey have thickened what we
call biliary sludge, or maybeeven gallstones, and they've
been told to avoid fats, or elsethey're going to end up having
to have their gallbladderremoved, or maybe they've had
their gallbladder removed.
Either way, whatever drivessomeone to eat less fat, for
(10:11):
example, or if they get theirgallbladder removed as a result
of reduced bile flow, manyexperience an increased risk for
gut infections.
In fact, we have studies fromback in the 1990s that show that
the incidence of H pylori,which is a very common gut
(10:31):
infection it's a bacteria thatcan often cause ulcers and
reflux but we have studies againfrom the mid-90s and just a
little bit earlier that showthat the incidence of H pylori
is twice as high aftergallbladder is removed.
So we know that if you reducebile flow through any mechanism,
(10:52):
that you lose some potentialability to fight off infections
that are quite common.
So just to reiterate, when youhave adequate bile flow, the
healthy bacteria in your gutmetabolize the bile and create
secondary bile acids, which thencan directly inhibit some
acid-resistant bacteria thatescape the stomach acid in your
(11:15):
stomach.
They can activate a wide rangeof immune cells, t cells, b
cells, natural killer cells.
They can enhance the ability ofgut-based dendritic cells to
surveil the environment, to pickup on infections and toxins and
alert other immune cells todeal with it, and it can enhance
the control over the TH17immune subsystem, which is again
(11:39):
specific to what we call hollowspace immunity, but also which
can drive autoimmunity if itgets overactive and it's not
controlled.
Obviously, this is very coolstuff.
One might say it is miraculous.
All right.
One final aspect of bile, andthat is its role in the
microbiome, not as a thing thatthe microbiome consumes to help
(12:04):
support immunity, but the impactthat bile has on the microbiome
itself.
Now, we've known this for atleast a decade, but I'm going to
share some insights fromseveral papers published in the
last few years.
I just told you that themicrobiome can take bile and
make these bile acids, but morerecently, scientists have
discovered that your microbiomecan take amino acid precursors,
(12:27):
things like taurine and glycine,which you get from your diet,
and actually make these bileacids by themselves.
They don't have to start withbile and then break the bile
down.
They can take the componentsthat the liver normally uses to
make bile and they can make bilecompletely independent of the
liver itself, and their capacityto do so goes way beyond these
(12:49):
typical base amino acids oftaurine and glycine that I had
mentioned before, even thoughthose are probably the most
common ones.
The microbiome can take almostany amino acid certainly the
most common ones that we talkabout and they can make some
form of a secondary bile acid,and so both primary and
secondary bile acids affect theprofile of the microbiome, and
(13:14):
this is very complex andscientists are trying to sort
this out.
But the simple story is thatcertain bile acids and
metabolites affect certainspecies of healthy bacteria, but
not others.
So, on one hand, we have bileand bile acids that help to kill
certain types of organisms thatwe don't really want in the gut
or that we don't want there inlarge amounts, and it can
(13:36):
enhance the growth of certaintypes of healthy bacteria, but
not all, and the type ofbacteria is going to depend on
which bile acid we're talkingabout.
So, again, it's verycomplicated.
If you consider the fact thatthere are dozens of known
primary and secondary bile acids, coupled with the fact that
there are thousands of bacterialspecies in your gut, you can
(13:59):
see why I say this iscomplicated.
Right on top of that, asscience and technology improves,
they find new types of bileacids that we couldn't identify
before and new probiotic species, which just simply adds to the
complexity.
But the fact remains that thereis this bidirectional
relationship between your gutbacteria and the bile that you
(14:21):
produce from your liver, andwe're seeing scientists using
the term the bile microbiomeaxis to describe how they work
together.
In addition to antibacterialeffects of bile, bile acids can
indirectly control the growth ofbad gut bacteria by regulating
the expression of nitric oxidesynthase as well as
(14:44):
antimicrobial peptides.
It is particularly important incases of IBS or irritable bowel
syndrome that might be causedby SIBO or small intestinal
bacterial overgrowth.
And not only can bile acidskill bacteria in the small
(15:06):
intestines, they protect the gutlining and prevent leaky gut.
Plus, they inhibittranslocation or the movement of
bacteria.
And this is another feature ofSIBO, where bacteria from the
large intestine migrate up intothe small intestine to cause
trouble.
And if you don't have adequatebile output and bile flow into
(15:26):
the small intestine, it's easyfor bacteria from the large
intestine to go too high in thesystem and literally to feed off
sugars, starches and fibers inyour diet and then cause issues
and cause problems.
Now one final note on bile andbad bacteria in the gut.
Some bacteria produce what arecalled endotoxins.
(15:48):
There are many different kinds,some are worse than others.
This is very common andpotentially a huge problem,
because these toxins, the morepotent ones, can not only mess
up the local gut environment,causing things like leaky gut
and gut inflammation and so on,but these endotoxins can either
cross the gut bacteria not thegut bacteria the gut barrier and
(16:11):
get into systemic circulation,or they can activate the
systemic immune system andcreate systemic inflammation,
even though the toxinsthemselves may actually stay
inside the gut, and that's amore complex mechanism I don't
want to go into right here.
Well, it turns out that whensomething interferes with bile
(16:31):
production and bile release intothe small intestine, these
endotoxins increase in the gut.
So lower bile means more toxins, and adding back bile acids or
restoring bile flow reduces thetoxin load.
How does that work?
Well, because bile acids actlike sponges to bind to these
(16:52):
toxins, which will neutralizethem so that you can eliminate
them before they have a chanceto create some kind of a
negative impact by erodingtissues, causing inflammation or
causing local and systemicimmune activity.
All right, I'm going to leaveit there for bile and
hydrochloric acid.
(17:13):
And I'm going to close out thismini-series on miracle molecules
, not because I've run out ofthings to talk about but because
, honestly, if I kept going,this series would never end,
because there's so many thingsthat go on in the body that are
just so cool to think about andso cool to talk about.
So, having said that, what'snext?
Well, I just recorded part oneof what's going to be a two-part
(17:34):
interview with a couple ofexperts in neurobehavioral
disorders, and by that I meanattention deficit or ADD, adhd
and autism and the entire autismspectrum, and I have part two
of that interview seriesscheduled for later in September
.
And so, in preparation forreleasing that interview, my
(17:57):
plan is to start a series thatI'll probably call the Better
Brain Equation.
This is a phrase that I've usedwith my own clients for many,
many, many years, and the basicidea is how do you take a brain
in any condition and make ithealthier?
And I sum that up in what Icall the better brain equation.
So what I'll do, more thanlikely, is I'll have a few
(18:17):
episodes where I lay thefoundation of brain development
and brain function and health,so that once I publish the
interview, you guys are going tohave a solid foundation to
understand how truly remarkablethe work of these two clinicians
has been, and I really lookforward to hearing that.
So stay tuned for that righthere on the Inflammation Nation
(18:39):
podcast.
This podcast is for generalinformational and educational
purposes only and does notconstitute the practice of
medicine in any form or capacity.
No doctor patient relationshipis formed.
The use of the information inthis podcast or any materials
associated with or linked to thepodcast is at the listener's
(19:02):
own risk.
The content of this podcast isnot intended to be a substitute
for professional andpersonalized medical advice,
diagnosis or treatment, andlisteners should not disregard
or delay obtaining propermedical advice when a health
condition exists and warns them.
And finally, functionalmedicine is not intended or
(19:22):
designed to treat disease, butrather is a natural approach to
support restoring health andwellness.
The use of diet and lifestylemodifications and nutritional
supplementation is supportivefor adjunctive care.
Hey everyone, welcome to the Inflammation Nation
podcast.
I'm your host, Dr SteveNoseberg.
Speaker 2 (00:08):
One of the greatest obstacles to crafting health and
wellness is identifying andcontrolling inflammation.
It's at the core of all complexand chronic diseases and it's
the driving mechanism thatunderlies the most common
symptoms that people like youstruggle to overcome.
Join us as we explore cuttingedge science and research to
give you the information andtools you need to create the
(00:28):
quality of life you want anddeserve.
And now here is the host ofInflammation Nation, dr Stephen
Noseworthy.
Speaker 1 (00:37):
Hey guys, welcome back to the podcast.
This is part two of the stomachacid and bile part of our
Miracle Molecules series, andwe're going to be talking about
bile today.
Last episode we talked abouthydrochloric acid and how it
functions to activate pepsin,which is actually what does the
(00:58):
digesting of protein in yourdiet.
It's not the hydrochloric acid,but it's the pepsin that comes
from that.
But what we focused on in thecontext of this idea of miracle
molecules was the fact thathydrochloric acid is used to
lower the pH of the stomach,which increases the acidity, in
order to kill potentialinfections hidden in your food,
(01:21):
and given that this isessentially the first line of
defense against ingestedmicrobes.
Hydrochloric acid is part ofyour what's called your innate
immune system and it plays a keyrole in immune competence.
Today we finish off by talkingabout bile, which, in addition
(01:41):
to its function in digestion,plays key roles in immune
competence, detoxification, aswell as balancing the microbiome
.
Now I did mention a fewfunctions of bile the last time
in my introduction, so I'll justgo through those quickly.
First of all, bile acids aid inthe digestion of fat from your
(02:03):
diet through a process calledemulsification, and that's
basically breaking down largefat droplets into smaller ones
that are easier to break downeven further by pancreatic
lipases for eventual absorption.
And because vitamins A, d, eand K are fat soluble and not
water soluble, you need bile tobreak down the fat from your
(02:26):
diet so that you can extract andabsorb vitamin A, vitamin D,
vitamin E and vitamin K.
Bile is also used to metabolizeand get rid of excess
cholesterol, and it neutralizesthe acidic pH of the food that
comes from the stomach into thesmall intestine.
It also provides bactericidalactivity or antimicrobial
(02:49):
activity against organisms againpresent in the food that you
eat, and it's part of thedetoxification system which you
know.
I've spoken aboutdetoxification system at length
in other episodes.
We probably won't revisit thatparticular topic, but I do want
to focus on a couple of things.
While hydrochloric acid killsbacteria by creating a very
(03:13):
acidic environment that somebacteria can't live in, bile
contributes to immunity througha different mechanism.
In fact, bile is not an acidlike hydrochloric acid is, but
it's what we call a base, whichis what neutralizes acid.
And you might think well, sinceinfections don't thrive in an
acid environment, then that'spart of the point of
(03:34):
hydrochloric acid.
Maybe if you neutralize theacid in the small intestine by
secreting bile.
Maybe that would encouragethings to grow?
Wouldn't that promoteinfections?
And the thought is, let's say,partially correct.
The reality is is that, as goodas stomach acid is at
(03:54):
sterilizing your food, somemicrobes that are in the food
that you eat are actually acidresistant and they will slip
through the stomach into thesmall intestine, right at the
spot where your liver and yourgallbladder release bile.
And while bile itself isn'tnecessarily directly
antimicrobial and that's kind ofa somewhat untrue statement,
(04:17):
but let's just for the momentsay bile itself isn't directly
antimicrobial, isn't directlyantimicrobial the secondary bile
metabolites that are the resultof good bacteria in your gut
metabolizing bile areantimicrobial.
So let me explain that.
Most people I think includingmany doctors think that bile is
(04:42):
actually made in the gallbladder.
Right, but bile is actuallymade in the liver, which uses
cholesterol as a base moleculeto make it, and the bile made in
the liver is then exported tothe gallbladder where it
accumulates, it getsconcentrated and then is
released, somewhat on demand, inlarge quantities when you eat
(05:03):
food that has fat in it.
And, as I said before, the bileemulsifies the fat, it breaks
it down, helps us get thosefat-soluble vitamins out of it.
But as the bile travels throughthe small and the large
intestines, the bacteria in yourgut, your probiotics gobble up
some of the bile and they makethese things called secondary
(05:24):
bile metabolites or secondarybile acids.
And there are many of them, butthe primary ones that we know
about that are, you know, prettyroutinely studied are called
deoxycholic and lithocholic acid.
Not that you need to know thosethings Now, this is a fairly
new area of research, but here'swhat I think we can say for now
(05:45):
with some certainty.
Number one bile itself, as wellas the secondary bile acids, can
directly inhibit certain typesof bacteria.
Bacteria like C diff and youmay have heard of that quite
often causes diarrhea in peoplewho use multiple rounds of
antibiotics or even a singlecourse of a very powerful
(06:08):
antibiotic like Cipro.
It also turns out that someimmune cells have bile acid
receptors, and so when thesesecondary bile metabolites
interact with immune cells, theyincrease immune activity in the
gut, making these immune cellsmore effective and more
efficient, and this includescell types like monocytes or T
(06:30):
cells, b cells, even what wecall natural killer cells, which
all coordinate together tocreate efficient immunity.
Bile acids also modulate thefunction of a very special type
of cell called dendritic cellsalso modulate the function of a
very special type of cell calleddendritic cells, which are
critical for immune competence,through the process of
surveillance.
Basically, these dendriticcells in your gut patrol the gut
(06:55):
environment and they pick upand examine potential infections
, even toxins, and essentiallyhelp your immune system decide
if it needs to deal with it, todecide whether or not it should
activate against whatever itfinds.
And then, finally, bile acidshelp to control the
over-activation of immune cellsthat are very specific to hollow
(07:17):
or open spaces, meaning yourgut, your Th17 system again,
which is necessary for openspace immunity or what we might
(07:37):
call mucosal immunity, referringto the lining of these open
spaces.
That Th17 system is veryimportant so that you can fight
off infections that target yourlungs, your gut, your sinuses,
your bladder.
But the Th17 system is alsowhat gets out of control when
you have autoimmunity, whichmeans that you want controlled
(08:00):
and balanced activation of Th17cells.
You don't want to lose controlof that and part of that control
comes from how your probioticsprocess bile into the secondary
metabolites which then modulateand help keep control and keep
balance of that Th17 system.
And all of this points tosomething that I've said many
(08:23):
times before, and that is thatwe tend to learn something about
how our body works and then wepigeonhole that thing and we
think that that's all that thatthing does.
So if you randomly asked peoplehow bile affects your immune
system, you would probably get apuzzled look, because almost
everyone thinks that the onlything that bile does is help you
(08:45):
to digest your dietary fats.
So I'm fairly sure that whatI've shared about the role of
bile in gut-based immunity isprobably new information, and I
hope it raises some otherquestions as well.
So, for example, if someonegoes on a low-fat diet, does
that have an impact on gutimmunity?
(09:06):
After all, a low-fat diet meansthat less bile is being
released into the intestines toemulsify the fat you eat,
because there's less fat there.
But less bile means lesssecondary bile acids and a
potential impact on gut-basedimmune capacity, meaning a
(09:27):
low-fat diet with low biliaryoutput or bile output could
result in decreased gut immunity.
Now someone might adopt alow-fat diet because they
mistakenly think that eating fatmakes you fat and maybe they're
trying to lose weight, or maybethey have a gallbladder problem
and every time they eat fattyfoods they get right shoulder
(09:47):
pain or they get this kind ofcolicky pain in the right upper
quadrant of their abdomen, maybethey have thickened what we
call biliary sludge, or maybeeven gallstones, and they've
been told to avoid fats, or elsethey're going to end up having
to have their gallbladderremoved, or maybe they've had
their gallbladder removed.
Either way, whatever drivessomeone to eat less fat, for
(10:11):
example, or if they get theirgallbladder removed as a result
of reduced bile flow, manyexperience an increased risk for
gut infections.
In fact, we have studies fromback in the 1990s that show that
the incidence of H pylori,which is a very common gut
(10:31):
infection it's a bacteria thatcan often cause ulcers and
reflux but we have studies againfrom the mid-90s and just a
little bit earlier that showthat the incidence of H pylori
is twice as high aftergallbladder is removed.
So we know that if you reducebile flow through any mechanism,
(10:52):
that you lose some potentialability to fight off infections
that are quite common.
So just to reiterate, when youhave adequate bile flow, the
healthy bacteria in your gutmetabolize the bile and create
secondary bile acids, which thencan directly inhibit some
acid-resistant bacteria thatescape the stomach acid in your
(11:15):
stomach.
They can activate a wide rangeof immune cells, t cells, b
cells, natural killer cells.
They can enhance the ability ofgut-based dendritic cells to
surveil the environment, to pickup on infections and toxins and
alert other immune cells todeal with it, and it can enhance
the control over the TH17immune subsystem, which is again
(11:39):
specific to what we call hollowspace immunity, but also which
can drive autoimmunity if itgets overactive and it's not
controlled.
Obviously, this is very coolstuff.
One might say it is miraculous.
All right.
One final aspect of bile, andthat is its role in the
microbiome, not as a thing thatthe microbiome consumes to help
(12:04):
support immunity, but the impactthat bile has on the microbiome
itself.
Now, we've known this for atleast a decade, but I'm going to
share some insights fromseveral papers published in the
last few years.
I just told you that themicrobiome can take bile and
make these bile acids, but morerecently, scientists have
discovered that your microbiomecan take amino acid precursors,
(12:27):
things like taurine and glycine,which you get from your diet,
and actually make these bileacids by themselves.
They don't have to start withbile and then break the bile
down.
They can take the componentsthat the liver normally uses to
make bile and they can make bilecompletely independent of the
liver itself, and their capacityto do so goes way beyond these
(12:49):
typical base amino acids oftaurine and glycine that I had
mentioned before, even thoughthose are probably the most
common ones.
The microbiome can take almostany amino acid certainly the
most common ones that we talkabout and they can make some
form of a secondary bile acid,and so both primary and
secondary bile acids affect theprofile of the microbiome, and
(13:14):
this is very complex andscientists are trying to sort
this out.
But the simple story is thatcertain bile acids and
metabolites affect certainspecies of healthy bacteria, but
not others.
So, on one hand, we have bileand bile acids that help to kill
certain types of organisms thatwe don't really want in the gut
or that we don't want there inlarge amounts, and it can
(13:36):
enhance the growth of certaintypes of healthy bacteria, but
not all, and the type ofbacteria is going to depend on
which bile acid we're talkingabout.
So, again, it's verycomplicated.
If you consider the fact thatthere are dozens of known
primary and secondary bile acids, coupled with the fact that
there are thousands of bacterialspecies in your gut, you can
(13:59):
see why I say this iscomplicated.
Right on top of that, asscience and technology improves,
they find new types of bileacids that we couldn't identify
before and new probiotic species, which just simply adds to the
complexity.
But the fact remains that thereis this bidirectional
relationship between your gutbacteria and the bile that you
(14:21):
produce from your liver, andwe're seeing scientists using
the term the bile microbiomeaxis to describe how they work
together.
In addition to antibacterialeffects of bile, bile acids can
indirectly control the growth ofbad gut bacteria by regulating
the expression of nitric oxidesynthase as well as
(14:44):
antimicrobial peptides.
It is particularly important incases of IBS or irritable bowel
syndrome that might be causedby SIBO or small intestinal
bacterial overgrowth.
And not only can bile acidskill bacteria in the small
(15:06):
intestines, they protect the gutlining and prevent leaky gut.
Plus, they inhibittranslocation or the movement of
bacteria.
And this is another feature ofSIBO, where bacteria from the
large intestine migrate up intothe small intestine to cause
trouble.
And if you don't have adequatebile output and bile flow into
(15:26):
the small intestine, it's easyfor bacteria from the large
intestine to go too high in thesystem and literally to feed off
sugars, starches and fibers inyour diet and then cause issues
and cause problems.
Now one final note on bile andbad bacteria in the gut.
Some bacteria produce what arecalled endotoxins.
(15:48):
There are many different kinds,some are worse than others.
This is very common andpotentially a huge problem,
because these toxins, the morepotent ones, can not only mess
up the local gut environment,causing things like leaky gut
and gut inflammation and so on,but these endotoxins can either
cross the gut bacteria not thegut bacteria the gut barrier and
(16:11):
get into systemic circulation,or they can activate the
systemic immune system andcreate systemic inflammation,
even though the toxinsthemselves may actually stay
inside the gut, and that's amore complex mechanism I don't
want to go into right here.
Well, it turns out that whensomething interferes with bile
(16:31):
production and bile release intothe small intestine, these
endotoxins increase in the gut.
So lower bile means more toxins, and adding back bile acids or
restoring bile flow reduces thetoxin load.
How does that work?
Well, because bile acids actlike sponges to bind to these
(16:52):
toxins, which will neutralizethem so that you can eliminate
them before they have a chanceto create some kind of a
negative impact by erodingtissues, causing inflammation or
causing local and systemicimmune activity.
All right, I'm going to leaveit there for bile and
hydrochloric acid.
(17:13):
And I'm going to close out thismini-series on miracle molecules
, not because I've run out ofthings to talk about but because
, honestly, if I kept going,this series would never end,
because there's so many thingsthat go on in the body that are
just so cool to think about andso cool to talk about.
So, having said that, what'snext?
Well, I just recorded part oneof what's going to be a two-part
(17:34):
interview with a couple ofexperts in neurobehavioral
disorders, and by that I meanattention deficit or ADD, adhd
and autism and the entire autismspectrum, and I have part two
of that interview seriesscheduled for later in September
.
And so, in preparation forreleasing that interview, my
(17:57):
plan is to start a series thatI'll probably call the Better
Brain Equation.
This is a phrase that I've usedwith my own clients for many,
many, many years, and the basicidea is how do you take a brain
in any condition and make ithealthier?
And I sum that up in what Icall the better brain equation.
So what I'll do, more thanlikely, is I'll have a few
(18:17):
episodes where I lay thefoundation of brain development
and brain function and health,so that once I publish the
interview, you guys are going tohave a solid foundation to
understand how truly remarkablethe work of these two clinicians
has been, and I really lookforward to hearing that.
So stay tuned for that righthere on the Inflammation Nation
(18:39):
podcast.
This podcast is for generalinformational and educational
purposes only and does notconstitute the practice of
medicine in any form or capacity.
No doctor patient relationshipis formed.
The use of the information inthis podcast or any materials
associated with or linked to thepodcast is at the listener's
(19:02):
own risk.
The content of this podcast isnot intended to be a substitute
for professional andpersonalized medical advice,
diagnosis or treatment, andlisteners should not disregard
or delay obtaining propermedical advice when a health
condition exists and warns them.
And finally, functionalmedicine is not intended or
(19:22):
designed to treat disease, butrather is a natural approach to
support restoring health andwellness.
The use of diet and lifestylemodifications and nutritional
supplementation is supportivefor adjunctive care.
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