Bile Salts: How They Work, Function, Benefits, Side Effects - Dr. Axe

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Bile Salts: How They Work + 9 Reasons You Need Them


Bile salts - Dr. Axe

Are you suffering from gas, bloating, abdominal pain and yellowing of the skin? You may be dealing with a bile or bile salts deficiency. A bile dysfunction can alter the health of your liver, gallbladder, colon and skin — leading to inflammation and the buildup of fats and toxins.

But what exactly is bile, and why are bile salts so important? It’s a complicated and multifaceted question, but this article is meant to simplify the answer so you can determine whether or not bite salts supplements are a good option for you.

Bile is a digestive liquid that’s produced in the liver and contains bile salts and other substances that help to break down fats from our diet. Each day, the liver produces approximately 500–600 milliliters of bile, which consists primarily of water and electrolytes, but also contains organic compounds like bile salts, cholesterol, phospholipids, bilirubin and ingested compounds, such as proteins. (1)

Bile, which is a greenish-yellow secretion, is in charge of aiding the digestion of fats in the duodenum, the first region of the small intestine. Waste products are also eliminated from the body when they are secreted into bile.

Bile is continually secreted from the cells of the liver and then passed to the gallbladder, which is attached to the liver and rests on top of the small bowel. In the gallbladder, bile is stored and concentrated by the absorption of water and small electrolytes. The body will store bile and other secretions until they are needed to perform digestion. After we eat, our bile duct opens and allows bile, enzymes and secretions to do their jobs.


Bile salts are the main organic component found in bile. They allow the body to excrete cholesterol and potentially toxic compounds, like bilirubin and drug metabolites. Bile salts are synthesized in liver cells that are called hepatocytes, then stored in the gallbladder and secreted into the first part of the small intestine. Then they are reabsorbed and returned to the liver, where they are recycled and used by the body again.

9 Benefits of Bile Salts

  1. Eliminate Cholesterol and Toxic Compounds
  2. Fight Infectious Agents
  3. Promote Gallbladder and Liver Function
  4. Help Dissolve Gallstones
  5. Allow for the Digestion and Absorption of Fats and Nutrients
  6. Affect Bacteria in the Gut
  7. Help Control Blood Sugar Levels
  8. Trigger the Release of Glutathione
  9. Eliminate Bilirubin

1. Eliminate Cholesterol and Toxic Compounds

Bile salts are amphipathic, which means that they have both a water- and fat-soluble region. This allows them to bind to fats and oils and emulsify them in the gut, which is a water-based environment, so they can be broken down by digestive enzymes. This is how bile salts play a role in cholesterol regulation and help get rid of wastes and toxins through bile.

About 500 milligrams of cholesterol are converted into bile acids and eliminated in our bile every day. Cholesterol is secreted into bile, which allows it to be eliminated from the body. Free cholesterol is insoluble in water-based solutions, but when it’s in bile, it’s made soluble by bile salts and lipids like lecithin. In this state, cholesterol can be transported and removed from the body through digestion. (2)

2. Fight Infectious Agents

Bile acids also work as a defense mechanism to fight infectious agents and toxins that can lead to a number of diseases, including sepsis, herpes, psoriasis and parvovirus infection. Bile works as a detoxifying detergent that protects us from “big viruses” that have an outer lipoprotein structure, according to research published in the journal Pathophysiology. This is called a “physico-chemical defense system,” and it wouldn’t be able to protect us properly if there weren’t enough bile salts present in the body. (3)

3. Promote Gallbladder and Liver Function

Bile salts can help to improve gallbladder function by reducing inflammation of the bile ducts and helping normalize blood flow. They also help relieve gas and bloating that can be caused by gallbladder dysfunction.

Bile salts can also improve the symptoms of diseases affecting the liver. They improve liver function by assisting in the process that removes toxic substances and pathogens from the body. If you have a bile salt insufficiency, taking supplements may help improve conditions of the liver like cystic fibrosis, non-alcoholic fatty liver disease and primary biliary cirrhosis. (4, 5)

4. Help Dissolve Gallstones

Gallstones, which are composed mostly of cholesterol particles, occur when cholesterol and other matter that are within bile bind together and become solid. As a result, they become lodged in the inner lining of the gallbladder and grow into cholesterol gallstones over time.

Bile salts help dissolve gallstones that have formed in the gallbladder, and they help to prevent them from forming in the first place by breaking down fats before crystallization. According to research published in the World Journal of Gastroenterology, ursodeoxycholic acid, a naturally occurring bile acid, can be used as an anti-inflammatory agent that works as an alternative therapeutic approach in high surgical risk patients with symptomatic gallstones. (6)

5. Allow for the Digestion and Absorption of Fats and Nutrients

One of the main functions of bile salts is to solubilize ingested fat and fat-soluble vitamins, which allow for their digestion and absorption. This happens when bile salts cause fat globules to break down into very small, microscopic droplets. This process is called emulsification, and it’s important for the digestion of fats because it increases the surface area of the fat so it can be digested by lipases, the main enzymes that break down dietary fats. (7)

Why is this so important? Because these healthy fats and fat-soluble nutrients (like vitamins A, E, D, K, magnesium, iron and calcium) are crucial to our health, so we need bile salts to make it easier for our bodies to absorb and digest them. If we don’t have enough bile salts in the body, we can develop nutrient deficiencies because they aren’t being properly absorbed.

Bile salts - Dr. Axe

6. Affect Bacteria in the Gut 

Bile salts have antimicrobial activity and can protect us against gram-positive bacteria that grow in the gut, and they actually play a role in intestinal homeostasis by controlling the size and composition of the gut.

Bile salts are antibacterial compounds that disrupt bacterial membranes, and a decrease in them may be correlated with an alteration of the gut microbiome and an overgrowth of potential pathogens. Bile salts also work as environmental signals for intestinal bacteria and species that are adapted to the gut and able to endure the antibacterial activities of the salts. This is an intricate relationship that helps regulate the bacteria present in the microbiota. (8)

7. Help Control Blood Sugar Levels

Bile acids act as metabolic regulators and play a role in glucose, lipid and energy expenditure. Research out of the Medica Sur Clinic & Foundation’s Department of Internal Medicine, Department of Endocrinology and Department of Gastroenterology in Mexico City shows that enhancing bile acid signaling in the intestine can contribute to glucose homeostasis, making bile acids useful as potential therapeutic targets for diabetes. (9)

According to research published in the Journal of Clinical Investigation, bile acids activate receptors to overcome the loss of insulin sensitivity and inhibit inflammation. Scientists are now looking for molecules that can mimic the effect of bile acids and help patients with type 2 diabetes. (10)

8. Trigger the Release of Glutathione

Studies indicate that when bile salts allow for the increase of bile flow, the amount of biliary glutathione increases as well. What’s so special about glutathione? Well, it’s considered the “mother of all antioxidants” because it plays a role in several vital bodily processes. It helps the liver detoxify fat before bile is emitted — taking stress off of the gallbladder — protects the liver against oxidative injury, helps detoxify certain toxins, and conjugates with drugs so they are more digestible and effective.


Various forms of liver disease show reduced cellular glutathione and increased oxidative stress levels. Bile acids play an important physiological role in regulating glutathione metabolism. (11)

9. Eliminate Bilirubin 

Bile salts work to eliminate bilirubin from the body, which is important because the accumulation of this waste product can have harmful effects on your health. (12) In fact, according to research published in the Journal of Lipid Research conducted at Northwestern University’s Department of Surgery, too much bilirubin in the skin and mucous membranes can lead to jaundice, a condition in which the skin and whites of your eyes become yellow, your urine darkens, and the color of your stool becomes lighter.

How They Work

To understand how bile salts work, it’s helpful to become familiar with the role of bile in our bodies. Bile helps enzymes in the body break down fats into fatty acids, which are needed for many body functions. Bile is made in the liver, then travels to the gallbladder through a channel that’s called the cystic duct. It is then stored in the gallbladder between meals, and when we eat, it’s squeezed through the bile duct to break down the food before it moves to the intestines.

Bile salts are components of bile that allow it to mix fats with the water, electrolytes and other organic molecules that are found in bile. Bile needs bile salts to break down fats and prevent them from crystallizing. These salts are made naturally by our bodies, but some people choose to use bile salts supplements to improve specific health conditions. (13)

What’s the difference between bile salts and bile acid? Most of the time, these terms are used interchangeably, but technically they are different because of their structure and biological characteristics. Bile salts make up the collective term that’s used for bile acids and bile alcohol sulfates, another major component of bile. When bile acid is combined with amino acids glycine or taurine, this forms bile salts. So bile acid actually turns into bile salts when conjugated with these amino acids. That being said, you may notice that bile salts are sometimes called bile acid.

How to Increase Bile Salts

If you have a bile salt deficiency, you may benefit from bile salt supplements that are available online and at your local health or vitamin stores. Bile salts supplements work to restore cholesterol-lowing effects by emulsifying lipids. When you have a bile salt deficiency, there aren’t enough functioning bile salts to absorb and initiate the breakdown of fats, so they can accumulate in the intestines and cause a list of symptoms.

Bile salts supplements are usually taken with a meal so they can aid in the absorption and digestion of fats and fat-soluble vitamins. When shopping for bile salts supplements, start with lower doses and monitor how you feel after meals. Look for a supplement that contains more cholic acid, which is a more water-soluble bile acid. You’ll also find that most supplements are made with chenodeoxycholic acid. Bile salt supplements are usually made from sterilized ox or bovine bile. It’s recommended to take bile salts supplements along with taurine, which can help restore healthy bile formation.


What are the symptoms of a bile salt deficiency? 

A deficiency in bile or bile salts may lead to the following symptoms or conditions:

  • Vitamin deficiencies: If you have a bile salts deficiency, you may also develop a fat-soluble vitamin deficiency, specifically vitamins D, A, E and K.
  • Heartburn: If bile salts are not able to neutralize the acidic foods that you’ve eaten, this may lead to heartburn symptoms.
  • Bloating and abdominal tightness: Without enough bile or bile salts present in your digestive tract, you will have difficulty digesting fats, which can lead to bloating and tightness in the abdomen.
  • Digestive issues: When fats pass through your colon without being broken down by bile salts, they can cause digestive issues like diarrhea, gas and stomach cramps.
  • Gallstones: Without bile salts to dissolve gallstones, which are made up of cholesterol, calcium deposits and other minerals, you may experience gallbladder symptoms like pain in the abdomen, tension around the stomach and nausea.
  • Jaundice: If bile salts aren’t present to eliminate bilirubin from the body, this can cause jaundice.
  • Hormone imbalance: When fats aren’t digested and utilized properly, this can lead to hormone imbalance.
  • Low cholesterol levels: Cholesterol levels lower than 170 may indicate a bile acid deficiency.
  • Liver damage: When bile salts aren’t created and released, this can lead to the formation of harmful chemical byproducts that may damage the liver.

What conditions are associated with a bile salt deficiency? 

Bile acid synthesis disorders are rare metabolic disorders that involve defects in the creation of bile acids. When the body fails to produce functional bile acids, it results in the accumulation of substances that would normally be broken down within the body, which can be damaging to certain organs. Bile acid synthesis disorders are caused by mutations in specific genes, and they can lead to serious health issues like cirrhosis and liver failure. These disorders can usually be treated with bile acid replacement therapy. (14)

Cholestasis is a condition that involves the reduction of bile flow, which can be caused by disorders of the liver, bile duct and pancreas. Cholestasis can be problematic because when bile flow is impaired, substances that are normally excreted into bile are retained. (15)

What causes bile salt deficiency?

Abnormal bile salts or bile acids formation is the result of improper bile flow, which is usually caused by a gene mutation. The improper synthesis of bile acids occurs when bile acids aren’t properly synthesized by the liver, which normally occurs through a series of complex chemical reactions that involve at least 17 enzymatic steps. When a gene that’s in charge of encoding a bile acid enzyme is mutated, this will lead to low bile acid functioning and can cause a deficiency. If bile acids can’t be made in the liver, then they aren’t available to conjugate with taurine or glycine, which forms bile salts.

A bile salts abnormality may also be caused by pancreatic insufficiency or having the gallbladder removed.

What are the best remedies for conditions affecting bile and bile salts?

  • Betaine: Betaine is an amino acid that’s created by choline in combination with the amino acid glycine. It benefits liver health by assisting with the process of digesting fats. By promoting liver detoxification, betaine helps break down and remove fats, toxins and chemicals so they don’t accumulate and cause damage to the liver. (16)
  • Pectin: Pectin is a carbohydrate that acts as a gelling, thickening and stabilizing agent. It can help relieve diarrhea, a common side effect of bile salts supplements and among people who have had their gallbladders removed. Pectin also helps lower cholesterol by binding to the lipids in the gut so they can be excreted. (17)
  • Choline: Choline plays a role in transporting fat from the liver to the cells throughout the body. It helps keep the liver clear from fat buildup that can accumulate, especially when you have a bile salts deficiency. (18)
  • Stay hydrated: To improve bile function, it’s important to stay well-hydrated, as 85 percent of bile is made up of water.

Risks and Side Effects

Taking bile salts supplements may cause diarrhea for some people because when they are unabsorbed, they move directly to the colon and have laxative effects. If you are experiencing diarrhea from bile salts supplements, it may be helpful to lower your dose.

Other digestive problems that may be caused by bile salts supplements include constipation, vomiting and stomach pain. Taking too much bile salt supplements can also lead to inflammation of the colon and skin, and it may even cause conditions like pruritus and erythema.

Talk to your doctor or health care provider before taking bile salts supplements. Start with low doses, and monitor how your body, specifically your digestive system, reacts to the supplements.

Final Thoughts

  • Bile is a digestive liquid that’s produced in the liver and contains bile salts and other substances that help to break down fats from our diet.
  • Bile salts are important for our health because they allow the body to excrete cholesterol and potentially toxic compounds, like bilirubin and drug metabolites. Other bile salts benefits include its ability to promote gallbladder and liver function, help dissolve gallstones, affect bacteria in the gut, control blood sugar levels, and release glutathione.
  • If you have a bile salts deficiency, you may benefit from bile salts supplements, which are available online and in vitamin stores. Bile salts supplements work to restore cholesterol-lowing effects by emulsifying lipids.
  • How do you know if you need bile salts supplements? You may be experiencing bile salts deficiency symptoms, such as heartburn, bloating and abdominal tightness, digestive issues, gallstones, vitamin deficiencies, liver damage, jaundice, and low cholesterol.

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