Let Your Bile Flow


With all this talk of fat-friendly feeding in the wellness landscape- and fabulous results for many following a ketogenic diet- I continually have patients reach out to me that have not succeeded in choosing fat as fuel. They have tried, but they still feel unstable. They report symptoms of adrenal fatigue and poor digestion, such as:


  • Erratic energy levels and unresolved fatigue
  • Weight loss that started and then abruptly stopped
  • Symptoms of toxic load like acne and headaches
  • Trouble getting to sleep or staying asleep
  • Depression, Anxiety, or both
  • Anorexia – loss of appetite
  • Cravings for carbohydrates at night
  • Cravings for coffee and other stimulants
  • Heartburn
  • Gas and Bloating
  • Constipation unaffected by water intake
  • Intense cravings for Salt

IS THIS YOU? … Eating less sugar and starch, boosting fiber, protein, and fat, making other positive lifestyle changes, and still riding a hormone and energy roller-coaster?


There are many reasons that someone may not thrive when suddenly switching to a high fat diet, and even more reasons if that diet includes intermittent or longer term fasting. This fat-focused nutrition therapy has helped many reduce weight and inflammation and can retrain metabolism to become more fuel-flexible. A key to having ketone-burning success, however, is recognizing that a high fat diet requires your digestion to work and your metabolism to have a certain level of flexibility to proceed without energy problems.


Problems with thyroid or adrenals can make your blood sugar too brittle to support fat and fasting without first creating more metabolic stability in other ways. A damaged digestive tract may not produce adequate stomach acid, bile, and digestive enzymes to digest and absorb fat. The only time I recommend someone “jump right in” to a full ketogenic diet is when time is of the essence- a brain cancer diagnosis, controlling epilepsy, or recently diagnosed diabetes severe enough to require a full break from carbs to improve insulin sensitivity as soon as possible. But there are consequences. Energy levels may not stabilize right away. Digestion may require supplemental support. Sleep may become erratic for a few weeks, and serotonin levels may not be adequate at first to reduce the anxiety of making so many changes.


In the next few posts, I am going to address some of these transitioning-to-fat-burning concerns, because the foundation for fat-as-fuel involves taking self-care steps that elevate mind, body, and spirit, apply to many other areas of wellness, and generally will help you feel great from the inside out! Today, we are laying the foundation for absorbing the fat you eat, and that means loving your liver, grazing for your gallbladder, and boosting your bile flow.

Bile: Digestion and Detox


In my previous post, I discussed the value of clarified butter in your diet- a beautiful mixture of short and long-chain fatty acids. But without bile to help you emulsify that long-chain fat- to bring oil and water together and support your digestion- you cannot absorb and use what you took in.


Bile is made in your liver, stored in your gallbladder, and released into your small intestine when you need it to perform important functions:


    • Digestion of Fat: Bile emulsifies fat, much like soap allows oil to be washed off a dirty plate or egg yolk phospholipids bind water and oil together in a mayonnaise. When you eat enough long chain fats, you send a signal to your gallbladder to release bile.
    • Absorption of Fats, Vitamins, and Antioxidants:  Bile helps you absorb fats such as omega-3s, fat-soluble vitamins A, D, E, and K, and fat-soluble antioxidants such as lycopene or medicinal plant compounds such as the curcumin in turmeric. Fat-soluble vitamins are so important that you store them in your liver for future use.
    • Detoxification: Every day we are exposed to thousands of toxic compounds that mimic estrogen in the human body. These toxins are fat-soluble (like estrogen), and are either bound to bile and released in your stool or, when your liver is overwrought, stored in fat (and taken out of circulation). Sadly, that estrogen-like activity of many toxins can actually thicken bile and impede its flow, making a toxic problem worse.


Do I NEED a Gallbladder?


Yes and no. Life is a whole lot easier with one.


Your gallbladder stores extra bile for you to eat a high fat meal or deal with a high toxin load, so if you don’t have one, you’ll have to accommodate this challenge by boosting your bile flow at the times you need it or avoiding these situations entirely: Eating a high fat meal like pizza, whole yogurt, or eggs, or detoxifying from a large (xenoestrogen) chemical exposure such as from quick weight loss, eating pesticide-laden protein and produce, being in a smoky indoor club, taking hormonal birth control, wearing paraben and fragrance-loaded beauty products and  make-up… this list could continue for pages.


Over 25 million Americans have a poorly functioning- or removed- gallbladder, usually a result of gallstones, a significant health problem in many developed societies.  At a quick glance, a person with obstructed bile flow, poor bile flow, or no gallbladder to stockpile extra bile, is in for a rough ride. This is scary when you look at some potential consequences:


Short Term Consequences


  • This set-up of low fats and fat-soluble vitamins primes you for low serotonin depression. Omega-3’s and Vitamin D work together to raise serotonin levels in your brain (less so than in your gut). Tank them and you’ll crave carbs, especially at night, to raise serotonin, and it may be harder to stay asleep because low serotonin levels compromise your melatonin levels.
  • Your skin and digestive tract will repair very slowly. Especially without adequate vitamins A and D to grow new cells and vitamin E to protect them, your layer of cells that connects you to the outside world will not repair and rejuvenate at a reasonable rate.  
  • Weight gain. Higher toxic burden drives weight gain (for toxin storage) and estrogen-like toxins stimulate growth. Also, some have problems detoxifying excessive amounts of normal estrogen that can drive weight gain, especially when a patient is taking hormonal birth control.


Long Term Consequences


  • Your bones can become brittle. Vitamins A, D, and K are needed for bone growth, remodeling, and internal support.  
  • Diabetes (with high triglycerides). Low vitamin D increases risk of insulin resistance while damage caused by toxic burden can hinder cells’ normal repair mechanisms, increasing the likelihood of developing both type 2 diabetes and late adult onset diabetes.
  • Your cancer risk increases in several ways. Without omega-3s to reduce inflammation, monounsaturated fats to build cell membranes, vitamin E to reduce damage to those membranes, cells cannot communicate well. With more toxic damage to cellular DNA, cancer risk increases. Vitamin D reduces risk of all cancers.


Risk Factors for Gallstones


While some risk factors for gallstones are unavoidable, others are not. Double your risk if you are an estrogen-producing female, at least quadruple your risk over 40 years old, and least quintuple your risk if your siblings or parents have gallstones. Certain ethnicities, especially American Indian or Northern European, are at higher risk. Large risk factors you can change or avoid include obesity, increased HMG-CoA reductase activity, bariatric surgery and rapid weight loss, dyslipidemia, diabetes, liver cirrhosis, Crohn’s disease, cystic fibrosis, lack of exercise, certain medications (Octreide, Ceftriaxone, thiazide diuretics), and a high calorie “Western” style diet.


As you might expect, your diet has a profound effect on your gallbladder. Protective dietary factors include avoiding very high fat and cholesterol diets, limiting carbohydrates, eating lots of fiber, legumes, nuts, calcium, vitamin C, and even drinking coffee. But there is more to protecting and nurturing your gallbladder with diet- read on to learn more!



Going Gall!


There are three main dietary steps to improving your bile flow: reducing challenges to bile flow, choose foods that support your ability to make bile before the meal, and choose foods that increase bile flow at the time you are eating. Supplemental support can be helpful, but food always comes first. Supplements are just that- supplemental.


  • Reduce your Liver’s Workload.

    • Avoid large high fat meals. If you do choose large high fat meals on special occasions, consume cholagogues (below) at that meal. If you have no gallbladder, choose smaller meals, always.
    • Focus on fish (and flax oil). As in many other situations, adequate omega-3 fatty acids not only appear to reduce inflammation and improve insulin resistance that contributes to poor bile flow and gallbladder challenges, but also helps produce thinner bile that flows more easily.
    • Choose organic produce and pastured, antibiotic free meats and dairy. The less toxins you introduce, the less you tax your liver. Food is our primary toxic exposure.

  • Build your Bile.

      • Bile acid is a mixture of bile salts (made from glycine or taurine) attached to cholesterol and secreted with lecithin (phosphatidylcholine).

        • Glycine is one of the simplest amino acids and is in all proteins. You make some glycine, but that production may not be enough. Glycine content is highest in gelatin and bone broth, robust in poultry, pork and beef, and lower in fish, peanuts, almonds, and pumpkin seeds.
        • Taurine is a sulfonic acid found in all animal and few vegetarian food. Great sources of taurine include seafood, beef, and chicken. Boosting bile production (and excretion) with supplemental taurine has even been shown to reduce LDL cholesterol.
        • Cholesterol. In a perfect world, you will recycle ~95% of your bile salts at the far end of your small intestine and reclaim your cholesterol so that you never have to eat any. But the more you need to remove toxins from your body, and the more fiber you eat, the more likely you are to excrete bile salts and cholesterol. Eat more animal foods, like red meat, hard cheese, and egg yolks, can help replace lost cholesterol, if you are running low- these are also great sources of choline.  
        • Choline. Phosphatidylcholine is the main component of lecithin and requires choline, another micronutrient found in far higher quantities in animal foods than plant foods. Egg yolks and red meats are excellent sources while sunflower seeds have a notable amount for a plant food. (Soy is not a great source but it is cheap to extract.)


  • Boost your Bile Flow.

    • Eat foods that promote bile flow (“cholagogues”) regularly, especially with high fat meals.

      • Some people drink water with lemon in the morning to boost bile flow; other citrus fruits like lime, orange, and grapefruit contain limonene, the chemical doing the heavy lifting.
      • Omega-3 fatty acids (both from animal and plant sources). Focus on fish, walnuts and walnut oil, flax oil (use raw only), ground flaxseed, and flaxseed tea to motivate thinner bile.
      • To some extent, all bitter tasting foods stimulate bile flow.
        • Start a meal with bitters to boost stomach acid and bile flow.
        • Choose heavy-hitting cholagogues like beets, cabbage, parsnips, celery, garlic, horseradish, watercress, daikon radish, organic green apples.
        • Choose cholagogue-rich spices and herbal teas such as dill weed, caraway seed, ginger, artichoke, turmeric, dandelion root, and yarrow.

    • Note these potent supplemental cholagogues that you might take for reasons beyond improving bile flow. Win-win! 

      • Milk Thistle is known for its support of liver detoxification, partially facilitated by stimulating bile flow.
      • Turmeric is known as an anti-inflammatory that needs fat to be absorbed and stimulates bile flow to absorb that fat, so it boosts its own absorption. Neat!
      • Berberine is often called upon to stabilize blood sugar, but it also helps boost bile flow and improve the ratio of desirable to undesirable bacteria in your gut.


Bites for Bile Flow


Snacks and light meal ideas that boost your bile flow have protein, fat, fiber, and cholagogues. Here are some ideas to get you started: 


  • 1 oz goat cheese mixed with thyme, a bit of red chili sauce, and ½ tsp of olive oil served with ~ 1 cup of celery and carrot sticks
  • Sliced Green Apples and Celery Sticks with Peanut Butter
  • Pork Sausage (made with caraway seed) with steamed radishes
  • Small Caesar salad sprinkled with pumpkin seeds and served with hot ginger tea
  • Smoked salmon on Flaxseed crackers
  • (Real, Fermented) Dill Pickles
  • Braised beets and cabbage (with apple cider vinegar and caraway seed)
  • Salmon sushi with sliced ginger on top
  • Watercress Soup (with mushrooms and chicken stock)
  • Daikon radish slices with roasted red pepper hummus
  • Parsnip Chips
  • Arugula Salad with Grapefruit wedges, tahini drizzle, and balsamic vinegar


Whether your gallbladder is underperforming, needs a light boost, or completely absent, foods like these will nourish your bile flow and improve your ability to digest and detoxify. Enjoy this delicious and very important step on your way to becoming more friendly to utilizing and burning fat- reducing spikes in insulin and your risk of many chronic diseases including diabetes and heart disease, reducing inflammation, improving cellular repair, and losing unwanted pounds! 

~~   Would you like delicious wellness and nutrition tips from an expert?  Join the Eating with Ease mailing list for delicious nutritious tips, mindful musings, and integrative and functional nutrition news!  ~~


Rebuild Your Carb-uretor: Build Food Habits that Fight Fatigue — Part 2 — Use Spacing and Timing to Balance Blood Sugar

Do you slump in the midafternoon without your coffee or pass out on your couch in the evening after eating a handful of starchy comfort food?  

Chances are, you ARE listening to your body, and your body is telling you that you need caffeine or sugar to fight fatigue.

You may find this post helpful in getting started using your snacks to help balance your energy levels and achieving a more graceful state of energetic being throughout your day.

I’ve been there, maybe you’ve been there, lots of us have been there:  Wake up — dragging. Coffee. Skip Breakfast. Maybe eat lunch, maybe just coffee– but is rushed. Maybe gassy because under stress and not digesting. Mid-afternoon. Tired and nauseously hungry. Grab more coffee, sugar, starch, or all three. Get irritable right about the time getting out of work. Get home. Need to make dinner. Eat more carbs while making dinner. Finally eat dinner. Feel full, but still craving carbs a few hours later. Eat snack. Sleep– well or unwell — and wake up at 4 am having to pee, thirsty. Go back to sleep. Wake up — dragging.

Image result for coffee and pastry

Sound familiar?  

As many people know, unstable blood sugar can be both an inconvenience — and, if it persists long enough, may lead to chronic disease.  Today we will discuss how to schedule your eating throughout a day to improve your blood sugar and energy control.

pexels-photo-89235 - Copy - Copy

1. As with all things — Begin with the End in Mind.

If you start your day spiking your blood sugar, it will crash low, increasing your desire for sugar (and maybe caffeine), and you are far more likely to end your day in a bag of starchy snacks. Choose a breakfast low in caffeine and high in protein and vegetables to reduce the sugar you eat in the first half of your day. Ensure you have protein to provide energy steadily even if you cannot find the time to prepare a meal high in fiber — a handful of nuts or a plain yogurt is a great starter breakfast if you are not a regular breakfast eater. If you aren’t very hungry, don’t push it — you’ll just create indigestion. Over time, and with less carb-eating at night and coffee intake in the morning, your morning hunger should improve.


2. If you are often nauseous and it resolves with eating, always have a snack with you.

Remember last week when we focused on the value of eating protein at every meal or snack? The best defense against eating sugar is a good offense of eating protein regularly. A snack bag of raw nuts and seeds, seaweed snacks and a piece of fruit, grass-fed meat or poultry jerky, or even canned seafood can travel with you at all times, just in case.  Be mindful, though, if you have allergies, that the older the protein, the higher the histamine level, leading to stuffiness and itchy redness.


3. Eat 5-6 small meals throughout the day that can fit in two cupped hands or smaller.

Stay ahead of your hunger with plenty of protein and fiber. A simple way to always be prepared is to have some fresh fruit and nuts on hand in your car or office desk, if those are snacks that you enjoy. I’ve had patients that keep organic sugar-free peanut butter at work as crave-support. Used to drinking coffee all day and barely eating until evening? Recognize you’ll need to train your digestion and start sipping — bring 32 oz of protein/veggie/fruit smoothie and drink 8 oz servings every 2 hours. Store-bought smoothies can be helpful, but are often much higher in sugar than is necessary to make a delicious meal-in-a-cup. Make your own so you can guarantee freshness and adequate protein. If you wait too long until your blood sugar crashes, you will be more tempted to make less healthful choices.

 vegetable-juices-1725835_960_720 - Copy - Copy

So if eating constantly can help, why do you hear all this talk about the benefits of fasting?  Consider that your body was built to fast, *but* it has to be retrained to do so with ease.  There are many benefits to fasting– including helping the gut repair if it has been gassy and overwhelmed–  but jumping into fasting without first finding balance in your daily energy levels is neither wise nor safe. Instead of fasting during the day, when energy is needed and it is harder to make good choices, fast overnight, as the body evolved to do. Avoid eating right before bed to improve your morning appetite for breakfast, and if you decide to experiment with fasting, start by fasting when the sun is down — you will have access to food if you require it, and can adequately hydrate, and will be sleeping for most of the time you are fasting — so this is the time you will have the greatest immediate benefit and the greatest ease.  If you would like to learn more about how meal timing and spacing can re-train our hunger, this article discusses these topics with greater scientific detail. In short, if you don’t feed the body what it wants when it asks you to, it will start asking for different foods at different times in its best effort to accommodate your choices. Better than nothing — but you may not feel too great and you may find yourself attracted to less-than-healthful choices that will, over time, run you down.

So, in these two posts, we have started to consider simple solutions for eating your way to more stable energy. Though these recommendations are a great start, they are not complete with regard to food and they do not address exercise, sleep, and stress management, though they may help you have the stamina to tackle those areas of your life as well!


So enjoy your delicious healthy snacks with protein and fiber and leave comments below — What tips have you used that work well?  What tips have you used that were a challenge?  How can you use this info in your daily life?


Rebuild Your Carb-uretor : Build Food Habits that Fight Fatigue — Part 1 – Soften the Blow with Substitutions

Do you slump in the midafternoon without your coffee or pass out in the evening shortly after eating sweet or starchy comfort food?

Chances are, you ARE listening to your body, and your body is telling you that you need caffeine or sugar to fight fatigue.

You may find this post helpful in getting started using your snacks to help balance your energy levels and achieving a more graceful flow to your day.

I’ve been there, maybe you’ve been there, lots of us have been there:  Wake up — dragging. Coffee. Skip Breakfast. Maybe lunch. It is rushed. Maybe gassy, maybe under stress with poor digestion. Mid-afternoon. Suddenly tired and nauseously hungry. Grab more coffee, sugar, starch, or all three. Get irritable right about the time getting out of work. Get home. Need to make dinner. Eat more carbs while making dinner. Finally eat dinner. Feel full, but still craving carbs a few hours later. Eat snack. Sleep– well or unwell — and maybe wake up at 4 am having to pee, thirsty. Go back to sleep. Wake up — dragging.

Sound familiar?  

As many people know, unstable blood sugar can be both an inconvenience — and, if it persists long enough, may lead to chronic disease.  Today we will deal with replacing the sweet foods you eat with alternatives less likely to make matters worse. Next week — stay tuned! — we will talk about how to schedule your eating throughout a day to improve your blood sugar and energy control.

The closer to straight sugar a food is, the higher it spikes our blood sugar when we eat or drink that food. The first step to balancing your blood sugar, and subsequently, reducing the peaks and valleys of energy throughout the day, is not to spike your blood sugar very high to begin with. The strategies for doing this are the same as a person with diabetes or pre-diabetes would use.

Here are the first food steps to taking control of your blood sugar:


1. Avoid sugar in liquid.  Liquid speeds the absorption of sugar.  Stay hydrated.

Sugar in liquid raises your blood sugar higher and faster than any other food.  Soda pop, fruit juice, sports drinks, sweet tea, sorbet, sweetened coffee drinks, and blended fruit powder drinks are in this category.  Replace these with kombucha, kvass, or other lower-sugar fermented beverages, water or soda water infused with a few berries or citrus, floral and herbal teas that lend a hint of sweetness (such as hibiscus, chamomile, or mint), or good ‘ol filtered water.  Caffeine is tricky because it raises your cortisol, a stress hormone that raises blood sugar, so having a lot of caffeine will cause spikes in blood sugar. This not only drives some weight gain around your midsection, but it also creates cravings for sugar, starch, and more coffee. For some, though, the dopamine-boosting effect helps reduce consumption of higher-sugar liquids and foods, so reduce caffeine after reducing sugar. (For instance, don’t use sugar in your coffee, and avoid the macchiato.)


2. Consume sugar with Fiber. Fiber slows the absorption of sugar.

Fiber is found in plant foods — fruits, vegetables, nuts, seeds, and legumes (beans and peas).  Many people point to oatmeal as the perfect slow-release-starch. Think about it how sticky oatmeal is — that gooey, glue-like fiber is called soluble fiber, and it helps bind your stool together and digests slowly, so your blood sugar rises less intensely over a longer period of time, giving you more stable energy with less crash later. Other foods high in soluble fiber that release sugar slowly include brown rice, apples, bananas, sweet potatoes, butternut squash, and beets. Some foods are lower in sugar and still high in soluble fiber, including brussel sprouts and avocadoes. There is also roughage fiber, or insoluble fiber. This type of fiber makes us slow down and chew more and helps eliminate stool. Like soluble fiber, it is not able to be burned for calories, so it fills up the stomach with food that we don’t gain weight from, displacing the calories from sugar and fat in our diets while making it easier to be satisfied. This article discusses both types of fiber and their roles as we understand it so far in preventing diabetes, the ultimate blood sugar challenge.


Swap out your juice for fruit, your fruit juice for a fruit smoothie, swap out the cookies for nuts and seeds or at least add oatmeal and nuts to your cookies. Replace fruit snacks with raisins. When you do choose milled flour products, choose whole grain options. To take it to the next level, start to replace noodles, pastas, crackers, and biscuits with vegetables — cabbage, leafy greens, sliced carrots/radishes/cucumbers, and roasted root vegetables, for example. But start simple and you may very well amaze yourself


3. Eat Protein with Every Meal or Snack.

For those who are more lower-bowel-sensitive, consume fruit alone to avoid gas and bloating.

For the rest of us, follow this rule at all times.

Protein can raise your insulin (increasing muscle building) without increasing your blood sugar (less high blood sugar spikes → less low blood sugar pits that cause fatigue and cravings) and, unlike carbohydrate, it can be used to build the muscles and maintain the body if it is not used for energy. The individual building blocks of protein, amino acids, can turn into either sugar or fat as needed to provide balanced energy to your body.  Imagine if you could break down your car door to power your car — protein is powerful stuff!

For snacks, try pairing fruits or vegetables with nuts, seeds, nut butters, yogurt, granola, cheese, canned fish and shellfish, goat cheese, or sipping a homemade smoothie blended with nuts, seeds, nut butters, dairy, or protein powders. A balanced snack MUST contain protein, ideally contains some fiber, and may contain varying amount of carbohydrate.

You also make every neurotransmitter — chemicals that communicate in your body and brain like serotonin and dopamine — from protein. High carbohydrate intake without sufficient protein makes it very difficult, after a long time, for your body to wake you up and cheer you up in response to the snacks and the coffee. You’ll therefore eat and drink more, leading to more of the same problems.  Bolster yourself against anxiety and fatigue with regular protein intake.

To summarize, swap our your processed snacks for some produce and protein and feel the difference in your daytime stability. Reduce your caffeine intake as you start to feel less like you need the boost — and see how you feel!  This is a great start — there is a lot more you can do from here — but without these fundamentals, sugar can take control of your life.

I hope you found this health update simple and useful.  Timing and spacing of what you eat is the next important consideration. Stay tuned for next week!

What changes have you made to stabilize energy and cravings?