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! 

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