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Psoriasis and Bile: What’s the Connection?

If you missed last week’s video about gallbladders and simple solutions for gallstones, be sure to check it out .

Indeed, disease usually begins in the gut, especially autoimmune disease.  Endotoxins are highly inflammatory in humans, and breaking down endotoxins is another critical role of bile (be sure to check out the video).  This is a topic that highly reinforces the role of intestinal permeability (IP) in chronic autoimmune disease activation.  This kind of study should make medical headlines:  bile salts therapy yielding 80% of psoriasis patients asymptomatic ( and a confirming study three years later showing the persistence of the benefits and a more recent affirmation).  Wow!

(If you’re really feeling geeky, learn more here about how endemic, beneficial microbes like Lactobacillus and Bifidobacteria develop resistant to bile – a strong antimicrobial – in order to flourish.  And an even deeper dive here.  Bile is important for preventing virulence and overgrowths, even SIBO.  Fluid, flowing bile matters.  Gallbladders concentrate bile for a more intense effect.  Gallbladders matter.  Yes, I’m taking a stand for the little guys.)

Obviously, comprehensive support of a client or patient struggling with AI disease (some of the people who need us the most!) requires a deeper investigation into boosting the immune system and eliminating triggers and reducing inflammation.  But getting at the root of a key,  systemic inflammation trigger (e.g. endotoxins) can bring dramatic relief.  If you’re interested in learning more, I’ve written before about the role of IP in AI disease and how this also can create food sensitivities as another source of persistent inflammation.   Get comfortable and confident working with these tools!

I hope this is of service to you and your patients and clients.

Warmly,

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P.S.  If you are passionate about transforming healthcare through the power of functional medicine, we encourage you to learn more about our training program here.

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Lizzie
Lizzie

I tried one capsule of Jarrows Bile Acid Factors with dinner but each time it gave me painful reflux symptoms. It’s quite a high dose and I’m thinking of purchasing empty gelatin capsules to transfer a half dose into and try that. Does a gelatin capsule protect against the corrosive acids? The original Jarrows appears to be a gelatin capsule. I am taking this for psoriasis. Many thanks

SAFM Team
Reply to  Lizzie

Gelatin is a protein-rich substance and it gets readily digested in the stomach acid. That being said, yes, going down with the amount of the bile acids in the supplement – starting ‘low and slow’ – is something that we recommend in general for all new supplements. Please consider working with a trained functional medicine practitioner, as the painful reflux symptoms that you are bringing up may be a sign of a more entrenched GI tract dysfunction.
You may also be interested specifically in these posts:
https://schoolafm.com/ws_clinical_know/psoriasis-and-general-autoimmune-considerations/
https://schoolafm.com/ws_clinical_know/intestinal-permeability-the-autoimmune-connection/
https://schoolafm.com/ws_clinical_know/autoimmune-dis-ease-myths-and-truths/

Angela Smith
Angela Smith

Regarding the reply to comment #2 (Valerie about her child)… Would you recommend doing all of these supplements and recommendations at the same time, or in stages?

SAFM Team
Reply to  Angela Smith

Definitely in stages and the order will vary with each particular person and their unique needs and situation, and not all of them may apply. This is another perfect example of how functional medicine approach and systems thinking is not linear and can be fit into handy-dandy protocols that anyone can follow. This simply is not possible because the needs always vary from situation to situation and one needs to get comfortable with approaching each new case with a begginers mind.

Victoria Rivera
Victoria Rivera

I was curious if you have treated patients with bile salts to improve biliary congestion in those with bile acid gastritis and or BE. Are bile salts tolerated in those with these conditions?
Thank you.

SAFM Team

No, the bile salts would not be the first choice for helping someone recover from these conditions. They may be helpful later, once the full situation is assessed and the primary root causes of bile acid reflux and Barretts’ esophagus addressed. You may appreciate this post as well:
https://schoolafm.com/ws_clinical_know/acid-reflux-truths-and-myths/

Pat
Pat

Hi,
What would be a good vegan alternative to bile? It could be prescriptions, that’s fine.

SAFM Team
Reply to  Pat

Artichoke leaf extract is a good option for people who don’t want to use ox bile as it stimulates the bile flow and supports liver health:
https://www.ncbi.nlm.nih.gov/pubmed/12587687
Also, using D-limonene, which is an orange peel extract will help with bile quality and flow. You may appreciate this post:
https://schoolafm.com/ws_clinical_know/gallbladder-rescue/

Paula Youmell

Tracy,
I see above your comment that bile salts do not need an enteric coating, is that really true?

Also, for anecdotal evidence here: about 15 months ago you sent an email about the bile / psoriasis connection. I tucked it away in my gmail folder knowing I would “get to it” eventually as I have mild psoriasis. I keep it very mild with diet and lifestyle.

So one night I notice I am getting thick patches on my scalp, literally out of the blue they started. I jumped in bed, ran through gmail, and found your email. Next day, I purchased bile salts and have been taking for about 3 weeks. Psoriasis on scalp was gone in less than a week. The tiny patches I get on elbows and knees (worse in winter) are also clearing up. The knee cap ones were light tough elephant skin… not anymore.

Next time, I won’t tuck emails so deeply or so long in my gmail files. Thanks!

SAFM Team
Reply to  Paula Youmell

Thank you for your healing story, Paula, so inspiring!
In general, bile salts in supplements are conjugated to taurine or glycine and do not get damaged in the stomach acid, that’s why the enteric coating is not required.

Tom
Tom

This is an amazing resource for psoriasis sufferers – thanks so much for the effort you’ve put in.

I wanted to ask about bile acid supplements…I’m using some 500mg ox bile capsules but I can’t swallow them! I’ve just a really bad gag reflex and I can’t get them down. Is it safe to tip the contents of the capsules into some yoghurt or sauce and consume them like that? And will this actually be effective?

SAFM Team
Reply to  Tom

We are so glad to hear that you find the information helpful, Tom! Ox bile and bile acids are actually quite corrosive and we don’t recommend opening the capsules. You’re not the only person who has issues with swallowing pills/caps and there are certainly a few different methods to help with this issue. One would be to try and swallow them with yogurt as they are – having foo in the mouth may make it easier for the body to have less of a gag response to the capsule. These are also methods worth trying:
https://www.health.harvard.edu/blog/two-tricks-make-easier-swallow-pills-201411137515

Lisa Jones Clark

For someone with psoriasis, is that 200-300mg ox bile daily or per meal? What if the person gets diarrhea after taking them?

SAFM Team
Admin
SAFM Team

Ideally twice/day, but optimal, tolerated dosage can vary *dramatically*. Timing with meals matters only if there is also a missing gallbladder. If there was no diarrhea (or even loose stools) before taking the supplement, then the dose is obviously too high (make sure that magnesium supplementation dose hasn’t now become excessive; part of the function of bile is to stimulate motility!). There may also be poor absorption of this bile (for enterohepatic recirculation), and support for nurturing the gut lining may be necessary. You might explore as little as 75-125mg/dose e.g Nutricology https://www.nutricology.com/ox-bile-125-mg-180-vegicaps . If there were loose stools at all before experimenting, I recommend you address the root cause of this before exploring any bile salt supplementation. Start with once/day with dinner.

Brad
Brad

Hello

The studies referenced in your article cite Suprachol; Acidum dehydrocholicum as the type of bile acid supplement. How and/or where do I get the same product? The results of these tests are amazing and I want to do all I can to ensure I get the same results.

Thank you for your help!
Brad C.

SAFM Team
Reply to  Brad

Yes, the science on bile acids and the psoriasis benefits are indeed quite impressive. If you would like to use exactly what was used in the research study cited, this may be helpful in finding this specific product:
https://www.drugs.com/international/dehydrocholic-acid.html
Otherwise, try the Jarrow Bile Salt Factors, I’ve had great results with this supplement as well. What I would recommend is playing with the timing of this supplement, some clients do great wuth it being taken in the middle of the day and with food other feel better and get better skin results when this is taken in the evening after dinner.

Anar
Anar

What is the typical dose of the Jarrow bile acids? It says on the bottle serving size is 3 capsule which equals a 1000mg of total bile acids.

Also, how does the Jarrow brand compare with Standard Process’s Cholacol?

Thank you so so much for all the useful info.

SAFM Team
Reply to  Anar

The dose of the Jarrow Bile Acid Factors will depend on an individual needs of a person, some people may require 3 capsules with every meal and others will feel better with 1 capsule only with meals that are richer in fats. This depends on their gallbladder status, present (less bile acids may be needed) or not(more bile acids amy be needed) and how well the liver is working with regard to the bile flow (thick bile or easily flowing) and other GI tract secretions and also on thier symptoms that they are trying to address.
To answer your second question, Jarrow’s Bile Acid Factors is a more direct and stronger, animal-based support for bile formation and it is widely available. Whereas, SP Cholacol is less potent, part plant- part animal-based source of bile salts and is available only to licensed practitioners such as chiropractors. Both are very good products and it is only a preference for individual preference and accessibility.

Marty
Marty

What about dosages of bile salts for younger children? Any precautions and suggestions for dosing bile acids?

SAFM Team
Admin
SAFM Team
Reply to  Marty

Indeed, I am not able to advise you on this, and given the young age, I would recommend appropriate medical oversight. Instinctively, of course, a child could have these same needs.
However, there is some evidence of different bile metabolism in children vs. adults, so further research is prudent. These are some readings which might be of help to you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882095/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1412900/ and https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1105662 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123376/.

Angelo
Angelo

Hello,
Very interesting info many thanks.
My understanding is that people with no gallbladder should be taking bile salts in enteric-coated capsules, can you please comment on this?
Also, does insulin resistance and fatty liver affect bile quality?
How do bile acids help the gallbladder resume function?
Kr Angelo

SAFM Team
Reply to  Angelo

Bile acids are generated from cholesterol oxidation in the liver and then are conjugated to glycine or taurine, excreted out of the liver, and stored in the gallbladder. In response to a meal, the contraction of the gallbladder delivers bile salts to the small intestine, facilitating the digestion of dietary fat.
Bile salts do not get damaged in the stomach acid so the enteric coating is not required. There are many examples of supplements that can help with boosting bile acid factors if needed, one of the supplements is this formula.
Indeed the relationship between bile and insulin resistance is fascinating as bile salts seem to do much more than simply make fat digestion possible. Bile modulates the microbiome and it affects gene expression as well as the bile salt production itself. If you’d like to dive into the detailed mechanism these are particularly good reviews:
https://www.nature.com/articles/s41424-018-0034-3
https://www.sciencedirect.com/science/article/pii/S2211383516301113

valerie
valerie

Hi Tracey.. Im just a mum who has a 15yr old with psoriasis on her scalp, it is quite bad and very noticeable as it is around the hairline.Can you give me any advice on how I could help her, I have read some of your article’s and realise that I need to start with the gut. as a mum who cannot afford to go to a natural health specialist is there any advice could you give to someone like me who is trying to do it on budget..What note’s I have taken is 1) eliminate gluten from the diet 2) heal the intestine to stop the endotoxin’s getting through the lining , what could I buy for this? and 3) pro biotic’s that include saccharoymyces and lactobacillus Rhamnosus.. am I on the right track? And were would I buy these as I’m assuming over the counter stuff wouldn’t do the trick.. I hope you read this and I hope that in some small way you can help.. we have used so many ointment’s, lotion’s, shampoo’s and they don’t do the trick, and unfortunately kid’s being kid’s a bit of bullying has started.. thank you Tracy.. Regard’s Valerie

SAFM Team
Admin
SAFM Team
Reply to  valerie

Indeed, this venue is not suitable for detailed individual guidance because every case is unique. What works for one will not work thoroughly for others; this is part of why those with autoimmune activation need individual attention. Indeed, psoriasis begins in the gut and then becomes a toxin issue. You are going to have to do some research (local or online) to find brand options, as of course these vary around the world. Amazon often offers alternatives. For balance immune function, make sure labwork shows all three of these markers in the upper half of the normal reference range: Vitamin D, Vitamin A, and RBC Zinc (ideally RBC, not serum). These nutrients are key! A few general points which might be helpful: (1) I would eliminate not only gluten but also all dairy foods, eggs, and all grains period (gluten-free or not, all forms, whole or otherwise), (2) support with bile salts (as in this article) three times daily, (3) take about 30mg zinc (citrate or picolinate) daily with a meal (to boost/rebalance immune function), (4) use a targeted probiotic; the species you mention are powerful e.g. Metagenics UltraFlora Acute Care, and (5) increase intake of omega-3 essential fast up… Read more »

SAFM Team
Admin
SAFM Team

A student asked a follow-up question, “What dose of bile acids would you recommend for a case of psoriasis? And are you talking about ox bile?” And I replied, “I would probably start with 200-300mg bile salts. Yes, typically this is an ox bile extract. I have recommended Jarrow’s “Bile Acid Factors” to several dozen clients with good results.”