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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.


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23 Questions for “Psoriasis and Bile: What’s the Connection?”

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  1. 12
    Angela Smith says:

    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?

    • 12.1
      SAFM Team says:

      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.

  2. 11
    Victoria Rivera says:

    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.

  3. 10
    Pat says:

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

  4. 9

    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!

    • 9.1
      SAFM Team says:

      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.

  5. 8
    Tom says:

    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?

    • 8.1
      SAFM Team says:

      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:

  6. 7
    Lisa Jones Clark says:

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

    • 7.1
      SAFM Team says:

      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 . 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.

  7. 6
    Brad says:


    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.

    • 6.1
      SAFM Team says:

      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:
      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.

  8. 5
    Anar says:

    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.

    • 5.1
      SAFM Team says:

      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.

  9. 4
    Marty says:

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

  10. 3
    Angelo says:

    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

    • 3.1
      SAFM Team says:

      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:

  11. 2
    valerie says:

    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

    • 2.1
      SAFM Team says:

      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 to 700-800mg twice daily (that’s mg of actual omega-3s (EPA, DHA), so the total fish oil dose will be 2-3x time amount – check the label), (6) hydrate rigorously with plain, clean water (get rid of sodas, sweetened beverages), (7) fill the diet with vegetables and fruits in particular – antioxidants are critical in this vein, (8) choose as much as possible organic food choices (the toxins – as mentioned above LPS – that the body has to deal with are already a major load in the liver; we don’t want to increase that!), (9) support the gut lining with a mix of mucilaginous herbs and agents to heal it (e.g. Designs for Health’s GI Revive or something similar that includes such agents as aloe vera, mashmallow root, slippery elm, t-glutamine, n-acetyl-glucosamine (this form, not others), and (10) skip all “high tech” potions and ointments and try to use very, very gentle and clean shampoo (ideally avoid all make-up, hair color, and other chemical-laden agents. Coconut oil may also help with soothing and scale removal as triage support e.g. (several drops each of lavender and thyme essential oil can also be beneficial; use very clean, food-grade oils only).

  12. 1
    SAFM says:

    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.”

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