Cirrhosis Bile Salts and Your Microbiome

author avatar Dr. Eric Berg 10/13/2023

The liver plays an essential role in many vital processes within our body, including bile production, which aids digestion and nutrient absorption and promotes a diverse microbiome.

Let's look at the importance of bile for overall health and how factors such as gallbladder removal, fatty liver disease, insulin resistance, and gut microbiome can impact its production.

Learn about the significance of maintaining a balanced gut microbiome and how bile salts can help to keep pathogenic bacteria at bay.

The Importance of Bile in Digestion

Bile breaks down fats and helps absorb fat-soluble vitamins and essential fatty acids by acting as an intestinal detergent to process rich foods in a water-based environment such as the digestive tract.

Bile emulsifies fat globules into tiny droplets, allowing enzymes to digest them and absorb essential nutrients like fat-soluble vitamins A, D, E, and K.

Bile is also crucial to absorbing essential fats, including DHA, an omega-3 fatty acid that maintains brain function throughout life.

holding tudca capsules

TUDCA Benefits and Bile Production

Tauroursodeoxycholic acid (TUDCA) is a type of bile acid naturally occurring in the body. The liver produces it and helps digestion by breaking down fats and absorbing fat-soluble vitamins.

The Benefits of TUDCA

  • Protects against chronic liver disease: Studies have found that TUDCA can protect against chronic liver diseases like nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC).

  • Improves bile flow: One of the main benefits of TUDCA is its ability to improve bile production. This can help prevent gallstones from forming and promote better digestion overall.

  • Promotes weight loss: Some research suggests that taking TUDCA supplements may help with weight loss by increasing metabolism and reducing inflammation.

TUDCA is a potent compound with numerous benefits for liver health, including improving bile production. Taking TUDCA supplements supports better digestion and protects against chronic liver diseases like cirrhosis and HCC.

Factors Affecting Bile Production

Several factors can interfere with bile production, reducing efficiency in breaking down dietary fat.

  • Gallbladder Removal: Without a gallbladder, your body may struggle to properly store enough concentrated bile to digest fats.

  • Fatty Liver Disease: Excess fat accumulation within liver cells can impair their ability to produce adequate amounts of bile.

  • Insulin Resistance: A diet high in refined sugars and carbohydrates contributes significantly to insulin resistance, which leads to increased levels of inflammatory markers in the bloodstream.

How to Support Bile Production

  • Eat a nutritious diet. Follow a nutritious low-carb diet like Healthy Keto®, focusing on whole foods such as grass-fed beef, organic vegetables, high-fat dairy, wild-caught game meat and fish, seafood, and seeds and nuts.

  • Maintain a healthy weight: Excess body fat can strain your liver and impair its ability to produce bile efficiently.

  • Avoid excessive alcohol consumption: Chronic heavy drinking is one of the leading causes of cirrhosis.

Microbiome's Role in Recycling Bile

Your gut microbiome plays a crucial role in bile salt recycling, which is essential for optimal digestion and nutrient absorption.

Bile acids facilitate fat breakdown during digestion, and your gut microbiome recycles primary bile acids into secondary bile acids for more efficient absorption.

This recycling happens up to 12 times daily, ensuring enough bile for optimal digestion.

Antibiotics' Impact on Beneficial Gut Microbes

Antibiotics, including the beneficial bacteria responsible for bile acid recycling, can disrupt your gut microbiome.

  • Broad-spectrum Antibiotics can significantly disrupt your gut microbiome and decrease bile recycling rates.

  • Diarrhea: Antibiotic-associated diarrhea can flush out harmful and helpful bacteria, leading to even poorer bile recycling efficiency.

Balancing Intestinal Microbes with Bile Salts

Good gut health requires adequate levels of bile to maintain balance among the microbial life in your intestines.

Bile salts selectively eliminate harmful bacteria like Clostridium difficile, while promoting the growth and proliferation of beneficial microbes.

Maintaining Healthy Gut Flora Composition

Consuming fiber-rich prebiotic foods and probiotic food sources, such as yogurt or sauerkraut, helps to promote a diverse microbiome, fosters bile recycling, and supports gastrointestinal well-being.

  • Probiotic supplements: Lactobacillus and Bifidobacterium strains are joint in probiotic supplements.

  • Prebiotic supplements: Inulin or fructooligosaccharides (FOS) are popular prebiotic ingredients.

Bile Salts in the Management of Cirrhosis & Liver Disease

Support your bile production, concentration, and recycling rates to improve cirrhosis and liver disease.

Eat a nutritious low-carb diet like Healthy Keto, including plenty of pre-and probiotic foods, while limiting alcohol consumption to support bile production, concentration, and recycling rates.

  • Pro tip: Avoid sugars and carbs to reduce insulin resistance.

  • Pro tip: Engage in physical activity to maintain a healthy weight and prevent nonalcoholic fatty liver disease (NAFLD).

  • Pro tip: Supplementation with fat-soluble vitamins such as vitamin D might be beneficial under medical supervision if dietary intake is insufficient or absorption issues are present due to existing conditions like Crohn's disease or celiac disease.


Understanding the importance of bile in digestion and its role in liver disease treatment is crucial for maintaining overall health.

The microbiome is vital in recycling bile and balancing gut microbial life with bile salts.

Lifestyle modifications and medical treatments targeting biliary issues can improve liver health. Proper nutrition, weight management strategies like the ketogenic diet, intermittent fasting, and avoiding antibiotics can prioritize gut health.


1. What's the Best Treatment for Liver Disease?

The most effective treatment for liver disease depends on the underlying cause. However, dietary and lifestyle changes may be necessary, and taking a bile salt supplement can improve liver function and enhance overall health.

2. What's the Latest Treatment for Liver Disease?

Research is ongoing, but one promising approach involves enhancing bile production and bile salt recycling rates to promote better digestion and overall health outcomes.

3. Is There a Cure for Liver Disease?

Some forms of liver disease can be cured or managed effectively with proper treatment.

4. What's the Goal of Treating Liver Disease?

The primary goal is to address the root causes while minimizing symptoms and complications, including reducing inflammation, reversing fat accumulation, improving bile production, and managing autoimmune reactions.

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