The surprising Impact of Bile Acids

By: Megan Kelly CNP

When most people think of bile, they think of digestive health and of course bile does play a large role in our digestive processes. However, recent research reveals the far-reaching effects bile acids can have, beyond our digestive system.

Bile acids are made from cholesterol in the liver. They then bind with the amino acids taurine or glycine through a process called conjugation.


They do, in fact, help us to break down fats. However, even within the digestive system, the effects of bile acids are much greater than we imagined. They are emerging as gut microbiome regulators. It appears they can have direct anti-microbial effects. In fact, reduced levels of bile acids in the gut are associated with bacterial inflammation, and excess levels can lead to an overgrowth of other bacterial species.

Furthermore, dysregulated acids can promote chronic inflammation and increased intestinal permeability (aka. Leaky gut).

In addition to their impact on the gut microbiome, bile acids are now being recognized as hormones! It turns out they actually produce endocrine-signalling actions and can travel in the blood to impact other systems beyond the digestive tract.

Increased serum bile acids are associated with obesity, type two diabetes, non-alcoholic fatty liver disease and PCOS.

In fact, a recent study found that women with PCOS had significantly increased bile acids in their blood compared to those without the condition. These high levels seem to be more directly correlated with increased testosterone and androstenedione (another androgen) levels in women, which sets the stage for PCOS development.

Bile acids work on the Farnesoid X receptor, which has hormonal actions throughout the body. Typically, these acids are well regulated by the body as an excess can be potentially toxic to the cells. There is a feedback system in the liver that prevents further production when levels are already high.

In cholestasis (dysregulation of or sluggish bile flow) there is often an increase in bile acids in the blood. This is because bile release is not being coordinated properly with the intake of food.

These increased blood levels of bile acids may contribute to overall hormone disruption.

It has also been found that increased bile acids levels can contribute to the development of insulin resistance.

Other research suggests they may increase cortisol secretion and adrenal androgen production, which could further contribute to androgen excess as seen in PCOS.


  • Difficulty digesting fats
  • Bloating & gas after meals
  • Nausea & burping after meals
  • Pale stool
  • Loose stool
  • Fatty liver disease

Reach out to your ND and nutritionist to develop a comprehensive plan if you think bile dysregulation may be affecting you.


Liu, Lei, et al. “Bile Acids Increase Steroidogenesis in Cholemic Mice and Induce Cortisol Secretion in Adrenocortical H295R Cells via S1PR2, ERK and SF‐1.” Wiley Online Library, John Wiley & Sons, Ltd (10.1111), 17 Feb. 2019,

Ridlon, J M, et al. “Bile Acids and the Gut Microbiome.” Current Opinion in Gastroenterology., U.S. National Library of Medicine, May 2014,

Zhang, B, et al. “Increased Circulating Conjugated Primary Bile Acids Are Associated with Hyperandrogenism in Women with Polycystic Ovary Syndrome.” The Journal of Steroid Biochemistry and Molecular Biology., U.S. National Library of Medicine, May 2019,

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