The body requires the gut and the intestines (both small and large) to store, digest, and transport the nutrients from food to all the body’s organs, tissues, muscles, and cells. These nutrients help the body by keeping it functional and promoting growth, metabolism, and immune support. When the food is being digested, the liver sends out bile acids to aid in the digestion process to break food particles and transport them and secreting them out of the body. Sometimes specific gut issues can start to affect both the intestines and gut, causing discomfort to the body. In this 2 part series, we will be looking at how bile acids are hormones, sterolbiome, and bile reflux. Part 1 looks at what bile acids are, their role in the gut, and what gall sludge is. By referring patients to qualified and skilled providers who specialize in gastroenterology services. To that end, and when appropriate, we advise our patients to refer to our associated medical providers based on their examination. We find that education is the key to asking valuable questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
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Are Bile Acids Hormones?
Research studies have found that the bile salts from bile acids are considered nutrient signaling hormones. They play a crucial role by allowing the gastrointestinal system to digest, transport, and metabolize nutrients throughout the entire body. Bile acids are hormones that regulate:
- Their synthesis and transport
- Glucose and lipid homeostasis
- Energy balance
- Microbial growth
Other research studies have found that the essential role of bile acids is that they act as regulators for energy metabolism by acting as emulsifiers to cholesterol in the intestines. They can act like typical steroid hormones by having specific intracellular receptors in the target cells. When bile acids are in the intestines, they ensure that the particles are broken down and secreted into the bloodstream.
The gut microbiome or sterolbiome produces endocrine molecules from cholesterol-based molecules in the gut known as bile acids. Bile acids are also known to shape the gut microbiome fundamentally and vice versa, as studies show that bile acids can facilitate fat absorption while playing a role in glucose and metabolism regulation. This is important for bile acids mechanics because it can help stimulate the secretion of gut hormones. Other bacteria in the gut known as Clostridium scindens can help both the male and female bodies. This bacteria can increase blood estrogen levels and convert cortisol to male sex hormones while deconjugating the estrogen, allowing the hormone to be absorbed from the gut, advancing a more active serum estrogen.
Other studies have found that when bile acids are returned to the liver after circulating throughout the intestines and the body and accumulating in the biliary pool, the gut microbial community will produce bile acid metabolites through their capacity from the liver as an endocrine hormone.
How Bile Reflux Affect The Gut
When bile acids are abundant in the gastrointestinal tract, it can cause a backup to the stomach organ and cause damage to the wall linings to the stomach and esophagus. It can cause tissue damage and inflammation in the gut system when this happens. If left untreated, it can turn into GERD or SIBO, causing more gut inflammation and making a person’s life miserable. However, there are some ways to dampen the effects of bile reflux by utilizing anti-inflammatory therapy treatments.
What Is GERD?
When the role of bile acids is a cause of esophageal inflammation or Barrett’s esophagus, a condition in which the esophageal lining cells become transformed (pre-cancerous). This is known as GERD or gastroesophageal reflux disease. Research studies have shown that GERD usually occurs when stomach acid frequently flows back and forth into the tube that connects the mouth and stomach, which can irritate the esophagus lining. So bile acids will be exclusively in conjugated form unless there is abnormal bacterial deconjugation in the duodenum.
There is little reflux of duodenal fluid into the stomach or esophagus in a healthy person because intragastric pressure is higher than intraduodenal pressure. However, in individuals with disordered gastroduodenal motility or pyloric sphincter dysfunction, there may be duodenal reflux that leads to reflux from the stomach to the esophagus. Other research studies show that now and then, mostly everyone has acid reflux and heartburn, which is entirely normal. However, if a person has acid reflux or heartburn more than twice a week, they are developing GERD in their gut system.
Reflux of duodenal contents through the pyloric valve is purported to be more common after cholecystectomy but is also seen in individuals with an intact gall bladder. Bile reflux, as research shows, can occur when the bile acids are backed up in the stomach and can be accompanied by stomach acid reflux into the esophagus. There are many ways this can happen to the gut as bile acids are produced in the liver, and their job is to break down food into particles. Other research studies have shown that when the valves in the digestive tract are not functioning right, bile reflux can happen and flow right back into the organs where they don’t belong.
Since the liver is the one to produce bile acids, it is known as a nutrient signaling hormone that is essential for gut metabolism, energy balance, and homeostasis to glucose and lipids. All in all, bile acids are part of the digestive system as they help break down foods into particles and help them be transported throughout the entire body. When there is little bile fluid in the intestines, it can cause gut disorders like GERD or bile reflux, causing the bile acid to go into the stomach and causing irritation to the wall linings esophagus, causing discomfort to the individual. Incorporating anti-inflammatory treatments into the gut system can help the bile acids return to normal and make the body functional.
Kuhre, Rune E, et al. “Bile Acids Are Important Direct and Indirect Regulators of the Secretion of Appetite- and Metabolism-Regulating Hormones from the Gut and Pancreas.” Molecular Metabolism, Elsevier, May 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6001409/.
Medical Professionals, Cleveland Clinic. “Bile Reflux: Symptoms, Treatment, Causes & What It Is.” Cleveland Clinic, 18 Nov. 2021, my.clevelandclinic.org/health/diseases/22056-bile-reflux.
Medical Professionals, Cleveland Clinic. “Gerd (Chronic Acid Reflux): Symptoms, Treatment, & Causes.” Cleveland Clinic, 6 Dec. 2019, my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview.
Ridlon, Jason M, and Jasmohan S Bajaj. “The Human Gut Sterolbiome: Bile Acid-Microbiome Endocrine Aspects and Therapeutics.” Acta Pharmaceutica Sinica. B, U.S. National Library of Medicine, 9 Feb. 2015, pubmed.ncbi.nlm.nih.gov/26579434/.
Staff, Mayo Clinic. “Bile Reflux.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Jan. 2022, www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115.
Staff, Mayo Clinic. “Gastroesophageal Reflux Disease (GERD).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 22 May 2020, www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940.
Zagoskin, P P, and E I Erlykina. “Bile Acids as a New Type of Steroid Hormones Regulating Nonspecific Energy Expenditure of the Body (Review).” Sovremennye Tekhnologii v Meditsine, Privolzhsky Research Medical University, 28 Oct. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC8596256/.
Zhou, Huiping, and Phillip B Hylemon. “Bile Acids Are Nutrient Signaling Hormones.” Steroids, U.S. National Library of Medicine, Aug. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4073476/.
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