The importance of Bile Flow, Phosphatidylcholine and N-acetyl Cysteine

Human Liver

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N-acetyl cysteine, commonly known as NAC, is a powerful amino-acid precusor which is more accurately a type of protein. NAC is the supplement form of the amino-acid cysteine. With over 40 years of clinical research this multi-use supplement has been shown effective in a wide variety of applications.

Most notably NAC has the powerful ability to restore the bodies intracellular levels of Glutathionine. Now more popular than ever, Glutathione is quickly being recognised as one of our bodies most potent antioxidants. In the field of detoxification Glutathione is an essential molecule capable of preventing damage to important cellular components caused by ROS (reactive oxygen species), these include, peroxides, lipid peroxides, free radicals and, perhaps most importantly, heavy metals.

Whilst NAC is commonly known as the precursor to glutathione, alongside Glycine & L-Glutamate, it is also known to play an important role in bile health.

Bile health including bile consistency, bile viscosity and bile flow is an often overlooked part of maintaining good health. Whilst it’s clear the research on the microbiome as well as detox pathways have been receiving much attention in recent years, a glaring lack of publicity has been shown towards the gallbladder, the liver, and bile health in general.

What is bile?

Bile is a yellow-green fluid with antimicrobial qualities, producted consistently in the liver and then stored and concentrated in the gallbladder. Bile acts as a detergent and emulsifier which is released to aid digestion predominantly in the presence of fats.

Furthermore bile and it’s antimicrobial qualities are used to disinfect the small intestine. In contrast to the large intestine, the small intestine is not designed to house bacterial colonisation. If the small intestine develops an overgrowth of bacteria it can cause numerous problems for the host. This bacteria will feed on the sugars of the undigested food within the small bacteria and can cause flatuence as well as problems with fully digesting food. This in turn leads to further complications as the undigested food makes it’s way to the large intestine.

Bile and SIBO connection

Overgrowth of bacteria in the small intestines is now more commonly recognised and has been aptly named, SIBO (small intestinal bacterial overgrowth).

SIBO is traditionally treated with a course of antibiotics for around 2 weeks. Whilst antibiotics certainly have their specific purpose, this doesn’t appear to be a particularly effective means of treating SIBO. Whilst antibiotics may treat the bacteria living in the small intestine it does nothing to address the route of the problem. People suffering from SIBO may notice improvements initially but are unfortunately very likely to have symptoms reappear as the bacteria starts to recolonise the small intestine.

One very often overlooked cause of SIBO is a lack of quality bile flow. One of the main functions of bile, besides fat digestion, is to flush out bilirubin and excrete it as faeces. Bilirubin is a large component of bile itself and occurs naturally when the body breaks down red-blood cells. Bilirubin is a waste product and needs to be safely escorted out of the body if we are to maintain good health. When bile flow is weak the body is unable to escort bilirubin out of the body or effectively break down fats.

When fats are unable to be digested the body can develop numerous side effects and eventually a condition known as Steatorrhea. Steatorrhea is the presence of excess fat in the faeces.

Symptoms of inability to digest fats or Steatorrhea:

  • Pale stools (can be yellow, grey or orange)
  • Foul smelling stools
  • Stools that float
  • Stools with visible greasey coating
  • Oil droplets in the stool/toilet bowl

People suffering from Steatorrhea may go undiagnosed for years, or potentially be misdiagnosed as suffering from IBS, gluten Intollerance, allergies, and many other gastrointestinal conditions. Widely known as a type of malabsorbion, poor fat absorbtion can result in a number of other problems. Steatorrhea is estimated to be the result of poor bile flow.

Symptoms of poor bile flow include:

  • SIBO
  • Eratic bowel movements
  • Pale stool
  • Gas
  • Alternating diarrhea and constipation
  • Abdominal pain
  • Indigestion
  • Heart burn
  • Foul smelling gas
  • Abdominal ‘tightness’
  • Bloating
  • Jaundice
  • Low appetite
  • Poor fat digestion
  • Acid reflux
  • Vitamins A, D, E & K deficiency
  • Calcium deficiency

If you suffer from one or more of these symptoms you may be experiencing the signs of poor bile flow.

Interestingly there is growing evidence that chronic Vitamin D deficiency can be in part due to poor bile health. Whilst Vitamin D & A have been found to be directly responsible for bile homeostasis, paradoxically a lack of quality bile flow may initially inhibit the absorbion of both vitamin D & A, creating a malabsorbion feedback loop. This is especially concerning considering adequete levels of Vitamin D are neccessary to maintain liver health to begin with.

What can we do to improve bile flow?

Bile production requries a conditionally essential amino-acid Taurine, and a non-essential amino-acid Glycine for adequate synthesis. It also requires ample levels of cholesterol, vitamin C, Vitamin D, Vitamin A and lecithin for optimal production.

To prevent a sludgy bile consistency, which in turn leads to poor bile flow, the body first requires Phosphatidylcholine. There are two commonly available sources of Phosphatidylcholine, these include Sunflower lecithin and Soy Lecithin. Lecithin itself refers to a group of natural fats found in both plants or animals. Lecithin is known as amphiphilic for its ability to attract both water and fatty substances, which aids its ability to prevent sludgy bile.

Phosphatidylcholine is even known to help prevent gallstones by maintaining a suitable ratio to cholesterol. Whilst in correct ratio to eachother Phosphatidylcholine prevents cholesterol from stagnating, solidifying and thus developing into gallstones in the gallbladder.

Gallstones are often a sign that bile production is weak to begin with which is why its important to maintain optimal Phosphatidylcholine levels. This is especially true for those who have already experienced gallstones, or may be prone to gallstones.

Maintaining healthy levels of Phosphatidylcholine is essential for regulating healthy bile flow and to prevent gallstones.

N-acetyl Cysteine (NAC) and Bile Flow

Preventing gallstones, or excess cholesterol buildup, in the gallbladder is key to healthy bile flow. Whilst experts are divided on the exact cause of gallstones, most believe a combination of poor bile flow, liver health and excess cholesterol is likely to be the cause. Your liver naturally secrets cholesterol which is dissolved by bile flow. However excessive amounts of cholesterol from diet can mean more bile is required, oftentimes your bile is unable to completely dissolve sufficient amounts of cholesterol, which can result in the formation of gallstones.

This is especially likely if you already have poor liver health, caused by either excessive alcohol consumption, perscription or recreational drug use, high-fat diet, chronic emotional disturbances, or simply genetics.

People are often surprised that improving the state of the liver can have massive benefits to digestive health. Many people report huge improvements in their gastrointestinal function as a result of targeting their liver. As the liver is our number one detoxification organ, it’s imperative it’s kept healthy to maintain well-being.

Modern life is full of enviromental toxins of which the majority have not been studied for long-term human consumption. Whilst we can make every effort to consciously reduce exposure to toxins, some exposure is simply unavoidable.

Examples of Liver Stressors

  • Coffee & Energy Drinks
  • Alcohol
  • Food allergies
  • Heavy metals
  • Pesticides
  • Smoking
  • Stress
  • Processed foods
  • GMO’s
  • Sugar
  • Perscription medicine
  • Infections
  • Fluoride
  • PCB’s
  • Excess iron
  • Flame retardants
  • Cosmetics & beauty products
  • Poor quality supplements

There is one over the counter supplement that has been linked to dramatic improvements to liver health and that’s NAC.

NAC or N-acetylcysteine is a mucolytic, which means it assists the body in thinning out or breaking down mucus. This is why NAC has been so successful in treating a variety of lung-conditions. It’s often perscribed or recommended to people suffering from bronchitis, COPD, or chest congestion.

What’s more interesting is this mucolytic can have similar benefits to our bile viscocity as well as overall liver health. In fact, NAC is such a potent antioxidant that it’s the main antidote perscribed to treat paracetamol overdose in emergency rooms. When used this way it boasts an almost 100% success rate in preventing liver damage when administered within 8 hours of the overdose.

Adding to its long list of established benefits, NAC has also been shown to be extremely helpful at improving bile flow. When used clinically NAC was shown to significantly improve bile production after liver surgery.

Another study has demonstrated the addition of NAC to bile systems accelerates the dissolution (disolving) of cholesterol gallstones. “These results indicate that the mucolytic agent N-acetylcysteine significantly accelerates in-vitro gallstone dissolution.

Coupled with it’s long established ability to increase gluathione in the body, NAC is likely one of the top-5 most beneficial over the counter supplements available today.

Although recent news has shown that this wonder-supplements availability may be in jeopardy. With increasing claims of its benefits comes increased scrutiny. Whilst NAC has received very little attention in the mainsteam or even alternative health industry for almost 40 years, it has recently come under fire.

One can only speculate as to why this may be the case. However studies in 2021 have shown NAC’s astonishing ability to reduce the risk for mechnical ventilation and mortality when patients are suffering with a certain novel viral infection. Showing NAC treatment significantly reduced 14- and 28-day mortality in patients with severe disease.

Perhaps the most interesting study surrounding NAC concludes with the following;

N-acetylcysteine (NAC) is inexpensive, has very low toxicity, has been FDA approved for many years, and has the potential to improve therapeutic strategies for a particular novel-virus. NAC administered intravenously, orally, or inhaled, may suppress this novel-virus replication and may improve outcomes if used timely. Potential therapeutic benefits of NAC include, extracellularly scavenging ROS radicals, replenishing intracellular GSH, suppression of cytokine storm, and T cell protection, thus mitigating inflammation and tissue injury. NAC administration in combination with other antiviral agents may dramatically reduce hospital admission rate, mechanical ventilation and mortality.

Supplementing with as little as 600mg of N-acetylcysteine has been proven to improve cell-mediated immunity. However many people supplement with anywhere between 600mg-2000mg for multiple months with no risk of toxcitiy. Some people also recommend taking NAC twice per day to maximise effects.

Final thoughts on Bile Flow, Phosphatidylcholine and N-acetyl Cysteine

Our bile flow remains an unpopular area of discussion for reasons unknown to me, however the evidence largely proves our entire health revolves around this mechanism of action. It would not be incorrect to assume improving ones bile health would have dramatic benefits to all areas of our health. Improving the health of the bile improves our digestion as a whole and can create a cascade of other benefits as a result. In conclusion an inexpensive way to maintain bile health can be achieved through healthy diet, as well as supplementation of both Phosphatidylcholine and N-acetyl cysteine (NAC).

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