The connection between bile and SIBO lies in understanding the antimicrobial properties of bile.
One of the underlying root causes of SIBO that no one is talking about is having insufficient bile production and low bile flow from the gallbladder. A sluggish gallbladder contributes to SIBO, also known as small intestinal bacterial overgrowth. But what is the connection between a sluggish gallbladder and SIBO?
Bile is a soap-like substance that aids in the emulsification of fats. Bile also has antimicrobial properties.
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The connection between SIBO and bile
Bile is antimicrobial and helps to keep the terrain of the small intestine clean. Having enough bile prevents bacteria from the colon from colonizing the small intestine. Bile is your body’s natural defense to prevent SIBO.
While there can be other underlying root causes of SIBO, having a sluggish gallbladder and low bile flow is one reason someone can develop SIBO.
SIBO is, just as the name implies, “small intestinal bacterial overgrowth.” In contrast, the colon contains large numbers of bacteria. The small intestine is not meant to house large numbers of bacteria.
Small intestinal bacterial overgrowth can be an overgrowth of bacteria from the colon or pathogenic bacteria. SIBO can also be an increase in the normal bacteria that are meant to be found in the small intestine. It is the overgrowth of any bacteria strains that causes symptoms of SIBO.
Some common symptoms of SIBO include
- bloating
- upper abdominal bloating
- burping
- heartburn
- gas
- stomach pains
- loose stools.
The Gallbladder and SIBO
One of the significant root causes of SIBO is poor bile production or low bile flow from the gallbladder.
Bile is produced in the liver by the hepatocytes and is stored in the gallbladder. The primary function of the bile is to emulsify fats so that the pancreatic enzyme lipase can further break down fats.
The second function of bile is to disinfect the small intestine to prevent SIBO. The antimicrobial properties of bile to prevent SIBO is often missed by many practitioners.
The production of bile requires amino acids taurine and glycine, cholesterol, vitamin C, and lecithin. Vitamin C is needed for the enzymatic conversion of cholesterol to bile salts. Taurine and glycine are conjugated with bile salts.
Phosphatidylcholine is crucial for bile flow support by preventing sludgy bile. Sunflower lecithin contains phosphatidylcholine, which keeps bile flowing smoothly out of the gallbladder.
Phosphatidylcholine also helps prevent gallstones from forming by preventing cholesterol from solidifying and developing gallstones in the gallbladder. The phosphatidylcholine to cholesterol ratio must be in balance to prevent gallstones.
The formation of gallstones can block bile flow from the gallbladder. Thus, phosphatidylcholine is crucial for bile flow support and the prevention of gallstones.
The hormone CCK stimulates the gallbladder to release bile when dietary fat is eaten. Having adequate phosphatidylcholine ensures the bile flows easily from the gallbladder. Understanding the connection between the gallbladder and SIBO is crucial for healing SIBO for good.
Symptoms of low bile flow and signs that your gallbladder requires support include:
- light or grey-colored stools
- constipation
- alternating between constipation or loose stools
- nausea
- right shoulder pain
- abdominal discomfort
- gallstones
- greasy stools
- floating stools
- fat malabsorption
These symptoms of low bile flow alongside SIBO symptoms indicate poor bile flow is an underlying cause of SIBO. Supporting a sluggish gallbladder is crucial to prevent SIBO overgrowth and relapse.
SIBO and Constipation
Low bile production and constipation is a common symptom I see associated with SIBO. Bile helps to stimulate peristalsis in the intestinal tract. If someone has poor bile flow, the bowels are often sluggish leading to constipation.
I always think about the gallbladder as a root cause of SIBO if someone has constipation and SIBO. Supporting the gallbladder with sunflower lecithin for bile flow often helps to relieve constipation. One of the primary benefits that I see with clients using phosphatidylcholine is improved bowel movements.
It is necessary to have both the ability to produce enough bile and to have adequate bile flow out of the gallbladder to prevent SIBO.
Phosphatidylcholine helps to promote bile flow. Gallbladder nutrients provide the nutrients required to make bile.
The purpose of bile for SIBO
You can think of bile as dish soap with two fundamental properties.
#1 The purpose of bile in the digestive process is to emulsify fats from the diet. Dietary fats can then be further broken down by pancreatic enzymes and absorbed. Bile also helps with the absorption of the fat-soluble vitamins A, D, E, K.
#2 Bile is antimicrobial which prevents bacteria from growing in the small intestine. Optimizing bile flow is key to maintaining an environment in the small intestine where SIBO cannot thrive.
There are many underlying causes of SIBO. But it is crucial to consider low bile flow as a root cause of SIBO and look at the body from a holistic approach. The antimicrobial properties of bile are huge for inhibiting small intestinal bacterial overgrowth.
Everyone may have different underlying factors that are contributing to SIBO. A sluggish gallbladder and poor bile flow are often missed when people have treated SIBO with antimicrobials or antibiotics. SIBO almost always returns even after treatment if the root cause of SIBO is a sluggish gallbladder that has not been supported. Problems with the gallbladder and SIBO is very common.
Getting rid of SIBO is not as easy as just taking a round of antmicrobials or antibiotics for SIBO. Especially for anyone who has a sluggish gallbladder. SIBO will often return for those who never addressed poor bile flow in their SIBO healing protocol.
The best way to prevent SIBO from occurring or reoccurring is to have optimal bile flow.
I pinpointed a sluggish gallbladder and liver as the root cause of my SIBO. Since using phosphatidylcholine and ox bile, I no longer experience heartburn which was one of my primary ‘symptoms’ of SIBO.
My digestion has massively improved since targeting the liver and gallbladder as the root cause of my SIBO symptoms. The liver and gallbladder were the digestive organs that needed the most support in my body.
How to use ox bile for SIBO
Using ox bile for SIBO in conjunction with phosphatidylcholine was the two supplements I used to kick my SIBO. It makes sense, though, when you think about it. Instead of using all sorts of antimicrobial supplements, you can support your antimicrobial defenses by providing bile flow support.
The reason why ox bile works for reducing SIBO is due to the antimicrobial factors found in bile.
I used ox bile on an empty stomach for its antimicrobial properties to reduce SIBO. The dosage for ox bile will vary for each individual.
Taking too much ox bile can cause diarrhea. I used 125 mg of ox bile from Seeking Health on an empty stomach to help get rid of my SIBO. I tolerated this amount just fine.
Many ox bile supplements come in 500 mg. When using a supplement for the first time, starting low and increasing as needed is always best.
Ox bile is best taken with a food that contains some fat to support fat digestion. Before using ox bile, I always like to support the body with nutrients to make healthy bile and promote bile flow first.
If low bile flow is one of the underlying root causes of SIBO for you, you may experience a die-off reaction. Hitting the nail on the head can cause a die-off reaction. This means go slow with the supplements.
When bacteria die, they can release endotoxins and histamine that cause die-off reactions. A binder such as activated charcoal helps absorb toxins and prevent die-off reactions. Optimizing the terrain of the small intestine with antimicrobial bile is crucial to prevent SIBO.
Seeking Health’s Optimal PC (phosphatidylcholine) helps to support the flow of bile from the gallbladder. It is also a key component that makes up bile. This supplement is best taken with food.
Gallbladder nutrients provide the liver with the nutrients to make healthy bile along with promoting bile flow. This supplement is crucial for maintaining a healthy gallbladder.
Taking a digestive enzyme with meals is also very beneficial to reduce SIBO. Pro Digestion Intensive helps to break down all food, including difficult-to-digest legumes, beans, fiber, sugars, and gluten.
Digestive enzymes ensure there are no excess undigested starches in the small intestine for bacteria to ferment.
Subscribe to my newsletter to recieve my ultimate gut health guide and access to my FREE resource library with recipe books for SIBO, IBS and weight loss.
If you are struggling with SIBO, Dr. Nirala Jacobi from the SIBO Doctor has a very informative patient SIBO success course to beat SIBO for good. This course covers
- additional underlying causes of SIBO
- testing for SIBO
- Symptoms of SIBO
- types of SIBO
- biphasic SIBO diet
- antimicrobials for SIBO
And much more!
Dr. Nirala Jacobi has been my go-to resource for information on SIBO. There is so much to know about SIBO, and the SIBO success plan covers all the essentials you need to know about SIBO to beat SIBO for good.
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How I Used Ox Bile and Sunflower Lecithin to Beat my SIBO
So happy to find this article!! So I would take the optimal PC but where would I get the ox bile? I have Standard Process choline and betafood here. Any of those any good?
Thank you!! Debbie
Hi Debbie, Yes both those supplements look good as choline is needed to help make phosphatidylcholine for bile flow and beets are one of my favorite super foods for the gallbladder, but often times that is still not enough for some people. I see Optimal PC being very effective. Ox bile is for additional fat digestion support which can be purchased from seeking health as well (it has a lower dose than most ox bile supplements which is a nice start) otherwise you can look for sunflower lecithin or ox bile on i herb as well:) thanks for your question and I hope that helps!
Thanks for the info! How much did you take to get rid of your SIBO?
Hi Natalie, I am glad you enjoyed the article. I took optimal PC for about a month once daily then brought in Ox bile in which I took on an empty stomach and fully got rid of my mild indigestion and heartburn which was my primary SIBO symptom. Optimal PC is a supplement that I still use in my long term maintenance protocol as it is a supplement that works really well for me to help with fat digestion and keeping my gallbladder happy 🙂
You took optimal first then after u quit that one you took ox bile right ? Or both together ? Also where can I find oxbile?
Hi Sorry for the late response. Yes I took optimal PC first for about a month then added in 1 capsule of Ox bile from Seeking Health every second day for about another month before I no longer felt the need to take the ox bile. I still take the optimal PC a couple times per week but because sunflower lecithin is high in the omega 6 fats I balance it with a the optimal fish oil from seeking health as well to be sure I am getting in the omega 3’s and not throwing my fatty acids out of balance 🙂 From time to time I will still use Ox bile on an empty stomach to maintain my results but my primary focus is support my body’s own production and flow of bile from the gallbladder.
Thank you so much for this informative article. I have struggled for years with bad digestion, bloating gas etc. My gallbladder was taken out 7 years back. Really grateful to you for sharing your knowledge. People like u make this world a better place to live in. May u be blessed with good health.
I would like to know how much of optimal pc to take with a meal? How many times in a day? Thanks again.
Hi Vandy,
Thanks so much for your response and I am so glad you found the article helpful. Everyone tolerates optimal PC at different doses. I would start with 1 tsp daily with food and increase to 2 tsp daily of the liquid optimal PC depending on how you feel with it. Also for the long term, I always recommend taking a fish oil with optimal PC to balance out the omega 6 fats in the optimal PC. Hope that helps 🙂
Hey great article, did you have methane or hydrogen dominant sibo in other others was it constipation or diarrhea. I ask because I have hydrogen dominant sibo (diarrhea) and don’t know if my issue is low bile or bile malsorption all together. Also did you have any side effects while taking these supplements?
Hi Joe,
I never tested for SIBO via a breath test but I was always more prone to loose stools and not constipation. I definitely had symptoms of fat malabsorption which is why I knew to target my liver and gallbladder. Optimal PC worked like magic for me overnight and turned my stools almost black and well-formed for a few days then returned to a normal brown color. After a month of taking sunflower lecithin, I noticed that I had more inflammation and skin scratches took longer to heal so I cut back and started on a fish oil to balance the omega 6 6o 3 ratios. It is important to balance sunflower lecithin which is high in omega 6 fats with omega 3 fats with any long-term use. I had minor red skin in the corner of my mouth after taking ox bile but aside from that no side effects for me although my SIBO symptoms of acid reflux disappeared after 1-2 months. Hope that helps 🙂
Hi- I just been diagnosed with a 21 mm size gallstone having been previously diagnosed with SIBO 2 years ago- your article is like a light coming on! I am currently following an AAyurvedic treatment plan for the gallstone/ NFLD ( stage 1 non alcohol related fatty liver) component but it sounds as if adding the phosphatidylcholine might help?
Hi Wende,
When I learnt about the SIBO gallbladder connection and the use of phosphatidylcholine for sludgy bile, it felt like a light coming on as well and was a very useful supplement for me. I see phosphatidylcholine work well for many people but always work with your practitioner with it. I also highly recommend reading Dirty Genes by Dr Ben Lynch and the Chapter on the PEMT gene:)
Question what does this mean if I have had my gallbladder removed, I had it removed about 5 years ago caused by gallstones. My digestion has been horrible and I believe I can have sibo.
Hi Marcela, thanks for your question. Yes Digestion would not be optimal if the gallbladder was removed as it is a primary organ involved in digestion. The gallbladder acts as storage for bile and releases bile when stimulated to help with digestion of fats. Phosphatidylcholine also needs to be in balance to prevent cholesterol stones from building up in the gallbladder so the production of phosphatidylcholine could have been sub optimal prior to surgery. I still like to support the production and flow of bile with gallbladder nutrients and optimal pc but you may also need to bring in external ox bile with fatty meals 🙂
Thanks for the information. I have been fighting methane dominant SIBO. I also have Humira-controlled Crohn’s Disease and an allergy to wheat and corn, I also have a fatty liver. I am 35 and 145 lbs. I have done 2 rounds of Xifaxin.
Hi Stephanie, Thanks for sharing your history. SIBO can be tough and hard to beat if a fatty liver and gallbladder issues are not addressed. Learning this information was a game changer for me and I always start with supporting the liver and gallbladder prior to anti-microbials to strengthen the bodies own internal defenses to prevent SIBO from recurring 🙂
Hi! Thank you for this article! Last year I was diagnosed with SIBO and malabsorption syndrome especially fat malabsorption (steatorrhea). My stools are yellow and oily. I lost 10 kilos, I was thin, now I’m skinny. Do you know how long it takes to absorb / gain weight with ox bile?
Hi Nat, Thanks for sharing your story. If you still have your gallbladder I actually like to optimize the function of the liver and gallbladder first before using ox bile with beet root and dandelion tea or with supplements such as gallbladder nutrients, liver nutrients and optimal PC from seeking health but go slow and work with a practitioner or reach out if you need additional support 🙂
If you have chronic diarrhea and diagnosed with sibo with fat malabsorption, does that still mean you aren’t producing enough bile? Or does that mean you are producing too much bile?
Hi Andrea, those symptoms are most likely associated with not enough bile being produced or a sluggish gallbladder where bile flow is low. Hope that helps 🙂
Hi, I was diagnosed with Sibo recently and have had ongoing pain where my gallbladder is located that wraps around my back. Two scans show no signs of stones so perhaps it’s just a sluggish gallbladder? I also have diahrrea not constipation, could that be too much bile?
Hi Yolanda, yes it still can be a sluggish gallbladder where there are no stones but the bile is still thick and sludgy. Diahrrea can be associated with hydrogen dominant SIBO. I personally was more prone to loose stools and never constipation yet symptoms improved for me with bile flow support so it still can be low bile flow. Both Diarrhea and constipation can be a result of a sluggish gallbladder and low bile flow.
Hi!
This article is so helpful, thank you.
I am wondering as someone with a long term history of SIBO and chronic issues with constipation, IBS/leaky gut, histamine intolerance, hypothyroidism, chronic fatigue syndrome, and difficulty digesting fats, would you suggest starting with the gallbladder or liver nutrients before trying optimal pc, or start with optimal pc? I am generally pretty sensitive. Thank you!
Hi Ash, I am glad you found the article helpful and thanks for sharing your story. If you find your self very sensitive with histamine intolerance I would actually start with the liposomal vitamin c from seeking health which has the optimal pc in it but in a lower dose than the optimal pc. It is also a liquid so you can start slow and easily work up. I have seen better results with with gallbladder nutrients and again that supplement is a powder that you mix with water so you can start slow with that as well:)
Hi! I do not have a gallbladder and I am extremely sensitive, as well. I have taken multiple rounds of xiafaxin and my sibo always returns. Since I do not have a gallbladder, what protocol should I follow? Will the liposomal vitamin c be a good start? So happy to have found this article as I am at my wits end with this. I also follow a low fodmap diet. Thank you!
Hi Amber, thanks so much for posting this, very informative. I’ve recently started supplementing with bile after getting generally bloated and lethargic when eating fats, and also noticing yellow and oily stools. I’ve noticed however that bile seems to make my stools quite a bit looser even at small amounts. I’ve also generally felt sluggish and had low energy. I have noticed though my bloating has dropped a bit.
I’m happy to persevere with it as I figured potentially the gut is getting used to having to re-absorb bile again, and that the slugglishness may just be a herx die off. Do this approach make sense to you?
Hi Will, thanks for your question, yes that does make sense to me and the loose stools could be a die off healing reaction. With healing reactions I generally pull back and go a bit slower but push through as well sometimes as long as i’m seeing improvements in other areas but if you don’t get better and notice improvements then I would check in with your practitioner. I also really focus on slowly optimizing the bodies own production of bile and bile flow through with gallbladder nutrients and phosphatidylcholine for anyone who still has a gallbadder before using the ox bile as this really addresses the root of the problem. Hope that helps 🙂
Hi, I really enjoyed your articles, and am wondering if once you heal the liver/gallbladder issues, and SIBO, will my Leaky gut issues resolve on there own? or will I need supplementation?
Hi Jason, I am glad you enjoyed the articles and found them helpful. Leaky gut can have many underlying causes with gallbladder issues and SIBO as a contributing factor so if you address and fix that probem yes it will help to heal leaky gut but you may also need to address other underlying causes and or take supplements to heal leaky gut. Everyone is different and it depends on if your symptoms resolve after getting rid of SIBO and supporting the gallbladder:)
Hello,
Thank you for the information. I just took a SIBO test and did an abdominal ultrasound which showed “gallbladder sludge”. I assumed they had to be somewhat connected and this seems to confirm that. My doctor has me on the bi-phasic diet for the SIBO but my issue is it requires that I avoid high fibrous foods like whole wheat and various veggies but everything I read about clearing gallbladder sludge says to increase the fiber intake. Is this supplement something that could maybe bridge the gap?
Hi Andrew, You have just pointed out the exact problem with the SIBO diet that I see especially when bile is sludgy and not flowing well from the gallbladder. The SIBO diet is often high in fat and protein and deficient in liver cleansing fruits and vegetables. Sunflower lecithin does help to bridge that gap and get sludgy bile flowing again. I really like to focus on low fodmap vegetables when on the SIBO diet such as leafy greens. Canned artichoke and beetroot in small amounts is great as well on the semi restricted diet. The SIBO Bi phasic diet is great for SIBO while also addressing the root causes such as the sluggish gallbladder. The SIBO diet is not intended for the long term but some people seem to get stuck on such a restricted diet if the gallbladder is not addressed. In time you should be able to add in more liver cleansing vegetables and fruits especially when antimicrobial bile is flowing better:)
Hi Amber. I’m on my 2nd try at eliminating SIBO to relieve my acid reflux. My practitioner has me on the Elemental Diet by Integrative Therapeutics. On the 1st try SIBO came right back. I will be on the biPhase restricted diet after the 14 day on the Elemental.diet. On that first try I saw no relief from the reflux (night time mostly).I can taste the reflux at night and my saliva gets yellow and my esophagus is hoarse upon waking. What do you think of the Elemental Diet and should I supplement the bi-Phase diet afterwards with Sunflower Lecithin and anything else? Thank you for your article; I thought I was at the end of my options list but I’m hoping this new information might help. George
Hi George, thanks for your question and sorry for the delay. If your SIBO came back after your first treatment then yes i would be looking at root causes such as a sluggish gallbladder. Addressing the gallbladder with lecithin and ox bile is how I got rid of my acid reflux. I also focus on liver cleansing vegetables. I have not used the elemental diet, so i do not have experience there but i can see how it is helpful to initially help reduce SIBO symptoms. Gallbladder Nutrients by Seeking Health is another fantastic supplement to support both bile production and bile flow. You can check out my latest blog post on that. It works well when combined with the sunflower leciithin. I do use the SIBO Biphasic diet for short periods of time but if SIBO continues to come back then I always look to supporting the liver and gallbladder to get bile flowing optimally. This is one of your bodies natural defenses to prevent bacterial overgrowth in the small intestine. While on the SIBO diet you can focus on low fodmap fruits and vegetables to cleanse the liver. A little beetroot and bitter greens such as rocket is fantastic. Hope this helps and good luck on your SIBO journey. If you ever need one on one support reach out 🙂
What do I do if I do not have a gallbladder? I read to take the Ox Bile but what else can I do?
Hi Tony, you can still support the liver with nutrients for optimal bile production and flow such as optimal PC and Gallbladder Nutrients from Seeking Health. But since you no longer have a gallbladder you wont store bile which is released in larger amounts by the gallbladder when fats are eaten. Ox bile is beneficial to take with meals containing fats as not enough bile is released at once for optimal fat digestion. Check with your health care provider or professional for what they recommend as well. Bitter greens, beets, artichoke, lemon and choline from eggs are fantastic foods to support the liver and promote optimal bile flow even though you do not have a gallbladder that stores the bile.
Hi Amber, Amazing article! I have SIBO (the worst my doctor has ever seen on test results!). Saying this, I have very few symptoms (bloating, constipation and a tiny bit of acid reflux). However, I have constipation – which is not the most common for hydrogen SIBO so like you I suspect a bile issue. I have been using Optimal PC in the last three days and have already seen an improvement for the constipation! I started the bi-phasic diet three weeks ago now. My doctor seems to focus on motility only (improve transit with herbs, etc) but I think that the issue is related to my gallblader and liver. Many thanks for all the info, it’s been a lifesaver. I say this as I had read Dirty Genes and the PEMT chapter last year but had not really paid too much attention to this connection so your article really heped connect the dots and highlight the issue in a clear, concise manner.
Quick question, I’m about to start liposomal Vit C (already on Rosita cod liver oil) and wanted to start the gallblader supplement and ox bile but from what you seem to recommend it would be best to wait a few weeks until Optimal PC works its magic? Also, the gallblader supplement contains ingredients only allowed in the second phase of the bi-phasic diet so I guess I should just wait to introduce it before I reach the second phase anyway?
Thank you!
Hi Elsa, I am so glad you found the article helpful and that you have already seen improvements! Yes, sometimes we need to hear or read things a couple times before we really connect the dots. So frequently I see and hear people struggling with the combo between constipation, SIBO and a sluggish gallbladder which doesn’t seem to be common knowledge so I’m glad you were able to put it together. I don’t always do a strict SIBO diet but I do always optimize gallbladder function as much as possible before using the ox bile or antimicrobials. It is nice to bring supplements in slowly but up to you if you want to wait or bring in the gallbladder nutrients sooner. I see optimizing gallbladder function as part of the phase 1 protocol but it really depends on how your body is responding. Then Yes Phase 2 of the SIBO diet is where additional Ox bile or antimicrobials are useful after you have addressed the underlying root cause 🙂
Interesting article. I have gallstones, and I suspect a sluggish bile flow. Constipation, yellowish stool. Is the hida scan with CCK a good way to assess this?
Hi Maggie, I am not familiar with the hida scan, but constipation and yellowish stool warrant a red flag. I go off of symptoms with my clients which you see to have a couple but be sure to work with a practitioner as you optimize or asses things 🙂
Hi Amber, thanks for sharing all this info on your very informative webpage. I have a specific question on taking ox bile as a supplement. Do you need to first increase the receptors that handle bile to protect the gut etc? I have red this on a few different online pages.
Thanks!
Hi David that is a very good question in which I don’t have the answer although everyone does have a different microbiome with some people harboring bacteria that deconjugate bile acids. It is often trial and error and starting low and seeing if you tolerate ox bile. I only recommend Ox bile for a short period of time unless someone has had their gallbladder removed in which it is beneficial to take with fatty meals.
Hi Amber
This is a great article. I have one question: in another article you mention that you took ox bile along with sunflower lecithin. I just ordered a supplement which has pure phosphatidylcholine, would this also work or is it specifically the sunflower lecithin that you recommend? Would love to hear back from you. Thank you.
I have used both optimal PC by seeking health with phosphatidylcholine and sunflower lecithin and they have both worked. Pure phosphatidylcholine is great as well as that is the ingredient I recommend in the sunflower lecithin to promote bile flow. Hope that helps 🙂
I am finding your emails and site very helpful! Thank you for sharing so much here. I haven’t taken PC yet, but I do take choline. Would it be fine to take PC with the choline, in your understanding? I am hoping to get my snps tested soon! The pieces are all coming together for me – history of gallbladder issues, gut issues, low stomach acid, elevated liver enzymes, mast cell, and now sibo symptoms. Thank you!