One of the underlying 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 gallbladder SIBO connection?
Bile is a soap-like substance that aids in the emulsification of fats. Bile also has antimicrobial properties. The connection between bile and SIBO lies in understanding the antimicrobial properties of 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 causes of SIBO having a sluggish gallbladder and low bile flow is one reason why someone can develop SIBO.
What is SIBO?
SIBO is just as the name implies “small intestinal bacterial overgrowth”. While 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.
One of the big contributing factors to developing SIBO include 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 breakdown 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 easily out or the gallbladder.
Phosphatidylcholine also helps to prevent gallstones from forming by preventing cholesterol from solidifying and forming gallstones in the gallbladder. It is very important that the phosphatidylcholine to cholesterol ratio is 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 gallbladder is stimulated by the hormone CCK to release bile when dietary fat is eaten. Having adequate phosphatidylcholine ensures the bile flows easily from the gallbladder.
- 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
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 am always thinking 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.
To prevent SIBO it is necessary to have both the ability to produce enough bile and to have adequate bile flow out of the gallbladder.
Phosphatidylcholine helps to promote bile flow. Gallbladder nutrients provide the nutrients required to make bile.
What is the purpose of bile?
You can think of bile as dish soap with 2 key 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 take low bile flow into consideration 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 are treated for SIBO.
Getting rid of SIBO is not as easy as just taking a round of antimicrobials 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 there SIBO 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 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.
Using ox bile for SIBO in conjunction with the phosphatidylcholine were the two supplements that 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 just 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 help support fat digestion ox bile is best taken with a food that contains some fat. 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 primary underlying causes of SIBO for you then you may experience a die-off reaction. Hitting the nail on the head can cause a die-off reaction. This means to go slow with the supplements.
When bacteria die they can release endotoxins and histamine that cause die-off reactions. Using a binder such as activated charcoal or bentonite clay helps to absorb toxins. 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 upon.
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.
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 🙂