Bile, Your Gallbladder, and Thyroid Health

Welcome to Healthy Gut Healthy Thyroid!

This is your weekly roundup of the BEST actionable steps for those people with thyroid and autoimmune thyroid conditions who want to restore their health…by healing their gut. Whether you have hyperthyroidism or Hashimoto’s you will benefit from the content in this newsletter.

In today's issue:

• Main Topic: The Relationship Between Bile, Your Gallbladder, and Thyroid Health

• Podcast Review: Do you need a thyroid meal plan?

• Understand Your Tests: Understanding Bilirubin

• Ask Dr. Eric: When should bile support supplements be considered?

The Relationship Between Bile, Your Gallbladder, and Thyroid Health

Bile is a vital fluid produced by the liver and stored and concentrated in the gallbladder. It plays a crucial role in digestion, specifically aiding in the breakdown of fats into fatty acids. A healthy bile flow is essential for efficient fat digestion and the absorption of fat-soluble vitamins (A, D, E, and K).

Each year, approximately 500,000 gallbladder surgeries are performed in the U.S., many of which could be avoided. Unfortunately, conventional treatments often fail to address the underlying causes of gallstones and poor bile metabolism.

The Real Problem Behind Gallstones

It is important to understand that most so-called "gallbladder issues" are, in fact, problems with bile metabolism. When bile becomes overly concentrated, substances in it can harden and form gallstones. While dietary habits are often blamed, other factors can contribute as well.

Estrogen dominance is one such factor. As discussed in Newsletter #18, estrogen dominance can be caused by various factors, including oral contraceptive use and hormone replacement therapy, especially when unopposed estrogen is administered. Research supports that both oral contraceptives,^1,2 and hormone replacement therapy^3,4 can increase the risk of gallstones.

Is There a Relationship Between Bile and Thyroid Health?

Thyroid hormones influence nearly every cell and tissue in the body, so it should come as no surprise that thyroid health directly impacts bile acid metabolism.^5,6 Studies show that thyroid hormones can alter bile flow.

In patients with hypothyroidism, bile flow is often reduced, which can increase the risk of gallstones.⁷ On the other hand, hyperthyroidism may lead to bile acid malabsorption,⁸ which also heightens the risk of gallstone formation.

How to Improve Bile Metabolism

Improving bile metabolism begins with dietary changes. A healthy diet supports liver function and bile production, both of which are essential for maintaining optimal bile flow and preventing bile-related issues.

✅Incorporate Whole, Plant-Based Foods. A diet rich in vegetables, fruits, and fiber supports healthy bile flow and helps maintain a healthy weight, reducing the risk of gallstones. High-fiber foods, such as leafy greens, cruciferous vegetables, and legumes, can aid in the excretion of excess cholesterol and bile acids.

✅Avoid Processed Foods and Sugars. Refined foods and excess sugar can overwhelm the liver and hinder its ability to produce healthy bile. Aim to limit processed foods, sugary snacks, and trans fats to reduce inflammation and improve liver health.

✅Support Liver Detoxification. Including liver-supporting foods like beets, artichokes, and milk thistle can help detoxify the liver and improve bile production. These foods enhance the liver's natural detox processes, which are essential for efficient bile production.

✅Healthy Fats. Consuming healthy fats, such as omega-3 fatty acids from fatty fish, flaxseeds, and walnuts, can help improve bile flow. These fats are important for the synthesis of bile acids and also support hormone balance.

✅Hydration. Staying well-hydrated is key for maintaining bile viscosity and improving its flow. Drinking adequate water supports overall liver function and helps keep bile from becoming overly concentrated.

Conclusion

Optimizing bile production and metabolism is essential for both digestion and overall health. By incorporating whole, plant-based foods, reducing processed foods and sugars, supporting liver detoxification, consuming healthy fats, and staying hydrated, you can improve bile flow and reduce the risk of gallstones.

Remember that thyroid health plays a significant role in bile metabolism, and addressing any thyroid imbalances can further support optimal bile function. Making these lifestyle adjustments can have a lasting positive impact on your digestive health and overall well-being.

Which Hyperthyroid Healing Diet Should You Follow?

There’s no single diet that everyone with hyperthyroidism should follow. Diet selection is a highly personal choice that must consider individual health conditions, lifestyle, and preferences.

In my book, The Hyperthyroid Healing Diet, I explore three different diets in detail, explaining what each involves and how you can start implementing the right one for you. This book will benefit those with Graves' disease, toxic multinodular goiter, and subclinical hyperthyroidism.

There is a lot of confusion when it comes to the foods people with hyperthyroidism should eat and which ones they should avoid, and the truth is that there isn’t a single diet that fits everyone perfectly. That’s why The Hyperthyroid Healing Diet doesn’t just focus on one diet, but instead gives multiple diet options, while at the same time guiding you towards the one most suitable for your situation and condition.

Note: those who purchase The Hyperthyroid Healing Diet will also gain access to the online resources, which includes dozens of recipes, checklists related to the different diet options, and a few bonus chapters not included in the book.

By reading this book you will discover the following:

✅ The ideal diet for Graves’ disease, toxic multinodular goiter, subacute thyroiditis, and subclinical hyperthyroidism

✅ Hidden sources of common allergens and other ingredients to avoid 3 ways to detect specific food triggers

✅ How much protein those with hyperthyroidism should consume on a daily basis

✅ The truth about food sources of iodine

✅ How to increase muscle mass and bone density

✅ What diet you should follow if you’re a vegan or vegetarian

✅ Addressing weight loss and weight gain concerns

✅ What you need to do to achieve optimal adrenal health How to optimize your adrenals, improve sleep quality and duration, and heal your gut

✅ And much, much more!

Click Here to Order the Hyperthyroid Healing Diet

Save My Thyroid Podcast Review

I have a podcast called "Save My Thyroid", where I discuss how people with hyperthyroidism and Hashimoto's can save their thyroid and regain their health. And during each edition of this newsletter I'll briefly discuss a recent podcast episode.

In a recent Q & A podcast episode I answered the question “Do you need a thyroid meal plan?” I start by explaining why paying attention to your body’s signals is more powerful than following rigid rules, then explore how a personalized, flexible approach creates more sustainable progress. I also share how I guide patients through food tracking, health coaching, and anti-inflammatory principles—all without relying on strict diets.

If you’ve ever felt frustrated trying to ‘follow the plan’ while still not seeing better results, this episode is for you. Tune in for a more grounded, individualized path forward.

Understand Your Tests

Understanding Bilirubin

Bilirubin is a vital component of bile, which plays a crucial role in the body’s detoxification processes. Bile is composed of three main components: 1) bilirubin, 2) bile acids and salts, and 3) cholesterol. Bilirubin is a toxic catabolic product resulting from the breakdown of heme, and one of bile’s primary functions is to facilitate the excretion of bilirubin from the body.

Roughly 80% of bilirubin is produced during the breakdown of hemoglobin in senescent (aging) red blood cells and prematurely destroyed erythroid cells in the bone marrow. The remaining bilirubin is derived from the turnover of various heme-containing proteins found in other tissues, most notably in the liver and muscles.⁹

Measuring Bilirubin in the Blood

Bilirubin levels are commonly measured as part of a comprehensive metabolic panel, a routine test that assesses the levels of several substances in the blood. Elevated bilirubin can be indicative of various underlying health issues, and there are several factors that can cause this marker to rise.

One potential cause of elevated bilirubin is hyperthyroidism. Over the years, I have observed many hyperthyroid patients experiencing transiently high bilirubin levels. These levels typically normalize once thyroid hormones are balanced.

Another common cause of elevated bilirubin is Gilbert’s syndrome, a genetic condition that results in mild increases in bilirubin due to a genetic variation affecting the liver's ability to process it. This condition typically does not cause major health issues, though bilirubin levels may fluctuate in response to stress, illness, or fasting.

Bilirubin in Urine

Bilirubin can also be detected in the urine as part of a urinalysis. Under normal conditions, urine should not contain any detectable bilirubin.

When bilirubin is present in urine, it may indicate liver dysfunction, biliary obstruction, congenital hyperbilirubinemia, viral or drug-induced hepatitis, or cirrhosis.¹⁰ The presence of bilirubin in the urine often warrants further investigation to determine the underlying cause of liver impairment.

Case Examples:

Patient Test #1: This test result shows a normal total bilirubin level, indicating that the liver is effectively processing bilirubin.

Patient Test #2: In this case, the patient had an elevated total bilirubin level, which could be indicative of liver dysfunction or other underlying conditions. In some cases, bilirubin levels can be reduced with proper medical intervention, although if the patient has Gilbert’s syndrome, the levels may not completely normalize.

Patient Test #3: This urinalysis result shows a negative bilirubin test, which is a normal finding. A negative result suggests there is no bilirubin present in the urine, ruling out conditions such as liver disease or biliary obstruction.

Ask Dr. Eric

During every issue I'll answer a question or two that I think can benefit most people with a thyroid or autoimmune thyroid condition. If you'd like for me to consider your question for a future edition of this newsletter email your question to [email protected].

QUESTION: WHEN SHOULD BILE SUPPORT SUPPLEMENTS BE CONSIDERED?

Dr. Eric, when should bile support supplements be considered?

Thank you for your question! To begin, it’s important to clarify which supplements fall under the category of "bile support supplements." Common examples of these include ox bile, taurine, and choline.

What Are the Benefits of These Supplements?

Taurine: Taurine is an amino acid that plays a key role in bile acid metabolism. It conjugates with bile acids to form bile salts, which are essential for the emulsification and digestion of fats. Adequate taurine levels are necessary for proper bile function.

Choline: Choline is a nutrient that contributes to bile production and secretion. It is often consumed in the form of phosphatidylcholine, a compound found in many foods like eggs and liver. Choline helps maintain the fluidity of cell membranes and supports liver function, which is critical for optimal bile flow.

Ox Bile: Ox bile supplements are concentrated sources of bile acids, primarily cholic acid and deoxycholic acid. These acids are essential for fat digestion and absorption, and taking ox bile can support individuals who have difficulty producing sufficient bile on their own.

When Should You Consider Taking a Bile Support Supplement?

While I often recommend digestive enzymes containing small amounts of betaine HCL and ox bile, there are specific situations where a dedicated bile support supplement is beneficial.

History of Gallstones: If someone has a history of gallstones, bile support supplements can help optimize bile flow and prevent further complications. Gallstones often form due to poor bile flow, and supplementation may assist in improving bile quality and flow.

Gallbladder Removal: After the gallbladder is removed, the body may have difficulty concentrating and storing bile. As a result, individuals without a gallbladder may need bile support supplements to aid in fat digestion. Removing the gallbladder does not address the underlying issue of bile metabolism, and supplementation can provide crucial support for digestion and nutrient absorption.

Additional Thyroid-Related Resources

Click Here for Do You Really Need a Thyroid Meal Plan?

Click Here for Bile Metabolism and Thyroid Health with Dr. Eric Balcavage (episode 142)

Click Here for The Importance of Bile In Thyroid Health (article)

Click Here to access hundreds of thyroid-related articles and blog posts

Click Here to join the Graves’ disease and Hashimoto’s community

Click Here to purchase one of Dr. Eric’s thyroid-related books

Click Here to work with Dr. Eric and his team

References:

Click Here to access the references

That’s a wrap