Bile Recycling

Bile is reabsorbed at the distal ileum, the final section of the small intestine. The body normally recycles approximately 97% of all bile that passes through the small intestine. Bile acts as a detergent in the small intestine, killing microbes that should remain confined to the large intestine. Ninety percent of all bile is recycled by gut microbes. Bile is a detergent-like substance produced by the liver, stored in the gallbladder, and released into the small intestine to emulsify dietary fats for absorption. Gut microbes are essential to enterohepatic circulation, the process by which bile is recycled back to the liver after use. Ileitis or other inflammatory conditions of the distal ileum impair bile reabsorption. Without microbial bile recycling, bile salt levels fall sharply and the body loses the ability to absorb fat-soluble vitamins A, D, E, K1, and K2. When microbial populations are insufficient, bile is lost through the stool rather than being properly reabsorbed. Omega-3 fatty acid and essential fatty acid absorption is also impaired when bile recycling is disrupted. Bile deficiency from inadequate microbial recycling cascades into deficiencies of all fat-soluble vita…