What should bile salt levels be

Bile acids are formed in the liver from cholesterol, conjugated primarily to glycine and taurine, stored and concentrated in the gallbladder, and secreted into the intestine after the ingestion of a meal.

In the intestinal lumen, the bile acids serve to emulsify ingested fats and thereby promote digestion. The efficiency of the hepatic clearance of bile acids from portal blood maintains serum concentrations at low levels in normal persons. An elevated fasting level, due to impaired hepatic clearance, is a sensitive indicator of liver disease.

Following meals, serum bile acid levels have been shown to increase only slightly in normal persons but markedly in patients with various liver diseases, including cirrhosis, hepatitis, cholestasis, portal-vein thrombosis, Budd-Chiari syndrome, cholangitis, Wilson disease, and hemochromatosis. No increase in bile acids will be noted in patients with intestinal malabsorption.

Metabolic hepatic disorders involving organic anions eg, Gilbert disease, Crigler-Najjar syndrome, and Dubin-Johnson syndrome do not cause abnormal serum bile acid concentrations. Significant increases in total bile acids in nonfasting pregnant females can aid in the diagnosis of cholestasis.

Other factors, such as complete medical history, physical exam, and liver function tests should also be considered. Total bile acids are metabolized in the liver and can serve as a marker for normal liver function. Increases in serum bile acids are seen in patients with acute hepatitis, chronic hepatitis, liver sclerosis, and liver cancer. Serum total bile acid testing is generally not suitable for differentiation among the various types of liver diseases.

Bile acids are essential, as they help the body digest food and absorb the fat-soluble vitamins we need for our bodies. During a meal, the gallbladder contracts and deposits bile into the gut if you have had your gallbladder removed, bile will be secreted directly to the gut.

Once there, and with the help of bacteria in the gut, the bile acids are turned into secondary and tertiary bile acids, including UDCA. This entire process is called the enterohepatic circulation. In ICP there is no evidence that individual bile acids need to be measured, so most laboratories will perform a total bile acid measurement, which includes both bile acids and salts. Click here for a pictorial representation of bile acid. The bile acids accumulate in the liver and eventually leak back into the blood, causing raised levels in the blood.

Because the bile acids are quite toxic it is important to try to reduce the levels. They are not thought to be harmful to you during an ICP pregnancy because they are only raised for a limited amount of time, but they may be the reason why some babies have been born prematurely or stillborn.

As previously discussed, exactly how bile acids are involved is still not fully understood. Further research is needed to identify whether either or both of these factors are implicated in the risk to the baby, and it is important that this research continues. For the moment, researchers advocate a cautious approach to managing the condition.

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