TL;DR

Biliary stasis happens when bile becomes thick and sluggish, making fat digestion and nutrient absorption harder. It is often linked to insulin resistance, fatty liver, and metabolic stress. Supporting insulin sensitivity and liver function may help improve bile flow—especially before gallstones develop.

What is Biliary Stasis?

When bile becomes thick, there is less of it, impairing the body’s ability to digest and absorb fats and oil-soluble nutrients. This situation is known as cholestasis, or biliary stasis. If biliary stasis persists, it can lead to gallstones, or bile can back up and cause further damage to the liver. It can cause problems like dry, itchy skin, digestive problems, gastric reflux, and a host of other complaints. Click to read more about biliary stasis. 

Rule Out Gallstones

Biliary stasis can eventually lead to gallstones. Gallstones will cause the same symptoms with perhaps a bit more discomfort under the right ribcage. It is a good idea to have your doctor rule out gallstones before trying to thin the bile. If a gallstone moves and blocks the common bile duct, that is a medical emergency.

The Link Between Biliary Stasis and Insulin Insensitivity

The most common cause of biliary stasis is insulin insensitivity. It is linked to fatty liver and biliary stasis. Fatty liver can progress to cirrhosis of the liver. Eating sugar and insulin insensitivity can progress to serious problems with the liver and gallbladder. One study[1]  linked insulin insensitivity and sugar consumption to gallstones and even cancer. Many studies have found that eating sugar and developing insulin insensitivity causes problems with the liver and gallbladder [2-5]. Read more about insulin insensitivity. Avoiding sugar and improving insulin sensitivity will help thin the bile. Here are a couple of things that can help:

  • Do not eat any food with a glycemic  load greater than 10. This means avoiding sugar and refined food, plus some other foods that may surpise you. Lists are available online. You could also follow the Roadmap to Health, which will help balance the microbiome and reduce inflammation as well.
  • Take magnesium: Insulin insensitivity and the overproduction of insulin found in type 2 diabetes may actually interfere with magnesium absorption [6].  Studies have shown it to improve A1C levels [7], improve the lipid profiles of diabetics [8], prevent the transition from insulin insensitivity to diabetes [9], and even improve neuropathy [10].
  • Take berberine: Berberine has been well researched and shown to reduce blood sugar and A1C. Studies have shown that berberine can help and that berberine performs similarly to metformin. Subjects have had significant decreases in A1C, fasting blood glucose, postprandial blood glucose, and plasma triglycerides [11,12,14,15,19].  It has even been shown to lower cholesterol [13,16,17], reduce BMI [20], and it may also help with fatty liver disease [18].

Note: If you are taking diabetes medication, discuss this with your doctor. The new disciplines will help control blood sugar and will change your medication needs.

Supplements for Biliary Stasis

Many vitamin companies make products to suppor gallbladder health. Here are some of the constituents you may see in these products:

  • Artichoke Extract is very effective in increasing bile flow (Increase in Choleresis [liver to gall bladder] by means of Artichoke Extract as reported by Kinchhoff and Associates, Phytomedicine) and avoids the use of beets and other foods high in oxalates. The history of artichoke is a perfect example of science finally catching up to the longstanding traditional uses of a medicinal plant. It has traditionally been used for gallstones, to support liver function, and as a liver and gallbladder bile stimulant [21-25].
  • Fenugreek has reduced gallstones in animal studies [26].
  • Phyllanthus niruri is also called Chanca Piedra, which means “stone breaker”. There is a lot of research showing its effectiveness against kidney stones [27-29] and even cholesterol stones, like those found in the gallbladder [29].  Phyllanthus niruri has been shown to protect the liver against toxic insult [30-32].
  • Beets/Beetroot Supplements: Beet extract is found as the main ingredient in a lot of gallbladder supplements. It is not as well researched as artichoke extract, but there are some studies [33,34].

Other components may include vitamin C, taurine, betaine, and phosphatidylcholine. Sometimes there is other liver support, like silymarin and lipoic acid.

Bottom Line

Biliary stasis is not something doctors commonly look for. Although it is frequently found in pregnancy and treated. It is usually a diet and lifestyle issue and if it has not progressed to gallstones, simple changes often produce results.

References:

  1. Br J Cancer. 2011 Oct 25;105(9):1424-9 Metabolic syndrome and insulin resistance in relation to biliary tract cancer and stone risks: a population-based study in Shanghai, China
  2. 2008 May;29(5):944-8 Polymorphism of genes related to insulin sensitivity and the risk of biliary tract cancer and biliary stone: a population-based case-control study in Shanghai, China
  3. Ann Oncol. 2013 Sep;24(9):2449-55 Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort
  4. J Hepatol. 2001 Nov;35(5):550-7 Impact of liver inflammation on whole body insulin resistance : a case report on primary biliary cholangitis
  5. 2013 May 10;5(5):1544-60 Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease
  6. J Clin Endocrinol Metab. 1995 Apr;80(4):1376-81 Effects of insulin on plasma magnesium in noninsulin-dependent diabetes mellitus: evidence for insulin resistance
  7. 2018 Dec 26;11(1):44 The Effects of Oral Magnesium Supplementation on Glycemic Response among Type 2 Diabetes Patients
  8. Magnes Res. 1994 Mar;7(1):43-7 Effects of oral magnesium supplementation on plasma lipid concentrations in patients with non-insulin-dependent diabetes mellitus
  9. Diabetes Care. 2014 Feb;37(2):419-27 Higher magnesium intake reduces risk of impaired glucose and insulin metabolism and progression from prediabetes to diabetes in middle-aged americans
  10. 2008 May;57(5):712-7 Efficacy of berberine in patients with type 2 diabetes mellitus
  11. 2008 May;57(5):712-7 Efficacy of berberine in patients with type 2 diabetes mellitus
  12. J Ethnopharmacol. 2015 Feb 23;161:69-81 Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension
  13. Nat Med. 2004 Dec;10(12):1344-51 Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins
  14. 2010 Feb;59(2):285-92 Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression
  15. J Clin Endocrinol Metab. 2008 Jul;93(7):2559-65 Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine
  16. Planta Med. 2013 Apr;79(6):437-46 The effects of berberine on blood lipids: a systemic review and meta-analysis of randomized controlled trials
  17. 2018 Nov 15;50:25-34 Efficacy and safety of berberine for dyslipidaemias: A systematic review and meta-analysis of randomized clinical trials
  18. J Transl Med. 2016 Sep 15;14:266 Lipid profiling of the therapeutic effects of berberine in patients with nonalcoholic fatty liver disease
  19. Metab Syndr Relat Disord. 2013 Oct;11(5):366-9 Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion
  20. BMJ Case Rep. 2018 Oct 9;2018:bcr2017221854 Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin
  21. Increase in choleresis by means of artichoke extract Kirchhoff CH, Beckers G.M., Kirchhoff H., Trinczek-Gärtner, O.Petrowicz, H.J. Reimann Phytomedicine Volume 1, Issue 2, September 1994, Pages 107-115
  22. Przegl Lek 2012;69(10):1129-31. [Artichoke–untapped Potential of Herbal Medicine in the Treatment of Atherosclerosis and Liver Diseases] Małgorzata Horoszkiewicz , Maksymilian Kulza, Katarzyna Malinowska, Anna Woźniak, Monika Seńczuk-Przybyłowska, Anna Wachowiak, Ewa Florek
  23. Kraft K. Artichoke leaf extract – Recent findings reflecting effects on lipid metabolism, liver and gastrointestinal tracts. Phytomedicine 1997;4(4):369-378
  24. Saenz Rodriguez, T., et al. “Choleretic activity and biliary elimination of lipids and bile acids induced by an artichoke leaf extract in rats.” Phytomedicine. 2002 Dec; 9(8): 687-93.
  25. Gebhardt, R. “Anticholestatic activity of flavonoids from artichoke (Cynara scolymus L.) and of their metabolites.” Med. Sci. Monit. 2001; (7) Suppl. 1: 316-20.
  26. Dietary fenugreek seed regresses preestablished cholesterol gallstones in mice R.L.R. Reddy, K. Srinivasana Department of Biochemistry and Nutrition, Central Food Technological Research Institute, Council of Scientific and Industrial Research, Mysore 570 020, India. Canadian Journal of Physiology and Pharmacology, 2009, 87(9): 684-69
  27. Cealan, A., et al. “Evaluation of the efficacy of Phyllanthus niruri standardized extract combined with magnesium and vitamin B6 for the treatment of patients with uncomplicated nephrolithiasis.” Med. Pharm. Rep. 2019 Apr; 92(2): 153-157.
  28. Pucci, N., et al. “Effect of Phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention.” Int. Braz. J. Urol. 2018 Jul-Aug; 44(4): 758-764.
  29. Agarwal, K., et al. “Investigating antiuroliathiatic potential of Phyllanthus niruri L. a member of the family Euphorbiaceae.” Am. J. Phytomed. Clinic. Thera. 2014: 2(7): 423-431.
  30. Ezzat, M., et al. “In-depth hepatoprotective mechanistic study of Phyllanthus niruri: in vitro and in vivo studies and its chemical characterization.” PLoS One. 2020 Jan; 15(1): e0226185.
  31. Jia, R., et al. “Protective action of the phyllanthin against carbon tetrachloride-induced hepatocyte damage in Cyprinus carpio.” In Vitro Cell. Dev. Biol. Anim. 2016 Jan; 52(1): 1-9.
  32. Bawankule, D., et al. “Protective mechanism of lignans from Phyllanthus amarus against galactosamine/ lipopolysaccharide-induced hepatitis: an in-vivo and in-silico studies.” Curr. Top. Med. Chem. 2014; 14(8): 1045-55.
  33. Nutrients 2020, 12(2), 540 A Whole-Food-Based Health Product (A-F Betafood®) Improves Gallbladder Function in Humans at Risk of Gallbladder Insufficiency: A Randomized, Placebo-Controlled Clinical Trial
  34. Front Nutr. 2023 Aug 17;10:1181706. Comparing effects of beetroot juice and Mediterranean diet on liver enzymes and sonographic appearance in patients with non-alcoholic fatty liver disease: a randomized control trials