Thyroid Thursday Episode 35: Ox Bile Supplementation Inducing Hypothyroid Symptoms
It is really common to see patients with hypothyroid symptoms who also have problems with bile physiology. They may have already had their gall bladder removed, they may get indigestion when eating fatty foods, or they may just have lab tests that indicate compromised bile physiology.
Compromised bile physiology is a significant problem in those with Small Intestinal Bowel Overgrowth (SIBO). Ox Bile is often recommended for those that need bile support. For many it works really well. But, if you or your patient finds they have increased hypothyroid symptoms when they take Ox Bile, you may need to use bile support formulas without it.
People with bile congestion, cholestasis, and gall stones typically have higher levels of bile salts in their blood due to the biliary congestion. The reduced bile flow and reduced bile salts in the bowel compromise digestion and absorption of fats. Bile salts supplementation in the form of Ox Bile can improve digestion. Unfortunately if you already have a high level of bile salts from congestion, the supplemented bile salts that are absorbed by the intestine also enter the blood. This combination of bile salts can cause significant increase in blood levels of bile salts.
What does any of this have to do with thyroid symptoms?
Bile salt levels in your blood peak about 30 to 40 minutes post meal. The elevated levels of bile salts in your blood stimulate a receptor (TGR5) on the pituitary gland. This increases an enzyme called Deiodinase 2 which than increases T4 to T3 conversion in the pituitary gland. As T3 levels rise in the pituitary gland TSH levels drop. As TSH levels drop, there is less T4 and T3 production by the thyroid gland. This means there is less thyroid hormone to support your peripheral tissues which can increase hypothyroid symptoms.
This reaction happens every time you eat. The temporary drop in TSH and thyroid hormone levels may not be noticed by many people. If however your T4 and T3 levels are already low or at the low end of normal you may notice an aggravation of your hypothyroid symptoms.
If you start taking bile acids regularly, the exacerbation of your symptoms may become more evident. An additional thing to consider is that not only will your T4 and T3 levels drop but your TSH level will be low as well. If you go to your doctor complaining of hypothyroid symptoms and they only evaluate you with a TSH test, you will likely be told you are fine as your TSH is low or low normal.
If you have a history of bile and gall bladder problems, use caution if your are going to use Ox Bile supplementation. If you develop symptoms, you’ll likely do better with support formulas that don’t contain Ox Bile.
References:
- Pituitary TSH Controls Bile Salt Synthesis, Journal of Hepatology
- Mechanisms of Thyroid Hormone Action, Journal of Clinical Investigation
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