Can psoriasis be treated with bile acids?

Can bile acid supplements be a useful tool in treating and managing psoriasis caused by bacterial endotoxin?

“What need is there to list all the nasty and painful indignities that come pouring in upon us as we go through the troublesome and disgusting process of digestion?”

—Plutarch, Banquet of the Seven Wise Men

Since as far back as Hippocrates, almost two and a half millennia ago, people have understood the important role digestion plays in health and disease. Good digestion leads to good general health, and poor digestion to poor general health.

But in modern times, Western culture tends to speak about disease as a result of random luck (disease is caused by genes), and health as something restored by medical intervention (pharmaceutical drugs and surgery). The more general, fundamental factors, like nutrition and digestion, seem to be regarded as so unsophisticated that they are seldom discussed as significant contributors to a person’s health. (GPs have told me, without a hint of irony, that diet has no effect on psoriasis).

However, a growing amount of scientific research casts light on the role that nutrition and digestion play in many diseases; adding deeper understanding and validation to the observations that have been shared as common folk wisdom for thousands of years.

“Happiness for me is largely a matter of digestion.”

― Lin Yutang

Endotoxin and disease

Endotoxin is a word that most people haven’t heard, since it’s not really used outside the realm of biological and medical research. Yet, this substance is becoming a significant area of study in diseases; especially inflammatory diseases such as psoriasis and metabolic diseases such as obesity and diabetes.

Put simply, bacterial endotoxin is a type of molecule produced in the gut by certain bacteria. These “bad” bacteria produce endotoxin as a part of their life-cycle, and release it into your guts either as a by-product of their own metabolism, or when these cells die.¹

Sometimes harmless, sometimes lethal

In a healthy, well-functioning digestive tract, bacterial endotoxin is relatively harmless, but it can be harmful and even lethal. Experiments on animals have shown that, when injected, a given dose of endotoxin is reliably lethal. However, this same dose administered orally can have little or no significant harmful effect at all. What is more surprising, is that oral doses have been shown to be harmless at three-thousand times the dose that would be lethal by injection². This discovery suggests that something in the digestive system prevents harmful endotoxin from entering the bloodstream in healthy subjects.

Endotoxin and psoriasis

In 1982, a group of researchers and medical doctors in the USA discovered that patients with psoriasis often do have elevated levels of endotoxin in their bloodstream. This information, along with many other observations that seemed to connect psoriasis with microbial factors (psoriasis often follows strep. bacterial infections; babies with diaper yeast infections often develop psoriasis; psoriasis is effected by dietary changes; psoriasis is exacerbated by alcohol consumption; etc.), inspired the group to ask the question: can psoriasis can be treated by lowering endotoxin³?

What happens when we reduce endotoxin in psoriasis?

This group tested the effect of a drug called Cholestyramine—known for its ability to detoxify endotoxin—on a small group of patients, and found that about half of them improved under this treatment⁴. This confirmed results produced in a seemingly forgotten experiment in the 1960s that showed the same beneficial effect of Cholestyramine on psoriasis.

Bile acid supplementation and endotoxin

Researchers in Hungary, in 1969, demonstrated that when the bile ducts of rats were bypassed—preventing bile from entering the intestines—the oral dose of endotoxin that was normally harmless became dangerous, and caused endotoxic shock in the rats. And this effect was shown to be a direct result of the lack of bile in the intestines⁵.

This seemed to demonstrate that bile is essential in helping the body detoxify endotoxin in the guts, and that bile acids may play a role in treating diseases that are caused by endotoxin in the gut.

Bile acid and psoriasis

Putting these pieces together: if cleaning the intestine of endotoxin could help reduce the symptoms of psoriasis; and if bile acids are effective in detoxifying endotoxin in the guts; then in theory, treating psoriatics with a bile acid supplement should help to treat their psoriasis.

These same Hungarian researchers eventually decided to test this idea on psoriatics in a controlled experiment in 2003.

The researchers took 800 patients with psoriasis and split them into two groups. The first group were given an oral bile acids supplement two or three times per day, for eight weeks. The second group, the control group, were given a “conventional” psoriasis therapy for the same time period. By adding this second control group, the effects of the bile therapy could be fairly compared against current alternatives.

The results from this experiment speak for themselves. During this treatment, 434 patients (78.8%) became asymptomatic. While only 62 of the 249 (24.9%) of the subjects receiving the conventional therapy, showed any clinical recovery during the same period of time⁶.

The researchers included in their paper:

In our view, the success of this treatment method can be attributed to the fact that by remedying the temporary bile deficiency the absorption of endotoxins and thus the release of cytokines [molecules that signal inflammation] are prevented. Thus, the recognized effect played by cytokines in the pathogenesis of psoriasis underlines the indirect role of bacterial endotoxins. This effect, however, probably occurs only, if bile secretion or discharge is disturbed… Therefore, the treatment of psoriasis with bile acids is actually the supplementation of a physiological substance rather than a medicinal therapy.

Summary

There seems to be convincing evidence suggesting that endotoxin is a contributing factor in psoriasis. And strong evidence has been provided for the role of bile in detoxifying endotoxin in the bowels. A controlled experiment with 800 subjects tested the hypothesis that supplementing bile acids leads to a significant improvement in psoriatic symptoms in the majority of subjects, and produced extremely promising results.

Bile acids are a cheap and relatively safe supplement that are apparently very effective at treating psoriasis.

Bile Acids are available from your local pharmacy, or online including on Amazon.com:

Nutricology Ox Bile (Affiliate link)
Nutricology Ox Bile (Non-affiliate link)