TUDCA and UDCA for Gallstones and SIBO

You may not have heard of the medication Ursodiol, but it’s a gallstone dissolver. This chemical is also something you produce naturally every day of your life.

Let me clarify, ursodiol is a drug, and also a human chemical made in the liver. 

It reduces cholesterol production to some extent, and even better, it dissolves the cholesterol crystals in bile which would otherwise cause more stone formation! Ursodiol goes by the initials of UDCA, and it’s related to a supplement called TUDCA.

Even more confusing, your body makes UDCA and then converts it to TUDCA later on. So TUDCA is a metabolite of UDCA, but for simplicity, I will at times refer to TUDCA as a dietary supplement because it’s sold widely under the name of “TUDCA.” I just want you to understand you make both UDCA and TUDCA.

Your gallbladder is on your right side and it’s a small pear-shaped organ that holds a fluid called bile. This bile is made in your liver and you need it to digest food, fats and vitamins. You don’t think about your gallbladder until it gets inflamed, or develops painful stones! Gallstones can be very painful to a person, producing uncomfortable symptoms. With all the Halloween treats coming soon, I am worried about everyone’s gallbladder! 

Speaking of Halloween, and not to derail you from reading this important article, but there are lot of disgusting things in our food and our candy today, and the FDA allows it! CLICK HERE to read about the disgusting tricks found in all those treats.

The risk for gallstones increases with age, pregnancy, use of oral contraceptives, and nutritional factors.

Ursodiol not just a medication for gallstone relief. It helps with the condition of “fatty liver.” Further, ursodiol reduces toxic levels of bile acids which is what occurs when a person has biliary cirrhosis. Cirrhosis is the medical term that refers to aliver breakdown which encompasses liver inflammation, thickening of the liver tissue and cell death. Cirrhosis is also the term commonly used when a person has alcoholism or hepatitis. If you have liver disease, please take a moment to read THIS ARTICLE about acetaminophen and your liver.

Biliary cirrhosis refers to the destruction of bile ducts in your liver, not the liver itself. And one more thing, the term “biliary cirrhosis” is a little outdated but that’s how most people know it. The new term is actually “biliary cholangitis” if I’m being medically-correct! Whatever you want to call it, the drug Ursodiol or “UDCA” is very important to the treatment of this disease. The abbreviation of UDCA stands for “Ursodeoxycholic acid” which is the chemical name of ursodiol. 

To avoid confusion, UDCA and TUDCA are two different things. I will explain this in a moment. But the important thing is UDCA is naturally produced in the body, and it’s also been made into a drug.

This medication UDCA goes by other brand names depending on where it is sold, for example Cholurso® and Ursofalk®, Ursactive®, Ursonorm® and Destolit® and others. Dosage forms vary as well, and there are capsules, tablets, and liquid options to appeal to all ages and preferences. 

Ursodiol is something you make, it’s a bile acid made inside liver cells and was first identified in the bile of bears. That’s how it got its name! Fun fact, the genus known as “ursus” includes polar bears, black bears, and others! So when they found this UDCA in bile bear they named it ursodiol. Pharma then went on to purify a form that could help people who suffer with gallstones, bile duct and other gallbladder diseases! 

A lot of people don’t know what bile acids are, or how important they are to good health. Allow me to digress –>Bile is nothing more than a fluid you make comprised of water, acids, electrolytes, and a few other minor components. It’s primary function in the body is to help digest the food we eat, and to help us absorb fat-soluble vitamins like vitamin K, vitamin A, E and D. Bile acids help break down cholesterol, and attack bacteria for us!

What is TUDCA?

TUDCA is a related to UDCA (ursodiol).
It’s a bile acid supplement. It’s used for liver and gallbladder support.*
The “T” in TUDCA stands for taurine, an amino acid. TUDCA is actually created in liver cells when UDCA joins chemically with a taurine molecule. The child is born and that is TUDCA.  Unlike UDCA which is a drug, TUDCA is available as a dietary supplement in dosages of 250 mg and up to 1,000 mg. Follow label directions for the product you buy.

TUDCA supplements may be taken without regard to meals, but I recommend you take them WITH your meals personally, and that’s because the compound will help you absorb your nutrients better, and break down the food easier.

So UDCA (or Ursodiol) is a medication that requires a prescription whereas TUDCA is a dietary supplement as of today, according to American laws.

I don’t mean to confuse the issue, but in your body, your form TUDCA from the UDCA. Your body converts it, and adds the taurine atom to it.

But again, TUDCA is manufactured as a supplement and sold in health food stores and online by that name. It’s not animal or bear-derived anymore but rather made in a laboratory nowadays like all other supplements.

Is TUDCA the same as UDCA?

Yes and no.

Yes, TUDCA does the same thing as UDCA, but chemically, the TUDCA has the taurine attached to it whereas UDCA has no taurine moiety. TUDCA stands for Tauroursodeoxycholic Acid.

Let’s not split hairs, it is the same thing for all practical purposes. TUDCA is a downline metabolite of UDCA. You make both.

In the US however, laws get sticky. According to the powers that be, disease claims cannot be made for dietary supplements. So because TUDCA is a dietary supplement, no claims about it’s ability to treat disease can be made. The FDA permits people to make disease-oriented claims if speaking about drugs (but not supplements).

So in this example, UDCA may be used for the treatment of a disease called Cholangitis, Gallbladder Disease, or Biliary Cirrhosis and it’s available at pharmacies via prescription by your doctor. And a bottle of TUDCA capsules is merely an antioxidant dietary supplement that supports gallbladder and liver health* and it’s available nationwide. So they are not exactly the same because chemically, they are not exact, and the method you can purchase them is different.

But their intended target organ and uses are the same —> gallbladder and stone formation.

There was an interesting animal STUDY that sought to investigate the effects of TUDCA on gallstone formation. The scientists fed rats a high fat diet, and then enhanced their diet with TUDCA supplementation. They evaluated several biomarkers during the study, and I noted a few interesting things:

1. The TUDCA group of mice showed a three-fold increase in the ratio of firmucutes to bacteroides. Ratios of these two predominant probiotics in the human gut microbiota are evaluated oftentimes. The lower the ratio, the tighter the association with IBD (Inflammatory Bowel Disease).  So TUDCA played a positive role here.

TUDCA supplemented rodents showed higher levels of this friendly bacteria “firmicutes.” Interestingly, firmicutes will go on to help your body produce a gut-healing compound called butyrate. (Butyrate is sold as a supplement, it’s pretty smelly just FYI!) But again, firmucutes (and therefore probiotics) help you to manufacture your own butyrate. Knowing the intestinal healing power of butyrate makes me realize that one of the mechanisms of action of TUDCA is ramped up production of butyrate!

2. Serum total cholesterol went down in a statistically significant manner.

3. The total amount of cholesterol crystals in the gallbladders of mice was less saturated in the mice supplemented with TUDCA. That’s great, and the goal! To be clear I am advocating a high-fiber, low-fat diet to help keep bile cholesterol in liquid form, prior to taking any supplements. Diet matters most, but after that, a little TUDCA may be useful. Of course speak to your doctor about taking supplements and making changes to your health regimen.

In the end, the researchers concluded that, “TUDCA can inhibit the absorption and synthesis of lipids in the small intestine by improving the intestinal microbiota in HFD-fed mice, thus reducing gallstone formation.”

Here’s another interesting tidbit about TUDCA. It may be used to reduce insulin in those who are obese. It was shown in this STUDY to increase the clearance of insulin and counteract obesity-induced high insulin. In the animal study, TUDCA supplements improved glucose tolerance and insulin sensitivity in the mice, even after they were fed a high fat diet. The researchers state, “TUDCA treatment reduced body and fat pad weight in the HFD + TUDCA mice.” 

Simply put, if I may extrapolate this data to humans, it means TUDCA may be helpful for people who want to faster achieve their weight loss goals. This 2014 PAPER defines the role that TUDCA plays in weight loss and adipogenesis. It also shows it to be a leptin-sensitizer, which again, can help reverse tendencies towards obesity. 

Obesity has become a serious public health problem in the developed world, and one of several modifiable risk factors for severe respiratory illness. There was a human STUDY using TUDCA and it was found to be help simply by improving insulin sensitivity by about 30 percent! I’m not sure we see that type of benefit with the drugs used for this purpose!  Hepatic and muscle insulin sensitivity did not change after placebo therapy in this particular study. 

Fatty liver is another condition that is increasing. It’s actually termed, “non-alcoholic fatty liver disease” and it will rise in the coming years. Currently, there are about 100 million people in the United States alone that have it! It’s of epidemic proportions and will continue to rise. There is not a very good drug for this yet. It’s possible that the drug Ursodiol and the supplement TUDCA could be employed as adjunctive treatment in certain people. On this continuum, I think TUDCA plays a role in lowering elevated serum ALTs. This is a liver biomarker. The serum  ALT (alanine aminotransferase) test us a popular blood test that doctors use to evaluate liver damage.

Doctors order it all the time. If your ALTs are high, TUDCA may be useful. What about liver cancer? That’s a tough one, I can’t make any claims and due to the serious nature of this disease, I must not comment. The medication UDCA is something you should talk to your physician about prescribing. For liver health, I recommend glutathione supplements, and you can read my other ARTICLE by CLICKING HERE.

SIBO Small Intestinal Bacterial Overgrowth

There was a STUDY in May 2020 that evaluated UDCA’s use for people with SIBO. The research is already available in regards to animal studies with positive benefits from UDCA. It’s clear that it has antibacterial and anti-inflammatory effects in the intestine. So the researchers engaged 24 patients with SIBO (as evidenced by a lactulose breath test), and tested UDCA the drug and the bile supplement you make yourself, not TUDCA which is sold as a dietary supplement.

After two months they reevaluated the symptoms of dyspepsia and discomfort and the UDCA treatment group of people showed significant improvement from their baseline (compared to placebo). After two months, the amount of methane production was down too, suggesting that persons with methane-dominant symptoms may benefit from UDCA.

Gallbladder and Liver Health – What Else Can You Do?

As described above, TUDCA supplementation (or a prescription for UDCA) may be useful for some of you. Please speak to your physician as I cannot advise or prescribe. My blogs are intended for educational perspective.

Aside from TUDCA, other well-known beneficial things can be done. In the order of importance try this:

1. Changing Your Diet

Follow a diet that is high fiber, and low in fat. Lean meats and proteins could be helpful, and fruits and vegetables. Avoid the obvious culprits that increase cholesterol and unhealthy fats (ie avoid junk food and refined items). Consuming healthy fats is very important, so consider the type of cooking oil you use. I never recommend vegetable oil, or canola oil. I’ve written an exclusive ARTICLE about this. You should read The Best and Worst Oils to Cook With.

2. Try an Omega-3 Supplement

We have known for decades that healthy fats in the diet offset the bad fats! Aside from that, there are well-documented studies with omega 3s that show it supports healthier cholesterol ratios and heart health. If your heart or your blood vessels are unhealthy, you are at much higher risk for blood clots, heart attack or stroke. To view a list of foods, spices and remedies that help prevent clot formation and support your cardiovascular system, read my article entitled, Foods and Spices are Natural Blood Thinners.

3. Digestive Herbs like Slippery Elm and Marshmallow.

The two most famous herbs for digestive health are slippery elm and marshmallow root. These help with bile release, liver health and intestinal problems of all sorts! A while ago, I made two videos about both of these items which you can watch HERE and HERE. These herbs are very easy to incorporate into your daily regimen, either as a tea, infused water, a gruel or supplement.

4. Milk Thistle.

The research on milk thistle for liver health is mixed. I do think that small amounts of silymarin (a compound found in milk thistle) ease inflammation and support liver, bile and gallbladder health. That said, it can be estrogenic for some people so monitor yourself if you’re taking it as a supplement. A tea is more gentle, and may be more suitable for some of you. The combo of TUDCA and Milk Thistle could be very helpful! 

5. Vitamin D3.

Levels of 25-hydroxyvitamin D are not significantly associated with gallstone disease so don’t take vitamin D for your gallstones, it’s useless. However, when it comes to the liver, D3 is important. The liver produces 25-hydroxy (25-OH) vitamin D, a.k.a. calcidiol. Calcidiol is the immediate precursor to your body’s metabolically active form of vitamin D called “1,25 dihydroxyvitamin D” also called calcitriol. So D3 is good for your liver, and fine (but not necessarily beneficial for gallstones).

In Closing…

In closing, if you suffer with fatty liver, gallstones, gallbladder disease or other intestinal issues, you may benefit from some of the items listed above. In particular, gut-healing benefits of herbs and supplements cannot be denied.

 With that said, if you have gallbladder inflammation, pain, serious problems or a real disorder please seek proper medical attention and care. Always find a knowledgeable gastroenterologist to help you with issues. My hope is that you find a solution here to your problems, and one day you realize how good you suddenly feel! One thing I didn’t mention today is that there is some emerging research on TUDCA’s role on brain health! Interesting.

Nutrition plays a big role, and so does exercise if you are physically able to. Getting your lymph moving when it has been stagnant for years is critical to helping detoxify and ‘clean out’ cellular trash. I do not feel like it’s just about popping the perfect assortment of pills. I never have, but I do feel they can play an important role in shifting laboratory biomarkers that would not otherwise move.

If you are seeking to purchase anything I have written about here including TUDCA, I do not sell it.

Please look online or call your local health food store for TUDCA. There are many high-quality products available today on Amazon (and other e-tailers), as well as your local health food store. I bought a brand from Amazon simply to take it and test it and learn more, but because I don’t have gallbladder disease, or stones, I was not able to garner any information. I personally buy and test virtually everything I write about in these blogs, in case you didn’t realize that. And I did tolerate this brand just fine. There are others available too. 

Alternatively, ask your practitioner if the medication Ursodiol (UDCA) is something that is useful for you. This way you don’t have to buy a supplement. Remember, in the human body UDCA is converted to TUDCA naturally with the addition of a taurine molecule.

My hope is that I can help you today (even if you have been dealing with issues for a long time) with a bit of my knowledge. Please forward this article to anyone you think it can help.