Bile is re-circulated through the iliem (called the “ileal bile acid transporter”) to the liver. There is a rich supply of digestive bile in the intestinal chyme shortly after meal.

Bile acids are “facial amphipathic”, that is, they are repelled by water and transiently bond with water through hydrogen bonding. They have the ability to micro-emulsify fat by its detergent action which greatly increases the surface area of fat making it available for digestion by a process called lipase. At the normal “pH” (acid/alkali) level of the small intestine, most of the bile acids are ionized and mostly occur as their sodium salts which are then called “primary conjugated bile salts.” (Conjugated describes a type of molecular bonding). In the lower small intestine and colon, bacteria change some of the primary bile salts to form secondary conjugated bile salts (which are still water soluble). Along the proximal and distal ileum, these conjugated primary bile salts are reabsorbed actively into hepatic portal circulation. Bacteria break the molecular bonds back to lipid soluble bile acids, which are passively absorbed into hepatic portal circulation. Finally, the conjugated bile acids which remained “un-ionized conjugated bile acids” are passively absorbed.

Note: Human pancreatic lipase (HPL) is the main enzyme responsible for breaking down fats in the human digestive system acts to convert triglyceride substrates found in oils to monoglycerides and free fatty acids. Bile acids are able to form a solution of fatty acids (lipids) by forming micelles - aggregates of lipids such as fatty acids, cholesterol and monoglycerides - that remain suspended in water. Bile acids are also critical for transport and absorption of the fat-soluble vitamins.

Venous blood from the ileum goes straight into the portal vein and directly to the liver where the hepatocyte cells extract bile acids very efficiently from the sinusoidal blood. Bile acids are then transported across the hepatocyte cells into the biliary system. The liver hepatocytes metabolize cholesterol to cholic acid and chenodeoxycholic acid and these lipid soluble bile acids are bonded mainly to glycine or taurine molecules to form water soluble primary conjugated bile acids. The net effect of this enterohepatic recirculation is that each bile salt molecule is reused about 20 times, often two or three times during a single digestive phase.

The bile acids made by the liver accounts for the majority of cholesterol breakdown in the body. About 500 mg of cholesterol is made in to bile acids and eliminated in bile each day by being secreted into the intestine every day, but only relatively small quantities are lost from the body. Approximately 95% of the bile acids delivered to the duodenum are absorbed back into blood within the ileum. This is because cholesterol is a lipid and will absorbed in the same way as all useable lipid either as cholesterol or a carrier for other lipids.

It is now thought that more cholesterol may be lost than originally thought and that bitter vegetables like cabbage and beets can reduced serum cholesterol level and enhanced faecal bile acid excretion and cholesterol. However naturally grown primitive varieties rather than the nutritionally deficient high varieties are superior. It is well known that cabbage can induce a biliary colic attack in people with gallstones. This is a sign that the cabbage is attempting to trigger the enterohepatic cycle but the biliary system is reluctant to respond because it is clogged. It has also been noted the egg yolks of hens fed on cabbage absorb the bitter compounds and a potentially good foods for correcting biliary dysfunction.

The flow of bile is at its lowest during between meals called the fasting phase; rapid filling and concentration of the gallbladder occurs at this time. When chyme from an ingested meal enters the small intestine, acid and partially digested fats and proteins stimulate secretion of cholecystokinin and secretin. As discussed previously, these intestinal hormones have important effects on pancreatic exocrine secretion. They are both also important for secretion and flow of bile:

Many of the drugs that we take are elimination from our bodies via bile and these are then reabsorbed in the intestinal tract. This makes the drugs available again via the bile in the enterohepatic cycle and results in results in the “recycling” of drug and prolongs the time required for the drug to be irreversibly eliminated from the body. This also means that some molecules from the drugs which would not otherwise be very toxic can become very even dangerously hepatotoxic as they reach unexpectedly concentrations in the liver. Drugs may remain in the enterohepatic circulation for a prolonged period of time as a result of this recycling process. This recycling can involve a host of substances from prescription drugs to health supplements, minerals and vitamins.

The primary purpose of the liver flush is to break this process and evacuated as much of the “toxic” hepatic bile salts as possible in an attempt to restart the enterohepatic  cycle with freshly produced bile. So much bile is lost during a liver flush that the liver may struggle to produce sufficient bile to support normal meals for some time. It will find cholesterol from any available source. As cholesterol is also made in other cells for the conversion to energy the liver may hijack this production. It is advisable therefore to eat non-taking simple meals following a liver flush and may help to explain why sometimes there is an unexplained change in energy levels. Glial cells in the brain appear to churn out their own cholesterol supply. Whether the disruption to cholesterol manufacturing and lipid supply caused by liver flushing affect the brain function isn’t known.

Because biliary sludge builds up in the gallbladder, biliary stasis causes  poor free flow of cholesterol and an abused liver becomes clogged it make take several flushes the fully clean the biliary system and remove heptatoxins and establish a healthy enterohepatic recirculation.

If you flush your liver and reabsorb some stale bile which has traces of toxins from the past then you may relive the effects of those toxins as they recirculated. So liver flushers complain of old memories returning which may be associated with a time marked by the deposition of the toxins.  As liver cleansing progresses highly toxin sludge and stones which may have been locked away in the liver and gallbladder for some years are liberated. These may cause a healing crisis as the toxins are absorbed released once more into the bloodstream in extremely high concentrations.

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