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Updated: Jun 17


As we continue to dive into some basic topics that you’ll need to know for the CNS exam, let’s chat about bile flow.

Now, this seems like an easy topic, but if you recall from school…how bile actually flows and recirculates can get a little hairy.

What Is Bile?

Bile is a fluid made by your liver and stored in your gallbladder to help aid in digestion. Specifically, digesting and absorbing fats. Those that don’t have a gallbladder, typically struggle to absorb healthy fats and fat-soluble nutrients.

Bile is thick, sticky, and has a greenish-yellow tint. When a client has greenish-yellow stools, they’re excreting bile in their stools and not recirculating it as they should be. Bile is released in the first section of the small intestine in the presence of fats. Without reading, can you recall what that first section of the small intestine is called?

If you guessed the duodenum, you’d be correct!

Once bile does its job in the small intestine, it’s recirculated from the ilium, the final section of the small intestine, back into the liver. This happens via the enterohepatic circulation.

Symptoms & Labs to Assess Bile

Common symptoms you may see with your clients that are struggling with adequate bile flow may be:

  • Nausea after meals, including fatty meals

  • Pain under the right ribcage

  • Pain between the shoulderblades

  • Bloating

  • Constipation

  • Floating stools

  • Pale or yellowish stools

There are a few labs that are commonly run by physicians that you can use to help assess bile flow with your clients.

  • Alkaline phosphatase (ALP) - this will be high for those with low bile flow

  • Alanine aminotransferase (ALT) - while this is a liver enzyme, this can be elevated in those with low bile flow

  • Bilirubin - this will be high for those with low bile flow

  • Triglycerides - these will be too low for those with low bile flow

  • Cholesterol - remember, bile is made partly from cholesterol so when cholesterol is too low, there isn’t enough to produce bile and help with hormone production

How to Support Bile Flow

Certain foods can increase bile production and flow especially bitter foods. Supportive foods include:

  • Beets

  • Coffee

  • Dandelion greens or root

  • Dark, leafy greens

  • Artichokes

  • Lemons

  • Citrus peels like orange zest

  • Milk thistle

Since bile is made partly of cholesterol, supporting healthy cholesterol levels is key as well. Having a balanced intake of fiber and an overall healthy diet help support healthy cholesterol levels.

And a healthy fat intake is important as well.

Bonus: For someone that doesn’t have a gallbladder and is low in fat-soluble nutrients, taking those nutrients with some medium-chain triglycerides (MCTs) will help their body absorb these nutrients. MCTs don’t need bile to be absorbed!

From studying bile flow to herb-drug interactions, SNPs, and more, our CNS Prep Course helps nutrition students successfully pass the CNS exam.  The course is created by CNS’s for CNS candidates. Weaving together CNS exam study tips, nutrition practice questions, study groups, a discussion forum, webinars, and 70+ modules of content, our prep course prepares nutrition graduates and students for the CNS exam.  Our pass rate is 80% for all students and 85% for interns in our Mentorship Program.

Dive into your studying! Sign up for our CNS test prep course here!


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