Mind & Matter Bile Acids in Health & Metabolic Disease | Ep. 282
Feb 28, 2026
Rebecca Haeusler, associate professor at Columbia studying insulin signaling, bile acids and metabolic liver disease. She explains how bile acids handle cholesterol and fat digestion. They discuss bile production and regulation, links between bile acids and insulin resistance or diabetes, effects of gallbladder removal and bariatric surgery, and ongoing lab work on bile transport and liver inflammation.
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Gallbladder Removes Concentration Not Bile Production
- Gallstones form when concentrated gallbladder bile is supersaturated with cholesterol relative to bile acids and phospholipids.
- Removing the gallbladder removes the concentrating reservoir but not bile production; bile flow becomes less pulsatile and fat tolerance can decrease.
Insulin Resistance Raises Specific Bile Acid Production
- Insulin resistance and type 2 diabetes are associated with increased bile acid synthesis, notably 12-hydroxylated bile acids.
- The enzyme CYP8B1 (12α-hydroxylase) is regulated by insulin signaling and alters bile acid composition and function.
Insulin Resistance May Boost Nutrient Absorption Adaptively
- One evolutionary hypothesis: insulin resistance may enhance nutrient extraction by increasing bile acid-mediated emulsification during perceived scarcity.
- Increased 12-hydroxylated bile acids could be an adaptive response to maximize fat absorption when energy is limited.