Bile acids are increasingly recognized for their broad metabolic effects, including the regulation of glucose homeostasis. In a recent study published in Nature Metabolism, researchers provide compelling evidence that alteration in bile acid flux — namely, in intestinal absorption and faecal secretion — can directly influence prandial glucose metabolism.
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References
Li, T. & Chiang, J. Y. L. Bile acid signaling in metabolic and inflammatory diseases and drug development. Pharmacol. Rev. 76, 1221–1253 (2024).
Salehi, M., Gastaldelli, A. & D’Alessio, D. A. Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia. J. Clin. Endocrinol. Metab. 99, 2008–2017 (2014).
Pournaras, D. J. et al. The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control. Endocrinology 153, 3613–3619 (2012).
Albaugh, V. L. et al. Role of bile acids and GLP-1 in mediating the metabolic improvements of bariatric surgery. Gastroenterology 156, 1041–1051 (2019).
Calderon, G. et al. Ileo-colonic delivery of conjugated bile acids improves glucose homeostasis via colonic GLP-1-producing enteroendocrine cells in human obesity and diabetes. EBioMedicine 55, 102759 (2020).
Wahlström, A. et al. Alterations in bile acid kinetics after bariatric surgery in patients with obesity with or without type 2 diabetes. EBioMedicine 106, 105265 (2024).
Honka, H. et al. Vagal activation alters prandial bile acid composition and glycemia in patients with hypoglycemia after Roux-en-Y gastric bypass surgery. Neurogastroenterol. Motil. 36, e14763 (2024).
Chaudhari, S. N. et al. Alterations in intestinal bile acid transport provide a therapeutic target in patients with post-bariatric hypoglycaemia. Nat. Metab. 7, 792–807 (2025).
Baud, G. et al. Bile diversion in Roux-en-Y gastric bypass modulates sodium-dependent glucose intestinal uptake. Cell Metab. 23, 547–553 (2016).
Kudchodkar, B. J., Sodhi, H. S., Mason, D. T. & Borhani, N. O. Effects of acute caloric restriction on cholesterol metabolism in man. Am. J. Clin. Nutr. 30, 1135–1146 (1977).
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M.S. is supported by a grant from the NIH, NIDDK (DK 140144).
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Salehi, M. Bile acids in the crosshairs for hypoglycaemia after gastric bypass. Nat Rev Endocrinol 21, 528–529 (2025). https://doi.org/10.1038/s41574-025-01153-5
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DOI: https://doi.org/10.1038/s41574-025-01153-5
