Bear bile

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Bear bilefact and science
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Objectives Our goals for today.

• What is bile?
• What is bear bile?
• What is UDCA?
• Medical uses of UDCA.
• TCM uses of bear bile.
• How is UDCA produced?
• What is the future of bile?
• Questions?

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Ill try not to bore you to death

• But there is no escape from a bit of chemistry.

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Lest we forget what we are made of
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And we also contain electrical systems.
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And of course there is plumbing.
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Formation of bile

• Synthesized by liver cells
• As bile flows in the liver water and electrolytes
  are added
• Bile is stored and concentrated in the
  gallbladder
• When needed, it flows through the common bile
  duct into the duodenum, a part of the small
  intestine

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Functions of bile

• Emulsify (dissolve) large fat globules
• Help transport fat across intestinal wall
• Helps in elimination of bilirubin, a product of
  heme (broken down blood red cells)
• Helps in elimination of excess cholesterol

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The composition of bile

• 97.5 water
• 1.1 bile salts
• .1 cholesterol
• .12 fatty acids
• .04 lecithin
• .14 Electrolytes (Na, K, Ca, Cl, HCO3)

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What are bile acids

• They are formed from cholesterol
• They include cholic acid, chenodeoxycholic acid
• And ursodeoxycholic acid

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More on bile acids.

• The primary bile acids, cholic acid and
  chenodeoxycholic acid (CDCA), are synthesized
  from cholesterol
• Secondary bile acids, including deoxycholate and
  lithocholate, are formed in the colon
• Another secondary bile acid, found in low
  concentration, is ursodeoxycholic acid (UDCA), a
  stereoisomer of CDCA.

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UDCAUrsodeoxycholic acid

• We now have arrived at an important point in this
  talk, please wake up now.

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M OST BILE ACIDS LOVE FAT
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UDCA LOVES WATER, HATES FAT
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UDCA is very different from the other bile acids

• It is hydrophilic
• The others are lipophilic

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UDCA

• Because it loves water it doesnt dissolve cell
  membranes. It protects liver cells from the
  effects of the other bile acids.

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Ursus is Latin for bear.
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UDCA

• Ursodeoxycholic acid (UDCA) is more abundant in
  bear bile than in any other mammal.

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We dont know why bears have so much UDCA

• You and I have 5
• Bears can have 40
• (These numbers are variable)

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Lets think about the last slide.

• UDCA protects liver cells.
• Helps prevent gallstone formation.
• Its the WD40 of the biliary system.
• Bears have increased UDCA.
• They do not suffer ill effects from prolonged
  immobilization.
• What would happen if we stayed in bed for months
  on end?

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Bears hibernate

• Without loss of bone mass
• Without loss of muscle mass
• Without loss of kidney function
• Without loss of neurological function
• Its amazing

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Bear biologists know that the normal effects of
inactivity, such as bone loss or muscle atrophy,
do not occur in hibernating bears.  When this
process is completely understood, it may lead to
advances in human medicine that will improve
health and even save lives.
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This animalis truly amazing.
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All life is a miracle of biology.
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UDCA was introduced into modern medical practice
in the 1970s. How this happened is not clear,
but it appears that the earliest reports were
from Japan.
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Keep this in mind no other component of bile has
ever been shown to have any beneficial effects in
humans. UDCA appears to be the unique
therapeutic component of bear bile. Its not
just an observation. It makes sense when you
consider the biochemistry.
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This is a powerful concept. This concept will
help eliminate bear farming.
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Once again, the properties of UDCA

• protection of injured cholangiocytes against
  toxic effects of bile acids
• stimulation of impaired biliary secretion
• stimulation of detoxification of hydrophobic bile
  acids
• inhibition of apoptosis of hepatocytes

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What is apoptosis?

• Programmed cell death is called apoptosis

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Is UDCA the fountain of youth
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Well come back to this in a minute.
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Current uses for UDCA

• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Intrahepatic cholestasis of pregnancy
• Progressive familial intrahepatic cholestasis
• Gastric bypass surgery

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What these diseases have in common

• Loss of normal bile duct architecture
• Abnormal bile flow
• Destruction of normal liver cells with fibrosis
  and scarring
• Cirrhosis
• Liver Failure

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There is also evidence of neuro-protective
properties (experimental)

• Stroke
• Huntingtons disease
• Alzheimers disease
• Retinitis pigmentosa (the eye is neural tissue)

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Acute Myocardial Infarction
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Steer et al.
Interestingly, we have shown that
ursodeoxycholic acid (UDCA), an endogenous
hydrophilic bile acid, is a potent inhibitor of
apoptosis by either stabilizing the mitochondrial
membrane or modulating the expression of specific
upstream targets. Herein, we review the main
effectors involved in the death machinery,
describe how they interact to regulate apoptosis,
and discuss the main pathways that control cell
death and survival.
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WOW!

• Can bears hibernate because of UDCA? I dont
  think we know.

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Should we all take UDCA?

• Should we buy stock in companies that produce
  pharmaceutical UDCA?

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Which brings us back to bear bile.
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Traditional Chinese Medicine (TCM)
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TCM indications for bear bile

• Applied topically for painful throat, sores, and
  hemorrhoids
• Epilepsy with convulsions
• To clear the liver
• To brighten the eyes (as drops)

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Bile is not essential in TCM.

• Historically not important.
• Historically not widely available.
• Its use is not endorsed by many.
• Its use is actually discouraged by many.
• Much of the use has probably been built by the
  bile industry, which includes farms, factories,
  distributors and stores.

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From a contemporary source
WARNING Both species of bear used for this
medicinal are endangered and protected by CITES
law. Furthermore, bear gall is now harvested by
draining the gallbladders of caged bears,
incurring animal cruelty. The use of xióng dan is
therefore strongly discouraged.
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Do the indications for bile use in TCM relate to
its pharmacology?
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Some facts about bear bile preparations

• Farmed bears have inflammation and thickening of
  the gall bladder.
• They have recurrent intra-abdominal infections.
• They have a high rate of liver cancers.
• The collection systems are not sterile.
• The lack of normal feedback mechanisms change the
  composition of the bile.

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More facts about bile preparations

• The techniques for collecting, storing and
  preparing the end product appear to be quite
  variable.
• The actual composition of the medicinal is not
  specified on the label, i.e. amount of active
  drug, other ingredients, etc.
• Many preparations have been approved by the SDA,
  but the amount of oversight in this approval is
  suspect.

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Some concerns about bile medicinals

• They may contain pus, debris, skin, and other
  impurities.
• The amount of UDCA is not specified.
• They may contain toxic materials.
• Some of these products have been shown to contain
  other animal bile.

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The properties of a pharmaceutical

• Purity
• Potency (active drug)
• Provenance
• Safety
• Pricing

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Is natural better?
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Does bear bile have a place in TCM?

• For those taking bile to obtain benefits that are
  specific to UDCA absolutely not!
• For those taking bile for non-specific
  indications, there are other agents that are
  endorsed by TCM practitioners.
• Either way the answer is unequivocal.
• TCM can benefit from this knowledge.
• Patients can benefit from this knowledge.

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Benefits of eliminating bile use

• Patient benefit through active drug ingestion in
  consistent dosage.
• Elimination of animal cruelty.
• Possible recovery of the Asiatic black bear and
  other critically endangered species.
• Improvement in the international image of those
  countries who sanction bear farming.

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One last thought on TCM

• Finally there will be those who refer to special
  elements of bile that cannot be reproduced in any
  pharmaceutical. With that in mind we wonder how
  the confinement, pain, and untimely death of the
  farm bear affect the healing properties that are
  attributed to its bile. The chi of a bear
  subjected to these conditions must be weak
  indeed.

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The use of bear bile violates the underlying
principles of any system of health and healing.
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Dont worry, were almost finished.
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How is UDCA produced?
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The pharmaceutical companies are

• Novartis (International)
• Dr.Falk Pharma (German)
• Axcan Pharma (Canadian based)
• Mitsubishi Pharma (Japanese)

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How much Urso is sold?

• Axcan reported 77.1 M dollars in North America
• Sold as Urso 250 and Urso Forte
• These contain 250 mg and 500 mg Urso respectively
• Cost to patient and 8.50 per day
• About 25,000 patients taking the drug every day

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I hope that pharmaceutical grade UDCA will, one
day, completely replace the use of bear bile. 
When this happens, bear farms will longer have a
use. 
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Jasper
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thanks you for your attention!
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I thank you for your time, interest, and
commitment to this important cause.
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Eric H. Busch M.D.