Bile Assaults: Is bile really that bad?

The four types of temperament proposed by humorism. Or how nobody has ever looked ever.

The four types of temperament proposed by humorism. Or how nobody has ever looked ever.

Something had me thinking about bile recently. I can’t be sure what it was and I wouldn’t want to date this blog post by relating it to any recent news events to take a guess. It seems to me that it has something of an unfair reputation. Bile that is. Obviously.  In language and to describe language, bile is often used to represent speech displaying a certain level of anger or peevishness.  “She spoke with great bile about the supposed comedian Paddy McGuinness” one might say, or “the very thought of the supposed theories of Susan Greenfield makes neuroscientists speak with bile in their voices.” Even gall. one of the other names for bile has been used in this fashion. Gall is used as a verb to represent the act of irritation and as a noun to indicate a bitterness of spirit or a sort of brazen insolence. For example you might say “it was with tremendous gall that he used his examples to mention things he disapproved of and it was beginning to gall the reader.”

A disturbing number of descriptions of bile as a bodily fluid begin by talking about its taste. Search for bile on the internet search engine of your choice (although choice may be the wrong word given that everyone always chooses the same one) and you’ll invariably meet with a definition beginning with how bitter it tastes. It is unlikely that you would find this with any of the body’s other sloppy bits.

Blood (noun): a metallic-tasting, red liquid. Try to keep it inside you.

Urine (noun): a sweet-tasting liquid of varying colour. Sweet? Get tested for diabetes.

Tears (noun): a salty, transparent bodily fluid brought about by thinking too much about the   consumption of human bodily fluids.

The previous descriptions seem odd and while this semi-intentional, the description of bile as “bitter” does not seem as peculiar. A fact which possibly relates to its other uses in the English language. This in turn has its roots in an ancient medical theory.

For approximately 2,000 years the medical theory of humorism was one of the most prevalent in Greece where it was systemised and eventually throughout most of Western medicine.  There is some evidence that the theory originated in Mesopotamia. Humorism states that the body contains four basic substances or “humors” the balance of which effects a person’s personality and health. These four substances were blood, phlegm, yellow bile (or chole) and black bile (or melan chole). Too much yellow bile for example resulted in a person that was very aggressive and was associated with “warm” diseases or fevers. Too much black bile supposedly caused a person to be depressed and was associated with illnesses that made one cold. And in a short leap from 400BC to now we have why bile may be associated with anger and melancholy can be another word for depression. I can also claim that despite criticism that this post definitely contains humour.  Even if it is badly spelled.

We now know through facts and evidence that humorism as a medical theory is not correct. Although this doesn’t stop people like Gary Smalley, a counsellor and founder of the Smalley Relationship Centre, using the humors and their resulting temperaments to explain his Christianity-based relationship advice. Except Smalley relates temperaments to the animal types of otters (blood/sanguines), lions (yellow bile/cholerics), golden retrievers (phlegm/phlegmatics), and beavers (black bile/ melancholies). It is perhaps easy to see why lions may relate to people who are angry but it seems odd that beavers are depressed. Are beavers particularly sad? Perhaps Smalley got confused with the association of the word “dam”.

Either way the humorism theory of medicine is of no use in modern medicine other than with its potential linguistic remnants in terms such as humoral immunity. Food also has descriptive links to this theory based on which of the humors they were supposed to influence. For example spicy, salty or sour foods were said to aggravate yellow bile while dry, stale food or excessive beans were said to aggravate black bile.  Perhaps here it is easy to see how excessive beans might make you sad.  It remains that bile is a much maligned liquid which seems unfair given that as a bodily fluid it does have a function. Without it you would almost definitely be much angrier or more depressed.

Bile is a bitter-tasting, dark green to yellow-brown liquid, produced by the liver and stored

The gallbladder: winner of The Organ Most Like A Deflated Balloon Award.

The gallbladder: winner of The Organ Most Like A Deflated Balloon Award.

in the gallbladder prior to its discharge into the duodenum at the beginning of the small intestine. Bile is an alkaline and as such aids in the neutralising of stomach acids if they should enter the small intestine. This in itself is useful. Bile is primarily composed of water (85%) as well as bile salts (10%), mucus and pigments (3%), fats (1%) and inorganic salts (0.7%). These bile salts are to an extent bactericidal, destroying some harmful microbes that may be present in the food. Already we can see bile does two things that aren’t that galling. Although technically they are literally galling. Stupid language.

Primarily though bile acts as a surfactant, allowing the emulsification and absorption of fats from food.  Without bile, the majority of the fats from food would be excreted in your faeces which as a result would be particularly foul smelling, greasy and difficult to flush. A condition that when it occurs is known as steatorrhoea or colloquially as I’d give that 5 minutes/hours. Perhaps diet-fans (if such a thing could be said to exist outside of people making money from books such as “The Eating Nothing Diet” or “A Moment on the Lips, a Lifetime on the Self-Esteem”) would think it desirable that no fat were to be absorbed and that a horrible case of the toilet Chernobyls is a small price to pay. But fats in the correct amount are of course necessary. For example some vitamins such as D, A, K and E can only be absorbed if dissolved in fat. And vitamins are good right? Especially these ones. If arranged in a certain way they make a word that rhymes with cake! Also health.

To accomplish the thankless task of aiding in fat-absorption bile salts are hydrophilic on one side and hydrophobic on the other side. That is to say at one end they are attracted to water and at the other end they repel it.  This means they gather around droplets of fat from food with the hydrophobic sides facing towards the fat and hydrophilic sides facing outwards.  The resulting structure is referred to as a micelle, not to be confused with a prison for rodents. Not that you would. The outward hydrophilic surface is negatively charged, and as like charges repel each other, prevents the micelles from coming back together like a more disgusting boyband reunion into larger fat particles. With lots of micelles we therefore have a larger surface area for fat digesting enzymes (lipases) to work on, which then break down the fats into fatty acids and monoglycerides for absorption through the intestine walls.

Bile of course isn’t perfect.  The cholesterol in it can form the occasionally unpleasant gallstones and you don’t want to taste it in the back of your throat. Ultimately it has a very important function. Language isn’t going to change to reflect this knowledge and a campaign to make it do so would be strange and ridiculous. This is the case no matter how moving the protest sign “Do not revile, the humble bile.” or how galvanising the chant “We’re appalled, we want accurately described gall, get used to it!” But next time you speak of something as “full of bile” or find something particularly galling, think of the humble bodily fluid and how it keeps you healthy and leaves your bathroom not as bad as it could be. Even if it does taste bitter.

8 thoughts on “Bile Assaults: Is bile really that bad?

  1. You are very quick to ridicule some aspects of the theory of humours, but what about this ? :

    I believe that it was the choleric temperament that was supposed to be associated with eating too much red meat. Since you are a medic, do you commend eating lots of red meat instead ?

    If not, don’t be so selective and supposedly so superior about what previous ages believed. Galen probably wasn’t totally useless at curing people, and nor, most likely, was Paracelsus, so don’t knock so much, just because they weren’t – ahead of their time – Lister or Pasteur ! Otherwise, it’s just a form of historical cultural imperialism to write this sort of blog : it suggests that you, back then, would obviously have known what you claim now to be medical truth.

    For, as for medicine knowing so much more, I am sceptical. What about the people, still alive, given a matter of months to live years and years ago ?

    • I didn’t ridicule the theory of humorism or those that believed in it when it wasn’t known that it wasn’t the case. At one stage I pointed out those that still continue to use this theory are misguided but that’s because it’s not consistent with current knowledge.

      I also didn’t claim that I know all of the medical truth although I would certainly argue that medicine is better now than it was thousands of years ago but this is obvious and not an interesting argument.

      As such I think you’re taking issue with something I didn’t say or certainly didn’t mean to say if somehow my words can be twisted into this historical imperialism.

      Hope that answers your comment.

  2. A circular argument ? : Current knowledge is correct, because it is current – it wouldn’t be current, unless it were correct.

    Medicine precisely is the domain not of cultural imperialism, but cultural arrogance : we don’t do that now / we know better now / that’s what they thought then…

    As to ‘twisted’, I say that I commented on what was the tone of your piece, and there is the assumption that every step is an advance towards, not a move away from, the truth, which is not grounded in the history and philosophy of thought.

    • Current knowledge isn’t better because it’s current but because it has been shown to be the closest approximation to the truth we can have with a methodology that done correctly gradually allows us to approach what’s “true.” This method isn’t perfect and there may be a better one as yet unknown but it is empirically better than what methods of finding the facts that went previously. Some medicine will have been shown to be good and we can continue or improve that. Some will be shown to be poor and we can abandon and improve that. It’s an ongoing process, science and an exciting one.

  3. Why does the phrase ’empricially better’ worry me ?

    Possibly because many people who use the word ’empirical’ by it actually mean little, though I am not suggesting that our writer is one of them : it is a sort of special pleading for something that, if it is correct, shouldn’t need it.

    As to finding the facts, didn’t the circulation of the blood get discovered in the 17th century (if not the 16th), and wasn’t Vesalius amongst those who dissected the human body before medical students ?

  4. Pingback: Basic Chemistry | the chronicle flask

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