What is tauroursodeoxycholic acid aka TUDCA ?
Tauroursodeoxycholic acid is a bile acid also known as TUDCA formed in the liver by conjugation of deoxycholate with taurine, usually as the sodium salt. While Western medicine has only gotten wind of the anti-apoptotic effects and its ability to protect mitochondria from cellular elements that would otherwise interfere with energy production within the past 20 years, or so, bear bile - you guessed it, a natural source of TUDCA - has an over 3,000 yearlong history of being used to treat visual disorders (Boatright. 2006), if which we know today that many of them can be treated and prevented by the administration of TUDCA and other bile-acids or bile-acid precursors, such as taurine (click here to read all about taurine).
So what's the suggested dose? That's actually quite a tricky question, because the number of human studies can be counted on the fingers of one hand (and this is still an exaggeration) and the available rodent data is mostly based on studies where the TUDCA was injected into the peritoneal cavity, which - depending on the compound that is used - will usually yield a bioavailabilty that's higher than what you will see with oral ingestion of the compound, yet lower than from intravenous injectionsThe distinction between different bile acids is difficile and beyond the scope of this mini-overview. What all of them have in common is that they are physiological detergents that facilitate excretion, absorption, and transport of fats and sterols in the intestine and liver. Bile acids are also steroidal amphipathic molecules derived from the catabolism of cholesterol, which makes them the ideal partner for both "water" and "fat soluble" molecules and allows them to do their job as major modulators of lipid secretion, bile flow and the absorption of dietary fats and vitamins. Aside from these long-established functions their role as regulators of key enzymes involved not only in cholesterol homeostasis, but also whole energy homeostasis has attracted more and more interest over the last years. The unique detergent properties of bile acids are essential for the digestion and intestinal absorption of hydrophobic nutrients.
All of the following values are calculated for an 80kg human using the standard HED formula and are based on rodent studies showing benefits for the respective organ:
All of the following values are calculated for an 80kg human using the standard HED formula and are based on rodent studies showing benefits for the respective organ:
- Heart - 650mg
- Diabetes - 975mg
- Liver - 400-3,200mg
- Alzheimer's - 4,000mg*
- Parkinson's - 350mg
- Pancreas - 3,250mg
No effect without "side effect"!
Yet despite their metabolic utility bile acids have potent toxic properties and can - at high dosages - actually disrupt the very membranes they help to protext when they are administered at lower doses, therefore their accumulation in the blood and tissue is usually tightly regulated. And while Martinez-Diez et al. have shown that conjugated.bile acids have a very high toxicity threshold compared to their unconjugated cousins (Martinez-Diez. 2000), we are most probably still dealing with one of those classic U-shaped dose-response curves for TUDCA (with no effects at very low, beneficial effects at medium levels and toxicity issues at high levels) which are so ubiquitous in nature and still so difficult to understand for someone acculturated to the typical Western "more is more" mentality (Zinc would be another example, by the way; cf. "Zinc: 15mg is Plenty!").
A non-exhaustive list of proven benefits
- With its modulatory effects on the cell cylce regulator c-Jun N-terminal kinase (JNK), the generation and scavenging of radical oxigen specimen and glutathione S-transferase (GST) activity, which is necessary for the masteroxidant glutathione to do its job, TUDCA effectively prevented / reduced neurodegenation in rodent model of Parkinson's disease (Castro-Caldas. 2012). It has also been shown to reduce the amyloid beta-induced synaptic toxicity that is so characteristic of Alzheimer's disease (Nunes. 2012; Ramalho. 2012)
Figure 1: Anti-inflammatory effect of TUDCA on FFA treated adipocytes; reduction in TNF-alpha and IL-6 (also vs. baseline; directly from Jia. 2011))
- The same anti-ER mechanism also protects the insulin releasing pancreatic beta cells of Wistar rats (Lee. 2010; Tang. 2012) and the kidney (Gao. 2012) from damage due to increased blood glucose. And Rivard et al. were even able to show that 400mg/kg of TUDCA, when they were administered intravenously were able to reduce apoptosis (death of hear cells) following myocardial infarction in rats (Rivard. 2007).
- TUDCA has also been shown to ameliorat insulin resistance in hypertrophic adipocytes (fat cells that burst from the seams; Jiao. 2011, Yoshizaki. 2012), to keep the expression of the adiponectine up (Zhou. 2010) and the inflammatory induced neovascularization in type II diabetes in check (Amin. 2012).
- Despite the fact that TUDCA is also effective against endoplasmic rectilium stress in the liver and in skeletal muscle it cannot save a methionine and choline deficient liver from getting clogged with fat (Henkel. 2012), or a palmitate (a saturated fatty acid) treated myotube from becoming insulin resistant, (Rieusse. 2012).
- What it can do, however is protect liver from apoptosis induced by natural or synthetic PPAR-gamma ligands (see "TTA + Fish Oil - Fat Burning Superfats or Hepatoxic Pro-Oxidants?" and "TTA + Fish Oil Revisited - Increased Intramuscular Omega-3 Levels Compromise Heart and Skeletal Muscle Performance"; cf. Nonaka. 2008) and ethanol-feeding (Colell. 2011)
Figure 2: Western blot analysis of influenza NP, NS1, and M1 proteins with corresponding densitometry displayed as averages with S.E. Proteins - reduced expression indicate a reduced replication rate (adapted from Hassan. 2011)
- TUDCA has also been found to have antibacterial effects, or rather to prevent the cytotoxic effects of Clostridium sordellii lethal toxin (CSLT) from virulent strains of Clostridium sordellii (Schulz. 2009)
- Only when it's conjugated to taurine UDCA (then T + UDCA = TUDCA ;-) will
promote hydrocholeresis or, put simply, the output of bile acid (Úriz.
2011; intravenous administration). In view of the emerging importance
of bile acids in overall energy expenditure and thyroid function
(Ockenga. 2012). This observation could well-explain the effects TUDCA has on the conversion of T4 => T3, which spiked your interest in the last installment of "On Short Notice", here at the SuppVersity (see "On Short Notice July 21, 2012").
- In this context it may also be wort mentioning that Nathanson et al. observed a direct stimulative effect of UDCA, the taurine devoid cousin of TUDCA on hepatic ATP secretion (Nathanson. 2001) and Drack et al. report that subcutaneous injections of 500 mg/kg in 0.15 M NaHCO3 to obesity prone mice reduced their weight gain by -22%; a significant effects on "normal" mice could was yet not observed in the study (Drack. 2012).
As mentioned earlier, the number of studies in which TUDCA was actually administered to human beings is negligible and of actual relevance in the current context are probably on these two:
|Figure 3: Effect of placebo or TUDCA on skeletal muscle insulin receptor substrate (IRS), Akt and JNK levels (Kars. 2010)|
- Improved liver & muscle, but not adipose tissue insulin sensitivity in obese men and women (Kars. 2010) The main finding of this randomized double-blind study in which 20 obese subjects ([means +/- SD] aged 48 +/- 11 years, BMI 37 kg/m²) were assigned to receive either TUDCA at a dose of 1,750 mg/day or a placebo was a highly significant increase in insulin sensitivity (~30%; p < 0.05), which was - and this is would actually not be a bad thing for a physical culturist - liver and muscle specific!In combination with it's effect on the muscular and hepatic expression of p-AKT, this could make TUDCA the nutrient repartitioner (R-)ALA is not (cf. "Lean & Muscular with Alpha Lipoic Acid?"), if those effects would translate to individuals with normal insulin sensitivity (they do translate into human muscle cells in the Petri dish, which are protected against glucosamine induced decreases in GLUT-4 activity, when enough TUDCA was present in the incubation media; cf. Raciti. 2010).
- Surprisingly ineffective adjuvant after liver transplantation (Angelico. 1999) While you would expect that something that is good for liver health would also help as an adjuvant to the treatment of patients who received a liver transplant, the 16 subjects who were randomized to the active 2x250mg TUDCA treatment arm of the study did not see any statistically significant benefit in terms of one-year actuarial survival.
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