TUDCA is a bile acid that may help with liver and gallbladder issues. It is also being researched for protecting the brain and improving eye health. Read on to learn about the potential uses and side effects of this bile acid.
What is TUDCA?
Tauroursodeoxycholic acid, more commonly referred to as TUDCA, is a bile acid that is found in trace amounts in the human body. Bile acids are compounds released from the gallbladder that help digest fats .
Unlike UDCA, TUDCA is not an FDA-approved medication in the US. UDCA is also known as URSO or ursodiol. UDCA is approved for the treatment of patients with primary biliary cirrhosis, which is an autoimmune liver disorder [2, 3, 4].
TUDCA is essentially the same molecule as ursodeoxycholic acid (UDCA). Specifically, TUDCA is UDCA with an added (conjugated) taurine. Both are bile acids and act on similar cellular pathways. They only slightly differ in solubility and bioavailability in the body .
Some evidence supports the use of TUDCA for diseases beyond the liver, though much more research is needed .
TUDCA is sold as a supplement. However, TUDCA supplements have not been approved by the FDA for medical use. Supplements generally lack solid clinical research. Regulations set manufacturing standards for them but don’t guarantee that they’re safe or effective. Speak with your doctor before supplementing.
The FDA issued a warning about TUDCA bulk products from China that are being used for research purposes. These products may be misbranded and are entering the US without passing any checks .
Bear bile, which contains large amounts of TUDCA, has been used in traditional Chinese medicine for more than 3,000 years. However, TUDCA obtained from bears is extremely controversial due to animal welfare concerns [7, 8, 9].
Bile is either extracted from live bears on “farms,” where bears are kept in small cages and are subjected to either perpetually open wounds or to constant invasive surgery or wild bears are hunted for their gallbladders. These practices persist even though TUDCA can be chemically synthesized [7, 8, 9].
However, TUDCA and UDCA are nowadays mostly synthetically produced. Scientists are continuously developing new methods for environmentally- and animal-friendly large-scale TUDCA and UDCA production, such as through the fermentation of certain bacterial strains [10, 11].
Mechanisms Of Action
Scientists propose TUDCA may act by:
- Increasing glucose-induced insulin release via the cAMP/PKA pathway, increasing insulin sensitivity .
- Relieving endoplasmic reticulum (ER) stress. The ER makes sure proteins are folded properly [13, 14].
- Reducing programmed cell death (apoptosis) in healthy cells . TUDCA prevents the molecule BAX from reaching the mitochondria. BAX causes mitochondria to release cytochrome C, which causes enzymes (caspases) to initiate apoptosis .
- Inactivating Bcl-2-associated death promoter (BAD), a molecule involved in apoptosis .
- Removing toxic bile acids from the liver and preventing them from damaging liver cells .
Potential Health Benefits of TUDCA
Possibly Effective for:
Cholestasis is a condition where bile doesn’t flow properly from the liver to the gallbladder and then to the small intestine .
Cholestasis is characterized by a lack of bile in the small intestine and accumulation of bile in the liver .
Cholestasis is often associated with other liver conditions, including primary biliary cirrhosis (PBC) .
TUDCA was able to reduce cholestasis caused by liver injury from a lack of blood flow .
Effect on Liver Enzymes in Cholestasis
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are two important enzymes in the liver. Elevated levels of these enzymes can indicate liver problems like primary biliary cirrhosis (PBC: an autoimmune disease that destroys bile ducts) or hepatitis [3, 20].
In one study done on 12 women with PBC over two months, TUDCA reduced liver enzymes by 51% .
In a study in 23 patients with PBC, TUDCA significantly improved liver enzymes levels (ALT, AST, gamma-glutamyl transferase (GGT), and alkaline phosphatase) .
Some scientists hypothesize that TUDCA may decrease liver enzyme levels at low doses, though proper clinical data are lacking. A study of 5 liver disease patients found that 10 – 13 mg TUDCA daily for three months was able to reduce the liver enzyme alanine transaminase (ALT) levels. The clinical significance of this finding is unclear .
Insufficient Evidence for:
The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of TUDCA for any of the below-listed uses.
Remember to speak with a doctor before taking TUDCA. TUDCA should never be used as a replacement for approved medical therapies.
2) Liver Cirrhosis
Cirrhosis is a condition of the liver in which scar tissue replaces healthy cells. It is a common cause of death and illness and is currently the fourteenth leading cause of death worldwide .
A study found that TUDCA was safe and effective in the treatment of liver cirrhosis in 18 patients with the disease .
A study of 150 patients with hepatitis C found that TUDCA was more effective than placebo and progressively improving chronic hepatitis over the six-month trial period .
In one study, TUDCA reduced liver damage, oxidative stress, and scarring of tissue in mice with fatty liver disease. The effects of TUDCA on fatty liver disease in humans remains unknown .
Scientists are also investigating the effects of TUDCA on hepatitis B and hepatitis D viruses in cells .
4) ALS (Lou Gehrig’s Disease)
ALSFRS-R is a functional rating scale for measuring disability in ALS patients, with higher scores indicating less disability. A study of 34 ALS patients showed that patients taking 1 g TUDCA daily had higher ALSFRS-R scores after one year .
TUDCA was well-tolerated, and there were no differences in adverse effects between the TUDCA and placebo groups .
Additional Research/Lacking Clinical Evidence
No clinical evidence supports the use of TUDCA for any of the conditions listed in this section.
Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies listed below should not be interpreted as supportive of any health benefit/medical property.
5) Diabetes Complications
No evidence supports the use of TUDCA for diabetic complications [13, 14].
Copper levels are often elevated in diabetic patients . One study found that TUDCA reduced high copper levels to normal levels in type 1 diabetic mice. Human data are lacking .
Diabetic retinopathy (DR) is a complication of diabetes in which the blood cells of the light-sensitive tissue in the eye (retina) are damaged. Scientists are exploring the effects of TUDCA on human retinal cells exposed to high levels of sugar .
6) Alzheimer’s Disease
Amyloid beta (Aβ) plaques are proteins that play a critical role in the development of Alzheimer’s disease. TUDCA reduced Aβ plaques in the brains of mice with symptoms of Alzheimer’s disease. It also prevented memory deficits in a mouse model of Alzheimer’s disease. However, its effects on Alzheimer’s symptoms and progression in humans remain unknown [1, 30, 31].
Researchers are interested to know if TUDCA can reduce neuron cell death (apoptosis) in dishes, as this process is involved in Alzheimer’s and other diseases of the brain .
7) Parkinson’s Disease
TUDCA protected nerve cells in a mouse model of Parkinson’s disease. It also reduced cell death in a rat model of Parkinson’s disease. However, no clinical trials on TUDCA in Parkinson’s disease patients have yet been completed [33, 34].
One randomized, placebo-controlled, double-blind clinical trial is currently recruiting patients to investigate the effects of UDCA on the progression of Parkinson’s disease.
Scientists believe UDCA might rescue the function of the mitochondria and prevent c-Jun N-terminal kinase (JNK) activation. The JNK pathway leads to the death of neurons in Parkinson’s disease [35, 36].
8) Huntington’s Disease
The effects of TUDCA on Huntington’s disease in humans are unknown.
A study found that TUDCA was protected nerve cells in a mouse model of Huntington’s disease. It also reduced brain cell death in rats with symptoms of Huntington’s disease. Human studies are lacking and placebo groups [37, 38].
Large-scale studies are needed before we can draw any conclusions .
A study in rats gave TUDCA one hour after a stroke and found that TUDCA raised bile acid levels in the brain. Scientists think this might be helpful for stroke recovery, though human studies are lacking .
In another study, TUDCA decreased blood clot volume and cell death due to stroke in animals. TUDCA reduced both wound volumes and cell death in the striatum (a part of the brain) of rats by 50% after a stroke [40, 41].
10) Heart Health
TUDCA reduced heart cell death following a heart attack in rats. The study suggested that the effects of TUDCA on heart function should be researched further in both animal models and humans .
11) Retinal Health
The effects of TUDCA on eye and retinal health in humans remain unknown.
Retinitis pigmentosa (RP) is a disease of the brain (neurodegenerative) that results in blindness .
A study done on mice reported that TUDCA improves RP in mice .
The study noted that TUDCA preserved rod and cone (cells of the eye responsible for vision) function, and prevented cell death of rods of cones .
TUDCA slowed retinal degeneration in mice and slowed retinal degeneration and vision loss in rats [44, 45].
Leber congenital amaurosis (LCA) is an eye disorder that damages the retina. TUDCA improved LCA in mice .
Choroidal neolization (CNV) is the creation of new blood vessels in the choroid layer of the eye, which is a thin layer directly behind the retina that absorbs scattered light. It results in significant and permanent vision loss from the formation of scar tissue .
In mice whose eyes were exposed to a laser to cause CNV, TUDCA prevented CNV formation .
The study suggested that TUDCA should be further researched for its effects on CNV-related retinal diseases .
Likely Ineffective for:
12) Obesity & Weight Loss
Based on the existing evidence, TUDCA is likely ineffective for weight loss and obesity.
In a study of 20 obese volunteers, 1,750 mg TUDCA daily for four weeks increased insulin sensitivity by 30% in muscle and liver tissue .
However, in the same study, there was no change in the sensitivity of fat tissue to insulin .
Moreover, no effects on blood glucose or insulin levels were seen, and TUDCA had no significant influences on body fat or weight .
Despite these negative findings, bodybuilders are using TUDCA as a weight-loss drug or muscle-building supplement.
TUDCA Side Effects & Precautions
Diarrhea has been reported from dosages of 1,000 – 1,500 mg of TUDCA .
The following adverse effects have been reported with the use of UDCA, which is similar to TUDCA :
- Worsening of pre-existing psoriasis
- Other skin issues (rash, urticaria, dry skin)
- Hair thinning
- Biliary pain and cholecystitis
- Digestive problems (constipation, stomatitis, flatulence)
- Mental health disturbances (anxiety, depression, sleep disorder)
- Arthralgia, myalgia, and back pain
- Cough and rhinitis
A dose-response study of TUDCA tested doses of 500 mg, 1000 mg, and 1500 mg per day over six months, finding that there was little difference between the doses on liver markers .
1500 mg was the most effective at lowering enzyme levels while 500 mg was the most cost-effective .
One study suggested 60 mg/kg/day as a tolerable and administrable dose for humans .
TUDCA taken at 10 – 13 mg daily for three months is able to reduce liver enzyme levels .
Scientists used 15 – 20 mg/kg body weight of TUDCA for improving bile salt composition .
In otherwise healthy obese persons, doses of 1,750 mg daily have been tolerated for up to four weeks .
In liver transplant patients, 500 mg of TUDCA taken daily for one year was not associated with any adverse effects .
In patients with PBC, 750 mg of TUDCA daily for two months was well-tolerated. Another study in patients with PBC found 1500 mg of TUDCA daily for six months was also well-tolerated [53, 3].
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TUDCA for nonalcoholic fatty liver (steatohepatitis): “TUDCA seriously played a huge role in saving my life. If you’re taking a lot of supplements or medications, or get frequent stomach pain across the upper quadrants, or else abuse your liver, try this”.
TUDCA for Parkinson’s disease: “I have been taking TUDCA since November 27th, 2014, about 6 months after my Parkinson’s diagnosis. I started with 1,000 mg of TUDCA plus an assortment of other supplements for alpha-synuclein aggregation and brain inflammation. After about six months, I was not experiencing any symptoms even when tired, stressed or sick. I still have no symptoms. It will be three years this November”.
TUDCA for bodybuilding: “My results were amazing and the side effects were essentially nonexistent and I truly think a lot of that had to do with me running this tudca as it was really the only thing different I had added to my usual cycle”.
TUDCA for liver health: “Anyone with liver issues will benefit from the product. The capsules taste awful but that’s not really an issue nor the manufacturer’s fault, some powders just have a foul taste even in a capsule. I’ve been taking it for 2 weeks now, since taking this my blood work has shown liver values are back in the normal range”.