What is TUDCA?
- Tauroursodeoxycholic acid (TUDCA) is a a water soluble bile acid, found in naturally in trace amounts in the body.
- It is the taurine conjugate form of ursodeoxycholic acid (UDCA)
- It has been used as a supplement to treat liver diseases (like cholestasis and cholelithiasis) and overall health (including brain health)
On the video below, Dr. Jerry Brainum explains how TUDCA can act as a liver protection supplement.
What is the recommended TUDCA dosing?
- Liver regenesis: 10-13 mg daily for 3 months.
- Improving bile salt composition: 15-20 mg per kg of bodyweight.
- Muscle and liver insulin sensitivity: 1750 mg daily for up to 4 weeks.
- Primary biliary cirrhosis: 750 mg daily for 2 months.
- Liver transplant: 500 mg daily for 1 year.
- Chronic hepatitis: 500 mg daily, for 6 months.
- ALS: 1 g twice daily for 1 year.
- Liver and eye health: two 250 mg capsules daily.
- Primary biliary cholangitis: 250 mg
- Bodybuilders: 500 – 1500 mg daily.
A wash out period of 3 months is recommended after each 6 month period of ingestion.
What are TUDCA’s side effects?
- 500 mg daily: no side effects.
- Over 1000 mg daily: Gastrointestinal symptoms (diarrhea), itch, rash and period pain.
UDCA side effects
UDCA (which is similar to TUDCA) showed the following side effects:
- Dry skin
- Worsening of psoriasis
- Hair thinning
- Biliary pain
- Gallbladder inflammation (cholecystitis)
Mental health issues
- Sleep disorder
Pain and fatigue
- Joint Pain (arthralgia)
- Muscle pain (myalgia)
Potential TUDCA benefits
TUDCA supplement benefits include support for:
- Cholelithiasis (gallstones)
- Cholestatic liver disease
- Cholestasis (blockage of liver bile flow)
- Liver Cirrhosis
- Liver enzymes, mitochondria and cells
- Gallbladder health and bile duct flow
- Insulin sensitivity for diabetes
- Gut microbiome and anti inflammatory
- Cholesterol reduction
- Gene expression
- Protein folding and reduction of stress on the endoplasmic reticulum (ER) of cells
- Brain and eye health
- Heart health
- Kidney health
Non-liver neurodegenerative diseases
- Alzheimer’s disease
- Parkinson’s disease
- Huntington’s disease
Can TUDCA help with Weight Loss?
- TUDCA may reduce insulin sensitivity, which prevents obesity and helps in weight loss.
- TUDCA has been considered an important regulator of energy metabolism in obesity.
- In a study with mice, TUDCA caused a reduction in fat deposits, which caused weight loss.
Glycolipid Metabolism Disorder in the Liver of Obese Mice Is Improved by TUDCA via the Restoration of Defective Hepatic Autophagy
500 mg/kg of TUDCA was injected into obese mice, and metabolic parameters, autophagy markers, and insulin signaling molecular were assessed.
- The TUDCA injections in the obese mice resulted in a reduced body weight gain, lower blood glucose, and improved insulin sensitivity compared with obese mice that were injected with vehicle.
- Meanwhile, TUDCA treatment not only reversed autophagic dysfunction and endoplasmic reticulum stress, but also improved the impaired insulin signaling in the liver of obese mice.
These results support the hypothesis that TUDCA improves the defective hepatic autophagy, activation of ER stress, and impaired insulin signaling induced by obesity, thereby offering novel opportunities for the treatment of obesity.
Can TUDCA help with Cancer?
Studies suggests that TUDCA can act as healing agent in some types of cancer:
- Liver Cancer: TUDCA reduces liver toxicity caused by liver cancer and prevents tumor formation by decreasing ER stress, inflammation and cell death in cancer tissue.
- Colitis Cancer: TUDCA prevents formation of tumors caused by colitis, hence TUDCA could be a treatment for colitis-associated cancer (CAC).
- Prostate Cancer: TUDCA treatment led to a lower expression of the genes that cause prostate cancer, so TUDCA could potentially help treat prostate cancer.
TUDCA Vs Taurine
- For TUDCA, the liver bile duct releases bile salts into the large intestine, then microbes metabolize these salts into ursodeoxycholic acid (UDCA), which gets conjugated to Taurine in order to create TUDCA.
- Taurine is an amino acid.
- For liver function, TUDCA is more powerful than Taurine.
TUDCA and Liver Enzymes
TUDCA has been proven to lower the following liver enzymes associated with liver disease:
- alanine aminotransferase (AST)
- aspartate aminotransferase (ALT)
- alkaline phosphatase (ALP)
- gamma-glutamyl transpeptidase (GGT)
- Title: Does tauroursodeoxycholic acid (TUDCA) treatment increase hepatocyte proliferation in patients with chronic liver disease?.
- Duration: 3 months.
- Health Status: chronic liver disease.
- Number of subjects: 5.
Despite numerous studies on the effects of bile salts therapy in chronic liver disease, there are no reports on the influence such therapy has on hepatocyte proliferation.
The aim of this preliminary study was to evaluate the effect of TUDCA on hepatocyte proliferation in 5 patients with HCV-correlated chronic liver disease. All patients were treated with TUDCA (10-13 mg/day) for three months and the determination of PCNA (Proliferating Cell Nuclear Antigen) expression was used to assess the proliferative activity of hepatocytes at the beginning and at the end of treatment.
TUDCA reduced both ALT and Knodell’s score in the 5 patients in whom a significant increase of PCNA-LI was observed after treatment.
TUDCA administration seems to stimulate hepatocyte proliferation in man.
- Title: Tauroursodeoxycholic acid for the treatment of HCV-related chronic hepatitis: a multicenter placebo-controlled study.
- Duration: 6 months.
- Health Status: chronic hepatitis.
- Number of subjects: 150.
One hundred and fifty patients with chronic hepatitis were randomly assigned to receive tauroursodeoxycholic acid at daily doses of 500 mg or 750 mg, or a placebo for 6 months.
A consistent decrease in aminotransferase serum levels was observed in patients treated with tauroursodeoxycholic acid compared with placebo (p<0.001) and a progressive improvement with time was also found (p<0.05; linear time effect).
Tauroursodeoxycholic acid improves the biochemical expression of chronic hepatitis. Long-term studies with clinically relevant end-points are warranted.
Primary biliary cirrhosis
- Title: Tauroursodeoxycholic acid for treatment of primary biliary cirrhosis. A dose-response study.
- Duration: 6 months.
- Health Status: primary biliary cirrhosis.
- Number of subjects: 24.
We performed a dose-response study on 24 patients with primary biliary cirrhosis who were randomly assigned to receive 500, 1000, or 1500 mg daily of tauroursodeoxycholic acid for six months.
- Biliary enrichment with ursodeoxycholic acid ranged from 15% to 48% and was not related with the dose.
- Liver enzyme levels decreased significantly after the first month of treatment with all three doses.
- No significant difference among the three doses was found, although further reduction over time occurred with 1000 and 1500mg daily.
- Plasma total and HDL cholesterol significantly decreased in patients administered the two higher doses.
- Diarrhea was the only side effect.
A dose of about 10mg/kg body wt/day of tauroursodeoxycholic acid should be used for long-term studies in patients with primary biliary cirrhosis.
- Title: Differences in the metabolism and disposition of ursodeoxycholic acid and of its taurine-conjugated species in patients with primary biliary cirrhosis.
- Duration: 2 months.
- Health Status: primary biliary cirrhosis.
- Number of subjects: 12.
- Gender: female.
The clinical effectiveness of ursodeoxycholate in the treatment of liver disease may be limited by its poor absorption and extensive biotransformation. Because in vitro and in vivo studies suggest that the more hydrophilic bile acid tauroursodeoxycholate has greater beneficial effects than ursodeoxycholate, we have compared for the first time the absorption, metabolism, and clinical responses to these bile acids in patients with primary biliary cirrhosis (PBC).
Twelve female patients with PBC were administered tauroursodeoxycholate and ursodeoxycholate (750 mg/d for 2 months) in a study. Bile acids were measured in serum, duodenal bile, urine, and feces.
- Biliary ursodeoxycholate enrichment was higher during tauroursodeoxycholate administration (32.6% vs. 29.2% during ursodeoxycholate).
- Lithocholic acid concentration was consistently higher in all biological fluids during ursodeoxycholate administration.
- Fecal bile acid excretion was the major route of elimination of both bile acids; ursodeoxycholate accounted for 8% and 23% of the total fecal bile acids during tauroursodeoxycholate and ursodeoxycholate administration, respectively.
- Tauroursodeoxycholate was better absorbed than ursodeoxycholate, and, although it was partially deconjugated and reconjugated with glycine, it underwent reduced biotransformation to more hydrophobic metabolites.
This comparative study suggests that tauroursodeoxycholate has significant advantages over ursodeoxycholate that may be of benefit for long-term therapy in PBC.
- Title: Ursodeoxycholic and tauro-ursodeoxycholic acids for the treatment of primary biliary cirrhosis: a pilot crossover study.
- Duration: 15 months.
- Health Status: primary biliary cirrhosis.
- Number of subjects: 23.
The effects of ursodeoxycholic and tauro-ursodeoxycholic acids were compared in 23 patients with primary biliary cirrhosis according to a crossover design. Both drugs were administered at the daily dose of 500 mg. in a randomly assigned sequence for two 6-month periods separated by a 3-month wash-out period.
Serum liver enzymes related to cholestasis and cytolysis consistently improved, as compared to baseline values, during the administration of both ursodeoxycholic and tauro-ursodeoxycholic acids, but no significant difference between these two bile acids was found. Both treatments were well tolerated and no patient complained of side effects.
In the short-term, tauro-ursodeoxycholic acid appears to be safe and at least as effective as ursodeoxycholic acid for the treatment of primary biliary cirrhosis.
- Title: Efficacy and safety of tauroursodeoxycholic acid in the treatment of liver cirrhosis: a double-blind randomized controlled trial .
- Duration: 6 months.
- Health Status: patients with liver cirrhosis.
- Number of subjects: 23 patients were randomly divided into TUDCA group (12) and UDCA group (11).
The patients were given TUDCA and UDCA respectively at the daily dose of 750 mg, in a randomly assigned sequence for a 6-month period.
- Albumin levels were significantly increased in both TUDCA and UDCA groups.
- Markers for liver fibrosis were slightly decreased with the difference being not significant in either group.
- Only one patient in TUDCA group had significant relief.
- Both treatments were well tolerated and no patient complained of side effects.
- It is suggested that TUDCA therapy is safe and appears to be more effective than UDCA in the treatment of liver cirrhosis.
- However, both drugs exert no effect on the serum markers for liver fibrosis during 6-month treatment.
TUDCA dose for ALS
- TUDCA 1 g twice daily (2g daily) for 54 weeks.
- Riluzole 50 mg twice daily (100 mg daily).
- Title: Tauroursodeoxycholic acid in the treatment of patients with amyotrophic lateral sclerosis.
- Duration: 54 weeks.
- Health Status: ALS.
- Number of subjects: 34.
Patients under treatment were randomized to placebo or TUDCA and were evaluated after a lead‐in period of 3 months.
- Tauroursodeoxycholic acid was well tolerated; there were no between‐group differences for adverse events.
- The proportion of responders was higher under TUDCA (87%) than under placebo (43%).
This pilot study provides preliminary clinical data indicating that TUDCA is safe and may be effective in ALS.
- Title: Tauroursodeoxycholic Acid may improve liver and muscle but not adipose tissue insulin sensitivity in obese men and women.
- Duration: 4 weeks.
- Health Status: obese.
- Number of subjects: 20.
Patients were randomized to 4 weeks of treatment with TUDCA (1,750 mg/day) or placebo.
- Liver and muscle insulin sensitivity increased by approximately 30% after treatment with TUDCA but did not change after placebo therapy.
- In addition, therapy with TUDCA, but not placebo, increased muscle insulin signaling.
- Markers of stress in muscle or adipose tissue did not change after treatment with either TUDCA or placebo.
This data demonstrates that TUDCA might be an effective pharmacological approach for treating insulin resistance. Additional studies are needed to evaluate the target cells and mechanisms responsible for this effect.
- Title: One-year pilot study on tauroursodeoxycholic acid as an adjuvant treatment after liver transplantation.
- Duration: 12 months.
- Health Status: undergoing liver transplantation.
- Number of subjects: 33.
- Sixteen patients were randomized to receive tauroursodeoxycholic acid (250 b.i.d. for 12 months) and 17 served as controls.
- Tauroursodeoxycholic acid was given from day 5 after transplantation for one year.
- Tauroursodeoxycholic acid treatment was safe and well tolerated.
- No drop outs occurred.
- The one-year actuarial survival was 78.6% in patients treated with tauroursodeoxycholic acid and 86.7% in controls.
- No differences were observed with respect to early or late graft function and survival, nor to acute cellular rejection.
- Tauroursodeoxycholic acid therapy was associated with lower cholesterol levels during the early postoperative months; with milder cholestasis; with a drop in biliary cholates but no changes in bile salts.
Long-term treatment with low dose tauroursodeoxycholic acid after liver transplantation is safe but does not affect graft function and survival.
Want to know more?
Click the links below to access the individual topic pages:
- Crosignani A, Battezzati PM, Setchell KD, Invernizzi P, Covini G, Zuin M, Podda M. Tauroursodeoxycholic acid for treatment of primary biliary cirrhosis. A dose-response study. Dig Dis Sci. 1996 Apr;41(4):809-15. doi: 10.1007/BF02213140. PMID: 8674405.
- Invernizzi P, Setchell KD, Crosignani A, Battezzati PM, Larghi A, O’Connell NC, Podda M. Differences in the metabolism and disposition of ursodeoxycholic acid and of its taurine-conjugated species in patients with primary biliary cirrhosis. Hepatology. 1999 Feb;29(2):320-7. doi: 10.1002/hep.510290220. PMID: 9918905.
- Crosignani A, Budillon G, Cimino L, Del Vecchio Blanco C, Loguercio C, Ideo G, Raimondo G, Stabilini R, Podda M. Tauroursodeoxycholic acid for the treatment of HCV-related chronic hepatitis: a multicenter placebo-controlled study. Hepatogastroenterology. 1998 Sep-Oct;45(23):1624-9. PMID: 9840118.
- Larghi A, Crosignani A, Battezzati PM, De Valle G, Allocca M, Invernizzi P, Zuin M, Podda M. Ursodeoxycholic and tauro-ursodeoxycholic acids for the treatment of primary biliary cirrhosis: a pilot crossover study. Aliment Pharmacol Ther. 1997 Apr;11(2):409-14. doi: 10.1046/j.1365-2036.1997.124295000.x. PMID: 9146783.
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- Elia, A E et al. “Tauroursodeoxycholic acid in the treatment of patients with amyotrophic lateral sclerosis.” European journal of neurology vol. 23,1 (2016): 45-52. doi:10.1111/ene.12664
- Kars M, Yang L, Gregor MF, Mohammed BS, Pietka TA, Finck BN, Patterson BW, Horton JD, Mittendorfer B, Hotamisligil GS, Klein S. Tauroursodeoxycholic Acid may improve liver and muscle but not adipose tissue insulin sensitivity in obese men and women. Diabetes. 2010 Aug;59(8):1899-905. doi: 10.2337/db10-0308. Epub 2010 Jun 3. PMID: 20522594; PMCID: PMC2911053.
- Angelico M, Tisone G, Baiocchi L, Palmieri G, Pisani F, Negrini S, Anselmo A, Vennarecci G, Casciani CU. One-year pilot study on tauroursodeoxycholic acid as an adjuvant treatment after liver transplantation. Ital J Gastroenterol Hepatol. 1999 Aug-Sep;31(6):462-8. PMID: 10575563.
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- Vandewynckel YP, Laukens D, Devisscher L, et al. Tauroursodeoxycholic acid dampens oncogenic apoptosis induced by endoplasmic reticulum stress during hepatocarcinogen exposure. Oncotarget. 2015;6(29):28011-28025. doi:10.18632/oncotarget.4377
- Kim YH, Kim JH, Kim BG, Lee KL, Kim JW, Koh SJ. Tauroursodeoxycholic acid attenuates colitis-associated colon cancer by inhibiting nuclear factor kappaB signaling. J Gastroenterol Hepatol. 2019 Mar;34(3):544-551. doi: 10.1111/jgh.14526. Epub 2018 Nov 14. PMID: 30378164.
- Tan B, Jia R, Wang G and Yang J: Astragaloside attenuates the progression of prostate cancer cells through endoplasmic reticulum stress pathways. Oncol Lett 16: 3901-3906, 2018
- P. Portincasa, V. Palmieri, F. Doronzo, G. Vendemiale, E. Altomare, C. Sabbà, G. Palasciano, O. Albano, Effect of tauroursodeoxycholic acid on serum liver enzymes and dyspeptic symptoms in patients with chronic active hepatitis.