Cholagogue Herbs and Psoriasis – the Leaky Gut Connection

Dr. Ian Spohn, NDIan Spohn, ND, is a staff naturopathic doctor for Energique who enjoys challenging the dogmas of both conventional and alternative medicine. He is a passionate supporter of the paleo diet and classical homeopathy.



The traditional herbal approach to psoriasis typically focuses on the use of gentle, liver-supporting cholagogue herbs, such as dandelion and burdock. Holistic treatments for skin disorders axiomatically emphasize supporting the liver, though the exact mechanisms involved are rarely elaborated beyond the use of the nebulous term “toxemia.” By supporting healthy liver function it is believed that toxins, erstwhile presumed to be eliminated pathologically through the skin to relieve the overburdened liver, will once more leave the body through their proper channels and cure the skin disorder. A more satisfying explanation might directly relate to most of these herbs’ ability to promote the healthy flow of bile, an underappreciated substance which aids the digestion and absorption of fats but also has potent antimicrobial effects. The presence of this antimicrobial substance in the gut takes on a greater importance when, in addition to the connection between the skin and the liver, the connection of the skin to the gut and particularly the integrity of the mucosal barrier is acknowledged.

Among the numerous environmental toxins to which we are exposed, one of the most potent, ubiquitous, and inescapable is lipopolysaccharide (LPS), a component of bacterial cell walls ever-present in the healthy digestive tract. Nothing, short of systemic antibiotics, can ever rid us of these remnants of the gram-negative bacteria thriving and multiplying in our colons, and yet this very thing is among the most inflammatory substances known, having the potential to cause rapid death from septic shock if spread systemically. Small quantities of LPS are constantly and inevitably absorbed by the gut, where they enter the portal circulation and are typically cleared by Kupffer cells in the liver. Anything that impairs liver function or increases the permeability of the gut mucosal barrier has the potential to overload the body with this destructive, inflammatory toxin. In fact, it is believed that alcoholic liver injury has more to do with the increase in LPS-induced inflammation than the effects of alcohol itself. This is because alcohol consumption dramatically increases intestinal permeability, and no diet, however clean, all-natural, or free of toxins, can ever eliminate the toxins latent to the gram-negative flora of our own microbiome.

The key, of course, to handling this dangerous material within our own intestines is to maintain an adequate defense in the form of a healthy, intact mucosal barrier. The breakdown of this barrier, known as leaky gut syndrome, is increasingly recognized to contribute to a variety of diseases, including skin diseases such as psoriasis.[i] Two interesting facts about psoriasis, which would need to be reconciled by any attempt to explain the true cause of the disorder, are the conspicuous effects of seasonal variation and alcohol consumption on the disease. It has long been known that psoriasis is often ameliorated in summer, and in fact ultraviolet light exposure is now recognized as an effective therapy. It is also well known that alcohol consumption is notorious for aggravating the disorder. That alcohol consumption might aggravate a skin disease makes sense according to the theory that eruptions on the skin result from an overflowing toxic burden, but would increased sunlight or vitamin D have any effect on this? Perhaps a more convincing theory, which has recently been gaining support, would be that psoriasis results not from toxemia in general, but more specifically hinges upon a leaky gut. This would make sense because, firstly, alcohol makes the gut dramatically more permeable,[ii] and, secondly, vitamin D supports the integrity of the gut mucosal barrier by increasing cadherin expression and enhancing tight junctions formed between colonocytes.[iii] So what abstaining from alcohol and increasing exposure to sunlight have in common, besides improving psoriasis symptoms, is enhancing the integrity of the gut mucosal barrier and preventing toxic LPS from leaking into the body. The autoimmune inflammation which triggers the appearance of psoriasis lesions may well be a cross-reaction to endotoxins absorbed from a leaky gut.

The body has another weapon against LPS, which in light of the above might provide a mechanism to explain why cholagogue herbs like dandelion and burdock have often been recommended as holistic therapy for skin disorders – LPS can be effectively neutralized by bile. This has been demonstrated by some interesting experiments with radio-labeled LPS administered to rats. In healthy rats, orally administered LPS was found to be harmless, but when researchers administered LPS to rats with cannulated bile ducts, the same dose of LPS was systemically absorbed and proved fatal. They then repeated the experiment but gave the rats sodium deoxycholate, a secondary bile salt normally produced from bile by intestinal bacteria, and found that it reduced the absorption of LPS by almost half. This is because bile, normally produced by the liver and secreted by the gallbladder, has the ability to disperse and deactivate toxic LPS complexes into smaller, non-toxic particles.[iv] Lipopolysaccharide is of course a lipid, the breakdown of which is the primary function of bile. Herbs that support healthy bile production in the liver would therefore also support the dispersion of toxic LPS in the intestine to prevent its absorption. In theory, this would strongly indicate these herbs in treating leaky gut and the disorders which likely arise from it. For this reason, in addition to minimizing toxic exposures and ensuring an adequate supply of vitamin D, liver-supporting cholagogue herbs should be considered an essential part of any holistic psoriasis treatment protocol.



[i] Ely PH. Is psoriasis a bowel disease? Successful treatment with bile acids and bioflavonoids suggests it is. Clin Dermatol. 2018 May – Jun;36(3):376-389. Accessed at

[ii] Purohit V, Bode JC, Bode C, et al. Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences: Summary of a Symposium. Alcohol (Fayetteville, NY). 2008;42(5):349-361. Accessed at

[iii] Kong J, Zhang Z, Musch MW, Ning G, Sun J, Hart J, Bissonnette M, Li YC. Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier. Am J Physiol Gastrointest Liver Physiol. 2008 Jan;294(1):G208-16. Accessed at

[iv] Kocsar LT, Bertok L, Varteresz V. Effect of Bile Acids on the Intestinal Absorption of Endotoxin in Rats. Journal of Bacteriology, Oct. 1969 p. 220-223. Accessed at



Any homeopathic claims are based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.


Claims that are based on traditional homeopathic practice are not accepted as medical evidence. Not FDA evaluated. Energique Pro requires that customers log in to certain areas of our website. Portions of the website are only available to certified healthcare professionals, and Energique Pro reserves the right to limit access to only them.

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