TUDCA and Gallstones: What the Research Shows

TUDCA is a licensed medicine for some gallstone problems in Italy, and in people with gallstones it made bile less saturated with cholesterol. But in the only trial that compared it with ursodiol (UDCA), a long-established prescription medicine, for dissolving stones, ursodiol dissolved stones completely more often, and we found no controlled trial showing that any supplement dissolves gallstones.

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Search for TUDCA and gallstones and the answers sound confident: TUDCA "can help dissolve" stones, prevent new ones and clear sludge. Look at the studies behind those answers and the picture is different. Several measured something other than stones, one was a trial of an acupuncture technique, and the only comparison that measured stones favored ursodiol.

This guide sets out what each TUDCA gallstone study actually measured, how dissolving gallstones with medicine works, what is known about sludge, and how silent stones and gallbladder attacks are handled. It is written for people who still have their gallbladder; if yours has been removed, a later section is for you.

Can TUDCA Dissolve Gallstones?

TUDCA supplements are not a gallstone treatment, and no one should rely on a supplement to dissolve stones. In the only randomized trial that measured stone dissolution with both, 31 people with gallstones completed six months of TUDCA or UDCA; complete dissolution was more frequent on UDCA, which also eased indigestion more and was better tolerated, although TUDCA was acceptable [1].

In the US, UDCA is a prescription medicine called ursodiol. It is a long-established medicine that doctors prescribe routinely, and being offered it is common. For gallstones, its US label covers some small stones in people for whom surgery isn't the right choice [2]. Whether any gallstone treatment suits you is a decision to make with your doctor, and TUDCA is not a substitute for it.

Why is TUDCA licensed for gallstones in Italy?

TUDCA has been a licensed medicine in Italy since 1991 [3, 4]. Its Italian label lists it for bile overloaded with cholesterol, for non-calcified stones in a gallbladder that still works, and for bile duct stones that remain or return after surgery [3]. A label states an approved use; it isn't a trial result, and it applies to the medicine used under a doctor's care, not to supplements.

What Do the TUDCA Gallstone Studies Show?

The studies of TUDCA in people with gallstones are mostly from the 1990s, with 31 to 96 participants each. Several are cited online for things they did not measure, so this table sets out what each one looked at. Doses are given as each study reported them.

Study	Who took part	TUDCA dose and length	What was measured	Result
Gallo 1993 [1]	34 people randomized, 31 finished; TUDCA vs UDCA	10 mg/kg a day, 6 months	Stone dissolution, symptoms	UDCA dissolved stones completely more often
Muraca 1995 [5]	33 people with non-calcified stones, no control group	3.5 to 16.6 mg/kg a day, 4 to 6 weeks	Cholesterol saturation of bile	Fell as the dose rose: 147% before, about 80% at 11 mg/kg a day
Bazzoli 1995 [6]	262 people on stone-dissolving bile acids, 31 on TUDCA	Not stated	Stones becoming calcified during treatment	4 of 31 on TUDCA, similar to the other bile acids
Portincasa 1996 [7]	People with gallstones and healthy volunteers	10 mg/kg, one dose, then 1 month	Gallbladder emptying, TUDCA vs UDCA	Emptying unchanged
Duan 2022 [8]	70 people, acupuncture technique vs sham, all on TUDCA	500 mg a day, 8 weeks	Symptoms, gallbladder emptying	No group off TUDCA, so TUDCA itself wasn't tested
Gao 2022 [9]	96 people before gallstone surgery	5 to 10 mg/kg a day, 2 weeks	Blood and bile chemistry	Stones not measured

The bile chemistry result is real: in Muraca's study, the more TUDCA people took, the less saturated with cholesterol their bile became [5]. The study measured bile, not stones, and had no comparison group. Bazzoli's study recorded stones that turned calcified, which ends any chance of dissolving them, and TUDCA did not stop that from happening [6].

Two newer studies are often quoted. In Duan's trial, everyone took TUDCA and symptoms improved in the comparison group, but with no group off TUDCA the change can't be credited to it, and stone size wasn't measured [8]. Gao's study gave TUDCA for two weeks before surgery and measured bile taken during the operation, not the stones [9].

How Does Dissolving Gallstones With Medicine Work?

Doctors use medicine to dissolve gallstones only in particular situations. According to NIDDK, nonsurgical treatments are used "only in special situations", such as cholesterol stones in someone with a serious medical condition that prevents surgery [10]. The US ursodiol label covers stones that don't show on X-ray, are not calcified and are under 20 mm, in people for whom surgery carries extra risk or who decline it [2].

Dissolution is slow and works best for small stones. You may need months or years of treatment [10]. Across 23 trials, about 37% of people on higher doses of ursodiol had their stones dissolve completely after more than six months, and stones under 10 mm dissolved more often than larger ones [11]. Stones can also come back: the ursodiol label says up to half of people within five years of complete dissolution [2], and a European guideline gives 25% to 64% after five years [12].

Practice differs between countries. The 2016 European guideline recommends against dissolving gallbladder stones with bile acids, because the treatment didn't prevent symptoms or complications [12]. In the US, NIDDK describes it as an option for selected people [10].

Is There a Supplement to Dissolve Gallstones?

We found no controlled trial in people showing that a supplement, herb, juice or flush dissolves gallstones, and that includes TUDCA supplements. The reports we found were single cases or small studies without a comparison group. For sludge, our Journal's review found no trial in people of a supplement, herb, juice or cleanse dissolving it on its own.

If you have gallstones that cause symptoms, the usual treatment is surgery to remove the gallbladder, and pigment stones usually require it [10]. NIDDK's eating advice for gallstones includes more high-fiber foods, and losing weight at a slower pace may make new stones less likely [13, 14].

What About Gallbladder Sludge?

Sludge is a mix of mucus, calcium bilirubinate and cholesterol crystals that shows up on ultrasound [15]. It often forms during pregnancy, fast weight loss or long periods without eating, and it often clears once the cause goes [16, 17]. Sludge that causes no symptoms is usually watched rather than treated [17].

We found no study of TUDCA in gallbladder sludge, so there is no evidence that it clears or thins sludge. Our guide to gallbladder sludge covers causes, symptoms and what doctors do.

Can Gallstones Cause Problems During Treatment?

Yes. Gallstones can cause attacks at any time, including during dissolution treatment. In one older series of 126 people on ursodiol, treatment was stopped in 13 because of severe gallbladder pain and in 12 because the duct leading from the gallbladder became blocked [18]. A European guideline found that complications on ursodiol happened at about the same yearly rate as in people not taking it [12].

Do Silent Gallstones Need Treatment?

Most people with gallstones have no symptoms [19]. NIDDK says that if your gallstones aren't causing symptoms, you probably don't need treatment [10]. Gallstones are common: NIDDK puts them at 10 to 15% of the US population [20].

Gallbladder attacks usually cause pain in the upper right abdomen, sometimes lasting several hours, often after heavy meals and in the evening or at night [19]. If you have had one attack, more are likely, so it is worth telling your doctor even if the pain passes [19, 10].

When to get help right away

See a doctor right away for pain in the upper abdomen lasting several hours, nausea and vomiting, fever or chills, yellowing of the skin or eyes, or tea-colored urine and light-colored stools [19]. These can be signs of an inflamed gallbladder, an infection or a blocked duct, and they need prompt care.

What If Your Gallbladder Doesn't Empty Well?

Some people have gallbladder-type pain without stones and are told their gallbladder doesn't empty well, often after a HIDA scan, which measures how much the gallbladder squeezes out [21]. A 2010 US surgical guideline usually defines low emptying as under 35%, while a 2011 expert panel puts normal at 38% or more, and methods vary between imaging centers [22, 23].

Surgery is sometimes offered, and the guideline says such patients "may benefit" from it [22]. The evidence is limited: a Cochrane review found one trial of 21 people [24], and a 2019 analysis raised the possibility that some of the improvement after surgery is a placebo effect [25]. TUDCA's Italian label lists a poorly contracting gallbladder as a reason not to take it [3].

Should You Take TUDCA If You Have Gallstones?

If you have gallstones, talk to your doctor before taking TUDCA. Its medicine labels say not to take it with frequent gallbladder attacks, acute inflammation of the gallbladder or bile ducts, a blocked bile duct, calcified stones or a poorly contracting gallbladder [3, 26]. Our guide to who should not take TUDCA lists every caution on the labels.

What If Your Gallbladder Has Been Removed?

Life after gallbladder removal is a different situation from gallstones: bile flows directly from the liver into the small intestine instead of being stored for meals [10]. Dr.Primal's TUDCA is made for life after gallbladder removal and taken with meals, to support healthy bile flow and fat digestion; it is not a gallstone treatment. Our guide to TUDCA after gallbladder removal covers the research.

Stones can occasionally form in the bile ducts after the gallbladder is gone [27]. Our guide to gallstones without a gallbladder explains how that happens and the signs to watch for.

In Summary: TUDCA and Gallstones

TUDCA is licensed for some gallstone problems in Italy and made bile less saturated with cholesterol in people with gallstones, but in the only comparison for dissolving stones, ursodiol dissolved them completely more often. Several studies cited online for TUDCA dissolving stones measured other things, and we found no controlled trial showing that a supplement dissolves gallstones or sludge. Silent stones usually need no treatment, and stones that cause symptoms are a matter for your doctor.

If you are working out what is behind your symptoms after meals, our digestion quiz is a quick way to put your symptoms and habits in order.

This article is for general education and is not a substitute for advice from your doctor. TUDCA is sold as a dietary supplement. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.