Numerous questions arise in the mind of the clinician and physiologist regarding the regulation of bile salt output and the rational therapeutic use of bile salts in hepatic and biliary tract disease. My associates and I have sought to answer some of these questions by studies on animals, since patients with a total bile fistula are scarce and none have been available to us. In addition, there are certain questions which cannot be answered by clinical observation.
It has been clearly established that protein stimulates the formation of bile and bile salt production.1 The situation with regard to fat and sugar is not so clear. There is no evidence showing that fat and sugar increase bile salt production; the available evidence is to the contrary. When sugar is given to a fasting biliary fistula animal that is receiving no bile salts enterally, cholic acid and bile volume output