{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T01:27:10Z","timestamp":1793582830552,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["faseb.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The FASEB Journal"],"published-print":{"date-parts":[[2026,9,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Bile acid biology has advanced through significant conceptual shifts. Once understood primarily as biological detergents, bile acids are now recognized as signaling molecules and, more recently, as a chemically diverse set of host\u2010 and microbe\u2010derived metabolites. The 2020 discovery of microbially conjugated bile acids (MCBAs) and the expansion of the recognized catalog from approximately 20 species to more than 200 mark a new phase in this trajectory. Clinical translation has not kept up. Direct farnesoid X receptor (FXR) agonism failed twice in trials for non\u2010alcoholic steatohepatitis, later received a serious liver injury safety communication from the U.S. Food and Drug Administration, and was voluntarily withdrawn from the United States market. The standard of care for bile acid diarrhea and post\u2010cholecystectomy diarrhea still relies largely on chemical binding with drugs introduced in the 1960s and 1970s. This Perspective argues that the gap between bile acid biology and bile acid medicine persists in part because the field has not been organized around the bile acid pool as a shared measurable output. Researchers studying dietary modulators of the gut microbiome have worked in separate communities around fiber, fermented foods, polyphenols, protein, and dietary fat. Each of these inputs can shape bile acid metabolism, yet many intervention studies do not measure it. The most immediately implementable bile acid\u2013targeted strategy is specified dietary intervention designed with measurable bile acid outcomes and evaluated with the precision of pharmacological therapy. Four recommendations follow: intervention studies should routinely measure bile acid outcomes; clinicians should test bile acid metabolism in conditions involving dysregulation; regulators should develop a framework for multicomponent dietary therapies; and researchers should build infrastructure for population\u2010scale longitudinal monitoring.<\/jats:p>","DOI":"10.1096\/fj.202602616rr","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:42:46Z","timestamp":1788424966000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bile Acid Metabolism as a Unifying Readout for Diet, Microbiome Function, and Gastrointestinal Disease"],"prefix":"10.1096","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6493-2024","authenticated-orcid":false,"given":"Jason","family":"Dichter","sequence":"first","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.284.5418.1362"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.284.5418.1365"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M209706200"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00223.2019"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-019-1785-z"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2047-9"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/imt2.243"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1021\/acs.jafc.5c03548"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)33041-7"},{"key":"e_1_2_13_11_1","unstructured":"Intercept Pharmaceuticals \u201cIntercept Receives Complete Response Letter from FDA for Obeticholic Acid as a Treatment for Pre\u2010Cirrhotic Fibrosis due to NASH. Press Release \u201d(2023) https:\/\/ir.interceptpharma.com\/news\u2010releases\/news\u2010release\u2010details\/intercept\u2010receives\u2010complete\u2010response\u2010letter\u2010fda\u2010obeticholic\u20100."},{"key":"e_1_2_13_12_1","unstructured":"U.S. Food and Drug Administration \u201cSerious Liver Injury Being Observed in Patients Without Cirrhosis Taking Ocaliva (Obeticholic Acid) to Treat Primary Biliary Cholangitis. FDA Drug Safety Communication \u201d(2024) https:\/\/www.fda.gov\/drugs\/drug\u2010safety\u2010and\u2010availability\/serious\u2010liver\u2010injury\u2010being\u2010observed\u2010patients\u2010without\u2010cirrhosis\u2010taking\u2010ocaliva\u2010obeticholic\u2010acid\u2010treat."},{"key":"e_1_2_13_13_1","unstructured":"Intercept Pharmaceuticals \u201cIntercept Announces Voluntary Withdrawal of Ocaliva (Obeticholic Acid) for Primary Biliary Cholangitis From the US Market. 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