This ratio reflects the conversion of primary bile acids by gut bacteria into secondary bile acids. A higher ratio may indicate increased microbial conversion or slowed bile acid turnover, while a lower ratio can indicate reduced bacterial activity or impaired bile flow. Maintaining balance is important for gut–liver communication, lipid metabolism, and overall digestive health.

This ratio indicates how efficiently intestinal bacteria transform primary bile acids into secondary bile acids. It offers insight into the relationship between the gut microbiota and liver metabolism.
A higher ratio may suggest increased bacterial conversion, reduced bile acid turnover, or changed intestinal reabsorption. It can also arise in instances of microbial overactivity or impaired bile acid clearance.
A lower ratio may indicate reduced bacterial activity, the use of antibiotics, or impaired bile flow from the liver. It can also suggest decreased microbial diversity or alterations in gut-liver communication.
Maintaining a diverse gut microbiota, ensuring adequate hydration, and consuming sufficient dietary fibre can support healthy bile acid metabolism. Supporting liver function and avoiding excessive intake of processed fats also helps preserve a balanced ratio.
