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The US Food and Drug Administration approved hydrophilic bile acid for the treatment of certain cholestatic liver diseases. It inhibits oxygen radical production, reducing endoplasmic reticulum (ER) stress and stabilizing the unfolded protein response (UPR). That ER stress contributes to insulin resistance and treatment with Tauroursodeoxycholic acid (TUDCA), a hydrophilic bile acid derivative that acts as a chemical chaperone to enhance protein folding, ameliorating ER stress and increasing insulin sensitivity.¹