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Bile Acid Malabsorption

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Did you know one-third of diarrhoea predominant IBS cases could actually be caused by bile acid malabsorption (BAM)?

What is BAM?

In usual digestion, your body produces bile salts (produced in the liver, stored in the gallbladder) to help break down the fats within your diet. These bile acids are released into your small intestine, where most of your nutrients are absorbed. Usually 95-97% of bile salts are then re-absorbed at the end of your small intestine which feeds back to your liver/gall bladder to prevent the release of more bile salts. The bile salts which are not reabsorbed will enter the large bowel, where in significant quantities they can cause irritation, resulting in loose stools which may be pale or orange/green in colour, as well as bloating, cramping and wind (many of the symptoms also present in IBS!)

What causes BAM?

BAM can be caused by intestinal surgery or direct damage to the end part of your small intestine (e.g. in a Crohn’s flare). Sometimes it may be secondary to gallbladder removal, chronic pancreatitis or SIBO, or it could be idiopathic (cause unknown).

What’s the treatment? 

Medications that bind the bile acids are usually prescribed via a gastroenterologist after a diagnostic test. Some people may benefit from a lower fat diet; however, this is on an individual basis and should always be guided or advised by a dietitian. Depending on the cause of BAM, some people may stay on medications or dietary changes long-term, and for others it might just be temporary.

TAKE HOME: if you’re struggling with diarrhoea and IBS symptoms despite dietary modifications, seek the support of a gut specialist dietitian and/or gastroenterologist for further advice.