What are the symptoms of bile acid malabsorption?
Typical symptoms include:
Some people also have:
Long-term symptoms can include:
About half of people have constant symptoms, and the other half only report occasional symptoms.
What causes bile acid diarrhea?
The symptoms of bile acid malabsorption — primarily, bile acid diarrhea, or BAD — result from the buildup of bile acids in your colon, where food waste turns to poop. Normally, 95% of the bile acids in your small intestine are reabsorbed in the last segment (the ileum) before passing on to your colon.
When too many are left over, however, they pass into your large intestine with the rest of the waste. Bile acids in your colon irritate the mucous lining, triggering it to secrete extra fluid and speeding up the muscle contractions that move poop along. This causes frequent, urgent diarrhea and cramping.
What causes bile acid malabsorption?
What causes bile acids to build up in your intestines is another question.
Researchers have classified the possible causes of BAM into four different types. Sometimes they classify BAM as either primary or secondary.
Primary BAM is caused by your liver overproducing bile acids (types 2 and 4.)
Secondary BAM is caused by damage to your small intestine due to disease, surgery or radiation treatment (types 1 and 3.)
Type 1 BAM is caused by a problem with your ileum itself. This is considered true malabsorption, because the problem begins at absorption stage of the bile acid cycle. You may have type 1 BAM if you’ve had the last part of your small intestine surgically removed, altered or bypassed to treat another condition. Certain diseases, such as Crohn’s disease, and treatments such as radiation therapy can also damage the ileum. Significant damage impairs its ability to absorb.
Type 2 BAM has sometimes been called “idiopathic,” which means that it happens spontaneously or for unknown reasons. However, current research suggests that it's a problem with the chemical signaling between your intestines and your liver. This signaling is what normally regulates your bile acid cycle (enterohepatic circulation.) Chemicals in your blood signal when your liver should produce and deliver more bile acids and when it’s time to stop, reabsorb and recycle them. But with type 2 BAM, your liver doesn't get the memo to stop. So, it keeps sending bile acids — too many for your ileum to absorb.
Type 3 BAM is caused by gastrointestinal diseases that can affect your ileum along with other parts of your digestive system. These include celiac disease, chronic pancreatitis and small intestinal bacterial overgrowth (SIBO).
Type 4 BAM is caused by excessive bile acid production as a side effect of taking Metformin.
What are the long-term effects of bile acid malabsorption?
Severe bile acid malabsorption can eventually lead to bile acid deficiency. If too many bile acids are coming out in your poop instead of recycling back to your liver, your liver will start to run out of bile acids to produce bile with. A lack of bile in your small intestine will affect your digestion and nutrition.
Bile acid deficiency in your small intestine leads to malabsorption of fats and fat-soluble vitamins (A, D, E and K). This can lead to malnutrition and specific problems related to fat-soluble vitamin deficiencies. For example, vitamin D deficiency affects your bones, and vitamin A deficiency affects your vision.
Type 1 BAM specifically may be accompanied by vitamin B12 deficiency. That’s because vitamin B12 is also absorbed in your ileum. In this case, the deficiency isn’t caused by BAM itself but by the condition that causes type 1 BAM — a dysfunctional ileum. Symptoms can include nausea, dizziness and fatigue.
Bile acid deficiency that leads to fat malabsorption may cause weight loss if you have trouble digesting enough calories. In other cases, bile acid malabsorption causes weight gain. This seems to be related to metabolism. BAM, or its causes, may affect the way your body processes and stores calories as fat.
FAQs
Bile acid malabsorption is a problem in your intestines. It causes chronic, watery diarrhea. Bile acids (bile salts) that aren't absorbed properly in your small intestine pass to your large intestine (colon) where they trigger diarrhea symptoms. You can treat the symptoms with bile acid sequestrants.
What is the root cause of bile acid malabsorption? ›
Causes include inflammation or removal of the ileum, due to conditions such as Crohn's disease or cancer treatment.
What is the best treatment for bile acid malabsorption? ›
A low-fat diet helps to reduce the symptoms of bile acid diarrhoea. Medicines that bind to bile acids in the gut (bowel) are usually very effective. Examples of bile acid binder medicines are colestyramine, colestipol or colesevelam. Colestyramine is the medicine most often used and is usually very effective.
What is the new treatment for bile acid malabsorption? ›
Colesevelam is reported to be 4–6 times as potent as traditional bile salt sequestrants, possibly due to its greater binding affinity for glycocholic acid. It is administered in tablet form, and in one study the rate of compliance with colesevelam was 93%.
What does bile acid malabsorption poop look like? ›
Excess bile acids entering the colon can cause the classic signs and symptoms of bile acid malabsorption (BAM), including watery stool, urgency and fecal incontinence. Although BAM has been associated with diarrhea for nearly 50 years, it remains an underrecognized and underdiagnosed cause of chronic diarrhea.
How do you stop bile malabsorption? ›
The first line of treatment for bile acid malabsorption is medications called bile acid sequestrants or bile acid binders. Cholestyramine and colestipol are most commonly prescribed. Colesevelam is an unlicensed alternative, but some people find it easier to tolerate.
What not to eat with bile acid malabsorption? ›
Following a low-fat diet can reduce the amount of bile acid your body produces, causing less of it to make its way to your colon. Having lower levels of bile acids in your colon lowers your chances of having diarrhea if you have BAM. To reduce your fat intake, try to avoid eating: butter and margarine.
What vitamins help absorb bile? ›
One group of nutrients that depend on bile acids for their efficient absorption are the fat-soluble vitamins A, D, E and K.
How do you bring bile acid down? ›
Taking a prescription medicine called ursodiol (Actigall, Urso, Urso Forte). This medicine helps to lower the level of bile acids in your blood. Other medicines to relieve itching also may be an option. Soaking itchy areas in cool or lukewarm water.
How to reduce bile acid naturally? ›
But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes:
- Stop smoking. ...
- Eat smaller meals. ...
- Stay upright after eating. ...
- Limit fatty foods. ...
- Avoid problem foods and beverages. ...
- Limit or avoid alcohol. ...
- Lose excess weight. ...
- Raise your bed.
A: At present there is no known cure for BAD, it is lifelong and is classified as a long term condition. The good news though is that there are treatments available and dietary adaptations which can help control symptoms of BAD and significantly improve quality of life.
What can I take instead of cholestyramine? ›
Cholestyramine Alternatives Compared
| Cholestyramine | Cimzia (certolizumab) | Vedolizumab |
|---|
| Brand Names |
| Cholestyramine Light, Prevalite | N/A | Entyvio, Entyvio Pen |
| Half Life The half-life of a drug is the time taken for the plasma concentration of a drug to reduce to half its original value. |
| 2 hours | 336 hours | 600 hours |
39 more rowsSecond, they found that steaming significantly improves the bile acid binding of collards, kale, mustard greens, broccoli, peppers, cabbage, as well as beets, eggplant, asparagus, carrots, green beans, and cauliflower, suggesting steaming vegetables may be more healthful than those consumed raw.
How did I cured my bile acid malabsorption? ›
Conventional Treatment for Bile Acid Diarrhea
Conventional treatments for bile acid diarrhea center around a low-fat diet and medications called bile acid binders or sequestrants. These medicines, like cholestyramine, colestipol, or colesevelam, bind to bile acids in the bowel.
Can a colonoscopy detect bile acid malabsorption? ›
Colonoscopy is the investigation of choice for diagnosis. Even a macroscopically normal mucosa on endoscopy can have abnormalities such as microscopic colitis and bile acid malabsorption (BAM).
How painful is bile acid malabsorption? ›
Bile salt malabsorption may also cause cramp-like pains in your abdomen; which can be very severe. You may also suffer from very smelly wind and very erratic bowel movements. Very occasionally, if too much bile salt is lost, sufferers start to lose weight.
What foods neutralize bile acid? ›
Therefore, one way to get rid of bile is to eat more foods that are high in fiber. Furthermore, eating fibrous foods that absorb bile can also help lower blood cholesterol levels by preventing the body from reabsorbing bile. Fruits; Vegetable; Cereals such as oatmeal; Nuts and seeds; Legumes such as lentils and beans.
What is the root cause of bile reflux? ›
Bile reflux is most commonly caused by a problem with the pyloric valve that's supposed to keep bile from escaping into your stomach. This might be a result of: Surgery, especially stomach surgery and gallbladder removal surgery. Obstruction of the pyloric valve by a duodenal ulcer or scar tissue.
How do you increase bile acid absorption? ›
2. EAT FOODS TO IMPROVE BILE FLOW
- Organic acids from apple cider vinegar, lemons, and limes.
- Bitter herbs such as parsley, cilantro, dandelion, and milk thistle.
- Warming spices like ginger, turmeric, and cinnamon.
- Prebiotic foods like artichokes, radishes, asparagus, and garlic.
- Beets, chicory, and rocket.
