Bile Acid Malabsorption

Hi Nycole!
I developed bile acid malabsorption after a complicated Appendix surgery which resulted in removal of part of my small intestine among other things. The lower portion of the small intestine is where your digestive bile is reabsorbed, so when that gets removed the unabsorbed bile goes into the large intestine and causes the loose stool.
My Surgeon was not very helpful with the loose stool issue, they recommended Citracell, which I had to take an enormous amount of and which also has the side effect of disturbing the mucous layer in your small intestine which is where your digestive bacteria live; when it gets thinned out enough you get leaky gut and digestive sensitivities to foods that use to digest well.
My primary care physician checked with a gastroenterologist and told me I had bile acid malabsorption. She suggested I try Cholestryamine, a bile acid sequestrant, which worked dangerously well. It made me so constipated it was scary. I finally figured out that calcium carbonate is constipating for me. I also take magnesium glycinate instead of citrate as the citrate encourages loose stool and through trial and error I found some probiotics that firm up my stool (SFI Health Ther-Biotic Synbiotic).
I think bile acid malbsorption if pretty common among people who have a portion of the small intestine surgically removed and am surprised you have run into physicians who are clueless. Every gastroenterologist should be aware of this issue.
With the removal of your gall bladder you are overproducing bile acid so would have a more severe problem than I am experiencing. I have read that for some fortunate people the bile acid problem resolves over time, hope you are one of the lucky ones!!

Thanks for suggesting SFI Health Ther-Biotic Synbiotic. I’ve tried Cholestyramine which worked for awhile then it stopped. Switched to acacia Senegal powder and now that seems to be somewhat tapering off from working. Idk maybe I’ll try Align with it. Someone suggested that or simply what you suggested. Got to be careful with the BAM. Going to be seeing a new PCP soon as it appears I may now be suffering with iron and/or vitamin B12 deficiency (anemia). Hoping you see this message. Wishing you the best of luck.

Align won’t work. I have found that nothing is that simple.

Hello Judith-
Yes, I checked into the reviews for Align and they were not that good. My plan is to revisit a 'new' PCP. The old one wasn't attentive at all. I'm going in with the my request list of blood tests as my blood tests are all rather old and I believe I've developed anemia from concentrating on eating probiotics and went on an elimination diet for gut issues. Honestly, sometimes I think we try too hard. Anyway, I can't beat ANYTHING until I get the basics down pat. Then I can go from there.

It called bile salt diarrhea post gallbladder removal.
Colestid is great at keeping it under control.
Normally when our body gets used to not having gallbladder to remove bile then it starts filtering through the liver over time.
I have pancreatic insufficiency post Covid. I take Colestid and pancreatic enzymes, 4 before every meal and at bedtime. It does get annoying taking so many pills 🤷‍♀️ but it's worth not going to the bathroom 10-15 times a day

Hi Mycole and Beebe-
My GI put me on cholestyramine and I did take it for about 8 mo. until I discovered two things. First of all, even though I took precautions I started to develop cavities. (I actually rolled the powder form into tablet form to bypass having to drink the sugary substance.) Second of all, after deep-diving into research produced an article that said that it can cause liver damage, although I'd have to go through all of my research papers to show exactly where I found it; something which I could do if need be. So, I decided to substitute with acacia 'Senegal' powder. So far so good. It has been regulating the bile salt for me pretty well. Next step for me to take care of is to get tested for any and all deficiencies that the bile acid malabsorption has caused. It seems to be rearing its ugly head and is actually something that I'm blaming on my GI doc because they haven't been listening to me. I have known for some time that I have been suffering from fat and sugar malabsorption but since my stool tests appeared to be normal they refused to acknowledge it. Well, we know our own bodies and since weight loss is telling me (common sense) that I am not absorbing nutrients that they're tests were inaccurate. They were supposed to tell me to eat a high-fat diet prior to taking the test and they did not. Hope this helps somone.

Hi Jeepgrl,
Wish I could tolerate the acacia powder, it seems to give me acid reflux but maybe I should try it again and hope it works for me this time.
I stuff the cholestryamine into capsules and drink plenty of water with it. It is amazing to think that there are people who can tolerate the smell and the gritty deposits it leaves behind. I take my dose early in the morning so it does not interfere with other supplements I take and that is a pain in the butt!
How much acacia do you take to control the bile acid?

My functional medicine doctor switched me from
Cholestyremine to colesevelam. I take one
tablet a day. It works.

Thanks for the info, I will be asking for a RX. Packing the gel caps with cholestyramine is a little time consuming!

I too struggled with BAM for years without knowing what it was. Lost a lot of weight. I finally stumbled upon it after no help from Drs. and realized its what I have after gallbladder removal. I used cholestyramine but didn't like it. I have recently started on Colestid(Colestipol) tablets and they are tolerable. I've yet to find the best dosage since it can cause constipation but the relief of not having to stay by the bathroom every morning, and to the point of having to wear sanitary napkins is indescribable.