Bile acids help the body break down fats and absorb key nutrients. The liver makes them, the gallbladder stores them, and they eventually go to work in the small intestine.
These bile acids are a great example of recycling in nature. After digestion, the body usually reabsorbs the bile acids, and the whole process starts again.
However, sometimes, the small intestine does not absorb the 95 percent of bile acids it is supposed to. The resulting condition is bile acid malabsorption (BAM). It is also sometimes called bile acid diarrhea (BAD).
BAM can cause significant gut problems. Experts report that roughly 1 out of 100 people may have BAM. Read on to learn about the causes, symptoms, and treatment options.
There are three different kinds of BAM, based on what causes the condition:
- Type 1: This form of BAM can happen after the surgical removal of part of the small intestine. Inflammatory bowel conditions, such as Crohn’s disease, can also cause type 1 BAM.
- Type 2: Type 2 BAM is also called primary or idiopathic BAM, which means it has no obvious cause.
- Type 3: This third form of BAM develops as a result of other conditions, such as chronic diseases, radiation treatment, or celiac disease.
The most typical symptom of BAM is diarrhea. Frequent, watery stools that make this condition difficult to manage and sometimes embarrassing.
People with BAM are prone to stools that are:
- urgent or uncontrollable
- yellow and particularly smelly
In addition, BAM can also cause:
- stomach cramps
- weight gain or loss
- lack of energy
- difficulty concentrating
BAM is not easy to diagnose. One study found that it took between 1 and 30 years for individuals to receive a diagnosis of BAM.
About 44% of people had symptoms for at least 5 years before their diagnosis.
One of the tests doctors can use to diagnose BAM is not available in the United States, though it is in Canada and many European countries.
That test, called a SeHCAT test, uses low-dose radiation and can be expensive.
The most common approach to diagnosing BAM in the U.S. is called a “therapeutic trial.”
People who may have BAM receive a bile acid sequestrant, a medication which helps treat the condition. However, this type of medication is not effective for everyone with BAM, and some people are not able to tolerate it, whether they have the condition or not.
Studies have found that although this diagnostic approach is helpful when other tests are not available, it is not a definitive approach to identifying BAM.
Blood tests show promise as an additional way to help a doctor determine whether or not an individual has BAM.
They may analyze the blood to look for chemical precursors of bile acid and levels of particular hormones associated with high levels of bile acid.
However, more research is necessary in this area of blood testing.
Effective treatment for BAM depends on what form of the condition a person is experiencing.
For example, those with Crohn’s disease who develop BAM may see their symptoms substantially disappear once they find the right treatment combination to control the underlying condition.
For the majority of people where doctors cannot trace their BAM to a specific cause, the most common approach is treatment with bile acid sequestrants, which are medications that bind bile acids until the body excretes them.
Common bile acid sequestrants include:
These drugs can help reduce the frequency and intensity of diarrhea, but it can be difficult to adapt to the medications. People using these medications should be wary of potential drug interactions.
One study found that 60% of people receiving treatment, usually with bile acid sequestrants, had less diarrhea once they started treatment.
The percentage of respondents reporting that they “always” or “mostly” experience serious diarrhea also dropped from 80% to 17%.
Researchers found that 52% of people with BAM felt they needed to stay close to toilet facilities because of their condition. But after treatment, 51% said they felt that way “only occasionally.”
Although diet does not directly cause BAM, many people with the condition find that what they eat and how often has a direct effect on their symptoms.
According to BADUK, a charity providing information and support to those dealing with BAD, eating less than 40 grams of fat a day in small, separate portions, can be helpful.
Also, certain foods may trigger flare-ups in some people, but not everyone’s symptoms are set off by the same foods.
Foods that people with BAM commonly report as causing symptoms include:
- processed foods
- high fiber foods
People with BAM can track both what they eat and when their symptoms are worse to identify their own trigger foods.
Cooking at home is a great way to be sure that what one eats is made with safe ingredients.
It is a good idea for an individual to speak with a nutritionist about how to get all the essential nutrients and maintain a healthful diet with BAM.
It is difficult for doctors to diagnose BAM, but people tend to see significant improvements in their symptoms and their overall well-being once they start receiving treatment.
Identifying and removing trigger foods and regularly taking medication can help people with this condition manage their symptoms.
Anyone who thinks they may have BAM may wish to speak to a doctor. Some people are nervous about talking about their bowel habits with a doctor, but a prompt diagnosis can help them receive treatment sooner. The earlier treatment begins, the sooner a person will start feeling better.