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THE IBS DIETITIAN

Kirsten Jackson Consultant BSc Hons PG Cert RD

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Could My IBS Be Bile Acid Malabsorption

by Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert 6 Comments

Bile Acid Malabsorption (BAM) is a condition which is often misdiagnosed as IBS.

It is thought that at least 1 in 100 people have BAM – pretty common! (1). If you have IBS which is sensitive to fat then you may BAM.

In this article I will explain what BAM is and the common symptoms. I will also guide you on how to get a diagnosis and what treatment options there are for BAM.

Bile Acid Malabsorption

What Is Bile Acid Malabsorption?

In normal digestion, your liver produces bile acids which are used to break down fat. After use,  bile acids are directed back to your liver by your small intestine.

The recycling of bile acid can happen several times a day.

Bile acid malabsorption occurs when the small intestine does not send these bile acids back to your liver. This results in poor digestion (2).

Symptoms

Symptoms of bile acid malabsorption vary in type and severity .

Here are some common symptoms which you may experience (3);

  • Chronic diarrhoea (2)
  • Urgency to open bowels
  • Abdominal pain
  • Bloating
  • Increased bowel frequency
  • Steatorrhoea (fat in stools)
  • Abdominal gurgling
  • Lack of control
  • Flatulence

Causes

Bile acid malabsorption can be caused for multiple reasons.

If you have had certain surgeries such as gall bladder removal, bowel resections or upper gastro-intestinal surgery this can be a trigger (4, 5).

If you have a condition or treatment that affects the very end part of your small bowel, this may cause BAM. Examples would be Chron’s disease or having radiotherapy in that area of your body (4, 5).

Conditions such as diabetes and pancreatitis have also been linked (4, 5).

Diagnosis

To find out if your IBS symptoms are caused by bile acid malabsorption you will need further testing.

There is only 1 test currently available for BAM called SeHCAT.

When you have the SeHCAT test you will swallow a radioactive version of bile acid. The doctor will then be able to use a machine to detect how well the substance is retained or lost in your bowel (3).

Here are the ranges your doctor will use to diagnose BAM (6);

  • 10–15% retention = mild bile acid malabsorption
  • 5–10% retention = moderate bile acid malabsorption
  • 0–5% retention = severe bile acid malabsorption

Treatment

There are several ways to treat bile acid malabsorption. The method used will depend on what stage you are at (3).

15-20% SeHCAT scan result

This is the least severe BAM level.

If you have this level then you may not require any medication. Instead, you will be advised on a low fat diet trial by a dietitian.

Your symptoms will be closely monitored whilst you trial the diet. Further medication may be required.

10-15% SeHCAT scan result

If you have this level of BAM, you may also be able to manage it through diet alone. Again you will be asked to trial a low fat diet.

Your dietitian may or may not recommend a multivitamin and additional, combined calcium /vitamin D supplement.

Again, your symptoms will be closely monitored whilst you trial the diet. Further medication may be required.

5-10% SeHCAT scan result

Your dietitian will immediately start you on a multivitamin and combined calcium / vitamin D supplement.

The reason you may need nutritional supplements are because you are not absorbing fats. Some vitamins are fat soluble and you will be at risk of certain nutritional deficiencies.

At this level you will be given a choice over your treatment. You will be given both the option of a low fat diet trial or medications.

0-5% SeHCAT scan result

This is the most severe stage of bile acid malabsorption.

If you are at this level then your doctor will immediately commence you on medications as well as the multivitamin and calcium / vitamin D combination.

You may or may not be required to start a low fat diet at this stage. This will depend on how your body reacts to medications.

The low Fat Diet

You will find that a diet at 42g of fat / day will improve your symptoms of BAM (3).

This diet is a medical therapy and needs to be done under the careful supervision of a trained dietitian.

The dietitian will also guide you on the use of additional nutritional supplements due to the risk of malabsorption.

Bottom Line

If you are experiencing the above symptoms then you may have bile acid malabsorption and not IBS.

Please see your doctor for further assessment to determine whether you need to go for testing.

BAM can often be managed through dietary changes alone. In severe cases you may require medications also.

If you do not manage bile salt malabsorption correctly then you will be at risk of certain nutritional deficiencies which could affect your long-term help.

Filed Under: Treatments, Testing and Diagnosis Tagged With: alternative diagnosis, bile salt malabsorption

About Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

Previous Post: « Can Hypothyroidism Cause IBS?
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Reader Interactions

Comments

  1. Julian RF Walters says

    at

    Good to raise awareness.

    We think that many “IBS-diarrhoea” patients are not malabsorbing bile acids but are actually over-producing them as the intestine is not telling the liver to reduce new synthesis. So we prefer to call it bile acid diarrhoea.

    Think about BAD, test and treat with bile acid sequestrants and a low fat diet.

    Reply
    • Kirsten Jackson Specialist Dietitian says

      at

      Thank you for your feedback Professor!

      Reply
  2. Maureen says

    at

    Can BAM or BAD be treated or cured with Chinese medicine or those type of remedies?

    Reply
    • Kirsten Jackson Specialist Dietitian says

      at

      Sadly not no.

      Reply
  3. Mousa says

    at

    I have continually diarrehea even medication also takened but after skip medication 5 to 6 letter again condition continue.

    Reply
    • Serena Bansal says

      at

      Hi Mousa. I am so sorry to hear that you are struggling with this. Please do reach out to us and email on admin@thefoodtreatmentclinic.com if you would like further support with your symptoms 🙂

      Reply

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😭 Can you relate?😭 Comment below 👇 ​​ 😭 Can you relate?😭 Comment below 👇 ​​​​​​​​​​​​​​​​
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😔 IBS can lead us to put significant pressure on ourselves in order to reach our goals and targets which can have its advantages. However, too much pressure can lead to stress and anxiety which in turn can worsen IBS symptoms.​​​​​​​​
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😥 Yes, IBS has many physical symptoms such as diarrhoea and bloating however, there is so much more than just the physical symptoms. IBS is burdensome and affects all aspects of human life 😢.​​​​​​​​
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🙏Instead of dealing with this awful condition alone. Makesure you embody the Take Control approach of community. This means looking into how you can connect with other people going through IBS like online FB groups or talking to friends (1 in 10 have this so the chances are one of them has it also).​​​​​​​​
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DO YOU DO ANY OF THESE? 😔 ​​​​​​​ DO YOU DO ANY OF THESE? 😔 ​​​​​​​​​​​​​​​​
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👉  In IBS, there are a lot of subtle behaviour changes that we make in order to hide our struggle 😕. We are scared if the judgement and we are scared of being singled out 😭. ​​​​​​​​​​​​​​​​
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👉  Instead of making behaviour changes to mask your symptoms, why not try making small changes to reduce your symptoms? In the Take Control Method we encourage individuals to be open about their problems, instead of hiding them from others so that they can receive the the support they need to put these changes in place ❤️. ​​​​​​​​​​​​​​​​
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🎉 🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.​​​​​​​​
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WHAT ELSE WOULD YOU ADD? 🥺 Comment Below 👇 WHAT ELSE WOULD YOU ADD? 🥺 Comment Below 👇 
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😞Experiencing IBS can be a lonely place and it can often make you feel isolated from your partner. IBS can place a wedge between the two of you and lead to a bit of resentment on both sides 😢. 
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🥰 A bit of understanding can go a long way for your relationship. In the Take Control Method we place a lot of emphasis on communication with loved ones and anyone else around you so that they can provide you with the emotional support that you need. 🙏🏻 
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DO YOU MOVE FOR YOUR GUT HEALTH? Comment below 👇​​​​​​​​​​​​​​​​​​​​​​​​
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🥵 We all know exercise is good for us, but the thought of intensive HIIT workouts doesn't exactly appeal to all of us...in fact intense exercise can actually contribute to IBS symptoms for some.​​​​​​​​​​​​​​​​​​​​​​​​
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🤔 But what if it didn't have to be so complicated? Instead of seeing movement as a scary and intense activity, why not try walking? - this counts as movement and has so many fabulous benefits for IBS as listed above. Movement is one of the KEY pillars of IBS management that we tackle in my Take Control Programme.​​​​​​​​​​​​​​​​​​​​​​​​
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🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀​​​​​​​​
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😥 On the surface IBS is just seen as just a ‘condition affecting the digestive symptom’ however IBS is way more than what’s seen at the surface and affects all aspects of human life!! 
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🙏🏽 In the Take Control method the main focus is on the 4 core foundation of IBS management such as movement, sleep mental health and diet! The focus is on a whole lifestyle approach rather than just ‘diet’ and by making small changes to each of these areas it will lead to life changing results!​​​​​​​​
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🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.
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🙋🏼‍♀️ Have you been asked this before? 🙋🏼‍♀️ Have you been asked this before? How did it make you feel?

⏩ People with digestive problems regularly get this comment.

📸 I shared this image of me and Esme with a family member. Their response was 'are you pregnant' after I explained how offensive that was, their response was 'you look bloated.'

⏩ I was going to write the post about body image and how it is normal to have skin rolls after a baby etc. But it's actually f*****g irrelevant. How someone looks is not for you to comment on.

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😭 Can you relate? Comment below👇👇​​​​​​​​
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😫 Suffering from IBS can be difficult and burdensome especially when trying to go about your daily life. IBS is a condition that cannot be seen which makes it even more difficult for others to understand and can often feel very isolating😢. 

👉 Sometimes having someone that understands can be helpful! In the Take Control Method, emotional support is seen as the foundation for IBS control - it is so important to reach out to others when you need extra support! 
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WHAT RULES DO YOU FOLLOW? Comment below!​​​​​​​​​​​​​​​​​​​​​​​​
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😔 It can be so easy to get bogged down with the 'nitty gritty' of IBS management like FODMAPs and identifying your specific food triggers. These are important, but it can become so easy to be focused on our diet and pay no attention to other aspects of IBS management. ​​​​​​​​​​​​​​​​​​​​​​​​
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🤔 So instead of focusing on the details, why don't we try mastering the basics that provides a solid foundation for your IBS management to grow on. Try following a few of these 'rules' this week endorsed by the Take Control Method and see how they can really help🙏.​​​​​​​​​​​​​​​​​​​​​​​​
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🎉 🎉  Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀​​​​​​​​
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😭 Can you relate? Comment below 👇 ​​​​​​​​​​​​​​​​
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😢 Life can be super busy and it’s so easy to neglect your health but this will ultimately lead to your IBS being even more debilitating😔. ​​​​​​​​
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🤔 Instead of letting it all build up, advocate for your own health and adopt the Take Control method by prioritising yourself and your well-being! By adopting small habits into your life it can really help achieve symptom relief!​​​​​​​​
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DO YOU FEEL GUILTY ABOUT THESE? 😔 Comment below DO YOU FEEL GUILTY ABOUT THESE? 😔 Comment below 👇 ​​​​​​​​​​​​​​​​
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👉 Nobody ever talks about the guilt and shame that comes as a result of having IBS…this guilt then leads to worsening of IBS symptoms because it can stress you out so much….​​​​​​​​​​​​​​​​
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👉 Imagine a life where this guilt didn’t exist because you were able to manage your IBS sufficiently? My Take Control Method enables this to become a reality. The Take Control Method is tailored to you so that you have exactly the right advice to see great improvement in your symptoms.​​​​​​​​​​​​​​​​
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👉 🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​​​​​​​​​
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WHAT DO YOU NEED ON THIS HIERARCHY? ☹️​​​​​​​​​​​​​​​​
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👉 So often in IBS we are told to “just avoid your food triggers”. Often people think that simply following the low FODMAP diet will fix their IBS. But as you can see from this diagram the picture is a lot more complex than just food and other elements need to be addressed before we even consider our diet. ​​​​​​​​​​​​​​​​
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👉 So instead of placing so much emphasis on your diet, start at the bottom of the hierarchy of needs and work your way slowly up from there which is the technique we use in the Take Control Method.​​​​​​​​​​​​​​​​
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🎉 🎉  Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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“When someone tells me they have ‘tummy troubl “When someone tells me they have ‘tummy troubles’ too”​​​​​​​​
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😭 Comment below if you can relate 👇👇​​​​​​​​
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😭 When you have IBS, why does everyone seem to want to voice their opinion? These unhelpful comments can leave you feeling even more alone than you already do.​​​​​​​​
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🤝 Instead of suffering this burden alone try to incorporate the Take Control principle of finding a group of other people just like you who you can talk to about the condition. This will help you be more at ease with your condition as you are supported. ⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​
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🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.

  #dietitian #ibs #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #bloating #irritablebowelsyndrome #fodmapfree  #healthygut #goodguthealth #gutfood #fermentedfoods #trustyourgut #chronichealth #microbiome #dubaidietitian #londondietitian #dubailife #glutenfree #dairyfree #prebiotics
😫HAVE YOU EVER CUT OUT GLUTEN FOR YOUR IBS? ⠀ 😫HAVE YOU EVER CUT OUT GLUTEN FOR YOUR IBS? ⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​​​​​​​​​
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😞Gluten is NOT the baddy! One of the first things many people do to help their IBS is to cut gluten out of their diet - but this isn’t necessary and can make your life all the more harder. ​​​​​​​​​​​​​​​​
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🤔So why do people find that gluten alleviates their symptoms? Fructans, which are FODMAPs are often found in food that contain gluten and these can cause symptoms. Good gut health is NOT about exclusion it is about inclusion. Implement the Take Control Method and aim for as varied and as unrestrictive diet as possible 🙏🏻. ⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​​​​​​​​​
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👉A note on coeliac disease - please make sure you visit your GP to get an accurate diagnosis of IBS to rule out anything else ( do not just assume it is IBS!).⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
WHAT ELSE WOULD YOU ADD? ​​​​​​​​​​​​​​​​
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😵‍💫 I will say it time and time again, IBS is NOT JUST a dodgy tummy. It is poor mental health, it is poor body image, it is an awful relationship with food 😔 . Mental health can play such a huge role in IBS. It can feel like a viscous circle of anxiety. We have anxiety about eating food/getting symptoms and then this anxiety itself leads to symptoms…​​​​​​​​​​​​​​​​
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🤩 But what if we could take control of this anxiety? Putting your mental health as a priority, in your IBS management, like in the Take Control Method, can make all the difference. Why not try using a food and mood diary to see if your mood directly impacts your symptoms?​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.​​​​​​​​​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
How do you self-soothe? 🥰​​​​​​​​
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😢In IBS we can take so much time focusing on our pain and daily struggles that we don’t take the time out to actually care for ourselves.Instead we feel stressed and defeated and feel like just giving up. ​​​​​​​​
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🤔Instead of focusing on your pain, adopt the Take Control Method by prioritising you and your mental health and well-being. Why not try one of the above self-soothe suggestions this week?​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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#ibsdiet #ibsfood #guthealth #lowfodmapdiet #selfsoothe #selfcare #ibs #irritablebowelsyndrome #lowfodmap #lowfodmaprecipes
😭 Can you relate? Comment below 👇 ​​​​​​​​
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😢 Having IBS can really take a toll on your mental health. In turn your IBS can cause anxiety and your anxiety can then cause IBS symptoms leading to a viscous cycle. Your fears are REAL and they are VALID and they can be really debilitating! IBS can impact so many aspects of your life big and small! ⠀⠀⠀⠀⠀
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🤔 But what if you no longer had to deal with any of these fears and could get your symptoms under control! Instead of continuing with these behaviours adopt the take control method of social support and open up about your IBS to someone!⠀⠀⠀⠀⠀⠀
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🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio. 
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#ibs #ibsdietitian #guthealth #irrtablebowelsyndorme #guthealth #lowfodmapdiet #guthealth #healthygut
🤔 WHICH ONES DID YOU KNOW? Comment below 👇 ​​​​​​​​
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😞 IBS is a very complex disorder to navigate by yourself. It’s more than just altering your diet, a lot of factors are at play with your IBS. Trying to work out what triggers your IBS is an absolute mind field.​​​​​​​​
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Adopting the Take Control Method, where the 4 pillars of IBS relief are all addressed (diet, movement, mental health and sleep), has helped so many of my clients to achieve that ultimate symptom relief because it considers EVERYTHING, not just what you out in your mouth.​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.​​​​​​​​
​​​​​​​​
#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
What is your positive? 😊 😥It can be really What is your positive? 😊 

😥It can be really easy to focus on the negatives of IBS as it is so debilitating. You plan your life around your IBS and you understandably feel resentful for that. 

💪🏼But living with IBS actually makes us a stronger and more empathetic person 💪🏼. I want to challenge you today to focus on a positive of IBS. Having a positive mindset is something we encourage in the Take Control Programme to support your mental health ❤️

⏩ If you haven't already, don't forget to grab my free IBS download - 🔗 in bio
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