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Bile Acid Diarrhoea: Understanding the Causes, Symptoms, Diagnosis, and Management

Updated: Jun 14

Bile acid diarrhoea (BAD) is a condition where excess bile acids in the colon lead to chronic, watery diarrhoea. It can significantly impact daily life, but with proper understanding and management, individuals can find relief. Let's explore what causes BAD, its symptoms, how it's diagnosed, and ways to manage it effectively.


Causes and Mechanisms:

BAD can stem from various factors, including issues with bile acid absorption, overproduction of bile acids, or disrupted regulation of bile acid synthesis. When bile acids aren't absorbed properly in the small intestine, they reach the colon in excess, causing diarrhoea. Additionally, conditions like Crohn's disease, ileal resection surgery, or certain medications can lead to secondary bile acid overproduction, worsening the problem.


The main symptom of BAD is persistent, watery diarrhoea. This can be accompanied by urgency to use the bathroom, abdominal discomfort, and fatigue. Some individuals may experience increased bowel movements after meals or in the morning. These symptoms can range from mild inconvenience to severely impacting daily activities.


Managing BAD involves reducing bile acid levels in the colon and alleviating symptoms. Medications like bile acid sequestrants or IBAT inhibitors can help bind bile acids in the intestine and improve symptoms. Dietary changes, such as reducing fat intake and avoiding trigger foods, may also be beneficial. In some cases, surgical options may be considered for those who don't respond to other treatments.


Bile acid diarrhoea can significantly impact quality of life, but with proper management, individuals can find relief from their symptoms. Understanding the causes, symptoms, diagnosis, and treatment options is crucial for effectively managing BAD and improving overall well-being.


Treatment options


1. Dietary Modifications: Naturopathic practitioners often recommend dietary changes to manage BAD. These include avoiding fatty foods, spicy foods, caffeine, and alcohol, as these can exacerbate symptoms. Increasing fiber intake through fruits, vegetables, and whole grains may help bind excess bile acids in the gut, reducing diarrhoea episodes.

2. Supplements:

- Psyllium Husk: Psyllium husk, a soluble fiber, can help regulate bowel movements and bind bile acids, alleviating diarrhoea.

3. Herbal Remedies:

- Berberine: Berberine, found in plants like goldenseal and barberry, has antimicrobial and anti-inflammatory properties. It may help regulate bile acid synthesis and absorption, thus reducing diarrhoea.

- Turmeric: Curcumin, the active compound in turmeric, has anti-inflammatory properties and may help reduce intestinal inflammation associated with BAD.

- Artichoke Leaf: Artichoke leaf extract may support liver function and bile production, potentially reducing the severity of BAD symptoms.

4. Probiotics: Certain probiotic strains, such as Lactobacillus acidophilus and Bifidobacterium infantis, may help restore gut microbial balance and improve digestive function.

5. Stress Management: Stress can exacerbate gastrointestinal symptoms, including diarrhoea. Naturopathic approaches often emphasise stress reduction techniques such as mindfulness, yoga, and deep breathing exercises to manage symptoms.

6. Lifestyle Modifications:

- Exercise: Regular physical activity can promote gut motility and overall digestive health, potentially reducing BAD symptoms

- Hydration: Adequate hydration is essential for proper bowel function. Drinking plenty of water can help prevent dehydration associated with diarrhoea


References:

Camilleri, M. (2013)](link1). Bile Acid Diarrhea: Prevalence, Pathogenesis, and Therapy. Gut and Liver, 7(2), 121–127.

Sadowski, D. C., & Camilleri, M. (2018)](link3). Mechanisms and management of diarrhoea in diabetes. Clinical Gastroenterology and Hepatology, 16(2), 203–210.

Tariq, S., & Singh, S. (2020)](link2). Bile Acid Diarrhoea. In StatPearls [Internet]. StatPearls Publishing.

Pattni SS, Walters JR. Recent advances in the understanding of bile acid malabsorption. Br Med Bull. 2009;92:79-93.

Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR, Andreyev HJ. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009;30(7):707-717.

Mottacki N, Simrén M, Bajor A. Review article: bile acid diarrhoea - pathogenesis, diagnosis and management. Aliment Pharmacol Ther. 2016;43(8):884-898.

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