Bile Acid Malabsorption (BAM)

Bile acid malabsorption (BAM) is a condition in which the small intestine fails to properly absorb bile acids produced by the liver. These bile acids are necessary for the proper digestion of fats and the absorption of fat-soluble vitamins. When the body is unable to absorb these bile acids, they can build up in the colon and cause a range of symptoms, including diarrhea and abdominal pain.

Symptoms, Diagnosis & Medications

Symptoms

The symptoms of bile acid malabsorption can vary from person to person, but may include:

Diarrhea
Abdominal pain and discomfort
Bloating and flatulence
Urgency and frequency of bowel movements
Fatigue
Weight loss

Some people with bile acid malabsorption may also experience urinary tract infections (UTIs). UTIs are infections of the urinary tract, which includes the kidneys, bladder, and urethra. Symptoms of a UTI may include:

Pain or burning sensation during urination
Frequent urination
Urgency to urinate
Cloudy or strong-smelling urine
Pain in the lower abdomen or back
Fatigue or weakness

Diagnosis

Bile acid malabsorption can be diagnosed through a combination of medical history, physical examination, and laboratory tests. Your healthcare provider may ask about your symptoms, family history, and any medications or supplements you are taking.

To confirm a diagnosis of bile acid malabsorption, your healthcare provider may recommend the following tests:

SeHCAT test: This test involves swallowing a small capsule containing a radioactive substance called SeHCAT. The SeHCAT is absorbed by the bile acids in your digestive system, and the radiation can be detected by a scanner. This test measures how much bile acid is retained in the body over a seven-day period.
Fecal bile acid test: This test measures the amount of bile acids in a sample of your stool. A high level of bile acids may indicate bile acid malabsorption.
Blood tests: Blood tests may be used to check for vitamin deficiencies or other conditions that may be causing your symptoms.

Vitamin Deficiency

Vitamin supplements: People with bile acid malabsorption may be at risk of vitamin deficiencies, particularly in fat-soluble vitamins like vitamin D and vitamin K. Vitamin supplements may be recommended to help prevent these deficiencies.

Medications

Treatment for bile acid malabsorption typically involves medications to help bind the excess bile acids in the colon and improve the absorption of fat-soluble vitamins. Your healthcare provider may recommend one or more of the following medications:

Colesevelam: This medication is a bile acid sequestrant that works by binding to the excess bile acids in the colon and preventing them from being reabsorbed into the body. Colesevelam is taken orally and is typically taken twice a day.
Cholestyramine: This medication is also a bile acid sequestrant that works by binding to excess bile acids in the colon. Cholestyramine is taken orally and is typically taken two to four times a day.
Ursodeoxycholic acid: This medication is a type of bile acid that is taken orally and may help to reduce the amount of bile acid produced by the liver. Ursodeoxycholic acid is typically taken once or twice a day.

Functional Medicine and Natural Remedies

In addition to these medications, there are also a number of functional medicine approaches and remedies that may be helpful for managing bile acid malabsorption. These may include:

Probiotics: Probiotics are beneficial bacteria that can help to improve the health of the digestive system. They may be especially helpful for people with bile acid malabsorption who are experiencing diarrhea and other digestive symptoms.
Digestive enzymes: Digestive enzymes are supplements that can help to improve the digestion and absorption of nutrients, including fats and fat-soluble vitamins.
Vitamin supplements: People with bile acid malabsorption may be at risk of vitamin deficiencies, particularly in fat-soluble vitamins like vitamin D and vitamin K. Vitamin supplements may be recommended to help prevent these deficiencies.
Dietary changes: Some people with bile acid malabsorption may benefit from making dietary changes to reduce their intake of fats and increase their intake of soluble fibers. This can help to reduce symptoms of diarrhea and other digestive problems.

Ayurvedic remedies may include herbs like Triphala, which is a combination of three fruits that can help to improve digestion and eliminate toxins from the body.

Conclusion

Bile acid malabsorption is a condition that can cause a range of symptoms, including chronic diarrhea, abdominal pain, and fatigue. It can also be associated with an increased risk of urinary tract infections. Diagnosis of bile acid malabsorption can be challenging, but there are a number of medical tests that can be used to confirm the diagnosis.

Treatment for bile acid malabsorption may include medications, vitamin supplements, and dietary changes. In addition, traditional systems of medicine like Ayurveda and homeopathy may offer some relief for symptoms, but should not be used as a replacement for medical treatment.

If you are experiencing symptoms of bile acid malabsorption or a UTI, it's important to talk to your healthcare provider to receive an accurate diagnosis and appropriate treatment. With proper treatment, most people with bile acid malabsorption can manage their symptoms and improve their quality of life.