Your liver creates bile, a yellow fluid that helps with the breakdown of dietary fats. It is stored in the gallbladder and secreted into the small intestine at meal times. Fat must be broken down into smaller molecules so they can be easily absorbed further down the digestive tract. If fat is not absorbed, it can come out in the stool, a condition known as steatorrhea.
Just like fat, bile needs to be absorbed too. If bile travels into the intestines, it can irritate the tissues, and lead to bile acid diarrhea (sometimes called bile acid malabsorption). People with digestive health diseases, such as inflammatory bowel disease, are the most susceptible to this type of diarrhea.
This article will teach you how to recognize the symptoms and offer dietary suggestions you can make to help you feel better. 1
People who have had a bowel resection (a portion of their bowel surgically removed) are at the highest risk for bile acid diarrhea. They have less square footage of the intestine to absorb fluids, and stools can be looser and more watery than normal. Other risk factors include: 2
The condition is rare compared to other bowel diseases. It is estimated only to affect one to two percent of the US population. These statistics are similar to the prevalence of Celiac disease. 1
The most obvious symptom of bile acid diarrhea is diarrhea. Bathroom urgency can occur within thirty minutes of eating, even faster if high-fat foods are consumed. Other common symptoms include painful cramping, bloating, and indigestion.
Medications can help lessen effects of bile aggravating the colon. These medications are called bile acid sequestrants and are only available via prescription. They neutralize bile salts so they cannot irritate the delicate tissues in the gut, and they stop water from being pulled into the colon, which contributes to loose stools.
Combining medication and lifestyle changes can have the greatest improvement for managing bile acid diarrhea.
Bile acid diarrhea can increase the risk of malnutrition. Fast-moving stools spend less time in the intestines, which decreases the chance for your body to absorb essential nutrients. This can expose you to deficiencies and undernutrition.
Ongoing diarrhea increases your risk of dehydration. Long bouts of dehydration will make you feel weak and can strain your kidneys. Choose water most often to stay on top of your hydration status. Other fluid-rich foods can also help you meet your goal; these include low-fat yogurts, soups, and even jello.
Following a low-fat diet can help manage bile acid diarrhea and reduce symptoms. Try to avoid butter, creamy sauces, and fried foods. You can still include easier-to-digest fats such as avocado, small amounts of nuts and seeds, and salmon or mackerel.
You can follow a three-day sample meal plan to start:
Day 1:
Day 2:
Day 3:
Soluble fiber helps to slow down transit time in your digestive tract. It absorbs liquids and creates a gel-like texture as it moves through the intestines. Foods naturally high in soluble fiber include oatmeal, legumes, applesauce - anything that can be mushy when you add water.
You should try a supplement if you can’t get enough fiber through the diet. Metamucil Ⓡ or psyllium husks are both popular and easy to take. Soluble fiber also helps stabilize blood sugars, reduce cholesterol levels, and lower blood pressure. 3
Managing chronic diarrhea makes everyday life harder. There may be fear that you can’t get to the bathroom in time, and road trips and traveling can feel out of reach. A registered dietitian specializing in bile acid diarrhea can help you find strategies to cope with these daily challenges.
Nourish has a team of registered dietitians who are compassionate and expertly trained. They offer fully-remote appointments to help with scheduling, and they are all covered by insurance. Click here to learn more and book an appointment!
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