An Overlooked Cause of Diarrhea

Do you struggle with chronic diarrhea? If so, it may be caused by bile acid malabsorption. Of patients with functional diarrhea or diarrhea-predominant irritable bowel syndrome (IBS-D), 25% to 50% also have evidence of bile malabsorption. Let’s learn how you can test for and treat this common condition.

If you need help with diarrhea or digestion, click here

An Overlooked Cause of Diarrhea

Dr. Michael Ruscio: Hi. This is Dr. Ruscio, and let’s talk about an overlooked cause of diarrhea.

Diarrhea is one of those symptoms that can encapsulate IBS, and when it becomes chronic in nature, it can certainly become very inconvenient. Diarrhea, again, can accompany other signs IBS, which may be gas, bloating, or abdominal pain, just to name a few. If someone has chronic diarrhea, certainly diet is one of the first things to look to, but if not diet and not something like an infection or overgrowth, like small intestinal bacterial overgrowth, for example, or some kind of intestinal infection, when those things have been ruled out, it’s possible that someone may have malabsorption of bile.

Now, bile is a fat-digesting substance released by the liver and stored in the gallbladder. It’s secreted into your small intestine to help with the absorption of fat. However, in some people, they have a syndrome known as bile acid malabsorption, and essentially what happens here is too much bile gets too far down the intestinal tract, so to speak, and when it does, it can cause diarrhea.

Now, what’s funny about this is oftentimes it’s recommended for people to supplement with bile to help potentially with diarrhea or with malabsorption. However, for people with this bile acid malabsorption, that may actually make them worse. I’ll put one study reference Trusted SourcePubMedGo to source on the screen here that shows anywhere from 25 to up to even 50 percent of people with chronic diarrhea may have this bile acid malabsorption at the root cause of their diarrhea.

How can you figure out if this might be you? Well, first you should try a healthy diet. Some sort of low-allergen diet, something like a paleo diet or a low-FODMAP diet, can be a very good first step. Then have evaluated SIBO, small intestinal bacterial overgrowth, or any kind of other dysbiosis like candidal overgrowth or even an infection like giardia or cryptosporidium, common intestinal infections that can cause chronic diarrhea. If the diarrhea then persists, this may be at the root cause.

There’s another cause of chronic diarrhea, which can be inflammatory bowel disease, but this can actually be involved with inflammatory bowel disease due to how inflammatory bowel disease can damage the part of your small intestine that is supposed to help reabsorb bile so that you don’t have bile acid malabsorption, which causes this diarrhea.

In recap, having too much bile may be one of the causes of diarrhea. How can we then treat this or test this? Well, there are tests available, but probably the most practical and also supported in the medical literature is a trial of what’s known as a bile sequestrant, or something that binds to bile, like a bile sponge. There’s a medication that can do this called cholestyramine, and there are also natural agents like guggul, propolis, and boswellia. Many of these compounds actually are known to lower cholesterol. For example, guggul and propolis are known to lower cholesterol, and they do so actually by being bile binders. If you’re not sure about one of these herbs’ ability to bind bile, if it’s a known cholesterol-lowering agent, that can help steer you in that direction.

Now, I wouldn’t do this on my own. I would do this under the advice or counsel of a clinician because there are other things, like I mentioned, that can cause chronic diarrhea that are important to have ruled out. But something to think about to bring to your doctor or discuss with your doctor is the potential of bile acid malabsorption as a cause of chronic diarrhea. In 25 to 50 percent of patients with chronic diarrhea, this can be the cause, according to the published medical literature.

This is Dr. Ruscio, and I hope this helps you get healthy and get back to your life. Thanks.

If you need help with diarrhea or digestion, click here

What do you think? I would like to hear your thoughts or experience with this.


I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!