Bile acid malabsorption.

Posted , 6 users are following.

I had my gallbladder out over 1.5 years ago. I have struggled with diarrhea ever since. It always hits after my first meal of the day. Most days it is tolerable, but some are not. Almost all of my stools feel acidic regardless of their consistency. Sometimes it hits hard and fast. Meaning I have 10 mins to get to the restroom. Today it happened and I tried to push it to get home, and I'm embarrassed to say I didn't make it. That was a first for me. And it's really bugging me that I couldn't just hold it. Now admittedly I screwed up today. I ate nothing from 7pm yesterday till 11:30am. And my first thing I ate was a bloomin onion from outback. Fried food is a big no no. And I've literally never done that before. It was a dumb choice.

I'm very resistant to taking meds. So other than trying to eat something high in fiber early in the day, what other solutions are there? Fiber does seem to help me, but I'd like other suggestions.

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9 Replies

  • Posted

    Hi Don, I have just read your letter on Patient forum. It could have been me writing it. I suffer the same as you. I really understand how you are feeling. It is terrible and some days I can't go out. What helps you? Do you take any medication? My name is Rita. I live in England. Please could you reply. Thank you.

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    • Posted

      Hi, Don,

      Since 2009, I've taken cholestyramine, which is a resin, also known as Questran.  It absorbs the excess bile in your system.  At times, I also use Immodium, when I absolutely need to slow down the digestive process.  I take it at bed time in 3 ounces of water and three ounces of apple juice, shaken up.  It works.  

      There's also a Facebook page for bile acid malobsorbtion.

      Best of luck!


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  • Posted

    I Know exactly what you are describing. After my GB was removed I took enzymes to help break up foods to replace the enzymes the GB produced.

    I ook RX enzymes for a short time. Now I take probiotics , eat yogurt and non fatty foods. No fried foods. No eating out and know any deserts with sugars and fats will be a instant issue. 

    I knew all the pit stops where ever I went until I finally went off these foods

    It's a matter of finding out what other foods cause issues with you. Everyone is different.

    Many raw veggies & fruits with skins I simply did not digest especially corn and lettuce. 

    Take care mabe once your eating the foods that do not cause upset and pain can help lead you to feel better along with choosing what foods work for you.

    Sometimes it's good to keep a journal of foods. Many pre made & boxed foods also have chemicals and ingredients that can create issues as well.

    Read all ingredients as you go along then once the offending foods are identified, you will find a way to be in a better place soon. 

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    • Posted

      By trial and error I found out that I can no longer tolerate green vegetables. Lettuce, bok choi, choy sum, cabbage, aspasragus, etc., all wrecks havoc in my system.

      Did some research, discovered that green vegetables are mostly insoluble fibers and repels water rather than absorb it. For fiber needs, I eat pastas daily, and this has helped me significantly.

      Hope this helps.

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  • Posted

    I had my gallbladder removed 12 weeks ago and suffer from chronic diarrhea.

    If fiber helps, then try the oridinary spaghetti or any other pasta that has iron supplement in it. Iron tends to slow down food motility in the intestine, so spaghetti might help. Also, it has fiber, so it may help to absorb excess bile in the lower intestine, which causes diarrhea.

    Also I hear calcium carbonate supplement helps. Theory is the same: iron takes longer to digest and pass through the intestine, and calcium has the same effect. However, I personally stay away from taking too much calcium as I've had kidney stone before.

    Just my small suggestion, good luck.

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  • Posted

    This is something I've learned only recently. There are two types of fibers from foods: soluble and insoluble. If fibers help you, then I recommend sticking to soluble fiber foods. Insoluble fibers can worsen the diarrhea symptoms.

    Basically, soluble fibers absorb water/liquid in the intestine while insoluble fibers won't. Green vegetables are almost all insoluble fibers. Grains like wheat, brown rice, oats, are mostly soluble fibers that absorb water in your intestine, so they should help to reduce diarrhea.

    I had my gallbladder removed 12 weeks ago. I've been suffering from chronic diarrhea from day one after the surgery. Though the severity has decreased somewhat, I still suffer from it.

    I've been on a strict, ultra lean diet from day one. Unlike what my doctor told me, everything I eat gives me diarrhea, just that some foods will reduce the effect, while others will worsen it.

    I have found the worst offenders are coffee and green vegetables. Oddly, though barley and flax seed are mostly soluble fibers, they go straight through my digestive system and worsen the diarrhea.

    What works best for me are pastas and grilled chicken. The pastas with iron supplement added seem to work best for my digestive tract in reducing diarrhea symptoms. Grilled chicken also helps.

    I think everyone reacts to foods differently after gallbladder removal. Some experience no diarrhea symptoms, while those like me suffer quite extensively.

    What I find helpful is selected few soluble fiber foods and grilled chicken. Rice and oats seem neutral to my system, so I eat them as I want. Though 12th week onward from surgery, I find that I am still unable to handle fatty/greasy foods and green vegetables, and particularly coffee and milk.

    I have tried digestive enzymes, probiotics, and vitamin B complex. None of them helps, so for now I'm sticking to what helps my system and avoiding what worsens the effect of diarrhea.

    I am holding back from getting a prescription medication for now. However, if the dreaded symptom persists with no sign of improvement through healing and recovery with a healthy diet, I may resort to either Welchol or Questran.

    Hope this helps, and good luck to your recovery.


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  • Posted

    I had my gallbladder removed 12 weeks ago. I too suffer from chronic diarrhea. When it triggers, I also have lower gut cramps in varying intensity, depending on the severity of my diarrhea. Although the symptoms have gradually decreased over the 12 weeks since surgery, I still suffer from it.

    I am also reluctant to take prescription medication till I've exhausted all other natural remedy. In doing some research, and through trial and error with various foods, I found what helps me is pasta and grilled chicken. They don't stop diarrhea completely, but they do seem to help mitigate it somewhat. Presumably it is the high fiber content in the pasta that helps to absorb water in the guts, so I've been looking into fiber supplements.

    Have you tried soluble fiber supplements like psyllium husk or acacia? If so, do they help more than eating high fiber foods? To anyone reading this log: if you have used a fiber supplement, does it help? Thx.

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  • Posted

    Hi Don,

    I had exactly the same experience as you, and what was frustrating was that the doctors at the time wouldn't recognize the condition as related to the gall bladder removal. Luckily I've found a solution for my condition which is working perfectly for me.

    Very soon after my surgery, I found that I would have extremely loose bowel movements after the first meal of the day. Sometimes this would happen after the first cup of tea or coffee or whatever. I did notice that the volumes I consumed would affect the urgency. i.e. more volume consumed meant more urgency immediately thereafter. This condition lasted for years. I was able to mitigate the condition somewhat by modifying my diet somewhat, such as eating a lot of non-soluble plant matter, eating very small breakfasts, low oils and fats, though at best these ended up working as half measures for me. I also tried a number of binders, enzymes etc.

    Eventually what I've found works perfectly for me, though dosing might need to be adjusted. Basically I start by taking 250mg ursodeoxycholic acid and 2 mg loperamide three times a day. It usually takes three or four days for the morning urgency to subside. Eventually it does. Once I get into a routine where the urgency is gone, and I have a movement only once a day or even once every two days, I cease taking the medication. Eventually, some time later I will have a loose but not too urgent bowel movement, at which point I immediately take 500mg of ursodeoxycholic acid and 4mg of loperamide. This generally returns me to a regular schedule. If it doesn't and the urgency continues, I start again by taking 250mgx2mg three times a day etc.

    I've been doing this for over a year now and it's made things much much easier.

    Generally, the lower fat/oil and more fresh fiber in my diet the longer the periods of stability last. Hope this helps you and others.


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