If you are getting loose or watery stools that range from bright to dark green, you may have a gallbladder problem. Natural treatments for bile acid diarrhea are hard to find and the condition can be debilitating with little to no long-term answers from conventional medicine.

You are not alone!! Many people experience increased frequency, increased urgency and even incontinence. Bile Acid Diarrhea or BAD can create embarrassing work place “emergencies” and even anxiety related to social events at places like restaurants or even limit you from going on planes or long car rides. (Yikes!)

As with most conditions, traditional medicine has medications for BAD, but they leave patients longing for why they developed bile acid diarrhea in the first place and wondering what lifestyle changes would help combined with what natural treatments for bile acid diarrhea are available if they don’t want to take the powerful drugs that are offered.

How Common Is Bile Acid Diarrhea?

When patients mention loose stools to me, they never want to talk about the urgency and bright green water in the toilet.  It’s embarrassing…right?  Well, while it may be embarrassing, it is more common than you think.  BAD is 3 to 5 times more common in the general population than Crohn’s and Ulcerative Colitis. The reason BAD goes unnoted is two-fold. First, lab testing is primitive. As I write this article, the best way to “officially” diagnose BAD is a 48-hour stool sample performed in the hospital which is costly and mostly tells you how much bile you are passing.

The second reason BAD goes under-diagnosed is because it is often thrown in to the diagnosis of IBS-D and considered one in the same. While both can have similar root causes, I do find that they have distinct differences and root causes.

What Causes Bile Acid Diarrhea? (Current Conventional Thoughts)

For quite some time, the belief was held that BAD was a problem with reabsorption of the bile as it passed through the digestive tract. Thus, BAD has also been referred to as bile acid malabsorption or BAM.

Newer, research is suggesting an overproduction of bile that is causing the dreaded “green diarrhea.”

I won’t go over the specific drugs currently being used, but most are cholesterol lowering drugs that can wreak long-term havoc on your vitality (and libido).

Houston, We Have a Problem!

Look at the two standard answers commonly provided to patients above. In each patient, either or both may be correct. But, the problem is, why isn’t anyone asking why you have poor re-absorption or why you may be creating an excess bile acid.

The two answers above satisfy most under-educated patients and they think that they were simply dealt a BAD hand of cards in life. This couldn’t be further from the truth. BAD can be figured out and natural treatments for bile acid diarrhea do exist if you look for underlying causes.

What is Bile Used For?

Looking at what bile is used for in the body helps us to understand why your body could possible overproduce bile salts. In all health conditions, you should always ask, why the body is doing what it is doing whether it is creating large amounts of bile salts or whether it is creating large amounts of inflammation, everything has its purpose.

The body can makes approximately 1 quart of bile per day to aid in the absorption of fats. While the liver produces bile salts, bile is also concentrated in the gallbladder by removal of water and other electrolytes.

For more information on why your gallbladder may be acting up, see my previous article “Save Your Gallbladder.”

Natural Treatments For Bile Acid Diarrhea (The Holistic Way)

The key to treating bile acid diarrhea effectively is treating the root cause, which is not as simple as the over- or under-production model that is often spoken of.  Below are just some of the most common reasons why you may have bile acid diarrhea.

Detoxification of Mycotoxins

Having a low-grade fungal infection in your digestive tract can lead to overburdening your liver and gallbladder with mycotoxins. Mycotoxins are any toxin released by fungus, candida, etc. If you have bloating regularly or a flat stomach in the morning and a round tummy in the evening, you may have a low-grade fungal infection that needs to be investigated.  By decreasing the amount of toxins in the bile, the gallbladder becomes less irritated and responsive to other environmental toxins.

Bad Fats

Fried food, canola oil and vegetable oils are often some of the aggravators of bile acid diarrhea. These should be avoided at all costs anyway, but if you have a small exposure, it may be enough to set off an attack and send you running to the bathroom. In the southwest, deep-fried Mexican food is the biggest offender.

Estrogen

Whether you are male or female, elevated estrogen can be a problem for the gallbladder and liver. In females elevated estrogen levels often go unrecognized. If you are a female and have any symptoms with your monthly cycle including cramping, bloating or breast tenderness, you will need someone to assess your estrogen levels. (See my previous estrogen dominance article here.) If you are a male and are 10lbs or more overweight or you have any nipple sensitivity, then you are over-aromatizing your testosterone into estrogen and thus are estrogen dominant.

When estrogen is elevated the bile becomes saturated with cholesterol or in other words, thicker, which creates a problem as you may have enough bile, but not usable bile. (For my article on estrogen dominance, click here.)

Progesterone

Progesterone has been shown to inhibit gallbladder contraction, which increases stasis or immobility of bile and decrease the gallbladders response to cholecystokinin or CCK. CCK is a digestive enzyme that improves digestion by slowing down then emptying of food from the stomach.  It is very common in my office that hormone replacement therapy can cause gallbladder and bile symptoms of any kind.  If CCK doesn’t slow down the emptying of food, you may have not only green stools, but also undigested particles of food in your stools.  CCK stimulates the gallbladder to “dump” bile.  The moral of the story is to be careful with hormone replacement therapies.

Glucuronidation – Glucuronic Acid

In the liver phase-II detoxification using glucuronic acid is the livers most abundant reaction. This glucuronic acid is also a precursor to making bile. The glucuronidation pathway is responsible for detoxifying most xenobiotics, hormones and environmental toxins. When this pathway is overburdened it creates problems in both bile production and detoxification. To address this pathway, I use artichoke leaf exract.

While you may have never heard of this pathway before, artichoke leaf extract is one of my top 5 supplements that I use in my office to help resolve difficult digestive issues, especially bile salt diarrhea, so don’t overlook this step. If you are looking for a bile acid binder, start with artichoke extract for liver detoxification support.

Coffee, Caffeine & Chocolate

The caffeine found in coffee can stimulate the gallbladder to contract forcefully. While people with bile acid malabsorption may be doing this unintentionally, many people throughout the world know this and use coffee as a stimulant to digestion. It works by causing the gallbladder to contract and decreasing the transit time of the intestines. So you get more bile release and less absorption. While the caffeine in chocolate can be problematic also, I find it clinically much less common to be causing anything severe. That being said if you are a choc-o-holic, then you may need to try decreasing your intake to achieve well formed stools.

Pancreatitis

One of the most common comorbidities with green stools is pancreatitis. Essentially pancreatitis is inflammation of the pancreas due to blood sugar imbalances and cortisol (aka stress) dysregulation. As you can see in the image below, the pancreas and the gallbladder work together constantly in the digestive process. If you go between dark green stools and light yellow stools, you may have pancreas and gallbladder issue that are related to each other. Decreasing stress and regulating your blood sugar ASAP is essential if this matches your symptoms.

bile sale diarrhea malabsorption

Bile Acid and Colitis 

One of the reasons you may overproduce bile is due to its electrolyte effects on the small intestine. The bile consists of high amounts of sodium that can help with inflamed tissue in the small intestine. The three most common reasons to have an inflamed small intestine are hidden infection or dysbiosis, food sensitivities and poor dietary habits with excessive additives and preservatives.

Natural Supplements For Bile Acid Diarrhea

The three major components that I most commonly address in an initial encounter with a patient suffering from BAD are blood sugar dysregulation, low grade infection and liver/gallbladder burden.

  • Step 1 is to balance your blood sugar by avoiding refined carbohydrates, especially corn based products like high fructose corn syrup.
  • Step 2 is to address stealth infection. The most common gallbladder and digestive toning supplement I use in my office is Chinese Coptis. (Buy Coptis here.)
  • Step 3 increase liver detoxification and bile production. I choose to do this by using an artichoke leaf extract. (Buy Artichoke here.)
  • Step 4 Find a bile acid or digestive expert in your area to work with. Realize that although I have great success with my patients and the above supplements are common in my practice, each patient can have unique circumstances that alter their unique individual requirements.

Natural Treatments For Bile Acid Diarrhea Conclusion

If you are suffering from BAD, there are answers and in most cases, it isn’t something you have to live with forever! You just have to address the condition from multiple angles, which is not the conventional approach.

If you continue to have BAD, you will develop nutrient deficiencies (often iron and zinc) and your health will slowly start to suffer. While BAD may seem like a digestive problem, it eventually leads to problems throughout the body that can be even more debilitating than your sprint to the porcelain throne.

Resources

Camilleri M. Bile Acid diarrhea: prevalence, pathogenesis, and therapy. Gut Liver. 2015;9(3):332-9. PMID: 25918262

https://www.sciencedirect.com/science/article/pii/S1542356512005216

https://www.sciencedirect.com/science/article/pii/S1542356515002499

https://doi.org/10.1016/j.cgh.2015.03.002

Dr. Houston Anderson is a top rated functional medicine doctor with expertise in natural treatments for IBS, leaky gut, SIBO, natural hormone balancing, food allergy and food sensitivity testing. He is a board certified Chiropractic Physician with a master's degree in Nutrition and Human Performance. He provides personalized natural medicine solutions to patients across the world.