If you are getting loose, watery stools that range from bright to dark green? Do you have an urgent need to run to the bathroom after you eat food? Then you may have bile acid malabsorption. Natural treatments for bile acid malabsorption 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 bile acid diarrhea goes unnoticed 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. Not why you are passing too much or too little bile.
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 Malabsorptino? (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 Malabsorption (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 extract.
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 Acid 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.
Bile Diarrhea Home Remedies
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. As a starting point or if your symptoms are not debilitating, home remedies are often a good start.
- 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 While the above steps are considered bile acid diarrhea home remedies, I highly recommend finding a bile acid or natural digestive expert to work with. I offer long-distance and in office consultations. While I do 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 Malabsorption Conclusion
If you are suffering from BAD and the dreaded “green poop,” 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. This is why we call it “functional medicine”.
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.
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Go To https://bilediarrhea.com to learn even more…
Resources:
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
Looking for a BAD doctor in the Bucks County or Philadelphia area
Peg, I don’t have a perfect person close in your area to recommend. You can find doctors that practice similarly to me here https://systemshealthcare.net/find-a-practitioner/ Also, read my latest article that talks about a common co-condition here https://drhoustonanderson.com/disaccharidase-deficiency-causes-and-treatment/
Hi I live in uk. I was diagnosed with crohns 5 years ago I am not on any medication I don’t get any pain bloating or blood loss. However I get chronic diareah with a lot of bright yellow bile. I am interested in the natural cures rather than going down the road of steroids and immune suppression. Any information would be much appreciated thank you Deborah Lloyd
Deborah, Finding a doctor in your area that is well versed in stealth infection and gallbladder support will be critical in your case. I highly recommend finding a natural practitioner in your area as long-term diarrhea can lead to nutrient deficiencies. Best wishes!
I am looking for a Doctor who treats BAD in Las Vegas, NV . I have been suffering with this for many years.
Thank You
Hello, L Robbins. I am the closest bile acid experienced natural doctor that I know of for you. I do offer phone consultations to get you started, but eventually office visits are recommended. Thanks!
Should I still use the artichoke if I have had my gallbladder removed? I currently have Sibo and have had bile salt diarrhea for 15 years. Oddly enough I only suffer from the diarrhea with meals before 4:00 pm. I can eat most anything after that and have normal BM. My Gastro doctor told me there is no test, only Cholestramine. I am nervous about long term usage. Any thoughts would be wonderful!! I am in upstate NY if you know of a good doctor.
Melissa, sorry for the slow reply. I recommend you contact Dr. Ray Cooley in Buffalo and see if he can take a look at your case. Artichoke is safe even if you don’t have a gallbladder, but there may be more to your case and I can’t provide specific medical advice online.
I am without a gallbladder – obstructed and infected – and have BAD. I’ve tried dietary changes and detoxing. Nothing helps. I drip bile at night and mornings are awful! Welchol helps but the side effects are debilitating. I need help binding the bile naturally.
Melissa, in the article I mention that my favorite natural bile acid binder is Artichoke Extract (see above). That being said, discovering the root of bile acid problem is critical. You should definitely look for an experienced practitioner in your area to work with that is well versed in the natural treatment of bile acid disorders.
Very informative. Do you have any thoughts on the specific carbohydrate diet? I find it really calms the gut, but how does it effect gallbladder/bile?
Do you have any ideas on how to treat this naturally in a nine month old baby? Also looking for a good doctor in my area to help him out! Des Moines, Iowa
Do you know anyone in the Atlanta area?
No specific comment on the SCD diet other than it does help many people while they try to discover their root cause. If you have to stay on a diet as restrictive as the SCD diet to feel well, then there is likely still something more to be addressed to get your gut to optimal health. I don’t like patients to be on something like SCD or AIP for more than a year.
Torrie, in a 9 month old baby it would be important to determine why this is the case, if the baby ever developed normal stools, etc. It depends on food intake color and much more in that age group. I don’t have anyone specific to refer you to in Des Moines.
Unfortunately I don’t at this time. Phone consultations are available for individuals outside of the referral network area.
I researched this a while ago for a client with BAD who was given cholestyramine (bile acid sequestrant). My research indicated that psyllium husk is also a bile acid sequestrant. Do you know anything about using psyllium for BAD?
Allison, yes psyllium can be used as a natural binder/sequestrant for bile acids, though it is one of my least favorite in difficult cases. I find that in patients with multiple sensitivities and food intolerances that they don’t tolerate psyllium or a high fiber diet. The first goal of treatment would thus be to quell inflammation of the digestive tract and then after that has occurred, sometimes pysllium can be beneficial. In general I don’t use psyllium anymore, but that doesn’t mean it won’t help someone out there. Thanks for the comment!
Thanks for the quick and helpful reply!
She has confirmed SIBO (methane) but my treatment hasn’t worked as yet even though it was a comprehensive protocol. I suspect maybe a clostridia overgrowth is lurking as that can influence BAD. Also had exposure to a very moldy house a while back which is when she was at her worst, so I might need to bring that up again. Also tested positive for blastocystis, but from what I gather, that could be a red herring because many strains are not pathogenic.
What do you like to use to get diarrhea under control quickly while working on underlying causes?
do you know someone in the Palm Springs area that can help to treat BAD naturally?
Becky, I don’t know anyone in Palm Springs. I am the farthest southwest practitioner that I am aware of. Best wishes!
Do you know a chiropractor in the Center Valley, PA area that would handle BAM?
Any referral for someone in the Nyc area?
Hi, I am from Israel, I had my gallbladder removed which means that I have constant flow of bile acids. I don’t understand, in my case, if I’ll take these supplements, I will have more bile produced, how will that help? I do response to pharmaceutical bile acid absorbabts, but they also not Allways working and have side effects. Please advise
Thanks, I Dalit
Dalit, it is not necessarily true that you have constant flow of bile acids just because you don’t have a gallbladder anymore. Other than ox bile, most supplements don’t increase bile production. Artrichoke for example supports binding of toxins and enhances the liver’s role in detoxification through glucuronidation. The goal would be to improve you overall digestive health in order for the bile salts to not irritate the lumen of your intesetines. Remember that you can have bile acid diarrhea due to excessive bile or insufficient bile. Thanks!
I am located in San Antonio
Is there. Doc here
Kim, I don’t have anyone in San Antonio. I apologize.
Hi! I had my gallbladder removed almost 8 years ago and that is when the BAM started. I only have major issues after I eat a fatty meal or a small meal with a sugary beverage. If the artichoke binds to the bile acids, but my problem is from too little bile acid, would this exacerbate my symptoms? Do you recommend this for patients even without gallbladders? Is there a certain artichoke extract you recommend? Just trying to find a natural solution. Thanks for your help!
Melinda, yes in general we still like artichoke extract for those without gallbladders. Its not necessarily too little bile acid, especially if a sugary beverage sets it off. Arithcoke Extract from AMG Naturals (see link in article) is what we use in the office because its pure. Artichoke contains glucuronic acid which will help your liver deal with the added stress of not having a gallbladder. You should consult with your physician if you have any extenuating circumstances.
Hi;
Thank you for this information. Aggressively treating Estrogen Dominance (male) for about 2 months has made a significant different in the random Bile issues (IBS). i’m not perfect yet, but a lot better.
I don’t get a bloated looking stomach that I can tell but get very uncomfortable burping / fullness, especially later in the day that I’m trying to figure out. I also think I may be getting bile in the stool as I find it is till very hard to clean. Still these are not as bad as the bile dumping type of issues I had.
Thank you for this information here, the part about estrogen dominance has been really helpful.
Thank you for the article- I have suffered with IBS-D for 50 years. Found cholestyramine 2 years ago and found 99% relief from 8 – 10 trips a day to loo. But now the medicine gives me horrible descending colon pain – so bad I can’t stand up straight or walk. I will try the artichoke extract – keeping my fingers crossed. Bless you for you sharing of knowledge, jd
Thank you forcthe article!
I need help in answers please!
I have bile reflux. Did MRI and everything is fine with gallblader. Ultrasound as well. I’m taking Ursofalk with strict diet. My concern is if I take Arthcoke extract will my bille reflux get worse? Will I overproduce more bile?
Thank you!
Elma, you would need to work with your practitioner directly in order to determine the safety of any nutritional supplementation.
Hi from Israel. very interesting!
I know that BAM is common after gallblader removal.
is the treatment the same?after all, the bile continiously flow from the liver to the intestine – this can never change.
how do I “repair” the intestine lining?
Dalit
Dalit, please read some of my other articles on healing your gut. Each treatment is different, there has to be some kind of natural healer in Israel that can help you. The treatment is similar in the way that you have to find the root cause. It is different in the way that you may require additional support and may not be able to tolerate some products. Thanks!