Bile acid diarrhoea - ox bile supplements?

[Chickens44]

I have recently found out I could have some problems with low bile production. I have had loose bowel for many years, but once I stopped PPIs last Christmas, which I had been on for 20 years, and started goats milk kefir and probiotics, my bowel movements got so much better. I was only having one visit to the loo with a lovely looking solid 💩.

But following my flu and Covid vaccines in early October I’ve been suffering with lots of loose bowel again, among other things. My nutritionist thinks I may have low bile acid. My question is has anyone had a temporary flare up which was treated with ox bile supplements. I don’t really want to go onto anything stronger until I know for definite whether it is this.

Would be grateful for any thoughts.

[Mimired]

No experience of Ox Bile supplements sorry. But colesevelam is such a clear, successful remedy for my BAD i'd definitely recommend asking your GP. I take 6 a day even though my test result was only mild BAD, and it's changed my life dramatically. I've also experimented with reducing or stopping and symptoms returned immediately so I feel comfortable the colesevelam is doing the job. I also recommend tracking dietary fibre and hitting 38g a day (check recommended for age, sex etc).

Wish you all the best...

[Edgar77]

Sorry I can't help you. If fact I also could do with some advice. I was diagnosed with BAM. People with BAM suffer diarrhoea But I have IBSC so they say the meds will not help me. All this does not make any sense????

[Bracondale in reply to Edgar77]

How was your BAM diagnosis made? (Agree it does seem confusing!)

[Edgar77 in reply to Bracondale]

I had the two scans first they gave me a bile tablet, had a scan then a week later a second scan to compare the difference.

[Edgar77 in reply to Edgar77]

It was only 13% if that means anything to you. It should be at least 15%

[Bracondale in reply to Edgar77]

Yes, that does confirm a degree of BAM ie that you're not reabsorbing as much bile as you should be at the far end of the small intestine. I understand it's due to inflammation which is usually caused by dysbiosis/imbalance of the gut bacteria. Dysbiosis can cause IBS-D or IBS-C. I'm having a good response to Elixa for IBS. It's a high dose six day course. There's a wealth of information on the website and you can email with queries.

[Bracondale]

I have similar symptoms so have been heavily researching this, but I think there may be some confusion here re bile acid diarrhoea and treating it with ox bile!!

I personally think that your original problems were caused by too little stomach acid due to the PPIs. Mainstream medicine is very behind with realising that 'indigestion' can often be due to too little acid rather than too much! (Stomach acid production declines with age and stress etc.) Too little stomach acid means that the gallbladder lacks stimulation to release bile so food is relatively 'undigested' and bad bugs can survive and overpower beneficial bacteria. This will cause loose stools due to gut irritation. Your experience with stopping PPIs and kefir and probiotics supports this theory.

Since your vaccines and recent loose stools, has your nutritionist suggested trying to increase stomach acid in the first instance (lemon juice, apple cider vinegar,betaine hydrochloride) which should help bile release if they think insufficient bile is the problem. If they actually think that the loose stools are due to bile acid diarrhoea/bile acid malabsorption (BAD/BAM) that is a totally different matter! That is actually caused by too much bile/problems with bile reabsorption and not too little, so ox bile would actually make it worse! (I've been looking into treating the underlying cause of BAD/BAM rather than taking bile acid sequestrants long term if you're interested).

I wonder if the vaccines have upset your gut microbiome . Although not a result of a covid vaccine, covid itself in May has left me with a a legacy of very loose stools with nausea and indigestion early on. (I gather that recent variants can cause predominantly gut symptoms). I've had definite improvement with a course of Elixa probiotics (very high dose for six days).

[Chickens44 in reply to Bracondale]

In addition, I did wonder is I may be a bit lactose intolerant. I have been drinking milk as I did a test in September and my blood calcium was low. But recent test has shown calcium much higher now, just under top of range.

[Bracondale in reply to Chickens44]

Yes, you can develop temporary lactose intolerance after gut infections/inflammation. Maybe try non dairy sources of calcium for a while to see if that helps. Looking online for myself yesterday, I was able to compile a good list....green leafy veg, broccoli, tinned sardines (with bones), nuts and seeds, chickpeas..........

[Chickens44]

my nutritionist is working to get my gut back to good health. My latest microbiome result showed low Lactobacillus, Bifidobacteria and Bacteroides, so she has recommended a supplement with guar gum. We have tried a few other things and I have been taking Betaine HCL for a while now. I have also tried lemon and lime juice and also a good ACV.

I had a liver test and it indicated high GGT level, but all other levels were fine, which is why I think she thought low bile acid. But I had drunk a couple of glasses of red wine the night before the test and didnt realise it could skew the results.

I would be interested to hear more on BAD/BAM and on whether I should or shouldn’t try ox bile supplement.

And going back to vaccines, I also had the over 65s flu one this year, which I understand is much stronger that the normal one. Just seems odd that my current symptoms started two days after.

[Bracondale in reply to Chickens44]

I think guar gum and other prebiotics can work well if any dysbiosis is mild. Mine was severe and Myota (which contains guar gum and other prebiotic fibres) badly aggravated it.

An isolated raised GGT suggests that the liver is strained by gut inflammation.

I can see a connection with vaccines in that they stimulate the immune system (most of which is in the gut) and will increase inflammation body-wide, hopefully temporarily.

Re BAD/BAM a SeHCAT scan should give a definitive answer. If normal, maybe ox bile would help. If it shows poor reabsorption of bile, ox bile will make it worse!!

If BAM is diagnosed these two links may be helpful to explain and offer a treatment of the underlying cause. (Don't be put off by the carnivore, keto title in the second one!)

youtube.com/watch?v=wgsdzeO...(Not working as expected?)

youtube.com/watch?v=xjWSF8V...(Not working as expected?)

[Chickens44 in reply to Bracondale]

Actually the last day or so the diarrhoea has stopped. I do find the goats milk kefir I have helps with loose bowel. It’s is still a bit yellow, but not watery like before, so hopefully it was just temporary.

[Chickens44 in reply to Bracondale]

Wow, just watched the first video. Very interesting and really makes me think it is the stomach pH that is my problem. I have done some gut tests in the past and it showed my stool had a high pH. It is better now, but was in the top range, which would suggest high bile in my stools, and less acid. I will continue with the Betaine and kefir. Horrible PPIs. I always tell people now to stop taking them when I hear they take them every day, because GPs certainly won’t.

[Jayjayvee]

Just on the ppi, how did you wean yourself off it? I try to miss the odd one but soon get reflux again. I don't know anything about lack of bile acid I'm afraid

[Chickens44 in reply to Jayjayvee]

I just stopped them. I was lucky I didn’t get any rebound symptoms. But then I was originally put on them for IBS I think, not reflux.

[Jayjayvee in reply to Chickens44]

Thanks