Dietary & nutrition advice for Bile Acid Diarrhea

Your liver creates bile, a yellow fluid that helps with the breakdown of dietary fats. It is stored in the gallbladder and secreted into the small intestine at meal times. Fat must be broken down into smaller molecules so they can be easily absorbed further down the digestive tract. If fat is not absorbed, it can come out in the stool, a condition known as steatorrhea. 

Just like fat, bile needs to be absorbed too. If bile travels into the intestines, it can irritate the tissues, and lead to bile acid diarrhea (sometimes called bile acid malabsorption). People with digestive health diseases, such as inflammatory bowel disease, are the most susceptible to this type of diarrhea. 

This article will teach you how to recognize the symptoms and offer dietary suggestions you can make to help you feel better.¹ 

Who is At Risk For Bile Acid Diarrhea?

People who have had a bowel resection (a portion of their bowel surgically removed) are at the highest risk for bile acid diarrhea. They have less square footage of the intestine to absorb fluids, and stools can be looser and more watery than normal. Other risk factors include:² 

• Being diagnosed with Chron’s disease or microscopic colitis.  
• Having irritable bowel syndrome that causes diarrhea (IBS-D).  
• Genetic variations that affect bile acid secretion and absorption.
• Radiation therapy that targets intestinal tissues. 
• Cholecystectomy (gall bladder removal surgery). 
• Your liver over produces bile acids. 
• Chronic pancreatitis (inflammation of the pancreas). 
• Excess bile production can be a side effect of Metformin, a medication commonly prescribed to help lower blood sugar levels. 

The condition is rare compared to other bowel diseases. It is estimated only to affect one to two percent of the US population. These statistics are similar to the prevalence of Celiac disease.¹

Symptoms of Bile Acid Diarrhea 

The most obvious symptom of bile acid diarrhea is diarrhea. Bathroom urgency can occur within thirty minutes of eating, even faster if high-fat foods are consumed. Other common symptoms include painful cramping, bloating, and indigestion. 

Medications can help lessen effects of bile aggravating the colon. These medications are called bile acid sequestrants and are only available via prescription. They neutralize bile salts so they can not irritate the delicate tissues in the gut, and they stop water from being pulled into the colon, which contributes to loose stools. 

Combining medication and lifestyle changes can have the greatest improvement for managing bile acid diarrhea. 

Health Risks Of Bile Acid Diarrhea 

Bile acid diarrhea can increase the risk of malnutrition. Fast-moving stools spend less time in the intestines, which decreases the chance for your body to absorb essential nutrients. This can expose you to deficiencies and undernutrition. 

Ongoing diarrhea increases your risk of dehydration. Long bouts of dehydration will make you feel weak and can strain your kidneys. Choose water most often to stay on top of your hydration status. Other fluid-rich foods can also help you meet your goal; these include low-fat yogurts, soups, and even jello. 

Nutrition Tips 

Following a low-fat diet can help manage bile acid diarrhea and reduce symptoms. Try to avoid butter, creamy sauces, and fried foods. You can still include easier-to-digest fats such as avocado, small amounts of nuts and seeds, and salmon or mackerel. 

You can follow a three-day sample meal plan to start: 

Day 1: 

• Breakfast: Two slices of whole grain toast with three pieces of avocado, black pepper, lemon juice, and diced red peppers.  
• Snack: whole-grain crackers with 1-2 tbsp of hummus. 
• Lunch: Chicken lettuce wraps with cucumber, tomato, and 1-2 tbsp of light crumbled feta. Dress with 1 tbsp of olive oil and fresh basil. 
• Snack: Low fat unflavored greek yogurt with blueberries. 
• Dinner: Baked salmon served with roasted carrots, onions, and garlic over quinoa. Add a side salad with a low-fat dressing to help increase the fiber content. 

Day 2: 

• Breakfast: two boiled eggs with a side of grapes, low-fat unflavored yogurt, and 1 tbsp of chia seeds. 
• Snack: Smoothie with no fat milk, banana, and oatmeal. 
• Lunch: Lentil stew with tomatoes, carrots, peppers, onion, garlic, and chili seasoning. Add a dollop of fat-free sour cream and sliced green onions to garnish. 
• Snack: A mixed cup of fresh berries dusted with cinnamon. 
• Dinner: Shrimp stir fry with spinach, peppers, zucchini, and sugar snap peas. Serve over brown rice. Add your favorite low-sodium teriyaki sauce, or make your own at home. 

Day 3: 

• Breakfast: A bowl of oatmeal made with water, topped with your favorite fruits, and ¼ cup of unsalted mixed nuts.
• Snack: Plain popcorn dusted with garlic powder and paprika. 
• Lunch: Canned tuna in water, mixed with 1 tbsp of light feta cheese, low-fat dressing, served with leftover lentil soup. 
• Snack:  Fresh red pepper with hummus dip. 
• Dinner: Stuffed sweet potato with black beans, arugula, and poached eggs. Dress with 1 tbsp of olive oil and lemon juice. 

Soluble fiber helps to slow down transit time in your digestive tract. It absorbs liquids and creates a gel-like texture as it moves through the intestines. Foods naturally high in soluble fiber include oatmeal, legumes, applesauce - anything that can be mushy when you add water. 

You should try a supplement if you can’t get enough fiber through the diet. Metamucil^Ⓡ or psyllium husks are both popular and easy to take. Soluble fiber also helps stabilize blood sugars, reduce cholesterol levels, and lower blood pressure.³

Work With A Registered Dietitian 

Managing chronic diarrhea makes everyday life harder. There may be fear that you can’t get to the bathroom in time, and road trips and traveling can feel out of reach. A registered dietitian specializing in bile acid diarrhea can help you find strategies to cope with these daily challenges.

Nourish has a team of registered dietitians who are compassionate and expertly trained. They offer fully-remote appointments to help with scheduling, and they are all covered by insurance. Click here to learn more and book an appointment! 

References

1. The Role of Bile Acids in the Human Body and in the Development of Diseases. 
2. Camilleri M. (2015). Bile Acid diarrhea: prevalence, pathogenesis, and therapy. 
3. Surampudi, P., Enkhmaa, B., Anuurad, E., & Berglund, L. (2016). Lipid Lowering with Soluble Dietary Fiber.

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