I have Bile Acid Malabsorption…

So lovely readers I have news I have news I have news ahhhhhhhhhh I have been diagnosed with something which has a really cool name: Bile acid malabsorption or BAM. I have BAM! Dun dun DUNNNNNN.

I know….you’re falling off your chair as you read this right? Or not maybe? Bile acid malabsorption, what the heck is that???

So if you’ve read any of my health history or kept up with my monthly health updates, you will know that for years and years and years, since I was a teenager probably, I have suffered with diarrhoea and after test after test after test the only diagnosis I have ever been given is IBS.

And as you will know if you’re a follower of this blog, I have attempted to ‘fix’ my ibs, as well as a number of my other health issues, with the adoption of a strictly gluten and dairy free diet.

Well…..things might be about to change. I know…….WOW right?

So – bile acid malabsorption or BAM for short, is a condition in which bile acids are not properly processed within the digestive system, resulting in symptoms of chronic diarrhea.

To best understand BAM, it helps to understand how digestion is supposed to work. Bile acids are substances produced by our livers and stored in our gallbladders. Your gallbladder is responsible for releasing bile acids into the small intestine for the digestion of fats. When BAM is present, these acids are not well absorbed and therefore excessive amounts are flushed into the large intestine. The effect of bile acids on the large intestine is an increase fluid production, resulting in watery stools and a speeding up of intestinal motility, both of which result in symptoms of diarrhoea. Lovely.

There are a few reasons why you might have BAM including Crohn’s disease, Coeliac disease, gastrointestinal surgery or various other complex gastrointestinal diseases but I have none of those apparently. I just have primary, unexplained, no cause or reason behind it, BAM. Weird.

But here’s the good thing and reason why when I was told about my diagnosis by my specialist today I actually laughed with sheer happiness – there’s a medicine that can fix me!!! Hooray and about bloody time!!!

Yes it means I possibly have to take yet another (as well as my lifelong thyroid meds) pill for the rest of my life but yes I am totally happy, in fact seriously excited and relieved, to take it.

The medication is primarily prescribed to lower cholesterol, however because of its effects on bile acid it it sometimes prescribed as a treatment for chronic cases of diarrhoea. It is classified as a bile acid binder or sequestrant.  It works by attaching itself to bile acids within the digestive tract so that they pass from the body. The medication reduces the action of bile acids in the large intestine, which has the effect of reducing diarrhoea symptoms. Hallelujah!

There are a few side effects including lack of absorption of vitamins and minerals so my specialist has advised me to take a daily multi vitamin and will blood test me regularly to check levels. I am already on a vitamin B supplement anyway and he has recommended I can continue taking that as well as the various other supplements that I already take to compliment my thyroid regime. I have to make sure to take this new medication at a different time of day as my other meds though which means I am gonna have to completely rethink my medication and supplement regime so I get the best effect out of everything.

But you know what I think is kind of amazing, statistically between 25-30% of patients diagnosed with IBS probably have BAM but remain undiagnosed. How did I succeed in getting a diagnosis then when so many poorly other people haven’t?

Dozens and dozens of trips to my gp armed with research and a bucket load of determination and patience. Demanding tests for lactose intolerance, coeliac disease, gerd, sibo, bacterial infections, food allergies and lastly finding a small amount of information on the web about something called a SeHCAT test which my dietician mentioned to me over a year ago. Having tried all sorts of different dietary control methods under the advice of this dietician, she was the first and only person to ever mention BAM and recommend I take the test for it.

A SeHCAT scan involves 2 scans one week apart, you swallow a tablet which has bile acids in it and then the acids are measured at each scan. The percentage of acids remaining gives an indication as to whether the patient has the condition or not. The typical range is above 15% = Normal, below 15% = signals excessive bile acid loss. My result was 7%.

Over a year later and having eventually persuaded my gp to refer me back to a specialist, I take the test and it is POSITIVE. A-bloody-mazing.

To be honest, you get used to these things, the constant trips to the doctors or the hospital, spending time researching and reading random chat group feeds about weird and wonderful syndromes and diseases and health issues. You get used to the running to the loo, to the painful cramps, to the other embarrassing symptoms as being part of your life. You begin to restrict your diet more and more trying to work out what it is that triggers you. I really had gotten used to it. How sad is that? But god it was depressing. And now…..now I have an actual reason for it. An actual medical diagnosis. And an actual medicine to take that it going to fix me. I can’t bloody believe it!

Oh and you know what, I forgot to tell you the most exciting part of all of this: I can start to eat cheese again!!!!!!! Seriously!!! I know! My specialist said since I definitely didn’t have lactose intolerance (I did the 4 hour long hydrogen breath test last sat morning) that the reason I have always suffered with my ibs so badly after dairy products is the fat in them and not the lactose. So I can probably already tolerate low fat yogurts, skimmed milk and the lowest fat cheeses but once this medication begins to kick in I ought to be able to go back to an entirely normal dairy intake. If I want.

I have to say, I couldn’t go back to drinking milk full stop, the smell of it now just turns my stomach. But at least I know I could have a drop in my tea if there was no other option. At home I’m more than happy with my almond milk so I’m going to stick with that. And we all like the new dairy free spread that I now buy but it’s good to know that I can bake again with proper butter, which as we all know makes cake taste so damn good!

But then there’s cheese…..if you’ve read enough of my blog posts you will know that I’ve spent the past 6 months trialling cheese free sauces till kingdom comes. And I make a pretty good one. And it’s not a bad cheese free alternative if that’s what you need to have. But to be completely honest with you, if I don’t NEED to have it, if I don’t NEED to deprive myself, then you know what – I’m gonna be eating cheese again soon! I have totally missed a rich strong mature cheddar, there’s nothing like it, and a gooey cheesy pizza, yes please. Yup yup yup. I’m excited about the cheese thing. Yes I am.

Oh and chocolate. mmmmmmm chocolate. Dairy milk, full of fat, totally bad for you and totally yummy and I’ve totally missed it. Ahhhhh chocolate, you will be welcome back indeed!

So watch this space guys….I’m going to slowly try reintroducing some dairy into my cooking and baking once the medication has taken effect and I’ll let you know how I’m doing. For the time being I am going to stick with being gluten free although my specialist advised I could probably start to reintroduce a little bit and see how if effects me. Ultimately because of my thyroid disease it might be a good decision to remain gluten free anyway but I’ll see how I feel about once I have settled down with the new medication.

So wish me luck! Please share this post with anyone you might know what suffers with unexplained ibs like I have for so many years. I hope my experience might be helpful to others. I hope it’s going to be a positive change for me and not another let down. I hope I’m going to feel better. I hope. Fingers crossed.

2 thoughts on “I have Bile Acid Malabsorption…

    1. Hi there, thanks for your question. My symptoms were very similar to ibs with constant stomach cramps, feeling nauseous and running to the loo after most meals. At my worst I would say a dozen times a day…not much fun. If you’re struggling in a similar way speak to your gp and BAM and ask for the Sehcat test to confirm. Any more questions just ask, Abi


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