Bile Acid Malabsorption: Causes, Symptoms, and How It Affects Your Digestion

When your body can’t properly reabsorb bile acids, digestive fluids made by the liver to break down fats. Also known as bile acid diarrhea, it happens when these acids spill into the colon instead of being recycled in the small intestine. That’s when things go wrong — you get watery diarrhea, bloating, and cramps, often mistaken for IBS. It’s not just stress or food intolerance. This is a real, measurable problem affecting up to 30% of people diagnosed with IBS-D.

Most people don’t realize bile acid malabsorption, a condition where bile acids aren’t reabsorbed properly, leading to chronic diarrhea can follow gallbladder removal, Crohn’s disease, or even radiation therapy. It’s also common after certain surgeries that remove part of the ileum — the last section of the small intestine where bile acids are normally caught and returned to the liver. Without that checkpoint, bile acids flood the colon, pulling water in and speeding up bowel movements. That’s why people with this condition often have urgent, greasy stools — their body can’t absorb fat properly, and undigested fat shows up in the toilet.

It’s not just about digestion. This problem affects nutrient absorption too — vitamins A, D, E, and K need bile to be absorbed. Long-term, that can lead to deficiencies, bone weakness, or even vision issues. The good news? It’s treatable. Medications like cholestyramine, a bile acid sequestrant that binds excess bile acids in the gut can stop the diarrhea fast. But many doctors never test for it, assuming it’s IBS. If you’ve had chronic diarrhea for months and nothing’s worked, this might be why.

What you’ll find in the posts below are real, practical insights from people who’ve been there — how symptoms show up, what tests actually help, and which treatments work without side effects. You’ll see how bile acid malabsorption connects to other gut issues like atrophic gastroenteritis and fat malabsorption, and why some diabetes meds can make it worse. No fluff. No guesswork. Just what you need to ask your doctor, what to watch for, and how to finally get relief.