BAM – Bile Acid Malabsorption

I’ve begun to believe that having BAM (Bile Acid Malabsorption) is a little bit of hell on earth. Unfortunately many people suffer from this digestive disorder and there isn’t a known “cure” but is treated like a maintenance type health condition. Some sufferers are helped by ingesting a binder, usually in powder form, that binds to the bile acids in the system to prevent “flare-ups”. I was prescribed one of these binding agents in a can of powder. It kind of reminded me of powdered lemonade. Mix in water and drink. Over the course of two months I learned that my body, specifically my kidneys, do not like this powder. I had my doubts when I saw the ingredients list that included two yellow food dyes and aspartame. I avoid these in foods, so why am I being prescribed something that is full of toxic materials, at least to me? I’ve learned that not all patients fair well on these powdered binders due to the resin in them.

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I kind of got ahead of myself there, let me back up a minute and discuss the topic, who gets BAM? I believe that anyone who has IBS, Crohn’s or UC experience BAM during times of “flare-ups”. The medical literature indicate that a portion of the patients who have their gallbladder removed suffer from BAM or BAD (Bile Acid Disease). Once the gallbladder is removed there isn’t a storage facility in the body for bile, ready for a diet containing fats. You see, it is bile that breakdown and help to digest fats. Bile is an emulsifier. If there isn’t a gallbladder to store the bile, the liver is required to make the bile on demand. Once the bile enters the digestive system it is reabsorbed in the distal ileum and recirculated back into the bloodstream. Patients with Crohn’s or other digestive diseases affecting the ileum, or patients that have had ileum resections, patients who have had their gallbladder removed and some patients that have had gastric bypass surgeries that affect the ileum are candidates for BAM. It’s interesting to note that certain drugs, such as Metformin, used to treat type 2 diabetes can cause BAM. In some patients the cause is unknown, or idiopathic.

The Causes for BAM


There is a test to determine whether you are suffering from BAM called the 75Se-homocholic acid taurine (75SeHCAT) test. However this test is not available in the USA. The patient is given a capsule to swallow and then given a nuclear full body scan which is repeated in seven days. The capsule contains SeHCAT, which is used to determine how much of the bile acids were retained by the small intestines. The rate of retention is less than 15 percent is diagnosed as BAM.

In the US, typically the physician will prescribe a medication that binds with the bile. This medication is being used “off label” for this condition. The medication was approved by the FDA for lowering cholesterol. The drawbacks are some people don’t tolerate the medications containing resin very well and the medication interferes with the digestion and absorption of certain vitamins, such as: Vitamin A, D, E, K, and folate (folic acid). Patients that are on these prescription binders should be monitored after 2-3 months on the medication and every six months thereafter to ensure these vitamins levels are normal and to check cholesterol levels.

Symptoms of BAM or BAD:

  • Watery diarrhea
  • Diarrhea with urgency
  • Diarrhea in the middle of the night
  • Soiling accidents
  • Bloating


I was one of the people who had problems with the medication after taking it for one month I began having discomfort in my flanks. After the second month on the medication I could no longer tolerate the pain that seemed to be radiating from my kidneys. I stopped the medication and the pain in my sides began to abate. I was desperate to find out how to address the issue in a more natural way. I knew the alternative might mean being homebound or forced to wear a diaper when out in public. Neither option was a long term solution, at least in my opinion. I started to research.

Natural Solutions

I had been researching and following treatments for patients with autism, since many autistic patients also suffer from GI issues. It was interesting to note that many of these patients were taking B vitamins, notably B6, B12 and zinc, were given as supplements. I had been researching previously about a condition that is called pyroluria, for which the supplements of B6 and zinc were recommended. I knew I had issues with a B6 deficiency but wasn’t sure whether I was low in zinc. My research pointed towards a zinc deficiency in me, as well. I noticed the symptoms of zinc deficiency included white spots on the nails and digestive issues. Off and on throughout my life I had noticed little white flecks on my nails but never associated them with nutrition or diet. I also had washboards for thumbnails, which I later learned are referred to as Beau’s lines. Which led me to research more about zinc deficiencies and conclude that adding zinc to my diet via supplementation wasn’t going to hurt me, it seemed to be a missing piece of my health puzzle. I use the ionic zinc drops that are added to 12 oz. of water once daily. I prefer not to take more pills or capsules that are made with starches and binders which are hard on a sensitive GI tract.

I opted for P5P which is the bioavailable form of B6. I have MTHFR issues and do better with the bioavailable forms of the B vitamins. I am an under-methylator so I also take methylated B12 supplements made by Metagenics, known as Methyl Care. I was tested and recommended to supplement with this by my integrative cardiologist after my sudden cardiac arrest.

So far, adding these two supplements to my diet has alleviated the worst of the BAM. I still have to watch what I eat, minimal amounts of fats, and the right kinds of fats, is important not to set off another flare-up. I don’t eat anything deep fried, never do I ever order anything at a restaurant that has any oil, fried, or in any dressings, or sauces. There are to many ingredients in restaurant food that doesn’t agree with me. I don’t eat out often and never do I ever eat “fast food”. When I cook with any oils, I use either coconut oil, olive oil, avocado oil, butter (or ghee), duck fat or bacon grease. I’ve learned to stay away from vegetable oils, canola oils, soy based oils or anything that is hydrogenated oil. Those oils aren’t good for anyone, but especially bad for people like me.

I’ve adopted a diet that is Paleo and leans towards AIP (Auto-immune Protocol). The more I avoid certain foods, especially the processed foods, the better I feel.

My Results

I’ve been off of the medication for several months now and it was touch and go at first. I had food grade charcoal capsules that I had to rely on for only a couple of different days. I learned the hard way that I was still sensitive to black pepper. I was told after my GI surgeries to try all foods and see whether I could now tolerate it. The dieticians at the hospital were convinced that all my food sensitivities were a thing of the past since my diverticulitis was resolved by the removal of the offending section of my colon. Not true. There are still foods I have to avoid in order to feel my best (get out of bed or out of the bathroom).

I will be interested to see what my GI specialist has to say when I go for my consultation next week. I’m used to doctors brushing me off, since their education doesn’t include an in-depth study of nutrition. Suggesting supplements isn’t in their wheelhouse, or as commonly referred to in the medical establishment as the “standard of care”.