From the Research
People with bile acid diarrhea typically do not experience weight gain; in fact, they are more likely to experience weight loss. Bile acid diarrhea occurs when excess bile acids enter the colon, causing increased water secretion and faster transit time through the intestines, resulting in watery diarrhea. This condition often leads to malabsorption of nutrients and calories, which can contribute to weight loss rather than weight gain. Symptoms commonly include chronic watery diarrhea, urgency to defecate, abdominal pain, and bloating. Treatment typically involves bile acid sequestrants such as cholestyramine (typical dose 4g 1-2 times daily), colesevelam (625mg tablets, 3 tablets twice daily), or colestipol (5g once or twice daily) 1, 2, 3, 4. These medications bind to bile acids in the intestine, preventing them from causing diarrhea. Dietary modifications may also help manage symptoms, including reducing fat intake since dietary fat stimulates bile acid release. If you're experiencing unexplained weight gain alongside symptoms of bile acid diarrhea, it's essential to consult with a healthcare provider as this could indicate a different or additional condition 5. Some key points to consider include:
- Bile acid diarrhea can result from either hepatic overproduction of bile acids or their malabsorption in the terminal ileum 3.
- The selenium homotaurocholic acid test is the gold standard for BAD diagnosis and severity assessment, but it is an expensive method and not widely available 4.
- The validation of the utility in the clinical practice of several other serum markers, such as 7α-hydroxy-4-cholesten-3-one (C4) and the fibroblast growth factor 19 (FGF19), is ongoing 4.
- An early and correct diagnosis of BAD would improve patient's quality of life, avoiding additional diagnostic tests that burden health care systems 4.
- Considering the limited availability and tolerability of specific medications for BAD treatment, future research is awaited to identify other therapeutic approaches, such as gut microbiota modulating therapies 4.