Questions On BAM and Bile

[jbrohlr]

Hello all,

Had a situation with my gut these past few days. I have been taking Cholestyramine every night before bed for almost a year (2/3rds of a dose). Six days ago I ran out (long story). First day without Cholestyramine everything was o.k. but then my stool gradually became looser until three days ago I had a watery, semi-urgent stool. I had some intestinal discomfort, cramping and Borborgylia at night as well.

I was able to get a prescription for Cholestyramine filled yesterday and took a dose twice yesterday. This morning my stool was at #6 Bristol and no Borborgylia last night. I am thinking that if my gut improves that I can be fairly certain that I have an issue with BAM. I had my gall bladder removed six years ago (2018) and had gut problems on and off until my full-blown flair in June 2021.

The only thing that would contradict my thinking on this is that I was taking such a small amount of Cholestyramine before this incident and doing pretty well, so I have a few questions on bile and BAM.

Does the amount of bile that you actually use to break down the fat you eat still exist after use or is it broken down to another chemical compound (that does not erode your colon lining)? Since your liver has to keep making bile I would think that it is broken down and that the only bile that causes BAM is the unused amount. That was the assumption I made with taking Cholestyramine at night before bed since nighttime and morning is the longest time period that I go without digesting fat.

Some sources say that reducing saturated fat intake will reduce the amount of bile produced by your liver. I thought that the liver just produced the same amount constantly and that the gall bladder was the organ that regulated the volume of bile going into your small intestine.

Is Imodium o.k. to take if BAM is the problem? I would think that if you have bile in your colon the best thing to do would be to get it flushed out as quickly as possible.

Bentonite Clay: there was one day in my ordeal that I had no BAM symptoms, not even a BM. The night before that happy day I took a tablespoon of Bentonite (mixed with water). I am not keen on ingesting clay but if there is evidence that the clay will bind with bile acid then I'll eat clay. Does anyone know of any literature out there on that subject? The only info I have found is vague at best.

That's about all. Hope everyone here on the site is well.

John R.

[tex]

I'm not aware of any medical research trials regarding the use of bentonite clay to treat BAM. Long-term consumption of bentonite clay is not recommended, especially as we get older, due to the risk of intestinal blockage if it builds up in the colon because of incomplete purging. Normally, the liver produces roughly 10 times as much bile as our digestive system normally needs to digest the fat in our diet, and the unused excess is then reabsorbed in the terminal ileum and recycled. The reabsorption reduces the amount of work that the liver has to do to produce bile, and it eliminates the downstream diarrhea risk, by preventing bile from being dumped into the colon.

The malabsorption problem associated with MC (due to the chronic inflammation) prevents normal bile acid reuptake in the terminal ileum, allowing it to be dumped into the colon, where it promotes diarrhea. One of the primary reasons why budesonide and other corticosteroids help to prevent diarrhea is because they promote bile acid reuptake by reducing the inflammation in the terminal ileum. So regardless of how we approach this problem, the inflammation that causes the malabsorption problem is the cause of the failure of normal bile acid reuptake in the terminal ileum, and if the inflammation cannot be adequately suppressed, then the safest long-term solution is the use of a bile acid sequestrant in order to allow the sequestered bile to pass through the colon without any ill effects. At least, that's the way I see it.

I hope this helps.

Tex

[jbrohlr]

Thank you Tex,

I also reread the paragraphs in Microscopic Colitis about bile acid malabsorption (which I should have done in the first place). I'm beginning to wonder whether my pancreas is functioning properly (maybe not producing lipase). I'll keep up with the cholestyramine doses and see if things improve, and maybe try pancreatic enzymes. I've tried Tudca in the past and I did improve but could not really say if Tudca was the cause because when I stopped taking it I kept improving.

There is inflammation in my gut for some reason and I have not changed my diet at all for the last year, so this is going to be a challenge.

By the way, did everyone move to Facebook? Since I've been reading this forum for 2 1/2 years there seem to be a considerable decline in people posting.

John R.

[tex]

Posting seems to run in cycles, but as you point out, it's been declining for a long time. Back when we first started, almost 19 years ago, we had way less than 100 members, but there were over 100 posts every day. And there were soon a number of MC discussion and support websites, but most of them have fallen by the wayside due to lack of activity. Most list owners would shut this one down, also, but I hate to do that because we have such a huge archive of shared posts, and these days we still seem to have quite a bit of traffic, but they're readers, not posters. Now we have thousands of members (many of them are new, every week), but no posts. Probably, as you surmise, most people are posting on Facebook and similar sites these days. And many MC patients aren't willing or able to stick to such a restricted diet — they would rather pop a pill, anyway, and hope for the best.

Tex

[threegen]

Thankyou for keeping this site running Tex, I often return to it to read what others have written. As you say there are more readers than posters and with you and others answering questions it's a goldmine of information.
many thanks Claire

[tex]

You're very welcome. I can still remember how helpless I felt when my gastroenterologist told me there was nothing more he could do for me.

Tex

[Cat Granny]

Morning! I'm going to second what @threegen said! Thank you Tex for keeping this site up! I read it for several hours each week. There is a TON of information in here. It helps so much knowing that I am not alone in this illness.

I am a fairly new member here, and was diagnosed last year. But I've had symptoms for several years now. Back in 2021, when I had my first flair and thought I was dying, I found this site! I wasn't sure what was wrong with me then, but I knew there were answers out there. You just have to find them.

I have been to the FB page. Reddit has a MC forum, but it is not active. I do see a lot of folks with MC posting in Reddit's IBD forum. Whenever I respond, I direct people here to this site, and recommend they read read read to educate themselves.

Again thank you Tex! You are a jewel!

[Gabes-Apg]

my observations

since the start of Facebook forums - rather than visit a site like this and do research and read previous discussions, Facebook forums has popularised the format of asking a question to get the answer.

the other aspect that is not new, people (not all but a reasonable quantity) wanting the easier solution. ie the medication that resolve the issue(s)

[tex]

Thanks, Cat Granny.

Tex

[dianebarkeridaho]

Hi there.

I am really curious about the original poster asking about the effect of taking immodium if the problem is bile acid. He asked if it was wise since the bile would just still be in the colon but just slowed down by the immodium.

I ask because that is what I am doing. I have stopped wheat, soy, oats and that made a HUGE difference. But still having 3 loose stools. So a couple months ago I started taking one tablet of immodium at night to slow my gut down. It has worked like a charm. But am I doing harm to my colon? Should I maybe be on cholestyramine instead?

I have what is called a hyperkinetic gallbladder. Ejection fraction on HIDA scan was 97%. Doc said it was normal. I asked how often he saw one that high. He said "almost never". So I said that doesn't sound normal then.

Any thoughts about the immodium?

[tex]

These are uncharted waters, so we can only guess. But in my opinion, if taking Imodium at night reduces your clinical symptoms (without causing any new symptoms), then it's probably safe. We have to listen to our body in cases like this because if our body doesn't like something that we're doing, it will let us know, and in situations like this it's probably smarter than we are. At least, those are my thoughts.

Tex