Bile Acid Malabsorption

BAM Is a Mechanics Issue, Not a Microbiome Issue (At First)

BAM happens when your bile acids aren’t reabsorbed in the small intestine like they should be — so they “spill over” into the colon, where they irritate the bowel and cause diarrhea or fat malabsorption.

This has nothing to do with bacterial balance in your colon at first — but over time, excess bile acids can damage or alter the gut lining and affect microbes too.

In my case, because I've eaten plant-based for years:

Likely supported a diverse gut microbiome

Had no issues until recently...

It’s very likely my microbiome is still in good shape. The issue may lie in:

How bile is being handled or recycled

A change in digestion or absorption ability (e.g. hormone shifts, thyroid, age-related enzyme/bile output)


 You Can Have Both:

A healthy microbiome

And digestive dysfunction (like BAM, SIBO, or mild pancreatic insufficiency)

What You Can Do:

1. Temporarily modify meals to reduce fat and fiber load just enough to ease digestion

2. Ask your doctor about testing or trying a bile acid binder (like cholestyramine or colesevelam)

3. Continue supporting your microbiome with fermented foods, gentle prebiotics, and moderate fiber when tolerated.

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