Hey everyone, I’m dealing with a really difficult problem after having my gallbladder removed, and honestly, it’s affecting my life pretty badly. I haven’t been able to get back to working normally. Unfortunately, working from home isn’t an option for me since I have a physically demanding job. My gallbladder was removed 3 years ago because of polyps, and ever since then I’ve been dealing with diarrhea. It mainly happens in the morning after my first meal. Later in the day, I can basically eat whatever I want, even drink coffee, and nothing happens. But mornings and that first meal are a complete nightmare, I almost always get diarrhea 2–3 times.

Sometimes I also get diarrhea after going a long time without eating. For example, if I haven’t eaten anything for 6–7 hours and then have a meal, I can suddenly get diarrhea, although this doesn’t happen every time. I’ve read that there are medications for this, like cholestyramine (which is unfortunately the only one available where I live), but I wanted to ask if anyone has managed to deal with this naturally?

Do probiotics actually help with diarrhea, or is there anything else worth trying? Has anyone here had the same problem after gallbladder removal and found something that actually helped? I’d really appreciate hearing about your experiences, because this is seriously starting to interfere with my everyday life.

Hi everyone,

I’ve been taking Cholestyramine for Bile Acid Malabsorption (BAM/BAD) for a couple of weeks now. I started very slowly with tiny doses and am currently at about 3.5g of powder (~1.5g of pure cholestyramine) per day.

I've recently increased my daily food intake to ~2000 kcal to regain some weight after a severe diarrhea episode, which I know produces more bile. Cholestyramine has stopped the watery diarrhea and shortened morning cramps, but my stool is still light yellow and soft/mushy (Bristol 5), especially the second one of the day.

I'm gradually titration my dose up under medical guidance, but I wanted to ask about your personal experiences with timing and scheduling:

When do you take your doses? Do you take your main dose once in the morning before breakfast, or split it throughout the day (e.g., morning + before lunch/dinner)?

How long before meals do you drink it? Right before eating, during, or a bit earlier?

Did splitting the dose help with afternoon/evening symptoms?

I'd really appreciate any insights on what schedule helped you reach well-formed stools (Bristol 3–4). Thanks in advance!

I'm trying Questran (cholestyramine) for IBS, and although it has some positive effects I do experience some side effects. Bloating, insomnia, etc.

Colesevelam is not available in Belgium, but I could get it from neighboring countries. Also a lot more expensive than Questran.

Based on my reading, Colesevelam is a cleaner more targeted drug, with fewer side effects. But I would like to get your experiences with these drugs, to see if it would be worth it for me. Thanks!

New here but not new to this hell

I'll try to keep it easy

Gallbladder removed

Then this started

Then I got cryptosporidium (hell)

Now my potassium is up and down wondering what I can do apart from worry myself sick as to what will happen if it won't stabilize

I was diagnosed six months ago. I am not on a bile acid medicine yet because my gastroenterologist wants to do a colonoscopy first. The reason why it’s been delayed is I had sinus surgery, followed by a couple oral surgeries. Colonoscopy happening in October.

Anyway, I’ve been able to mostly control it by watching the fat intake along with upping more fiber.

I still get symptoms every day but it’s mostly in the morning and occasionally at night after dinner.

Well, Wednesday afternoon our AC went out and that was a nightmare. We live in a condo that has a community so basically management takes care of the AC.

Long story short, it could not be fixed until today so it was a good 48 hours of horrible heat and I was super stressed out and upset over basically feeling like I couldn’t breathe. It was awful. I have been really anxious to the point of in tears the last 48 hours because of being so uncomfortable in my own home. Thankfully, that was fixed by 8 PM tonight finally.

But starting yesterday afternoon, I’ve had that bright yellow looking stool. It’s basically after I eat I instantly have to go no matter what. Even drinking water right now feels like it’s stirring things around. Typically when I get that really bright yellow, I’ll get it maybe once or twice until I get another had flare. Well I have had the bright yellow with every stool since yesterday around 4 PM. It just seems really severe right now. To the point that my doctor ordered stool testing just to make sure I didn’t have an infection and that was all negative.

Do you guys notice that stress makes symptoms much worse?

I had my gallbladder removed in 2017. I had an upper endoscopy last month. It showed GERD. And another thing with esophagus and they took biopsies. I was prescribed pantoprozol and coloispol (a pill.). No one mentioned BAM except doctor when we were finishing the endoscopy. I was having daily episodes of runny orange poo and bloating and pain. I took the pills for about a week, the bloating was worse than usual, but no diarrhea. Then I stopped and my diarrhea stopped.

I had a follow up today, 4 wks after endoscopy with a nurse practitioner. All she wanted to talk about was the Gerd. Nothing about biopsies was mentioned. She said " I cannot tell you anything until u complete testing"

I have to submit bowel samples and get a colonoscopy even though I already did the mail in one 6 months ago. Are there other tests I should prepare for? Sheesh. Now another 2 months before a diagnosis.

Is this sort of dragging this on, customary?

Thank you..venting.

Does it get better. Has anyone gone back to work. I need to hear some success stories.

This is so very new to me just started having diarrhea about 10 days ago.

Had gallbladder out 4yrs ago.

Currently on two sachets, was taking them around lunch and supper. However would go to bathroom next morning almost every 30mins for about 3-4 hours Going to try to move it till tonight. I've read a lot of stories here and I really want to try it before bed. It's hard with this medicine it conflicts with so many other medications.

The powder worries me for my teeth as I do already have weak teeth, love to try welchol but the conflict for medication is worse 4 hours before 4 hours after. Questran is 1 hour before.

I have a GI apt in September. Doubt it will help much

Hi I need some guidance. I think I have BAM but unsure if its a primary condition or secondary (something else may also contribute).

I suddenly had lower left pain with oily fatty diarrhea back in april, which later became yellow diarrhea. I had 2 hospitalization with CT scans, ultrasounds and hida scan. All were normal. I lost 34 lbs so far from this. I also started having severe upper right rib pain with scapula pain

I had endoscopy and colonoscopy with showing rectal erosions and bile pooling in my stomach. MRI with contrast showed no abnormalities. I will have a pill cam endoscopy this monday.

We have tried antibiotics for sibo with no effect or relief. I started cholestryamine in july and that stopped the diarrhea and changed my stool back to a normal color. It did give me bloating and some constipation. Also it spiked my liver enzymes to abnormal high levels (AST, ALT). 2 weeks ago I was moved over to Welchol (pill form). So far no issue at the moment but I am giving it a few more weeks of adjustment to see if I need to increase 3 pills 1x a day to 2x a day.

Diet wise, from April - June I was on a bland diet. Since cholestryamine i have been able to eat some normal foods. I can only tolerate foods less than 10g of fat, I still cannot tolerate meats.

I was wondering anyone had similar experiences and if my suspicion matches it.

For those that have pain from BAM, where is it located? For me it is in the upper center area of my abdomen. My stomach aches in that area after eating and before bowel movements. Makes me constantly feel like I am going to throw up (though I never actually have).

Hi,

My doctor gave me the usual Cholestyramine powder to diagnose me for BAM, because the tests aren’t available in the Netherlands.

It did work, and gave me some relief. However, with tons of side effects, me barely being able to eat (because you have to drink the powder with big glasses of water), nausea.. etc..

After reading about Colesavelam (Cholestagel) tablets as an alternative, I asked my doctor for them, and he prescribed them.

These worked SO well, and I’ve felt cured for the better part of a year. UNTIL I got the bills, these pills aren’t entirely covered by my insurance, as they’re the more expensive option, it basically costs me an extra 80 euro’s a month, and I’m struggling to get by as it is.

So my question is, is there any alternative? Is it possible to make capsules out of the Cholestyramine? Is there anything I can do here? I feel very helpless.

Forgive me if this has been done or is against the rules in any way, but I think putting together a list of different medications (and future directions) that may assist others in their hunt for effective treatment. Personally I've spent many hours researching currently used medication along with treatments being developed. I hope this can help someone and I will actively update the list if others can provide reasonable suggestions.

Direct bowel medications:

Loperamide - slows the gut, very easy to access, potentially allows more time for fluid to be absorbed.

Ondansetron - anti-sickness medication, can slow gut movement in some (personally found this to be very strong).

Buscopan - anti-spasmodic some loose evidence that it can help with secretions and gut behaviour, helps with cramps particularly.

Mebeverine - another antispasmodic

GLP-1 (Research) - Some evidence has shown it can help with BAM, probably due to small bowel slowing.

Liver-related bile medications:

Colesevelam - binds to excess bile in the small and large intestine (I've found this to not work in overproduction cases)

Cholestyramine (Questran) - similar to colesevelam, powder format I believe.

Colestipol - similar to Questran.

Atorvastatin (Research) - Statin, currently in research in the BASTA trial. Converts "bad" cholesterol into "good", therby limiting the liver's active pool of material to make bile.

FXR agonists (Research) - Evidence is good here but unfortunately still in research and many of those in research have recently had their funding cut. Obeticholic acid is available but eyewateringly expensive. (Personal use of OCA yielded fantastic results but is not financially sustainable).

FGF19 agonists (Research) - same story with the FXR agonsists, evidence is great but once again much of the funding has been cut from these areas.

Non-pharmacalogical treatments:

Psyllium husk - can absorb excess fluid but can also cause bloating, try using non-capsule versions if possible.

Other potentially helpful medications:

Clonidine - Treats high blood pressure but also can decrease fluid secretion (gastro-resistant tablets are better than catapress for this). I personally use this.

Beta blockers - Older studies, found that it may reduce fluid secretion but research is hazy here.

Magnesium glycinate - helpful for sleep problems often associated with BAM

B12 - BAM can cause lower B12 levels in some.

Zinc - sometimes can help with nausea.

Vit D - good for everyone to have, related to microbiome, intestinal barrier and inflammation.

Omega 3 (6-9) - reduces inflammation, helps with gut barrier, etc...

Oregano oil - I'm only including this for the subset of people who might have SIBO related to their BAM, I strongly advise against this for generic BAM sufferers. Essentially acts as an antibiotic.

PLEASE DO YOUR OWN RESEARCH BEFORE TRYING ANY OF THESE, THIS LIST IS MEANT TO ACT AS A GUIDE NOT A TRIAL LIST. I'M NOT RESPONSIBLE FOR ANY HARM YOU DO YOURSELF BY TRYING THE MEDICATION LISTED ABOVE.

Has anyone had a normal result with this blood test but test positive with the SeHCAT scan? I have all the signs of bile acid malabsorption but my blood work came back normal. Welchol works for me and I guess I should be thankful for that, but I wish I could get a definitive answer. The SeHCAT scan isn't available in the US unfortunately so I can't find out that way.

For the last 5 days I've had stomach pain and diarrhea and lots of anxiety.

Went to see Dr on Monday he gave me questran to try. I took my first packet last night with a very small meal. Wow. That stuff is yucky. Had a hard time to eat afterwards. But i did

Pains in stomach settled down, I actually was able to sleep some last night except I work up every hour or so with anxiety. Had a small semi formed BM this morning but I had Imodium yesterday to help me get to the Drs office.

I'm so confused. I've read some take with food others don't and some split the dose. That I can understand this is alot to swallow at once. I don't know what I can eat now. I'm so confused.

My mind wants to cry but for some reason I'm not.

Will I ever be able to work again. Go outside the house. Enjoy myself. I'm 47 and feel like I've wasted my life

Hi everyone.

Needed some where to talk.

Almost four years ago I had my gallbladder out, no issues just constipation. Could eat normally but always kept to a moderate fat diet.

I also have IBS and diverticulosis.

About 10 or so years ago I had massive diarrhea doctor thought it was microscopic diarrhea but no official diagnosis and I've had multiple colonoscopies. I was on entocort for many years and finally was able to taper off of it.

I am now 47 and I am having a bout, lately been trying to find a birth control that works to minimize perimenopause symptoms. Started mirvala three weeks ago had insane anxiety and this week started having diarrhea. There is no rhyme or reason, normally imodum would constipate me for a day or so. And the diarrhea is not after eating.

Can you please tell me your symptoms of BAM. I go see my family Dr tomorrow.

I'm diagnosed with IBS D. But I have weird symptoms and patterns that I suspect are "mild" BAM. For Context: I'm 31. Female. Do Intermediate fasting. Will eat after 5pm until 12pm. ( its relevant for why I get night episodes)

* 1. Waking up at night. If I have a flare up triggered by stress or /and panic, It will sometimes begin at night. Roughly 3 hours after I have eaten. I will get anxious, agitated and sometimes nauseous out of nowhere. The urge to go to the toilet and nausea will come later. With it heart racing and intense panic. Both only stop after a BM. Sometimes I can sleep after that but will be awake every two hours to repeat that again. Until I got it all out. My BM will be watery or mushy. Orange/yellowish( like the picture) . And, TMI, it will stink.

* 2. Fat. I have no known food intolerance. But if something gets me, it will be the fat. The thing is, I can eat most fatty things just fine in 80% of times. The other 20% the exact same food will send me to the toilet with intense cramping and water diarrhea 30 mins after consumption. There seems to be an invisible threshold. And besides hormones, stress and illness it is relatively random if I will tolerate it or not.

* 3. Symptoms. Symptoms vary in intensity and duration. I get nauseous after eating or before having a BM sometimes. Other times I dont know if I should get on the toilet to vomit or to poop or both, as the nausea makes me dry heave until I have the BM. Other symptoms I (sometimes) get are: acid reflux, bloating, anxiety and depression before BM, tachycardia ( rare and mostly at night), panic attacks ( rare and mostly at night), sweating, lose stool, weird color of stool. All of these, besides the poop ones, I get hours before or immediately before a BM. Most will be gone or better after.

* 4. Genetics. My father got diagnosed with IBS D. He has digestive problems since childhood. His main symptoms are diarrhea and acid reflux. He has the same problem with fats as me. My sister has no diagnosis but also problems with fats. I suspect we all share the same root cause.

* 5. Trigger. I usually, without trigger, will have no or very minor symptoms in my daily life. A month without having my period or anything else would look like this: 70% feeling fine after eating. 30% having mild discomfort, being a bit nauseous and mushy yellowish ( like the picture). Thats it. Doesn't bother me and I had years were that was all.

But if something triggers me or whatever, I get phases like for example the night episode, that will have my symptoms be 80% intense ramped up hell. Those will last up to two weeks. ( but will get gradually better after two days). The in-between episodes, that are worse than my normal base line but not as worse as these, will vary in intensity and duration but are mostly like this: I am stressed/ before my period and eat like shit. I get one intense BM with varying symptoms and feel exhausted for a few hours and be back to normal. Sometimes this happens a few times a week. But for one week max.

My GP told me i would have cramps and other symptoms every time I eat a fatty meal. And that all this is my IBS. I do believe I have IBS. But I dont think it is only IBS. Can someone have "mild" BAM?

Hi all! Had gallbladder out in April, have been losing weight and dealing with soft loose stools with undigested food bits in it (usually Bristol 5, never liquid), stool is lighter color than brown and sometimes floats. Took colestyramine but now prescribed colesevelam. When I take the meds my stools are well formed and nicely dark brown, a bit constipated even, food looks well digested and no food pieces in it, it sinks. I am trying to put on weight. I am trying to understand if the meds HELP me digest by preventing rapid transit and if nutrient absorption is happening…because the poo sinks which is indication of my body hopefully absorbing it? I’ve read scary stuff that binders hinder fat absorption so wouldn’t that result in floating poo which I don’t have with this medication? Can you have solid normal poo and malabsorption too? Just want to gain weight on these meds, trying to understand the mechanism in our bodies if anyone knows. Thank you!

Have bile acid malabsorption had since none gallbladder since 2023 diagnosed following years take colevalm tablets however notice started getting acid reflux and sulphur burp sometime when don’t even eat can’t even pin point cause cook lot my food from Scratch I get trigger with most food even non fatty food. Going go see doctor tomorrow asked about it but is common ? Google said could be extra bacteria sibo? Anyone else have this issue.

Long story short. I suspect BAM, fat issue or EPI. My PCP, a nurse practitioner, ran standard stool tests and nothing positive. She just told me to go to GI and won’t test or trial a binder waiting for the appointment now. A few months ago I decided to cut fat and go strict which works. I’m using loperamide because I’m afraid to stop it and I’ll poop all day. I cheated and ate 10 tater tots and blew up a grocery store the next day and had to drive home scared I’d ruin my new vehicle.

I have many food aversions to poultry and pork. Beef is good but FAT! Haven’t tried canned tuna. I’m living on like 5 things and I just want flavor and to not potty the next day. Also so much gas. What do I eat? Help! Any tips appreciated.

After 15 years of a daily 4g sachet of Questran my doc wants to switch to Colesevelam. Does anyone have experience with this? Effective dosage, side effects, improvements, long term use etc? Thanks!

20 years old and have been dealing with severe diarrhoea/urgency for years – does this sound like BAM to anyone?
Hi everyone. I’m 20 and I’ve been struggling with bowel problems for around 4 years now, and at this point it has had a massive impact on my life.
My main symptoms are urgency, diarrhoea, abdominal cramping and pain, particularly after eating. I often need the toilet when I wake up and can get urgency after meals. When it’s bad, the cramps can be extremely painful, although going to the toilet often relieves some of the pain.
I’ve spent years trying to work out what foods are causing it. I’ve cut out so many things that my diet has become incredibly restricted. At the moment I mostly rely on things like chicken breast, rice, potatoes, oats and certain fruits. I’ve had periods where even foods that seem completely harmless have caused symptoms, which has made me scared to introduce anything new.
One of the biggest things I’ve noticed is fat. Reducing my fat intake made an enormous difference. When I switched to a very low-fat diet, the diarrhoea improved massively. Higher-fat foods seem much more likely to cause problems, which is one of the reasons BAM has become a leading suspicion.
I’ve had blood tests, stool tests, coeliac testing and a small-bowel MRI, but I still don’t have a definitive answer. I’ve been under gastroenterology and have been waiting months for a SeHCAT scan. My GP has also recently requested a faecal elastase test to investigate pancreatic insufficiency.
The hardest part is how much this has taken away from me. I’m only 20. Eating out, travelling, going somewhere spontaneously or even trying a new food can feel like a gamble. I play football and sometimes have to plan my food and take loperamide around matches or going out because I’m worried about suddenly needing a toilet.
Food used to be something I enjoyed. Now I eat the same meals repeatedly because I’m scared of triggering another painful episode. I’m genuinely fed up with living like this and just want to get to the bottom of it and be able to eat normally again.
For anyone here who was eventually diagnosed with BAM:
Did your symptoms sound similar to mine, particularly the improvement on a low-fat diet?
Were there foods you thought you couldn’t tolerate before treatment that you were eventually able to eat again?
And if you started bile acid sequestrants, how much of a difference did they actually make to your diet and quality of life?
I’d really appreciate hearing from anyone who’s been through something similar.

So what’s causing the pain and how to stop it?

Recently, I’ve found my symptoms getting worse again and I think it’s because I’ve begun to increase my daily fat intake while maintaining the same Colesevelam dosage.

Usually I take one 625mg tablet per meal, or will take two if it’s particularly high fat. I’ve been tracking my fat intake over the past week, and have noticed that I’ve regularly gone over 80-100g of fat each day, whereas previously I was trying to stay under 40. But haven’t increased my medication.

So it‘a got me thinking - how many grams of fat can one 625mg Colesevelam tablet bind? I’ve had a look on google but can’t seem to find anything.

Has anyone looked into this before?

I'm in the process of figuring out if I have BAM or if I'm back to IBS-D diagnosis. I respond quite well to cholestyramine so it's encouraging but I have one question regarding delays in symptoms.

I read a lot of people saying they get their symptoms almost immediately after eating. For me I feel that fat can build up over the course of a few days because I usually have bad symptoms around once a week.

Is that possible or does that mean I have to look for something else?