# Understanding the Root Cause



## stuschr (Jul 13, 2013)

I promised myself when I found the solution to dealing with my 15 year problem, I'd help others. A great deal of information out there is dated or based on questionable definitions of "success". Very few websites reflect the recent research (especially in the UK) that has identified the cause for many IBS-D suffers, which is too much bile acid in the small and/or large intestines. (we don't yet know why there is too much BA in the intestines). FGF19 is the control hormone for producing bile acid and, while they don't yet know if it is a problem of too much BA production or too little BA reabsorption in the terminal ilium, or if it stems from unbalanced bacteria from past antibiotic use (as it is believed bacteria forces bile acid reabsorption, which is a good thing and antibiotic use may have killed off the bacteria that facilitates bile acid re-absorption in the terminal ilium).

What is now known is that certain drugs such as Welchol will solve the problem of excess BA by chemically binding with Bile Acid in the gut. This gets rid of all the symptoms of excess bile acid in the gut (many of these symptoms are described here and elsewhere) and has the side effect of a small lowering of cholesterol in the body. I had IBS-D for 15 years and listened to (and tried) all the wives tales the doctors told me. Lactose intolerance, stress, foods, etc. Of course food triggered it....what do you expect when food hits an intestine full of excess bile acid...watch out. Much of the practicing medical community is as confused on IBS-D (more accurately known as Bile Acid Malabsorption) as when they thought ulcers were caused by stress or spicy foods, even after H. Pylori was discovered...

I went to a TOTAL cured state of living by taking 1 Welchol tablet in the morning and 1 at night. (no, I don't work for any drug company). First I ruled out all the other things in a methodical way. Had abdominal MRIs, stool tests, parasites, tried Riframax, pancreatic enzymes, probiotics, etc. Pancreatic enzyme deficiency was checked and I even tried enzyme supplements, but they only gave me a 50% "cure". Tried the pro-biotics, but they provided no relief. Went through years of avoiding different foods thought to be the cause. Took calcium (Caltrate & Citrical) for several years (which actually provided the best relief (i.e., 75% solution) of anything else. While some of these things caused minor to moderate changes which could be interpreted as some level of improvement, none of them made any meaningful or permanent type of solution. Finally, after re-running updated tests to rule out everything else, my (new) doctor and I, after extensive research by myself, tried the bile acid binding resin, Welchol. Within 4 hours I felt different. That was 5 months ago. Now, I literally drink a quart of milk a day (which I used to love and gave up12 years ago due to the fallacy of lactose intolerance, and have no (i.e., zero) restrictions on my foods. If your stools are frequently greenish or yellowish and occasionally burn the anus, that is the excess bile acid that has moved past the terminal ileum and causing all those symptoms, and you need to try Welchol. My weight lifting had been on hold for years (since intense weight training was a trigger) and now I'm back in the gym with maximum intensity.

My estimate from reading so many stories is that 50% of IBS-D sufferers have a very real thing - not a syndrome. And that issue is excess Bile Acid production and/or mal-absorption. Not stress, not foods, not in your head.

Let's hope the researchers who are zeroing in on this can identify the intestinal bacteria that facilitate bile acid re-absorption in the ilium and we can take a pill, repopulate our gut and fully solve this puzzle.


----------



## Kathleen M. (Nov 16, 1999)

Technically you aren't supposed to have a lot of bacteria in the ileum, you get too many that causes a condition called SIBO (small intestinal bacterial overgrowth) which then needs to be treated.

I don't know if bacteria are involved in bile uptake, do you have something that explains that? http://bmb.oxfordjournals.org/content/92/1/79.full talks about the various feedback loops and the transport of bile, but doesn't say that bacteria is the main or only thing that mediates that.

There is a test to actually prove that excess bile is the issue as the bile acid binders tend to be quite constipating in people who do not have diarrhea so may benefit some who have IBS-D for any other reason.


----------



## IMuscle (Jun 1, 2013)

This is interesting. I have taken probably far too many antibiotics in the past year (id say 5 different doctor trips for strep throat, rashes etc) and my parents were telling me it may have messed up my stomach. I have had IBS for 3-4 years now but the past year its been unbearable.

Welchol is not an OTC drug correct?


----------

