# Predominant Diarrhea IBS or Bile Acid Malabsorption



## ManagingIBS (Feb 26, 2015)

I started having diarrhea 7-8 years ago after a very severe stomach flu. I tried to stop it with diet but nothing worked. It would then "flare-up" and my intestines would ache, it was hard to sit down at times. I finally went to a gastroenterologist four years ago and was diagnosed with Predominant Diarrhea IBS and GERD. I was put on some antispasmodics and they did nothing. Nor did the probiotics. I tried several acid reflux meds until I was put on Protonix (generic Pantoprazole) a proton pump inhibitor. My diarrhea disappeared! I had become very depressed with the never-ending diarrhea, when it disappeared it was incredible! The doctor was pleasantly surprised but could not tell me why the Protonix stopped the diarrhea.

I would like to have children in the next few years and for that I have to get off the Protonix. I weaned myself off the Protonix hoping my diarrhea would not come back, it did, within about a week or two. I went to a new gastroenterologist (because I moved) and she put me through another round of tests with the same result.

I believe I have something called bile acid malabsorption. Unfortunately the test is not available in the US, it's called SeHCAT. Neither of my doctors could explain why the Protonix stopped the diarrhea. Maybe it was never GERD, maybe it was bile acid reflux. It all makes sense. Proton Pump Inhibitors are also used to treat bile acid reflux. So for some reason my body is over-producing bile or just pumping too much into my intestines or it's not re-absorbing. I don't know. I read an article about a woman in the UK, it all sounded so familiar.

http://www.dailymail.co.uk/health/article-2255492/Bile-acid-diarrhoea-For-40-years-doctors-said-I-IBS-In-fact-hormone-problem-cured-simple-pill.html

The medication for bile acid malabsorption is another medication that cannot be taken while pregnant. Not that I would even try, a lot of the reviews of it seem awful. And since the protonix works perfectly, I wouldn't bother switching.

So my question, does anyone know of a way to reduce bile acid production with something that can be taken while pregnant? Or at least someone who may know? My doctors are quite satisfied with diagnosing me Predominant Diarrhea IBS and are not willing to discuss any other optionsL They just want to treat the symptoms. I bet they would be a lot more determined to help if they suffered through constant diarrhea!!!!


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## Kathleen M. (Nov 16, 1999)

Some people who have had their gall bladder removed on this site (which means you can't control the flow of bile so may get more bile in the intestines than you can reabsorb) seem to do well on calcium carbonate supplements.

See the calcium thread pinned in the diarrhea forum.

I would think calcium supplements would be OK when pregnant.

Calcium carbonate tends to be a bit constipating in all people so may work even if "just" IBS diarrhea.

Pregnancy by itself can sometimes be constipating (not sure if hormones or organs getting compressed) so a fair number of women find their IBS goes away during pregnancy although the typically constipated people may get more constipated than usual. It isn't always, but it may mean you won't need meds during the time you don't want to be taking meds.


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## SteveInAustin (Aug 22, 2007)

Look into bile acid sequestrants or bile acid binders.

As for drugs that are "okay" for pregnancy (class "B", but not class "A"), read up on Colesevelam and Colestipol and ask your doctor if he/she would be okay with pregnant women taking them...

http://en.wikipedia.org/wiki/Colesevelam

http://en.wikipedia.org/wiki/Colestipol

Class "B" drugs for pregnancy means it's not been shown to be a problem in animal studies, but human studies just haven't been done yet...

http://www.drugs.com/pregnancy-categories.html

Cholestyramine is a class "C" drug, so that's out.

Another very simple route to try, and probably the first thing I would attempt, is to try taking lots of soluble fiber. Soluble fiber binds to bile acids. And it's cheap, doesn't require a prescription, and doesn't have any pregnancy issues that I know of (consult your gastro doctor to make sure). You can get it in Citrucel, Metamucil, Heather's Tummy Fiber, and so on. Dosage will vary, so there is some experimentation to be done. My recommendation is to first try Citrucel at about 20-30 grams, 3 to 4 times a day. You'll take it with about 1-2 cups of water about 30 minutes before each meal and about 1 hour before bed.

http://www.livestrong.com/article/456696-is-it-safe-to-take-citrucel-while-pregnant/

Aside from that, it's time to start munching on leafy greens. Leafy greens bind to bile. The best ones, according to the research are (in order from most bile binding to least) : Mustard Greens, Kale, Broccoli, Cabbage and Green Bell Pepper. Sautee or steam for best results. Raw greens may not be as good.

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=20482#.VO9pRLuVtmM

And yes, I think the idea of using calcium chews (Tums, etc.) to neutralize the bile acid would work. Just requires some trial and error to figure out the right dose. You want to use just enough, but no more than that, to cause you to have normal stools. If you over-alkalize your stomach, it can prevent digestion, which isn't good for your fetus.


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## itsmebaby (Apr 15, 2010)

Hi there,
I had my gallbladder removed last year and I take Nexium and Questran. The Questran helps for sure. 
I stopped having the yellow, constant diarrhea after starting Questran. So, I know for sure I have bile acid diarrhea. It irritates my intestines. One of the previous posters recommended calcium and fiber - both good ideas since the more you have in your intestines to soak up the bile, the better. Even on Questran, I find I dont do well going without food. 
Pregnancy did help me, but in some women, it can make gallbladder issues worse.
Definitely worth talking to your GI doc about this.
The only reason i take Nexium is because I'm stuck on it. When i try to go off, i get the acid hypersecretion... It is horrible. Dont take any Ppi long term or you will end up like me!

I wanted to edit my post to clarify that the Nexium really didn't help my gallbladder related diarrhea. I have recurring gastritis.


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## SteveInAustin (Aug 22, 2007)

Questran is cholestyramine, which is a class "C" pregnancy drug. Off-limits to pregnant women.


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