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HBO and The Ringer's Bill Simmons hosts the most downloaded sports podcast of all time, with a rotating crew of celebrities, athletes, and media staples, as well as mainstays like Cousin Sal, Joe House, and a slew of other friends and family members who always happen to be suspiciously available.
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In Episode 15 of Wrestling the Octopus: the IBD Patient Podcast, Nigel and I cover a topic that receives not nearly as much attention as it should: Bile Acid Diarrhoea (BAD) / Bile Acid Malabsorption (BAM) in Crohn's disease. Our expert guest is gastroenterologist, Professor Julian Walters from Imperial College London in the UK.
Through Nigel's story, we also get a candid view of what BAM feels like for inflammatory bowel disease patients who have had their terminal ileum removed.
What You'll Learn In this Episode
What is BAD/BAM? How bile acids normally work versus what happens when they’re not reabsorbed properly, especially in IBD patients with ileal disease or resection.
Updated terminology: Why “bile acid diarrhoea” is now preferred over “bile acid malabsorption,” and what that means for diagnosis and treatment.
Common causes of BAD: Crohn’s disease, gallbladder removal and genetic variants that lead to excess bile acid production.
How to get diagnosed: A breakdown of the SeHCAT scan, C4 blood test and why access to testing varies across the UK.
Treatment options that work: From bile acid sequestrants (like colesevelam and cholestyramine) to loperamide - can combining them help?
Getting the timing right: Why taking sequestrants at night on an empty stomach may be more effective than following cholesterol-lowering instructions.
Diet and lifestyle tips: How fatty meals can trigger symptoms and what you can do to reduce flare-ups.
Emerging treatments: A glimpse into GLP-1 receptor agonists like liraglutide and semaglutide, and their potential role in managing BAD.
Key Points
- BAD affects more people than Crohn’s disease or ulcerative colitis - yet it remains underdiagnosed.
- SeHCAT is the gold standard test, but blood tests like C4 may offer cheaper alternatives soon.
- Don’t rely on loperamide (Imodium) without a formal diagnosis of BAD / BAM.
- If your symptoms fluctuate, track your diet as fatty meals may be the culprit.
- Nighttime dosing of sequestrants might be a game-changer for symptom control.
Follow Professor Julian Walters on Facebook
Follow Rachel at @bottomlineibd
Follow Nigel at @crohnoid
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