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Is it IBS-D or could it be BAD?


A woman in a white long sleeve shirt and black shorts lies on her side on a bed, dark hair fanning out, with a bunch of dried brown flowers protruding from between her legs

IBS-D is a common diagnosis when someone tells their GP that they have chronic loose bowels, but what if it's not IBS at all?


Bile acid diarrhoea (BAD) is a condition that affects the digestive system, leading to chronic and debilitating diarrhoea. It occurs when there is an excessive amount of bile acids in the colon, resulting in the disruption of normal bowel function. Let's explore the signs and symptoms of BAD, and delve into recent research findings, plus discuss the crucial role of restricting fat intake in its treatment.


Bile acids are produced by the liver and play a vital role in the digestion and absorption of dietary fats. They are typically reabsorbed in the small intestine, but in individuals with BAD, this process is impaired, leading to an excess of bile acids in the colon. These excess bile acids stimulate fluid secretion in the intestines, resulting in loose and watery stools.

The signs and symptoms of bile acid diarrhoea can vary from person to person but commonly include:

  1. Frequent episodes of watery diarrhoea

  2. Urgency to pass stools

  3. Abdominal pain or discomfort

  4. Flatulence and bloating

  5. Fatigue and weakness

Research on bile acid diarrhoea has shed light on its prevalence and underlying mechanisms. Studies suggest that up to one-third of patients with chronic diarrhoea may have BAD, making it a significant contributor to this condition.


Sound familiar? Reducing your fat intake can help

Managing bile acid diarrhoea primarily revolves around reducing the levels of bile acids in the colon. One of the most effective ways to achieve this is by restricting fat intake, particularly foods that are high in saturated and insoluble fats. It's important to work with a qualified practitioner before reducing your fat intake to avoid developing nutrient deficiencies and to ensure you are eating enough calories.


By reducing fat consumption, you can help alleviate the symptoms of BAD. Here are some practical tips:

  1. Choose lean proteins: Opt for lean cuts of meat, fish, and poultry. These sources of protein are lower in fat and easier to digest.

  2. Increase soluble fibre intake: Soluble fibre, found in foods like oats, fruits, and vegetables, can help absorb excess bile acids and regulate bowel movements.

  3. Limit dairy products: High-fat dairy products, such as whole milk and cream, can worsen symptoms. Opt for low-fat alternatives or lactose-free options.

  4. Avoid fried and greasy foods: Deep-fried and greasy foods can trigger diarrhoea. Opt for baking, grilling, or steaming methods instead.

  5. Read food labels: Pay attention to food labels, especially regarding fat content. Avoid foods that contain excessive amounts of saturated or trans fats.

While dietary modifications play a crucial role in managing bile acid diarrhoea, it is essential to consult with a healthcare professional for an accurate diagnosis and personalised treatment plan.


Bile acid diarrhoea can significantly impact your quality of life. Recognising the signs and symptoms of BAD and understanding the importance of restricting fat intake are essential steps towards managing this condition. If you suspect you have BAD, don't despair! With the right support you can experience improved bowel function and alleviate the troublesome symptoms associated with BAD.


[Photo cred: Yuris Alhumaydy on Unsplash]

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