Today we’re talking about something that affects millions of people but is often misunderstood — bile acid malabsorption and bile acid deficiency, especially after gallbladder removal.

If you’ve had your gallbladder removed and are now struggling with chronic diarrhea, bloating, urgency after meals, or other digestive problems, this blogpost is for you.

What is Bile and What Happens After Gallbladder Removal?

Let’s start with the basics. Bile is a digestive fluid produced by your liver. It helps you break down fats and absorb fat-soluble vitamins like A, D, and E.

Your liver sends bile to your gallbladder where it’s concentrated and stored, and then released when you eat. But when your gallbladder is removed — a procedure called a cholecystectomy — that interrupts this process. Now bile drips continuously into your intestines instead of being released in controlled amounts.

This can disrupt your ability to digest foods and can lead to two different but related problems: bile acid malabsorption and bile acid deficiency.

What Is Bile Acid Malabsorption?

Bile acid malabsorption (BAM) happens when your intestines can’t reabsorb the bile acids, which is what normally happens. This is especially problematic after gallbladder surgery.

Instead of being reabsorbed and recycled, excess bile acids spill further down the intestinal tract and into the colon — irritating it and leading to bile acid diarrhea, also known as chronic diarrhea. Other common symptoms include:

• Frequent loose stools, often after eating

• Sudden urgency

• Gas and bloating

• Fatigue or nutrient deficiencies over time

Many people are misdiagnosed with IBS-D (Irritable Bowel Syndrome with Diarrhea) when they actually have BAM.

Bile Acid Deficiency: The Other Side of the Coin

On the flip side, some people experience bile acid deficiency. Without proper bile flow when they need it, they can’t break down fats effectively. This leads to:

• Floating or greasy stools (steatorrhea)

• Fat-soluble vitamin deficiencies

• Bloating and indigestion

• Unexplained weight loss or malnutrition in severe cases

So while some people have too much bile in the wrong place, others don’t have enough where and when it’s needed. And yes — it’s possible to have elements of both of these issues at the same time.

Diagnosis and Testing

Unfortunately, bile acid malabsorption is underdiagnosed. The most accurate test is called a SeHCAT scan, but it’s not widely available in the U.S.

Instead, many doctors use a therapeutic trial of bile acid binders like cholestyramine,  or colestipol. This is perfectly acceptable and is a good test. If your diarrhea improves, that confirms your diagnosis.

For bile acid deficiency, that’s more difficult to diagnose directly via a test. Indirect tests, such as testing for elevated fat in the stool and measuring blood levels of fat-soluble vitamins can help reveal what’s going on.

Treatment Options

The good news? There are solutions.

For bile acid malabsorption, we often prescribe bile acid binders, such as cholestyramine, to bind excess bile and reduce diarrhea. A low-fat diet might also help reduce bile production.

For bile acid deficiency, we look at improving the digestion of fats with ox bile supplements and digestive enzymes to support fat breakdown and absorption. And here’s a link to my favorite product to use for bile acid deficiency.

Nutritional support is also key — so we often check and replace vitamins A, D, and E, if needed.

If you're struggling with digestive issues after gallbladder removal, don’t let anyone tell you it’s all in your head. Bile acid malabsorption and bile acid deficiency are real — and treatable.

But, also keep in mind that they are not the only possible causes for your symptoms. In my experience it’s often that the gallbladder was never really the primary cause of your problem in the first place. And that could be why you never got any better once it was removed.

If any of this sounds like you and you need help, give us a call. We are experts in this area.

This video was sponsored by the IBS Treatment Center, helping people from around the world via telemedicine since 2005.

If you found this video helpful, please give it a thumbs up and subscribe to my channel for more insight like this into your health.

If you’ve had your gallbladder removed, or you have any questions, please share your story in the comments section below. I’d love to hear them.

And remember to take good care of your body. It’s the only place that you have to live.

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