A little-known yet common cause of bloating, fatigue and poor nutrient absorption — and how nutrition can help.
By Isabelle Maës, Nutritherapist.
When someone suffers from chronic digestive issues gas, bloating, abdominal pain, diarrhoea or constipation conventional medicine often focuses on ruling out structural diseases such as cancer or Crohn’s.
If no such condition is found, the patient is usually given a vague diagnosis: irritable bowel syndrome or functional colopathy. And too often, that’s where the conversation ends.
But there is another side to the story. A dozen non-organic digestive disorders can cause these same symptoms — and many can be successfully treated through nutritional therapy.
One of the least-known, yet surprisingly common, is bile acid deficiency.
What Are Bile Acids?
Bile acids are produced in the liver from cholesterol. Two main types, cholic acid and chenodeoxycholic acid, combine with amino acids such as glycine or taurine to form bile salts. These are stored in the gallbladder and released into the intestine during meals.
Around 95% of these acids are reabsorbed and recycled by the liver, while the remainder are transformed by gut bacteria into secondary bile acids.
Bile acids play a vital role in digestion. They emulsify fats, helping form micelles that enable the body to absorb lipids and fat-soluble vitamins (A, D, E and K). Secondary bile acids have antimicrobial properties, help regulate the composition of the gut microbiome, and activate receptors that influence glucose and lipid metabolism as well as liver and immune function.
When Things Go Wrong
When bile acid production or recycling is impaired, the consequences can be wide-ranging.
Typical symptoms include:
- Steatorrhoea (pale, greasy, floating stools)
- Bloating and abdominal discomfort after meals
- Urgent need to use the bathroom, often with diarrhoea
- Fat-soluble vitamin deficiencies causing fatigue, nerve pain, poor night vision, balance issues or easy bruising
- Sometimes weight loss
Diagnosis combines clinical observation with lab testing — including blood or stool bile acid measurements, or the C4 blood test (7α-hydroxy-4-cholesten-3-one), which reflects how actively the liver is producing bile acids.
Causes Behind the Deficiency
Bile acid deficiency can stem from a variety of conditions, including:
- Liver insufficiency (cirrhosis, chronic hepatitis)
- Cholestasis (bile duct obstruction, gallstones, narrowing)
- Gallbladder dysfunction or removal
- Crohn’s disease or ileum resection
- Short bowel syndrome or SIBO (small intestinal bacterial overgrowth)
- Chronic pancreatitis (fat digestion impairment)
- Antibiotic use (disrupting gut bacteria)
- Very low-fat diets or bariatric surgery
- Low stomach acid from age, stress, or long-term PPI use (e.g. Pantomed)
Note: Cholestyramine and colestipol, drugs used for cholesterol or bile-related diarrhoea, can worsen an existing deficiency.
How to Manage It
The first step is identifying and treating the underlying cause. Nutritional therapy then supports bile acid production, reabsorption and recycling, while correcting deficiencies.
Helpful strategies include:
- Ursodeoxycholic acid (UDCA) for cholestasis
- Pancreatic enzymes for pancreatic insufficiency
- Bovine or porcine bile extract capsules to improve fat digestion
- Liver-supportive plants: artichoke, black radish, boldo, turmeric, rosemary, milk thistle
- The Broader Picture
Bile acid deficiency is just one of many conditions that may masquerade as IBS. Others include:
- Intestinal dysbiosis
- Leaky gut
- Gluten intolerance or food sensitivities
- Chronic pancreatitis
- SIBO or candida overgrowth
- Histamine intolerance
- Certain genetic polymorphisms (e.g. FUT2)
A skilled nutritherapist can identify the mechanisms at play and design a personalised, medically compatible plan.
Why Gut Health Matters So Much
Digestive health is the foundation of energy, cell renewal, and nutrient absorption. Chronic dysfunction disturbs the microbiome, affecting immunity, inflammation, and even mood.
In truth, gut health is the cornerstone of overall health. Taking care of your digestion is not a luxury, it’s a necessity.
About the Author
Isabelle Maës is a nutritherapist based in Brussels, specialising in digestive disorders, weight management, hormonal health (PCOS, endometriosis, fertility, menopause), and immune and thyroid imbalances. She also supports patients undergoing cancer treatment.
www.isabellemaesnutrition.com
