 Hi, this is Dr. Urschow and let's talk about an overlooked cause of diarrhea. Now, diarrhea is one of the symptoms that can encapsulate IBS. And when it becomes chronic in nature, it can certainly become very inconvenient. And diarrhea, again, can accompany other signs of IBS, which may be gas, bloating, abdominal pain, just to name a few. And if someone has chronic diarrhea, certainly diet is one of the first things to look to. But if not diet and not something like an infection or overgrowth, like small intestinal bacteria overgrowth, for example, or some kind of intestinal infection, when those things have been ruled out, it's possible that someone may have malabsorption of bile. Now, bile is a digestive, a fat digesting substance released by the liver and stored in the gallbladder. And it's created into your small intestine to help with the absorption of fat. However, in some people, they have a syndrome known as bile acid malabsorption. And essentially what happens here is too much bile gets too far down the intestinal tract, so to speak. And when it does, it can cause diarrhea. Now, what's funny about this is oftentimes it's recommended for people to supplement with bile, to take a bile supplement to help tend to with diarrhea or with malabsorption. However, for people with this bile acid malabsorption, that may actually make them worse. And I'll put one study reference on the screen here that shows anywhere from up to 25 to up to even 50% of people with chronic diarrhea may have this bile acid malabsorption at the root cause of their diarrhea. So, how can you figure out if this might be you? Well, first, you should try a healthy diet, some sort of low allergen diet, something like a paleo diet or a low FODMAP diet can be a very good first step. Then, have evaluated SIBO, small intestinal bacteria overgrowth or any kind of other dysbiosis like Candida overgrowth or even an infection like Giardia or Cryptosporidium, common intestinal infections that can cause chronic diarrhea. If the diarrhea then persists this may be at the root cause. There's another cause of chronic diarrhea which can be inflammatory bowel disease, but this can actually be involved with inflammatory bowel disease due to how inflammatory bowel disease can damage the part of your small intestine that it's supposed to help reabsorb bile so that you don't have bile acid malabsorption which causes this diarrhea. So, in recap, having too much bile may be one of the causes of diarrhea. And, how can you then treat this or test this? Well, there are tests available but probably the most practical and also supported in the medical literature is a trial of a bile, what's known as a bile sequestrant or something that binds to bile, like a bile sponge. Now, there's a medication that can do this called cholesteramine and there are also natural agents like Google, Propolis, Boswellia. Many of these compounds actually are known to lower cholesterol. For example Google and Propolis are known to lower cholesterol and they do so actually by being a bile binder. So, if you're not sure about one of these herbs ability to bind to bind to bile, if it's a known cholesterol lowering agent that can help stir your interaction. Now, I wouldn't do this on my own. I would do this under the advice or counsel of a clinician because there are other things like I mentioned that can cause a chronic diarrhea that are important to have ruled out. But something to think about to bring to your doctor or discuss with your doctor is the potential of bile acid malabsorption as the cause of chronic diarrhea, which can be present in 20, around 20 to up to up through 50% of patients with chronic diarrhea. This can be at the cause according to the published medical literature. So, this is Dr. Ruscio and I hope this helps you get healthy and get back to your life. Thanks.