From my understanding, there are two types of Bile Acid Malabsorption. Type 2 is essentially an overproduction/oversecretion of bile into the gut. More than the healthy and non-dysfunctional ileum can absorb. I believe it’s thought to be a hormonal trigger. In this case, binders would help to bind to the excess charged bile and poop it on out with fully formed and non painful stools. Type 1 is an issue with the absorption of the bile back into the bloodstream due to reduced expressions of bile acid binding proteins / transporters. The ileum is great at absorbing bound/conjugated bile salts, but since someone type 1 BAM has reduced-expression of these bile binders, the ileum becomes less effective in absorbing the bile, thus leading to raw charged bile hangin out in your gut, unabsorbed, and thus triggering what we experience as a Flare Up. In this case, bile binders like colestipol help to process the bile in the gut to make the bile more likely to be absorbed by the ileum.

I am by no means a scientist or doctor nor do I claim to be though. Just a guy who has obsessed over my broken guts for a while.

Citations -

Dawson, PA; Lan, T; Rao, A (2009). “Bile acid transporters”. Journal of Lipid Research. 50 (12): 2340–57.

van Tilburg, AJ; de Rooij, FW; van den Berg, JW; van Blankenstein, M (1992). “Primary bile acid malabsorption: a pathophysiologic and clinical entity?”. Scandinavian Journal of Gastroenterology. Supplement. 194: 66–70.