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News
A small but encouraging trial found that a high-dose, eight-strain probiotic taken for 3 weeks reduced fecal primary bile acids in patients with bile acid malabsorption (BAM) — a common but underrecognized cause of chronic diarrhea. The probiotic also shifted gut microbiome composition compared to placebo. Symptom improvements weren't statistically significant, but researchers say larger, longer studies are warranted.
Bile acid malabsorption (BAM) is a frequently overlooked driver of chronic diarrhea, and treatment options remain limited. A new randomized, placebo-controlled trial from Mayo Clinic tested whether a high-dose, eight-strain probiotic (the De Simone formulation, 900 billion CFUs) could shift the biochemical landscape in 22 patients with confirmed BAM — and the early results are encouraging.
Over 21 days, patients taking the probiotic saw a significant reduction in fecal primary bile acids — particularly chenodeoxycholic acid — while the placebo group actually saw an increase. Gut microbiome composition also diverged meaningfully between the two groups by the end of treatment. That said, no significant differences were found in stool frequency, consistency, intestinal permeability, or serum bile acid markers — a reminder that biochemical changes don't always translate quickly into symptom relief.
Key Takeaways
Why it matters: BAM affects a meaningful subset of patients with chronic diarrhea, yet it often goes undiagnosed and undertreated. This trial offers early proof-of-concept that probiotics can modulate bile acid metabolism — a key mechanism in BAM — though larger, longer studies are needed before this becomes a clinical recommendation.
