Could Probiotics Help in Bile Acid Malabsorption? New Data Offer Early Insight

By Jenna Sheldon, DO, MS

If you live with chronic diarrhea, urgency, bloating, or unpredictable bowel habits, you know how disruptive these symptoms can be. But what if there were an underlying cause that often goes unrecognized? One possible, but often overlooked, cause of these symptoms is bile acid malabsorption (BAM). New data presented at the Digestive Disease Week (DDW) 2026 suggest that the high-potency medical food probiotic Visbiome may positively influence certain bile acid-related measures in people with BAM, offering early insight into a possible new approach.¹

What Is Bile Acid Malabsorption (BAM)?

Bile acids help your body digest fats. They are made in the liver, stored in the gallbladder, and released into the digestive tract when you eat.  Normally, they are reabsorbed in the intestine and recycled in the body. In people with BAM, bile acids are released into the digestive tract but are not reabsorbed properly. As a result, excess bile acids can reach the colon, where they may irritate the lining and contribute to symptoms such as diarrhea, urgency, and loose stools.

BAM can occur in people with certain intestinal diseases or after surgery involving the ileum (the last part of the small intestine). It may also be present in some people diagnosed with diarrhea-predominant IBS or functional diarrhea. Emerging data also suggest that BAM may involve several overlapping mechanisms, including increased fluid secretion in the gut, changes in gut motility, increased intestinal permeability, and interactions with the gut microbiome. These insights have sparked interest in whether probiotics may help influence bile acid activity and improve symptoms.

Why Are Bile Acids and the Microbiome Connected?

Bile acids are not just digestive substances. They are also influenced by the bacteria in the gut. The gut microbiome helps break down and transform bile acids. When the balance of bacteria in the gut shifts, it can affect how bile acids behave in the digestive tract. This connection has led researchers to explore whether targeted microbiome support, including probiotics, could help improve bile acid-related abnormalities in BAM.

What Does the New Data Show?

At Digestive Disease Week (DDW) 2026, researchers presented results from a double-blind, placebo-controlled study conducted at the Mayo Clinic. In this study, patients with BAM were randomly assigned to receive either Visbiome (De Simone Formulation) or placebo for three weeks. The probiotic group received 900 billion bacteria per day, divided into two doses. Researchers evaluated several measures, including bile acids in stool, a blood marker called 7αC4 (which reflects bile acid production), intestinal permeability, bowel function, and other microbiome-related measures.

Compared with placebo, the probiotic group showed a significant reduction in primary bile acids in stool and an improvement in intestinal permeability. These findings suggest that the probiotic may have influenced the gut environment in ways that could be relevant to BAM.

What Did Not Change?

It is equally important to understand what the study did not show. Over the 3-week study period, the probiotic did not significantly improve levels of serum 7αC4, and there were no meaningful differences between groups in average stool frequency or consistency. These results were not unexpected given the short duration of the trial and the small number of patients involved. Larger and longer-term studies are warranted to better understand these early pilot findings.

Why This Matters for Patients

For patients with BAM, these new data are encouraging because they suggest that supporting the gut microbiome may help improve certain underlying biological processes associated with the condition. That does not mean probiotics are a proven treatment for everyone with BAM, but it does suggest that the microbiome may be an important part of the picture.

The probiotic was also reported to be safe and well tolerated, with mild, self-limited bloating as the most commonly reported adverse event.

The Bottom Line

Bile acid malabsorption is an underrecognized condition that may contribute to chronic diarrhea and other bowel symptoms. New data presented at DDW 2026 suggest that dietary management with Visbiome may improve certain bile acid-related and intestinal barrier measures in patients with BAM, although larger and longer studies are still needed to determine whether these changes translate into meaningful improvements in symptoms.

If you are experiencing ongoing diarrhea or urgency, it is important to speak with a healthcare professional. BAM can be difficult to recognize, and getting the right diagnosis is the first step toward finding the right management plan.

References

1. Damianos et al. Multi-Strain Probiotic Improves Bile Acid Profile and Intestinal Permeability in Patients with Bile Acid Malabsorption. Colon. S-345, Mo1423. 2026