Everything You Need to Know About Bile Acid Malabsorption as an Employer

Have you ever heard of bile acid malabsorption (BAM)? It is also referred to as bile acid diarrhoea (BAD) or bile salt malabsorption (BSM) [1].

Bile acid malabsorption is a gastrointestinal disease [2].

Research estimates that 1 in 100 people suffer from BAM [3] however Bile Acid Diarrhoea (BAD) UK believe it is even more common with 1 million people in the UK living with bile acid malabsorption. Despite the numbers, somehow, it seems to be relatively underheard of. Especially if you compare it with the likes of Crohn’s Disease or Colitis which latest figures estimate 500,000 people [4] suffer from in the UK (roughly 1 in 123 people [5]), yet more people seem to have heard of these conditions.

In this article, we will examine bile acid malabsorption and how you, as an employer, can support your employees who are suffering from it.

Bile is made in the liver before being stored in the gallbladder. When you eat food, the bile is released into the small intestine (also known as the gut). When the bile reaches the final section of the small intestine (called the ileum), roughly 97% of the bile acids are reabsorbed and return to the liver. This cycle is called enterohepatic circulation [1].

Bile is made up of bile acids which serve two primary functions:

1. To breakdown and absorb fats and vitamins from food when it passes through the gut

2. To assist with the removal of waste products [1]

Bile acid malabsorption occurs when bile is not reabsorbed properly in the small intestine leading to more bile being present in the colon. The excess bile results in the lining of the colon becoming irritated which causes it to stimulate salt and secrete water. This accelerates the time it takes for waste to pass through the colon resulting in chronic, urgent diarrhoea.

As mentioned above, the main symptom of bile acid malabsorption is chronic diarrhoea which can occur day or night and is usually very frequent (sometimes more than 10 times a day [1]). Sufferers of bile acid malabsorption often have fecal (bowel) incontinence meaning they have no control over their bowel movements [2].

Diarrhoea, however, is not the only symptom. Bile acid malabsorption can also cause fatigue, extreme abdominal pain, cramping, bloating, indigestion, excess wind and sore skin around the perianal area [2].

Long-term symptoms can also include dehydration, malnutrition, vitamin deficiencies, issues with digestion, headaches, dizziness and nausea as well as weight gain or weight loss [2].

Reread the section above and take a moment to imagine having this disease.

Think about the last time you had diarrhoea. Now imagine having it multiple times a day, every day.

Imagine rather than looking forward to mealtimes and indulging in your favourite foods that a part of you is filled with dread knowing that this is very likely going to irritate your stomach every single time you eat.

Our bodies are hard-wired to take pleasure in eating. Scientists have even named the feeling we get after eating “ingestion analgesia” [6] as food acts as a pain relief. For those with bile acid malabsorption, one of life’s greatest pleasures has been marred and even if you are fortunate enough to be able to manage the disease, you are essentially on a very carefully curated diet and medication for your whole life and, even then, it may not be completely reliable.

It will come as no surprise that many sufferers struggle to keep up with a routine. Depending on the severity of the condition, sufferers can get little to no warning when they need the toilet. In turn, this can lead to sufferers becoming very isolated and feeling trapped in their own home due to the lack of confidence in the control of their bowel movements and the overwhelming fear of having an accident in public.

In 2023, Lacy May opened up about her experience living BAM stating that it “is so challenging and one of the most crippling and mortifying disabilities to have. It’s widely misdiagnosed, unheard of and not many people truly understand the impact on your day-to-day life due to this horrific disability” [7].

Bile acid malabsorption is classed as a disability [8] and as an employer you must make reasonable adjustments to accommodate employees living with this disease.

As stated in the Equality Act 2010, it is against the law to discriminate against anyone because of their disability. Disability is one of nine protected characteristics including age, gender reassignment, marital status, being pregnant or on maternity leave, race, sex and sexual orientation [9].

To create a positive working environment for your employees living with bile acid malabsorption, you will need to make reasonable adjustments. This includes, but is not limited to, the following.

Please be aware that each person’s experience of BAM is different, and you should speak to them directly to determine what the best solution is for them.

• Build trust with your employee

For those suffering with BAM, it can be very isolating and bring with it feelings of anxiety and embarrassment. Having a safe space where they feel supported and able to discuss the difficulties they are facing is key. Some employees may find it challenging disclosing the severity of their symptoms and how debilitating it can be when they urgently and frequently need the toilet.

If an employee feels comfortable sharing this information with you, we recommend investing time in visiting the UK’s leading charity for information, help and support in dealing with bile acid malabsorption, BAD UK to learn more. Being well-versed in the difficulties your employee faces will allow you to have a fuller understanding and be able to support the individual better. It may also make the individual feel valued.

• Offer remote working

For roles that lend themselves to remote working, some people may prefer this option rather than being in an office. If the employee prefers to work in an office, offer a desk or office space with easy access to restroom facilities. If possible, having a private bathroom that is well-ventilated could be a particularly helpful solution for those living with BAM.

• Offer flexible working patterns

Symptoms can change largely depending on the day and even the time of the day. By allowing your employee to adjust their hours as needed this can give them peace of mind to allow for frequent toilet breaks.

Due to BAM being linked to food – it may be worth discussing what the best approach could be to timely breaks to allow for flare ups. If the employee’s symptoms are particularly active in mornings, then consider a late start to accommodate or vice versa.

• Parking

Provide employees with BAM with an allocated parking space close to their workplace. This means if they need to visit the restroom urgently, they have comfort knowing they don’t need to scour the parking lot for an empty space. Anxiety can exacerbate symptoms hugely so try to alleviate it as much as possible.

• Encourage regular check ins

To make the sufferer feel less isolated and more supported, we encourage employers to offer regular meetings to check in with their employee. Living with bile acid malabsorption can have a big impact on sufferer’s mental health and having a positive experience in the workplace with an understanding manager and team can make a big difference.

• Foster an inclusive workplace

Have you ever heard of the Hidden Disabilities Sunflower? The Hidden Disabilities Sunflower allows people to voluntarily share, with the use of a green sunflower lanyard, that they have a non-visible condition or disability which may mean they need additional support.

A white sunflower lanyard is available to those who support individuals with a hidden disability. Encourage your business to become a supportive environment where people feel safe to discuss any barriers they may face and how they overcome them. Hidden Disabilities Sunflower offers training and insights into different hidden disabilities and ways you can support individuals living with them.

When it comes to chronic health conditions, support from an employer can be the difference between retaining an excellent employee and losing them. Alongside supporting your employees through flexible line management, another practical way to support them is through an effective group health insurance policy.

At Everywhen , we offer flexible health insurance solutions that can extended to support both your employees and their wider families, with different cover options available.

To find out more reach out to a member of our team on everybodybenefits@everywhen.co.uk.

[1] Bile acid malabsorption - Guts UK (gutscharity.org.uk)

[2] Bile Acid Malabsorption: Symptoms, Causes & Treatment (clevelandclinic.org)

[3] Bile acid malabsorption - Guts UK (gutscharity.org.uk)

[4] A guide for employers (crohnsandcolitis.ork.uk)

[5] New research shows over 1 in 123 people in UK living with Crohn’s or Colitis (crohnsandcolitis.org.uk)

[6] Ingestion analgesia occurs when a bad taste turns good - National Library of Medicine

[7] Bile salt malabsorption: 2023 eBook : May, Lacy: Amazon.co.uk: Books

[8] Life With Bile Acid Diarrhoea — BAD UK (bad-uk.org)

[9] Discrimination: your rights: Types of discrimination ('protected characteristics') - GOV.UK (www.gov.uk)

Consistent with our policy when giving comment and advice on a non-specific basis, we cannot assume legal responsibility for the accuracy of any particular statement. In the case of specific problems, we recommend that professional advice be sought.