Itching, diarrhoea, stomach complaints: Is bile acid loss syndrome behind it?
Thank you for listening to or watching my lecture!
A warm welcome to you! My name is Tanja Gehring, I am a graduate biologist, naturopath and have been working with patients in my own practice for over 20 years.
Please imagine the following:
A lady comes to my practice, shakes my hand (at that time it was still possible), still has her coat on, exclaims: “Mrs. Gehring, Mrs. Gehring, it’s good that I finally have this appointment with you! You wouldn’t believe how I feel! This constant itching, every- where! But especially back there, where I can’t reach it! You know, I live alone and I don’t have anyone to scratch me, back there – I’m supposed to sit down there?” – sits down – jumps up again – “oh God, I still have my coat on”… – hangs up her coat, is to- tally restless and rowdy, takes something out of her pocket: a wooden spoon – sits down and says: “yes, I always need it, because it’s always itching back there; and then I always do like this” – scratches her back with the wooden spoon between her shoulder blades “ah, hmmm”, “So! And now you can start…” – looks at me expectantly….
I do a special stool analysis with her (why special is in Appendix I) and a BICOM treatment as described under T1 in Appendix II.
Case 1: What do I do in such a case?
While the person is talking and I am asking questions about the medical history, I start the basic therapy with the explanation that she will feel better if we do it immediately. I also explain that she should not drink coffee for 6 hours afterwards and should drink a lot of water. Usually there is an objection: “What? No coffee for so long, not even an espresso after a meal?” In this case I already know that coffee plays a big role in their life. Funnily enough, these people always come to me in the morning and are completely horrified: “No coffee after dinner. That’s not possible!” Then I always say, “That’s already half the therapy!” Do you want to help? You have a lot of control over how you feel. If you help, it’s quicker and cheaper! I provide you with “friendly helpers” or “supporters”. This is more or less help for self-help, “friends” who help you to become healthier, to feel better, to become fit. A “friendly helper” means, for example, fresh, clear, pure, non-carbonated water. Many then say “Me, I can’t get that down!” and I say: “Well practice makes perfect.” Start practicing NOW, right here to- day and after you get out of here: Practice, practice, practice, means: water, water, water.
Then comes my explanation of the origin of itching on the one hand, how this is re- lated to the intestine, and on the other hand, that signs on the skin, outside, are re- lated to the condition of the intestinal mucosa, inside.
An analogy to explain “Why the intestine?“
I always compare it to the airfield at an airport: When you are in the airport building, you (usually) cannot see the airfield and therefore look at the display board to see if the planes have taken off or landed. The display board shows you what is happening on the airfield.
The airfield is an analogy for the intestinal mucosa because you can’t look there either, and the display board, is the analogy for the outer skin. It shows me what’s going on in the intestinal mucosa (the airfield). So if something is wrong on the outer skin, then I know something is wrong with the intestinal mucosa!
When I look at the area between the tips of the scapula on the patient’s skin and see changes there (brown/yellow discolouration, ribbles like in the mud flats, pimples, raised areas, redness and/or changed, itchy areas), then that is the display board in- forming me of a liver/bile issue. If it itches, in the vast majority of cases it is an indication of bile acid loss syndrome, abbreviated by me as BALS.
What is it? Most colleagues I have spoken to, even internists, don’t have it very pre- sent in their practice, hence the reason for this presentation.
Now a short digression on bile acids, abbreviated BA here. We all know that bile acids are used over and over again in the enterohepatic cycle, a real recycling process. However not all of you may always have the details and the consequences at hand when the processes are disturbed, so I would like to briefly point this out to you.
The fat in our food is broken down in the duodenum, packed into micelles, into little soap bubble like structures, which are then absorbed by the intestinal mucosa! The fat is absorbed into the cell, and the bile acids, on the other hand, remain in the lumen and travel further through the small intestine until they are finally absorbed in the terminal ileum and returned to the liver. The liver then produces fresh bile acids from the used BA. (Like the retreading of a car tyre in the past.) These BA are then available for the next fat digestion. This is how recycling goes round and round in a cycle.
Here I will now show you the weak points in the system:
a) The resorption of the mucosa in the terminal ileum can be hindered by:
Fatty deposits
Inflammations
Bacteria that have risen from the large intestine: these block the function of the interaction at the mucosa, (SIBO, small intestine bowel overgrowth).
b) If the fats, in this case triglycerides, are not broken down properly, they remain un- digested, and ferment instead of being digested. In this case they stick to the intestinal wall and putrefactive gases develop. The deposits lead to fatty stools, which can cause constipation (sticking of the fats) as well as diarrhoea, when the intestine secretes more water than normal to rid itself of the fatty deposits (detoxification).
c) If the bile acids are not reabsorbed at the normal rate, the liver “runs on empty”,
i.e. has less and less BA in the bile fluid up to a lack of BA! The liver therefore has to expend much more energy to form new BA and the affected person becomes tired, listless, unfocused, and “bilious” (this can even be a cause of ADHD and I often observe this even in children). Much worse is then that:
d) Excessive bile acids attack the walls. Bile acid is a strong acid, stronger than stomach acid and normally these acids do not reach the large intestine to this extent! This in turn can lead to inflammation, diverticula, polyp growth, increased permeability and haemorrhoids if the acid is not regularly bound. The affected person cannot feel any of this, as the intestine has no receptors (“feelers”) for this BUT it will result in:
e) Diarrhoea after eating, 30 minutes to hours after eating, (which I call “flitting” be- cause people really have to run to the toilet very quickly). This is an unmistakable sign of bile acid loss syndrome.
f) Here it should also be checked whether (in addition or alone) an exocrine pancreatic insufficiency (EPI) or weakness is present, which also causes diarrhoea after eating: typically this diarrhoea occurs 30 min after eating.
Case 2: Tall, lanky young man, clearly a leptosome.
.. He sits in front of me, bent over with grief, looking completely without hope:
“I always have heartburn, belching, nausea. My daughter and my wife always complain that I stink so much from my mouth, yet I brush my teeth often and hard, have a mouthwash and have been to many dentists because of it. Nothing helps. I’ve had several gastroscopies. There was Helicobacter, which we got rid of it, then I thought, now it’s good…. But nothing happened! I still have a burning stomach.”
After the questioning and physical examination, the following picture emerged:
Burning behind the breastbone, in the larynx area and in the gastric triangle (the heart had already been clarified.) Sensitive pressure in the gastric triangle and in the area of Vater’s papilla. The last gastroscopy was without findings. Sometimes a twinge under the right ribcage; ultrasound of abdominal organs by family doctor and colonoscopy by specialist: no findings.
The region on the back between the shoulder blades was discoloured and brownish, but no itching. I started BICOM treatment as described under T1 (see Appendix II be- low) already at the first appointment. I also sent in a stool sample with the following analysis:
Total bile acids
Digestive residues
Pancreatic elastase 1
Pancreatic elastase was measured here, due to the pain under the right costal arch, since exocrine pancreatic weakness or insufficiency is often the reason for this twinge. In my experience, this kind of twinge under the costal arch can occur on the left as well as on the right. I usually find elevated bile acids in the stool when the twinge is more frequent on the right than on the left. In my experience, if it is more frequent on the left than on the right, it is more likely to indicate exocrine pancreatic insufficiency (EPI) This said, no matter on which side the twinge under the ribcage occurs, if it occurs, I clarify both: EPI and BALS.
Other things were not analysed here for reasons of cost. In such case I place more value on the fact that the patient still has money for the therapy and spends less on the analysis/diagnosis.
Case 3: Middle‐aged woman
During a fasting hiking week in the Palatinate Forest, a woman complained to me that she had such severe rosacea on her face that the beautician, doctors and pharmacists were at a complete loss. She did not want to have laser treatment. Fasting would help, but it could also get worse in between. She hardly dared to go out with people any- more because everyone talked to her about it. Even a well-known fasting clinic with a good reputation did not “get rid” of it. It was a mystery, not a normal fasting eczema. After hearing from me that I would examine the skin manifestations via the intestine, she was curious and came to me a short time later.
The special stool analysis (SpeziSta) confirmed my suspicion of bile acid loss syndrome, BALS. The mucous membrane was also inflamed. Haemorrhoids had also formed. A major cause, besides weak veins in this area, is frequent diarrhoea after eating. Ask your patients about this, often they are so used to haemorrhoids that they do not mention them by themselves.
We treated as described in Appendix II under T1 with bioresonance subtly and as de- scribed in Appendix I with Colibiogen orally and MyI materially. Since this year 2008, the phenomenon formerly called rosacea has not reappeared and the patient appears once every few years to check the bowel movements and for parallel BICOM treatment.
Case 4 : Female G. K. *1945
This elderly lady came to me on the recommendation of a classical homeopath be- cause her diarrhoea after eating could not be controlled with any previous method. She was considered to be “untreatable” according to all the gastroenterologists and general practitioners she had seen in the last 20 years since the diarrhoea episodes had started. She was relegated to the psycho corner and now has really depressive tendencies because nothing helped. She no longer dared to leave the house, let alone travel by bus or train. It is exactly what her husband had looked forward to most in his old age, so she wanted to come along for his sake. She tried her best, but after a terrible toilet experience on the last bus trip, she now refuses to travel. This puts a lot of strain on her relationship with her husband and drags her down.
She has always taken Immodium acute (sublingual) so that she has peace of mind when travelling, but now this remedy is also failing to help her. She is devastated. Even a stroll in town is impossible for her, as there are hardly any customer toilets any- more, and if there are, they are overcrowded or inappropriate. She also cannot simply wait in the queue, because her bowels always “explode” so much, and the people wait- ing then also notice the “explosions”. It is so terribly embarrassing and a few times something “went in her pants” because she couldn’t hold the stool. In the past, char- coal tablets had had some effect, but that was a long time ago.
The stool analysis showed a massive bile acid loss syndrome, so I advised her to have the preparation Cholestyramin prescribed by a (specialist) doctor for 6 weeks. From a certain level of bile acids in the stool onwards, it really does make sense to take this route first. At which level of the bile acid value this makes sense should be discussed with the determining laboratory (in this case Enterosan), since from time to time the limits of measurability or the reagents change. Due to the fact that, according to SpeziSta, she also had a leaky gut and an elevated sIgA, I gave her Colibiogen orally so that the intestinal mucosa could at least be built up. I used BICOM therapy to treat the depressive mood right at the first visit. Of the programmes tested (see appendix). I use the low-frequency programme 3027.0 depression, physical causes extended to 30 min. the first time. It is really amazing how quickly results are seen with this. Patients often leave the room exhilarated after just one treatment and lots of water. This is also one of the reasons why patients have given me the name ” Practice for joy of life”.
Case 5 : Male, “Bear” of a man, *1964
Mr. X always came to me with his wife, recommended by a colleague: “Your colleague told us that you are specialised in intestines and the stomach.” It is always the wife who speaks for her husband, even if you ask him directly, he rarely answers more than one word … “he always has such problems with the stomach, it always burns … he has pain … and the strange Pantroprazol just doesn’t help, he has had it so many times …” (I immediately think: at some point, I will eliminate the allopathic “zoles” with the BICOM device).
In addition, he almost always has diarrhoea after eating; sometimes after 30 minutes, sometimes after 3 hours, sometimes at some point. In any case, he always has to “scurry” (hurry up a lot) because the imperative urge to defecate* is very strong and cannot be contained with all previous methods.
*): According to DCCV e.V.: “Imperative urge to defecate is a matter of seconds. What is meant here is a period of between 10 and 20 seconds. A minute is not reached. The urge to defecate does not announce itself. It comes suddenly and can be accompanied by tenesmus (pain immediately before defecation). It is involuntary and cannot be controlled or held even with the strongest effort of will. Abdominal breath- ing, biofeedback or pelvic floor and sphincter training do not control it.”
During the physical examination I noticed loud sounds like clapping applause in the small and large intestine heard by stethoscope. There was also severe hardening in the area of the gastric triangle/ duodenum/ Vater’s papilla, and gurgling flow sounds after pressure on bile points under the kneecap**] The stomach and intestine had been investigated several times in the past, but except for slight reddening in the antrum, there were no findings.
**]: at a further training course I once learned that the liver/bile system is mapped quasi 1:1 on the right leg around the knee, so that I can trigger a flow of bile in the abdomen by pressing on the bile points di- rectly below the kneecap. This is then easy to hear. Since then, I always check this at the same time as the physical examination. If the bile flow is triggered by itself while lying down and listening to the abdomen, the tightening of the muscle around the Vater ́s papilla is not as strong as if I have to trigger it first. Usually I then ask about the stress level the person is feeling currently.
There is no helicobacter but stress is affirmed, scale 9/10. The last gastroscopy was less than three weeks ago with no findings; but the patient has been taking Cholestyramine 40mg***) prescribed by the internist daily for some time. Nevertheless, he has often sudden diarrhoea 1/2 -2 hrs after eating which is very unpleasant. He is often with forest workers, with no toilet nearby, and without bushes always available.
***): Has anyone thought about BALS (bile acid loss syndrome)? Why does he still have the “flitting” af- ter eating? Although cholestyramine is the allopathic drug against BALS, that’s not why it was used here.
As a result, he stopped eating in spite of hard physical work and at some point he col- lapsed. Now he sits in front of me and complains of stomach pains like stomach ulcer (fortunately it had already been clarified that it is not that)! The colour and structure of the skin on his back between the tips of his shoulder blades has changed, and he occasionally itches. He then goes “like a bear to the tree and rubs his back on it”. So you see, even a “bear of a man” can really be brought to his knees by this syndrome.
What did we do?
1. SpeziSta (Special Stool Analysis, see Appendix I for more details):
Digestive residues (microscopic analysis)
(Total) bile acids
Fats (biochemical analysis)
Pancreatic elastase
Alpha-1-antitrypsin (indication of leaky gut)
Anti-gliadin + anti-transglutaminase sIgA
(Why gluten sensitivity/ intolerance? Often the reason for the loud clapping /applause like noise when listening to the intestine is due to permanent
inflammation, silent inflammation, or fat digestion disorder!)
Breath analysis because of small intestine overgrowth (V.a. SIBO)
Alkaline baths (foot and full baths) first, because of extreme hyperacidity and he loves baths
Liver compresses (see book DARM-FITNESS new edition 2020, p. 248/249)
BICOM treatment during every appointment
Conductance value measurement
Basic therapy according to conductance (with/without DMI (according to testing) Amplifying/attenuating (according to testing) + substance complexes: according to categories e.g. in Goodies: energetic fit-maker or energetic fit-maker for nerves
Support the liver as an elimination organ according to testing: Mostly Progr. 3064 (8 min);
Activation of vitality: Progr. 900.1 (4 min)
(For programme 900.1, we use the same applicator as for 3064: black flexible applica- tor on the front, only moving if necessary and modulation mat on the back moving- from crosswise to upright). This is very quick! For me, this is also very important with these BALS people, as they are often very restless, stressed and/or impatient. Two pro- grammes and about 15 minutes of time are already an acknowledgement that this per- son is willing to put up with it. The nice thing is that the more the treatment of the BALS progresses, the less restlessness there is. When the inflammation subsides and the diarrhoea subsides, the patient becomes visibly calmer and more relaxed.
This is also what happened here with Case 5.
Case 6: Male, R. H. *1962
This man also came to me on recommendation. He is a professor of natural sciences, so he was not sure whether he was in the right place with me. His main problem was terrible headaches and migraines with and without aura. While he was telling me where and how exactly his headache runs, how it wanders until he thinks his skull bursts, my eyes fell on the REGUMED poster and I was amazed that this person had just shown me exactly the course of the bile meridian with his hand. This gave me the idea to check his bile acids in the stool, in spite of me not usually doing this for head- aches and migraines. I can only say: it was worth it! When the results came in, I was amazed:
All parameters were OK – and we checked a lot in the stool, because he wanted to have a complete check from that perspective. ONLY the bile acid loss syndrome, BALS, was present. So bull’s eye!
As he had scheduling difficulties and was travelling worldwide, I did not do any bio- resonance. He managed with only a generous intake of Myrrhinil intest after every meal, which he took with him everywhere, and his migraines were history. In addition, he always had a diarrhoea preparation with him on his travels in case normal travel diarrhoea should affect him.
So hooray for the beautiful poster from REGUMED!
Total duration of therapy, therapy time BALS
As a rule, the entire treatment of BALS with me lasts at least 6 months with regular intake of the preparations mentioned in the appendix and the accompanying BICOM treatment with chips and lots of clear drinking water.
Depending on the patient’s interest, budget and time, we check the bile acids and
the other changed parameters after 3 months (at the earliest), always after 6 months, often one year after the start of treatment as well as half a year after the end of ther- apy/taking the preparations. During the therapy period, I always test which preparations can be adjusted and in what form.
You can also do a stool test while taking the preparations, but you do not always have to stop taking them (all of them) in order to check the success of the therapy. The Enterosan laboratory will be happy to inform you about this. As a rule, the treatment is completed after one year at the latest.
However, there have been cases in the last 20 years where people affected by BALS have had to undergo repeated courses with the specified preparations.
A particularly impressive case was: BALS treated by me, gluten avoidance. Everything was fine with the patient. Then I was not available for a year, the patient had a colonoscopy, the doctor said there was no reason for the gluten avoidance and for taking the healing preparations. After only 3 weeks of consumption, the patient had diarrhoea again after eating! When the doctor’s treatment with PPI (proton pump inhibitor) and/or cholestyramine was no longer sufficient, he came back to me, we checked by means of stool analysis and built up with BICOM. A few years later we did the “game” again; now, after the third “Gehring therapy”, he is now convinced that he re- ally should continue to take the naturopathic preparations, quasi “for life”, and now treats himself to a BICOM treatment every now and then.
CONCLUSION: It is possible that the affected person is symptom-free and can do every- thing, but the BALS is not cured and this person then continues to diligently take his preparations in order to be without complaints.
Summary / Take home message
I hope that after this lecture you will now consider bile acid loss syndrome, BALS, in the future in puzzling cases or in the presence of one or more of the following symptoms:
Itching on the skin, especially itching in the shoulder blade area on the upper back.
Rosacea on the face, butterfly erythema
Neurodermatitis, psoriasis, “behaving” in an atypical way
Diarrhoea after eating, “flitting”
Fecal incontinence
Bad breath, especially if it does not go away with any common method
Pressure or pain in the gastric triangle
Heartburn
Burning in the larynx
Burning behind the breastbone, if heart causes have been clarified
Other stomach reactions that do not fit into any picture
Exhaustion syndromes, especially after emotional stress phases with anger, grief, separation, caregiving.
Even in the case of therapy-resistant haemorrhoids, it is worth taking a look at the bile acids in the stool!
Most of the so-called IBS, irritable bowel syndrome could be solved in the last 20 years in my practice with the examination by SpeziSta and treatment of BALS! BALS is more widespread than thought!
BALS can also be a contributory cause/amplifier of IBD (chronic inflammatory bowel disease).
There are also more cases of joint problems (especially in the shoulder and knee) (frozen sholder, calcified shoulder, impingement) that are related to the BALS and disappear when the BALS is corrected. Bear in mind, that joints also have mucous membranes, which ultimately depend on the condition of the intestines in the long term.
Finally, emotions are not to be neglected: Grief, sadness, anger, stress, wars, tension, existential fears etc. have a very strong effect on the emotional system “human” or “liver/bile” (not only according to TCM).
Then it is good to think of BALS in connection with ADHD.
Finally – last but not least – don’t forget case 6 where the connection to headache
and migraine should be remembered.
Thank you and farewell
I wish you much success in treating these symptoms with this new therapeutic approach! Please feel free to send me any questions or feedback by email at: [email protected].
Perhaps you would also like to recommend my book to one or the other patient, which also contains a lot about BALS and other intestinal stories. This extended new edition was created especially for BICOM therapists. Here, too, special thanks to the former managing director Florian Sinn, who advised me to dare to speak here and to rewrite my book for you. Currently this book is only available in German!
Many thanks to the entire REGUMED and AKI team for allowing me to give this talk here! I hope to see you again “live and in colour” next time in Fulda! Greetings from all over the world
Yours,
Tanja Gehring.