I am suffering with BAM & just come out of hospital last Friday after 4 days in Leicester Royal infirmary, thought my constant toilet visits was down to my Crohn's flare up but stomach pains down to BAM, i was told to take Calasavelum 4 per day, 2 tablets, 10 mins before food, still in pain & lots of toilet visits, can anyone advise regarding their usage of the same medication. Thought i would mention my goul bladder was removed June last year. Look forward to any help or advice on this forum
Bile acid malabsortion
- Thread starter Allan1957
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Hoping someone can chime in here. Seems as though all of Canada has run out of cholestyramine with no clear date of re-stocking. So for those of us who've had a few re-sections as well as had a gall bladder removed, it's time to see if there are ANY alternatives that work for people.
I had a BAM problem some years back for about 8 months, luckily mine eventually went away as my chrons reduced in severity.
If you're taking the 625mg ones that I took you can actually take up to 6 in one day regularly or as the occasional one off you can take 8 in one day.
You don't want to be taking more than 2-3 per meal though
How you spread them out is up to you. The way I would do it is if the food was very low fat (just fruit and a protein yoghurt as an example) I would have 1 as I started eating.
If I was having something with fat in it I would have 2, one when I started eating and one when I finished eating.
Absolutely no reason to my knowledge why you should be having them 10 minutes before eating, however there is good reason to have another one if the meal has fats in it after you've finished eating.
Some people find it's good to have a third one 2 hours after a meal just to ensure everything gets mopped up properly.
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Hey Aituk! Thanks for chiming in. 
My gastro got me on Colesevelam last week. He actually advised to start with one pill a day and to keep adding until I hit a balance. I'm a week in and finding that 4 per day (2 breakfast / 2 dinner) is helping a lot but not perfect. Like you I was thinking of experimenting with number of pills based on what I'm eating. Seems like 2 with breakfast (oatmeal and yoghurt for bile absorption and probiotics) is overkill but two in the evening is too little depending on what I eat. In my case I can't go low fat since I'm underweight and need to gain some fat (believe it or not). So I don't shy away from it. But I think it's causing some looseness the next day as the 2 pills can't keep up. So I like your idea of 2 at dinner and a 3rd after for "mopping up". Have you ever split your dose over 3x/day? Meaning including a pill at lunch?
My gastro got me on Colesevelam last week. He actually advised to start with one pill a day and to keep adding until I hit a balance. I'm a week in and finding that 4 per day (2 breakfast / 2 dinner) is helping a lot but not perfect. Like you I was thinking of experimenting with number of pills based on what I'm eating. Seems like 2 with breakfast (oatmeal and yoghurt for bile absorption and probiotics) is overkill but two in the evening is too little depending on what I eat. In my case I can't go low fat since I'm underweight and need to gain some fat (believe it or not). So I don't shy away from it. But I think it's causing some looseness the next day as the 2 pills can't keep up. So I like your idea of 2 at dinner and a 3rd after for "mopping up". Have you ever split your dose over 3x/day? Meaning including a pill at lunch?
Yeah you can do any combination you like. The only hard rules you have to consider is maximum of 6 per day but that can be stretched to 8 occasionally and no more than 3 in a short period of time.
I wouldn't force yourself to eat fat if its making things difficult, even if you need to put on weight as carbohydrates are converted by your body into fat so you can go heavy on them instead instead if you like and it'll do the same thing but be easier on your BAM. Thing's like bread and pasta are good for this!
I split my dose however I decided to eat that day. I just think of it as 1 for a low/no fat meal. 2 for a meal with some fat in and 3 if I have lots of fat.
Other than that you can mix and match as you want. I used to eat lots of snacks sometimes instead of a big meal. In which case I'd have 1 tablet with each snack. Sometimes I'd have 8 tablets, one taken with each snack with an hour or so inbetween. It's completely up to you.
Remember there's no real danger to overdosing or anything so you don't have to be too strict, it's just your gut needs time to clear it out afterwards. Bile acid sequestrants are barely absorbed into the bloodstream, they just dissolve in gut acids and then bind your bile acids to the food making it solid to pass with stool. So the acid would have come out as liquid which can be inflammatory and painful, instead it comes out as solid which is relatively harmless but the sequestrant mostly comes out with it.
I wouldn't force yourself to eat fat if its making things difficult, even if you need to put on weight as carbohydrates are converted by your body into fat so you can go heavy on them instead instead if you like and it'll do the same thing but be easier on your BAM. Thing's like bread and pasta are good for this!
I split my dose however I decided to eat that day. I just think of it as 1 for a low/no fat meal. 2 for a meal with some fat in and 3 if I have lots of fat.
Other than that you can mix and match as you want. I used to eat lots of snacks sometimes instead of a big meal. In which case I'd have 1 tablet with each snack. Sometimes I'd have 8 tablets, one taken with each snack with an hour or so inbetween. It's completely up to you.
Remember there's no real danger to overdosing or anything so you don't have to be too strict, it's just your gut needs time to clear it out afterwards. Bile acid sequestrants are barely absorbed into the bloodstream, they just dissolve in gut acids and then bind your bile acids to the food making it solid to pass with stool. So the acid would have come out as liquid which can be inflammatory and painful, instead it comes out as solid which is relatively harmless but the sequestrant mostly comes out with it.
I've been on Calasavelum for a few years now, and it's been a lifesaver for my BAM. It took a few weeks to kick in fully, but once it did, my diarrhea and stomach cramps improved significantly. I'm still on a low-fat diet, but I can eat a lot more variety now without problems. Hang in there, it might just take a bit more time to work for you.
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Thanks for the input Aituk and Cartmore! You've been very helpful. Last night we indulged in our favourite Pakistani takeout: lots of cooked veggies, biriani and Tikka Masala. I took a 3rd pill after dinner as Aituk suggested "to mop up" and today it's been smooth sailing. So again... thanks for everyone's insights on this medication.
