Exploring a complex case involving a patient with microscopic colitis, bile acid malabsorption, and multiple gut issues. After long-term use of Budesonide failed to provide relief, they tackled the patient’s parasites, food allergies, and eventually discovered bile acid malabsorption. Starting bile acid sequestrants brought significant improvement. The Turds also discuss the difficulties in diagnosing and treating microscopic colitis, along with potential long-term concerns such as bismuth toxicity, emphasizing the importance of addressing dysbiosis, inflammation, and malabsorption in such cases.