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The prevalence of Diarrhea Predominant Irritable Bowel Syndrome (IBS D) and chronic diarrhea has been one of the most troublesome diagnoses inflicting approximately 5% of the population annually. These entities have always perplexed physicians that attempt to offer relief to millions of sufferers. Because of the magnitude of the problem, physicians and researchers have been reaching out to further classify and understand these entities. This review will shed some light on current analysis and thinking of IBS-D and offer a challenging new alternative approach in understanding and treatment for this condition. It will indicate that IBS-D is not a true clinical entity in fact, it demonstrates that a more detailed history and clinical work up of patients may indeed lead to a true and treatable clinical diagnosis, highlighting a more significant role of Bile acid abnormalities in the pathogenesis of chronic diarrhea.