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Is it IBS or is it FAT Malabsorption? Here’s Why You Continue To Suffer with IBS Symptoms

Fat Malabsorption refers to decreased intestinal absorption of fat from the diet. If you are struggling with Symptoms such as feeling bloated all the time,

  1. Feeling bloated all the time? Like someone just pumped your belly full of air
  2. Stool that floats and looks like rabbit pellets?
  3. Fullness even after eating a small meal or when you wake up in the morning?
  4. Passing lot of gas or belching regularly?
  5. Pale colored foul-smelling stool?
  6. Weight loss and Fatigue
  7. Frequent Low Vitamin D Levels

If you said yes to more than three of those symptoms, then you might have something called Fat malabsorption or Pancreatic insufficiency and possibly even chronic pancreatitis.

Fat Malabsorption is the inability to properly digest fats and it can at times be a very serious problem. Fat malabsorption is not something to take lightly especially when you also have weight loss.

I’m Dr Hagmeyer and I am the clinic director here at where we help patients from all over the world, find Natural solutions to Chronic Health problems such as fat malabsorption, and pancreatic insufficiency using Functional and lifestyle Medicine.

In today video, I will be covering

  1. What causes fat malabsorption/fat maldigestion
  2. How I test for Fat malabsorption
  3. Steps you can take to improve fat maldigestion and absorption issues and finally
  4. Specific Enzymes that I recommend for this.

So let’s jump into this….

What Causes Fat Malabsorption/Fat Maldigestion and How It’s Related to IBS- 

  1. Pancreatic insufficiency- this happens when the pancreas fails to release an enzyme called elastase. – Elastase is a pancreatic enzymes to help with the breakdown of fats. In a healthy pancreas, elastase will be passed in the stool. If little or no elastase is found in your stool, it can mean this enzyme isn’t working as it should. This is called pancreatic insufficiency. Pancreatic insufficiency can cause a number of health problems, including malabsorption and malnutrition, both of which affect your ability to digest and take in nutrients from food.
  2. Chronic Pancreatitis- Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to permanent damage to the pancreas. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic enzymes
  3. Inflammatory Bowel disease like Crohn’s, Ulcerative colitis and Celiac Disease- these conditions damage the mucosal lining of the gut leading to poor absorption of fats.
  4. Liver congestion- The liver is the organ that makes bile which helps break down fats.
  5. Bile acid malabsorption- This occurs when bile is not reabsorbed in the small intestine. This can lead to diarrhea and
  6. SIBO- Small intestinal bacterial overgrowth can occur when certain kinds of bacteria unconjugate bile salts.
  7. Bacterial deconjugation of bile acids is another important feature in SIBO. This leads to the formation of free bile acids, which further damage the intestinal lumen and also reduce micelle formation, being absorbed in the jejunum rather than the ileum
  8. Parasites
  9. Gall bladder or Bile duct obstruction- in response to fats, the gallbladder will release bile into the small intestines – damage or inflammation to these ducts can impair fat absorption.
  10. Chemo/radiation- again these drugs are toxic to the microbiome, the nerves that regulate motility and they damage the intestinal mucosal lining- all of of which can lead to fat malabsorption.
  11. Medications- Birth control pills, antibiotics- when does an antibiotic not damage the gut in some way? Other medications that cause fat absorption include the highly popular diabetic mediations Metformin and certain medications that block cholesterol synthesis- these are bile acid sequestrants. And lastly diet
  12. Not eating enough good fat- not eating enough good fat can cause fat malabsorption because- the presence of fat stimulates bile production and stimulates motility.

So, those are 12 possible reasons behind your symptoms of bloating, belching, nausea, greasy, smelly, pale colored stool and IBS

Understanding Digestion and Fat Malabsorption

You have this poorly functioning liver, and one of the 200+ plus functions that your liver is designed to do is to produce bile.

The bile is sent to the gall bladder where it is stored there and released into the small intestines for the digestion of fats. The purpose of bile is to neutralize the food that was in the stomach which is very acidic as well as to emulsify which essential means to coat the fats and prepare them for breakdown.

When someone has fat malabsorption, the gall bladder fails to release bile at the right time or in the right amount/dose.

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Perhaps you have gall stones, or inflammation, some other blockage, perhaps you don’t eat enough fat which normally signals the release of bile, or perhaps there is weak vagal stimulation and the gallbladder doesn’t contract and that causes a release of bile.

Remember, bile not only helps with fat digestion it also traps and removes toxins, kills bacteria/parasites, it removes heavy metals, hormones from our body.

So you don’t want your gallbladder getting “backed up” and not releasing bile. You want to keep your pipes clean and flowing so to speak.

So remember a low fat diet is not a good thing in general because when we eat very little fat, the amount of bile released is reduced, bile then gets thick and doesn’t flow the way its suppose to.

Then when you do eat a high fat meal the thick and sluggish old bile fails to flow properly and the fat you just ate does not get properly digested leading to bloating, light colored stool, rabbit pellet poop and sometimes even diarrhea. While there are many tests that should be done in order to understand what is causing this problem, let me go over 3 of the most important ones.

How To Test For Fat Malabsorption

Whenever I suspect a problem with fat malabsorption or I have a patient who has been diagnosed with IBS or they have bloating, abdominal pain, diarrhea, foul smelling stools there are several concerns and there are certain tests that should be done.

#1 Functional Stool tests

Functional Stool tests is the number one way I test for fat malabsorption, but the kind of test I recommend not only provides information on fat absorption, it also helps me understand how to support many problems related to chronic GI problems, things like IBS, SIBO, Celiac and Inflammatory Bowel disorders.

Take for example this test- this patient has high levels of fat, choleseterol showing up in their stool.

Is it IBS or is it FAT Malabsorption?

These tests can also show me if a person’s pancreas is producing sufficient amounts of enzymes that help break down fats like you see with this patient.

Low Pancreatic elastase is a very common cause of fat malabsorption and tells me this patient has pancreatic insufficiency.

Many people with fat malabsorption suffer from pancreatic insufficiency, high fat levels high cholesterol in their stool, but also have carbohydrate malabsorption and protein malabsorption. Stool testing for fat malabsorption can measure amount of fat in samples of stool, or feces. Stool testing is the most reliable because fat is usually present in the stool of someone with fat malabsorption syndrome.

Another nice thing about testing a stool sample is that you can test a variety of other markers that are also associated with fat malabsorption, you can detect levels of gut inflammation, you can check for parasites, or yeast overgrowth, bacterial overgrowth, you can check if there is protein maldigestion and you can check for the presence of bile acids in the stool. So that’s the first test that we need to see.

#2 Functional Nutritional Blood tests-

The reason for blood testing is because fat malabsorption can be associated with many different diseases like we talked earlier (Celiac disease, Crohn’s, SIBO, Leaky gut, etc), As result this can lead to a variety of nutritional deficiencies, these Functional Nutrition blood tests measure things like vitamins, amino acids, essential fatty acids, oxidative stress, glutathione levels and many other things related to nutritional status.

What I like about these tests, is that they really help me understand the kinds of nutrients a patient needs in order to help heal and support the gut- We are not guessing about the nutrients needed, we know what those deficiencies are in the context of a fat malabsorption or other malabsorption disorders.

#3 The Next test is a SIBO Breath Test- Hydrogen and Methane Breath testing.

Hydrogen and methane Breath testing should also be considered in people who have abdominal pain, bloating, gas, constipation and diarrhea.  We know that SIBO not only affects intestinal motility, it can also be a cause fat malabsorption. (watch this video if you suffer with diarrhea)

Depending on the type and strains of bacteria in the small intestine, some individual with SIBO can develop bile acid malabsorption or BAM, because the bacterial overgrowth can unconjugate bile leading to more bile in the colon where it does not belong. Too much bile in the colon or poor reabsorption of the bile will lead to diarrhea and fat malabsorption.

Lets Talk Big Picture When It Comes to Fat Malabsorption

Big picture when it comes to Fat Malabsorption is understanding that we have multiple organs involved and sometimes diagnostic imaging done in hospitals can miss the functional problems and patterns that many people continue to suffer from.

When it comes to fat malabsorption, the first step includes supporting healthy bile production and secretion. Again, think Liver, Stomach, Gallbladder, Small intestines. These are the organs you want to identify as a functional problem and then support.

So, if you or a loved one suspects fat maldigestion and you are struggling with the symptoms of bloating, diarrhea, constipation, abdominal pain, let me share you with a few dietary changes that you can make as well as some supplements that can help with this.

If you have already been diagnosed with fat malabsorption, or you have had your gallbladder removed, you will need to use very specific supplements and I will go over what those in just a minute- stay with me here!

Tips to Improve Fat Malabsorption IBS

Tip #1 Increase Good Fats Slowly!

#1 If you have been on a low fat diet, or you have been a vegetarian, gradually increase the good fats- the key here is gradually. You don’t want to make drastic changes in your diet.

If you change your diet overnight, you will exacerbate a fat malabsorption problem. You will go from bad to worse. Your symptoms will only get worse. The kind of fats you want to start incorporating into your diet include fats like grass fed butter, Ghee which is clarified butter, extra virgin olive oil, avocado oil, walnut oil and coconut oil. I recommend that you avoid nuts until your digestion and gut health improves by 80-90%.

Bile support. Because it is so similar to human bile, it works by breaking down fats in your digestive tract. If you have had your gallbladder removed, then you need a permanent bile replacement to help your body digest dietary fats. Here is one I reccomend

Tip #2 Increase Vegetables especially the ones that are called Bitter Greens- 

Bitter greens help stimulate digestion. Some examples of these include mustard greens, collard greens, kale, arugula, dandelion greens. You can check out my website for several juicing recipes that incorporate them.

Other vegetables that are great for liver and gallbladder function include beets, beet greens, garlic, onions, radishes again…..All very good for gallbladder.

If you have SIBO, I recommend you start a Low FODMAP diet because of the connection between fat malabsorption, bile salts and SIBO. If you are not familiar with the Low FODMAP diet, this is a diet limits starches, most fruits due to fructose sugar, certain vegetables

For more information on SIBO you can visit my website where you will all kinds of free resources, you can also download my free SIBO Guide that explains how I work with patients who have SIBO. It includes a free SIBO Recipe guide with over 20 recipes. If you have SIBO I encourage you to also watch a 10 part video series I did on the topic of SIBO. Next

Tip #3  Supplement with Pancreatic Enzymes

Enzymes are critical to help with fat malabsorption. Enzymes like amylase, lipase and proteases. This is especially important if you have a history of pancreatitis, pancreatic insufficiency indicated by low Pancreatic Elastase-1 or if your gallbladder was removed.

Tip #4- Supplement with Betaine and Pepsin

Next thing I recommend to Improve overall digestion is Betaine and Pepsin. The stomach is designed to be very acidic a PH of 1-3. Just for reference, water has a PH of 7.0.

This highly acidic environment start the digestion of proteins and fats, but it also triggers the entire chain reaction of digestion. This is why proper stomach acid is one of the keys to supporting and fixing downstream digestive problems.

When the stomach isn’t producing enough HCL, Pepsin, pancreatic enzymes other digestive secretions are not signaled to be released- this brings digestion to a grinding halt and this is also how we can develop SIBO, develop fungal overgrowth, yeast, H.pylori and a host of other GI problems.

So taking an enzyme specifically to aid in protein digestion can help minimize this. The next thing we need to consider when addressing fat malabsorption is

Tip #5- Support Your Liver. Remember the liver makes the Bile and the gallbladder stores it. Many people who struggle with SIBO and IBS have a Toxic liver.

Bile helps the body break down fats. One of my favorite supplements that support both liver and Gallbladder is liver defend. Things like Taurine, NAC, Turmeric, Silymarin, selenium, artichoke, alpha lipoic acid are all natural supplements clinically proven to support the liver- and all can be found in liver defend.

Video #6 The Pill and Liver

And finally, when it comes to fat malabsorption, I think about the importance of fat-soluble vitamins.

Tip #7 Take Your Fat Soluble Vitamins and Essential Fatty Acids 

For a variety of reasons, people with fat malabsorption become very deficient in fat soluble vitamins and essential fatty acids like omega 3, omega 6 and omega 9.

For this reason, I recommend supplementing with a high quality balanced omega 3,6,9 with GLA.

Essential Fatty Acids like Omega 3,6,9 are a crucial part of human cell membranes. They also have a number of other important functions, including:

  • Improving heart health: Omega-3 fatty acids can increase “good” HDL cholesterol. They can also reduce triglycerides, blood pressure and the formation of arterial plaques
  • Supporting mental health: Taking omega-3s can reduce symptoms of depression, schizophrenia and bipolar disorder. It can also reduce the risk of psychotic disorders for those who are at risk
  • Reducing weight and waist size: Omega-3 fats play an important role in weight management and can help reduce waist circumference
  • Decreasing liver fat: Consuming omega-3s in your diet can help decrease the amount of fat in your liver
  • Supporting infant brain development: Omega-3s are extremely important for brain development in babies
  • Fighting inflammation: Omega-3 fats are anti-inflammatory, meaning they can reduce the inflammation in your body that can contribute to a number of chronic diseases
  • Preventing dementia: People who eat more fish, which is high in omega-3 fats, tend to have a slower decline in brain function in old age. Omega-3s may also help improve memory in older people
  • Promoting bone health: People with higher omega-3 intake and blood levels tend to have better bone mineral density
  • Preventing asthma: Omega-3 intake can help reduce symptoms of asthma, especially in early life

So, there you go! I really hope you liked todays video- If you did be sure to leave a comment below. Don’t forget to check out other videos on my Youtube channel.

Also, If you have questions about working with me, or one of my nutritionists in my practice, whether you need help with implementing a certain diet or you are looking to dig deeper into the Root cause of your health problems, visit my website and look for the start here button.

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