If you are struggling with abdominal pain, cramping, diarrhea and your vitamin D levels just came back being low, you might have Fat Malabsorption Syndrome. Fat malabsorption is a digestive disorder that comes with serious complications such as increased risk of infections, bone fractures, weight loss, bacterial overgrowth and gallbladder stones.
Digestion and Absorption Of Fat Occurs in Three Phases:
- Intraluminal hydrolysis of fats, proteins, and carbohydrates by enzymes—bile salts enhance the solubilization of fat in this phase
- Digestion by brush border enzymes and uptake of end-products
- Lymphatic transport of nutrients
The term malabsorption is commonly used when any of these phases is impaired, but, strictly speaking, impairment of phase 1 is maldigestion rather than malabsorption.
I’m Dr Hagmeyer and not only can Fat maldigestion and Pancreatic insufficiency cause these symptoms on a larger scale its causing Major vitamin deficiencies.
Fat Malabsorption, (also called steatorrhea or fat maldigestion), is the inability to properly digest fats and it is a leading cause of gallstones and ultimately gall bladder surgery.
In today video/article depending on how you are viewing this, I will be covering
- What causes fat malabsorption/fat maldigestion
- How I test for Fat malabsorption
- Some of the lesser known symptoms of fat malabsorption/maldigestion
- Steps you can take to improve fat malabsorption/absorption issues and finally
- Specific Enzymes that I recommend for this.
So let’s jump into this….
What Causes Fat Malabsorption/Fat Maldigestion
What causes fat malabsorption? Let me give you 10 potential reasons you are struggling with fat maldigestion and if you want more information on these you can visit my website for further information. Possible Causes of Fat Malabsorption Include:
- Pancreatic insufficiency- this happens when the pancreas fails to release pancreatic enzymes sufficient amounts of pancreatic enzymes to help with the breakdown of fats.
- Inflammatory Bowel disease like Crohn’s, Ulcerative colitis and Celiac Disease- these conditions damage the mucosal lining and of the gut leading to poor absorption of fats.
- Injury to the Brush Border- These cells produce brush border enzymes that aid in digestion of starches and disaccharides .
- Liver congestion– The liver is the organ that makes bile.
- Bile acid malabsorption– This occurs when bile is not reabsorbed in the small intestine. This can lead to diarrhea and
- SIBO- Small intestinal bacterial overgrowth can occur when certain kinds of bacteria unconjugate bile salts.
- 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.
- 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.
- 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
- 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 a few reasons behind your symptoms of bloating, belching, nausea, greasy, smelly, pale colored stool and IBS symptoms.
Fat Malabsorption- Big Picture Summary
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.
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 it is supposed 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 we use in Functional Medicine.
How To Test for Fat Malabsorption
Whenever I suspect fat malabsorption and 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 need to be done. These includes a functional stool tests, a nutritional panel and SIBO breath test.
#1 Functional Stool Tests
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 correct many problems related to chronic GI problems. Take for example this test- this patient has high levels of fat, cholesterol showing up in their stool.
These Functional Stool Tests can also show me if a person’s pancreas is not 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.
These tests can also be done at home which is nice.
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 Blood Tests For Nutritional Deficiencies –
The reason for blood testing is because fat malabsorption can be associated with many different diseases like we talked earlier (Ulcerative Colitis, Celiac disease, Crohn’s, Leaky gut, etc), and as result can lead to a variety of nutritional deficiencies,
- Cellular Energy & Mitochondrial Metabolites
- Neurotransmitter Metabolites
- Vitamin Markers
- Toxin & Detoxification Markers
- Urine Amino Acid Analysis
- Essential and Metabolic Fatty Acids
- Oxidative Stress Markers
- Nutrient Elements
- Toxic Elements
#3 Hydrogen and Methane Breath Test (SIBO Breath Test)
Hydrogen and methane Breath testing should also be considered in people who have abdominal pain, bloating, gas, constipation and diarrhea because we know that SIBO not only affects intestinal motility it can also be a cause fat malabsorption. A combination of low B12 and high folate levels is suggestive of SIBO , because intestinal bacteria use vitamin B12 and synthesize folate.
Depending on the type and strains of bacteria in the small intestine, some individual with SIBO can develop bile acid malabsorption because the bacterial overgrowth can unconjugated bile leading to more bile in the colon where it does not belong. Ultimately, this ends in diarrhea caused by fat malabsorption.
So 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 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.
Tip #1- Make Gradual Changes to the Diet
If you have fat malabsorption or fat maldigestion, you may have been told to go on a low fat diet and so over night, you cut out eating all fat. This is not a good idea. While you may need to reduce the amount of fat you are currently eating, you need fats to keep the system running. 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. 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%.
Tip #2 Pancreatin (Ox Bile) For Fat Malabsorption
Supplement with Pancreatin aka ox bile to improve fat malabsorption. Ox bile is what the name implies – bile from oxen. Why an ox? 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 pancreatin support (bile) to digest your fats. The next thing I recommend is that
Tip #3- Start Eating Bitter Greens and and Supplementing With Eating Bitters
Increase vegetables 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 include Beets, beet greens garlic, onions, radishes again…..All very good for gallbladder.
Tip #4-Get Tested for SIBO
A big problem for people with fat malabsorption is SIBO. 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, certain vegetables or fruits that are high in Fructose.
For more information on SIBO you can visit my website where you will all kinds of free resources, you can download my free SIBO Guide that explains how I treat SIBO, a SIBO Recipe guide, and you can also watch a 10 part video series I did on the topic. Next
Tip #5- Enzymes Therapy
Supplement with very specific enzymes that help with fat malabsorption enzymes like amylase, lipase and proteases. This is especially important if you have a history of pancreatitis, if you have pancreatic insufficiency indicated by low Pancreatic Elastase-1 or if your gallbladder was removed.
Tip #6 Acidify Your Gut
The stomach is designed to be very acidic a PH of 1-3. Water has a PH of 7.0.
This highly acidic environment digests proteins and fats, but it also triggers the chain reaction of digestion.
When the stomach isn’t producing enough hydrochloric acid, pancreatic enzymes and other digestive secretions are not signaled to be released- this bring digestion to a grinding halt and this is 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.
Tip #7 Don’t Ignore Your Liver
And finally, when it comes to fat malabsorption, I think about the importance of fat-soluble vitamins. For a variety of reasons, people with fat malabsorption become very deficient in vitamins A,D,E, K as well as omega 3 and omega 6’s.
For these reasons, I recommend supplementing with a high quality omega 3,6,9 with GLA as well as those fat soluble vitamins I just mentioned.
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 contact us to see if we are a good fit. We are here to help.