fecal fat

[ldubois7]

Hello!

Please tell me more about fat malabsorption. I definitely have this issue although I didn't include it on my Enterolab testing, so I don't have any data.

I see my reg. doc on Monday, and wondered if I should ask him to run some tests, so I know how much damage I have? I'm just tired of being tired......

Article explaining some tests: http://www.drmyhill.co.uk/wiki/Malabsor ... _from_food



Thanks for your advice!

:)

[tex]

Hi Linda,

Like everything else, except for alcohol (which is absorbed in the stomach) and water and electrolytes (some of which are also absorbed in the colon) fat is absorbed exclusively in the small intestine.

Fat is digested by the enzyme lipase, some of which is found in saliva, and a small amount is also secreted in the stomach. Fat stays in the stomach longer than carbs, and this is why including fat with a meal helps to satiate hunger, and it also helps to keep us feeling fuller for a longer period of time.

As the partially digested food (known as chyme) leaves the stomach, bile is added (from the gallbladder, by way of the common bile duct) in order to emulsify the fat (bile breaks it down into smaller particles so that it is easier for lipase to complete the digestive process of the triglycerides). The primary source of lipase is the pancreas, which injects lipase into the common bile duct, so that it is added to the chyme in the duodenum, along with the bile. After the fat is broken down to sufficiently small particles, it can be absorbed from the small intestine into the bloodstream. The bile is then reabsorbed in the terminal ileum, and recycled to replenish the body's cholesterol supply (which is used for making bile, vitamin D, and many other essential elements that are necessary for good health, including neurological benefits for the central nervous system and the brain). Bile can also be lost when it binds to soluble fiber, and the fiber will carry it on out of the body with stool. Most health authorities consider this to be a desirable process (because it lowers the body's available cholesterol supply), but personally I disagree with that convoluted logic, since cholesterol is a necessary feedstock used for so many vital body functions.

A "normal", healthy digestive system will typically absorb about 95 % of the dietary fat present in the chyme. The bottom line is that fat is not usually malabsorbed because of an inability of the small intestine to allow the absorption of fat, but rather because the fat is not properly digested. IMO, in the case of IBDs, this usually occurs because of a deficiency of lipase (because of inadequate lipase production by the pancreas), and/or because of gallbladder issues that interrupt the supply of bile. The reason for the inadequate lipase production can usually be traced to an inflamed pancreas. Remember that MC can and often does affect any part of the digestive system.

This may confuse your doc, because conventional medical wisdom says that MC does not affect the small intestine. He or she may incorrectly conclude that it is impossible for you to have a fat malabsorption problem, or if you actually have fat malabsorption, then you must have celiac disease. That viewpoint is totally incorrect, however.

Most of us have the problem, when we are reacting. It resolves as we heal. Tests to measure malabsorption levels are haphazard at best, because the interpretation of the results is based on a "normal" diet, and none of us eats what our doctor is likely to consider to be a "normal" diet.

IMO, anyone who has MC can safely assume that if they don't already have a malabsorption problem, they will have, if the disease goes untreated long enough. In your case, the problem will resolve, as healing progresses as a result of your diet changes.

Tex

[ldubois7]

Thanks for your wisdom, Tex.

I wonder, then, if I should have any blood work done for gall bladder/pancreas function? Would it matter?

I am g-f, e-f, d-f, s-f, and have eliminated the foods I reacted to most severely on the Enterolab tests (chicken, beef, oats, rice, & tuna), but still eat (several times a week) the foods I reacted to moderately (pork, & corn) because it's tough to find anything to eat, and I haven't gained any weight for 4 months. There was some re-activity to potato, cashew & walnuts, and it was easy to substitute other nuts for those, but I have had white potato twice a week.

Would you change anything I'm doing food wise? I'm still very fatigued, have joint aches, but don't have D as often as I used to.

[tex]

I wonder, then, if I should have any blood work done for gall bladder/pancreas function? Would it matter?

Many members have done that, and their doctors informed them that they had gallbladder problems/pancreatitis. Some have even attempted (to no avail) to treat those issues. In every case that I'm aware of (unless the patient prematurely agreed to surgical removal, in the case of gallbladder problems), those issues resolved automatically, as their digestive system healed in response to diet changes.

You may be sensitive to all nuts, not just the most common ones that are tested. I can't handle nuts of any kind, for example, but I can tolerate almond milk just fine, and there are other members here in that same boat. Remember that just because a food is not tested by EnteroLab, doesn't mean that it is safe for all of us.

You may just need more healing time, but your joint aches suggest that you may be reacting to certain foods. For example, foods in the Solanacea family (commonly known as nightshades) are well known to promote joint pain/stiffness. You might try sweet potatoes or manioc (tapioca) or some other starch substitute for white potatoes.

Even red potatoes might be safer than white potatoes, because the starch found in red potatoes is primarily amylopectin, rather than the amylose starch that is primarily found in russets and similar varieties of white potatoes. Amylopectin is soluble in water, but amylose is not. Amylopection is easier to digest than amylose starch. That's why most members find rice easy to digest. Most rice is about 80 % amylopectin, 20 % amylose. Waxy rice is only about 2 % amylose.

Besides red potatoes, there are other types of waxy potatoes, including Carlingford, Nadine, Round White, Round Red, Yellow Potato, Salad Potato, La Soda, Red La Rouge, Red Pontiac, Red Nordland, Red Bliss, Yellow Finnish, Ruby Crescent, and Australian Crescent. Waxy potatoes aren't good for deep-frying, but they're good for using in soups, casseroles, and potato salads, and they work pretty well for baking/roasting. Russets, for example, are at the opposite extreme (they contain mostly amylose starch), and they're known as mealy potatoes. Russets make good mashed potatoes, because they fall apart when boiled (but their starch is more difficult to digest than the starch in waxy potatoes). Waxy potatoes don't tend to fall apart when boiled, so they're not particularly good for making mashed potatoes.

And that's my 2 cents worth on potato starch.

Tex

[ldubois7]

Maybe all nuts are my issue. I've been soaking & dehydrating macadamia & filberts & pecans, as they suggested at Enterolab. Maybe it's coconut as that's the milk I drink & use for a treat.
I'm running out of options for foods because I had reactions to rice & oats.....

Am I correct in assuming that I need to gradually eliminate all 11 foods that I reacted to on the lab test?

Sometimes I don't know if I'm doing the right things.

[tex]

I don't recall if anyone else is sensitive to coconut milk. That's not a common problem.

What was your overall score on all 11 foods? If it was significantly above 10, then everything except for the "least reactive" category is highly suspect.

Please don't feel like the Lone Ranger — we all have to make "guesstimations" and hope that we're on the right track until we're able to get some sort of confirmation that we're making the best choices.

Tex

[ldubois7]

Tex,

My overall score was 30 units for the 11 foods. Is that considered significantly above 10? I did cut out everything except the least reactive foods, about 5 weeks ago. I will try waxy potatoes twice a week.
I still feel I'm doing things haphazardly because just when I think I have the answers, I don't see the healing happening as I think I should.

I am very strict with the foods I consume right now, and I guess I just need to give it more time for healing.

Any other suggestions or insights would be greatly appreciated.

[tex]

Whoa! I believe that's the highest result I've ever seen on that test. You must have double DQ genes, to have that level of sensitivity. No wonder that improvement is elusive.

I still feel I'm doing things haphazardly because just when I think I have the answers, I don't see the healing happening as I think I should.

We all feel that way at various times during our recovery.

Did you order the gene test? Most people who have double DQ genes have more sensitivities and a higher level of sensitivity than the rest of us. That isn't an iron clad rule, but it's reasonably reliable, for most of us. IOW, if you have double DQ genes, it will probably take longer to reach remission, and tracking down problem foods may require more detective work. Double DQ1 seems to be the worst combination, based on our accumulated records.

Tex

[ldubois7]

I did not have the gene test done. I was starting with panels A & C, then thought I'd do more depending on what they showed.
Would it benefit me to do the gene test, or fat malabsorption testing?

So, do you think that I should try the MRT testing to pinpoint more sensitivities, given my issues?

Thank you.

[JFR]

Whoa! I believe that's the highest result I've ever seen on that test. You must have double DQ genes, to have that level of sensitivity. No wonder that improvement is elusive.

My result for the 11 foods was 38, so Linda is not alone. I have eliminated all but the least reactive and it seems to be working if I combine it with low histamine. I still have some isues, more c than d, but also some pain and bloat type issues thst I think may be related to what I was told several years ago was pelvic floor dysfunction. Who knows? I stick to my restricted diet and try to remain patient.Certainly compared to a year ago things are much much better.

Jean

[tex]

I did not have the gene test done. I was starting with panels A & C, then thought I'd do more depending on what they showed.
Would it benefit me to do the gene test, or fat malabsorption testing?

It depends on whether or not you feel a need for verification of what you believe is probably true. Some of us (myself included) like to see laboratory evidence on which to base our decisions, but such tests aren't essential to our treatment and recovery. If you have any kids, the gene test results can give you an idea of what their odds might be of developing similar issues in the future, for example. And if you have a significant fat malabsorption score, that raises the prospect of celiac disease, or it at least indicates a more significant damage level to your digestive system.

So, do you think that I should try the MRT testing to pinpoint more sensitivities, given my issues?

Thank you.

I was going to suggest that you might want to consider mediator release testing, because it can be very useful for pinpointing less common sensitivities. But remember that the foods that are listed as "green" still require careful testing to insure that they are actually safe, because the MRT often misses major problems such as wheat, barley, rye, casein, etc. IOW, the EnteroLab test results trump the MRT results, whenever there is a conflict.

You're very welcome,
Tex

[tex]

Jean,

What can I say? Sometimes my memory leaves a lot to be desired.

Tex

[JFR]

Jean,

What can I say? Sometimes my memory leaves a lot to be desired.

Tex

And here I thought you were perfect Tex

Jean

[ldubois7]

Haha, Tex & Jean!

Well, this gives me a lot to think about.

I appreciate the help!

[ldubois7]

One more question....do I want the IgG or IgE MRT testing done?

What are the benefits/drawbacks?

Thank you!