You may have fat malabsorption… and not know it
Fat malabsoprtion, also called steatorrhea or fat maldigestion, is the inability to properly digest fats. Many people experience fat malabsorption without knowing it! Fat malabsorption contributes to common issues like hormone imbalance and is the primary cause of gallstones and gallbladder pain.
I wrote this post to explain the role of fat digestion and gallbladder health. You’ll learn if fat malabsorption is contributing to your health issues and learn how to address it.
What causes fat malabsorption?
Fat malabsorption results from poor digestion and specifically from one or more of these three causes:
- Liver congestion – the liver can’t synthesize good bile
- Poor quality bile – the gallbladder can’t release thick, sticky bile
- Lack of pancreatic enzymes – these enzymes, along with bile, digest fat
Here’s how fat digestion works, if everything is working properly:
- The liver synthesizes bile. It packages up old hormones and toxins that need to leave the body in the bile. Then it ships the bile to the gallbladder.
- The gallbladder stores bile and secretes it into the small intestine when we eat a meal with fat. The bile breaks down the fat, so we can absorb it, and then the toxins in the bile exit the body with the feces.
- The pancreas secretes digestive enzymes into the small intestine. Some of these enzymes, called lipolytic enzymes, further break down the fat and allow us to absorb it.
Symptoms of fat malabsorption:
- Greasy, smelly, light-colored and/or floating stools
- Gas and belching after meals
- Very dry skin (indicates fat isn’t being absorbed or not enough is being consumed)
- Gallbladder pain (right side, under ribs)
- Gallstones
- Nausea after eating
- Hormone imbalances, because fat is necessary to synthesize new hormones and eliminate old hormones
Bile: The key in fat malabsorption
When it comes to fat malabsorption, the first step includes supporting healthy bile production and secretion. When we experience fat malabsorption, it means that the bile in the gallbladder is thick and sticky. The gallbladder tries to squeeze it out, but it can’t. In a vicious cycle, toxins and old hormones are re-absorbed because the bile isn’t leaving the body.
The main factor that causes poor bile quality is a low fat diet. The presence of fats in a meal signals the gallbladder to release bile into the digestive tract, and the bile emulsifies the fat so we can absorb it.
What happens when we only have a few measly grams of fats in our meal? Bile release isn’t signaled, so bile sits in the gallbladder, turning thick and viscous. Then, if we do eat a meal heavy in fat, the gallbladder can’t squeeze out the thick bile and the fat passes through our digestive tract undigested and unused for critical tasks in the body.
Are you ready to improve your fat digestion? Here are 8 ways to correct fat malabsorption
1. Gradually increase the good fats
Quickly switching from low fat to a higher fat diet will temporarily cause fat malabsoprtion. This results because the bile will be thick and stagnant due to the low fat diet. For some individuals, the symptoms are slight and resolve quickly. For others, this transition causes severe symptoms of fat malabsorption.
Don’t go from 20 grams of fat per day to 80 grams of fat the next day. Gradually increase your consumption of healthy fats over a period of weeks. Healthful fats include traditional, unprocessed fats such as:
- Butter, preferably from grassfed cows
- Ghee, preferably from grassfed cows (I like this brand)
- Pure olive oil (I like this brand)
- Avocados and avocado oil
- Whole nuts and seeds, in moderation
- Cold-pressed nut and seeds, in small amounts
- Pastured whole eggs
- Meats and whole-fat dairy from grass-fed, pasture raised animals
Highly processed, non-traditional fats such as canola oil, soybean oil, safflower oil, cottonseed oil, peanut oil and grapeseed oil exacerbate liver congestion and should be avoided.
Wait, isn’t canola oil heart healthy? And doesn’t the cholesterol in butter clog arteries? Nope, you’ve got your fats mixed up! We know from study after study, as well as the dietary patterns of traditional cultures, that unprocessed fats support all aspects of health. I share the science in my post 10 Reasons Why Low Fat is Not High Nutrition.
2. Include coconut oil in your diet
Coconut oil, one of the most healthful foods ever, consists primarily of medium chain fatty acids. Coconut oil fights candida, boosts the metabolism, fuels weight loss, and supports skin health. Because of the fatty acid composition, coconut oil is absorbed without bile.
This is a good and bad thing. If you struggle with fat malabsorption, you will likely be able to absorb at least some of the fat from coconut oil. But because it doesn’t stimulate bile, you should consume it in addition to sources of animal fats.
3. Supplement with ox bile to improve fat malabsorption
Ox bile is what the name implies – bile from oxen. Because it is so similar to human bile, it works by breaking down fats in your digestive tract. As a “band-aidsupplement,” it improves bile quality so you can digest fats better in the long run.
Take 1-5 tablets of ox bile – I recommend this one – with each meal. Use it for 2 weeks and up to 2-3 months. After 2-3 months, take a break from it for at least a couple of months, otherwise your body can get reliant on it and stop producing its own bile.
If you have had your gallbladder removed, then you need a permanent bile replacement to digest your fats. In that case, most natural health practitioners recommend taking ox bile with each meal.
4. Say Goodbye to “Healthy Whole Grains”
When we lack an healthy digestive system, as in the case of fat malabsorption, grain consumption causes problems. “Healthy whole grains” like fiber cereals, whole wheat breads and pastas contain numerous anti-nutrients such as phytic acid that only stresses the body.
Grains fuel a vicious cycle called carbohydrate malabsorption. This wears down the filaments in the small intestine, called microvilli, that are responsible for absorbing our food. As the microvilli become damaged, it leads to a syndrome called Leaky Gut when the tight junctions between intestinal cells loosen. This allows undigested food to leak from the small intestine into the blood stream, causing inflammation and food allergies.
All of the recipes on Empowered Sustenance are grain free, and you’ll find thousands of more grain free recipes on my Pinterest boards.
5. Eat mindfully and calmly
It seems like common sense, but your body cannot digest any macronutrient – fat, carbs or proteins – well when it is stressed. Digestive juices, including stomach acid and bile, are secreted when the body is in parasympathetic nervous system mode. The parasympathetic mode is the opposite of the “fight-or-flight” sympathetic mode.
Sit down for meals. Focus on chewing and tasting your food. Eat with gratitude. Put down your phone and turn off the TV. Your body will thank you for it, and you’ll digest your fats better!
6. Enjoy fermented foods to help fat malabsorption
Naturally fermented foods pack a potent dose of probiotics, those friendly bugs that help restore balance in the digestive tract. Additionally, the enzymatic activity in the raw foods drastically increases during the fermentation process. These active enzymes support pancreatic health and improve digestion.
Low-fat, sugar-laden yogurts may claim “a rich source of probiotics” but don’t buy into this marketing hype. These highly-processed options pale in comparison to slowly fermented dairy and vegetables. Better options include making your own fermented veggies and dairy products.
Alternatively, you’ll find healthful options at your health food store. Look for naturally fermented sauerkraut and pickles, in the refrigerated section. Grassfed, full-fat yogurt and kefir also provide nutrient-dense options.
7. Supplement with pancrealipase for fat malabsorption
Pancrealipase is a pancreatic enzyme that helps digest fat. I use the supplement Beta-TCP, found here, in my Nutritional Therapy practice. It contains porcine-derived pancrealipase and this supplement makes a wonderful “transition supplement” to improve fat malabsorption. It can be taken alone or in conjunction with ox bile.
A general recommendation is 1-6 tablets with each meal, for a period of 1-3 months. After 2-3 months, take a break because your body can become reliant on the enzymes and get lazy with its own enzyme production. You can also take 1-6 tablets right before bed, to support liver health. As always, I recommend working with an experienced health practitioner when taking various dietary supplements.
For best results, chew the Beta-TCP tablets instead of swallowing them whole. They taste, um, not so good. But you can do it! When I used this supplement, I would chew them while holding my breath, swallow, chase with a sip of water, and then breathe. This helps 🙂
8. Improve overall digestion with hydrochloric acid
The stomach is supposed to be an acid tank. A very acidic stomach digests food and triggers the chain reaction of digestion. When the stomach isn’t producing enough acid, pancreatic enzymes and other digestive secretions are not signaled.
Doesn’t stomach acid cause heartburn? No. As a matter of fact, 90% of people with heartburn suffer from too little stomach acid. In this post, I explain how to correct low stomach acid naturally with foods and specific supplements including hydrochloric acid supplements.
Do you think you may have fat malabsorption? Have you tried any of these steps?
I have had Bile Acid Diarrhea for 17 years since gallbladder removal, mainly before 4:00 pm during the day.(strange) Last year I got Sibo, and began having bile acid diarrhea through the rest of the day. I have lost 30 pounds that I didn’t need to lose. I have had good luck using Propolis pills and Apple pectin for the diarrhea. I have tried Ox Bile because I am concerned about not absorbing fats, but those seem to exacerbate diarrhea, even in small amounts. I have many symptoms of fat malabsorption including dry skin and eyes, muscle wasting and constant right sided pain. All other serious issues were ruled out with endoscopy/ colonoscopy. I supplement with A, D,E, K2, MCT oil and eat Paleo. I’m trying to gain weight and find relief from abdominal pain/ muscle problems. Any advice would be welcome. I did experiment with ox bile for three months without improvement and saw worsening diarrhea. Very frustrating! Should binding the bile or absorbing fats be the primary goal. I did use HCL for three months up to 2500 mg per meal, and have definitely re-acidified my stomach. I now don’t need any at meals as they cause burning, as do digestive enzymes that I had been using. I always have frequent belching 30 minutes after eating and right upper shoulder and abdominal pain. I did retest negative for Sibo three months prior.
Have you tried whole food plant based? Abundance of fruits and vegetables.. tons of nutrients, vitamins, water and fiber! Nothing processed.. and I only had to Supplement the first 6 months or so. Also take a vitamin/nutrient panel. I was severely deficient in D and B vitamins. Hope this helps!
Thanks for the suggestions. My Vitamin D level was 95 and B 12 was 700, folate was overly high. I had a recent CT scan showing calcium deposits in heart valves, feeling very scared about that. Being Paleo, I do consume alot of meat, but also lots of veggies. I dont eat any processed foods. I cook everything fresh. I dont eat dairy, nor do I take Calcium supplements. The only negative I have on labs has been a steadily declining Alkaline Phosphatase. Dr. Said was not a concern, but went from 50 last year to 40, 36, 34, and most recently 28. Not sure where to go from here, still getting tons of muscle and rib pain.
Hi Melissa, if you have fat to spare, look into prolonged fasting (consult your doctor first, start slow).. Abandon Paleo and look into Keto diets (if you’re able to cut Carbs). It’s a complex issue you won’t find direct answers here.
If you have Calcium deposits in soft tissue (heart valves), then you may have a deficiency of Vitamin K2. As I understand it, K2 is sort of the “traffic cop” for calcium, directing it away from soft tissue and into bones & teeth. Look it up.
Yes, thank you. I have been taking 180 mcg K2 daily for over a year. I think that maybe I am not able to keep the good fat in my body because of BAM, so very frustrating. They recently found a mildly elevated PTH, with higher end of normal calcium. The doctor will only do a watchful waiting approach. Does anyone feel that supplementing and getting D to a high level might possibly have been a parathyroid trigger? I can only find inverse info about low vitamin d triggering an elevated parathyroid. Parathyroid and elevated calcium seems like it could explain ongoing muscle and bone pain, even digestive issues. Doctor will not order scans unless calcium is over 10, mine is always 9.6 to 9.8.
Hi Melissa, my heart goes out to you. 1) ox bile is not a good idea because that’s more bile acid that your small intestine has to aborb….which it cannot. It might be better to take pancreatic enzymes for fat absorption. 2) you need to heal you small intestine especially your terminal ileum so that you can reabsorb the bile acid before it dumps into the colon. 3) while in the healing process, yes you will need soft carbs such as white rice, etc, but no whole grains. Also small amounts of fat (coconut, olive, avocado).
3) You still need plenty of soluble fiber and some insoluble fiber to slow the digestive process down, but as speed it up if needed. (BTW, your body can make fat from carbs.) Heather’s tummy fiber is a good option.. follow directions carefully, it will absorb the acid. Also reduce or avoid bile stimulants such as ginger, etc. even too much HCL acid stimulates the gall bladder! This will take a long time. Paleo can be good but not when you are not ready! God bless! Hope this helps
Thank you Pat, I am ordering the fiber, reviews looked great!!
The muscle and joint pain could be from low vitamin D and yes low vitamin D can trigger elevated PTH. The reason your calcium is not low but your vitamin D is, is due to calcium is not fat soluble and vitamin D is and when you have fat malabsorption you will be deficient in fat soluble vitamins but your water soluble vitamins may be in range. If your doctor is taking the standard american healthcare approach with watchful waiting then get rid of your doctor. True professionals don’t delay diagnosis and treatment by sitting back and doing nothing (watchful waiting) while the patient is suffering. True professionals do what’s in the best interest of the patient
It’s been a while since you posted this, but in case you’re still suffering: please have your Dr. check for hyperparathyroidism. A CT scan of your neck should confirm what your blood work is showing. Levels of both PTH and calcium fluctuate, so a “wait and see” approach is irresponsible and outdated if you have calcium deposits in your heart valves. You’re at a higher risk for heart attack. I know, because I was misdiagnosed in 2016 as having “low vit D” when hypercalcemia showed up and ended up in the hospital with heart attack symptoms in 2018. I had a parathyroidectomy in 2019 and my bone pain & anxiety were gone when I woke from the surgery. It’s now 2020 and my blood work remains normal. If your Dr. won’t take this condition seriously, please find a new doctor. There is no alternative or nutritive cure for this condition…believe me, I scoured the internet looking. Surgery is the only fix for it.
I have had similar issues and another friend lost tons of weight for most of his life and had fought to keep weight on. There is a product that makes FRESH probiotics in the milk carton and you just pour in a starter and shake the milk, put the sleeve over the milk and let it cook the yogurt for 8 hours or so. It isn’t all that expensive and is SUPER easy to make. I shared about it on my blog: thesecretisgratitude and youtube channel with the same name because it was so easy to use. At first, I could only take 1/2 a cup in the morning and at night due to not being able to digest dairy all that well. My friend I shared about, hadn’t eaten dairy in many years and now takes the probiotic yogurt he makes and can actually eat dairy now. The product is called EZyogurtmaker. Best of luck with your health issues and I hope you have a blessed day!
Ox Bile and Pancrelipase enzymes may help you in a small extent. You need to restrict Fat intake to reduce the BAM symptoms, and slowly infuse your system with Good Fat like MCT OIl, Olive Oil, Avocado Oil. Never use HCL for acidifying your stomach. This will do more harm than good. Good idea for supplementing with Vit. A,D,E and K2. Use Olive OIl with MCT oil to strengthen your heart , LIver and Gall Bladder. Use Pomegranates for providing with good Antioxidants.
You will recover slowly.
I have definitely attempted to slowly introduce good fat only, but it literally runs right through me. I have a very rapid intestinal transit. If I eat a ton of fiber and charcoal I can make it to 10 hours, with a ton of pain and bloating. On a normal basis I get gurgling and diarrhea within 20 minutes of food consumption. I test the transit time with the charcoal or corn myself(sorry tmi) Thanks for all your thoughts.
I fully sympathise with you. People don’t realise how debilitating this is unless you have experienced the embarrassment and humiliation that goes with these symptoms. I had the same for 30 years – tried every diet and and every therapy known to mankind. Wasted a truck load of money. I was reading about Questran (cholestyramine) and asked my doctor if i could try it. She said she couldn’t prescribe it without doing a 24 hour stool analysis. I begged and pleaded and pointed out that I could only just get to the toilet on time never mind try collecting anything! Eventually she gave me a script and it was life changing for me. Worth investigating if you haven’t already. 🙂
I have been on that medication for about two weeks, and it has caused me problems. I was prescribed it for BAM, it has caused me horrible acid reflux/heartburn, and created a painful diarrhea and vomiting situation the other day. So I am going to discontinue it. I am reading a lot on this page But having a hard time understanding it all as it’s new to me and overwhelming. I am trying to find a nutritionist or dietitian in the New York area to help me but I can’t seem to find one. I’m looking into digestive enzymes for this BAM situation. (half of my colon was removed a year and a half ago due to repeated ischemic colitis attacks. I suspect that this might’ve been caused by BAM which I wasn’t Diagnosed with until two weeks ago.)
I am lactose intolerant and have fat absorption (from a stomach operation). I have terrible diarrhoea and gas. I find it hard to keep on weight. The only way I function is to take Gastro Stop every second day. I take creon with meals (2 with a lactose free biscuit – 6 with normal meals). I take a good probiotic. I watch my diet carefully. I do not drink fruit juices or softdrink. I follow a lactose free diet. Do not have spicy foods. Can you help?
Can you eat too much fat , I eat grass fed dairy, cheese, milk , cream & avocado but when I added a small amount of coconut oil and a small amount of fish oil I got terrible bowel issues like I wasn’t digesting fats . I have trouble digesting grains except oat porridge . I eat fresh vege, but fruit in moderation, I do eat ferment ed foods like yogurt, sauerkraut, occasionally kefir. Kombucha upsets my stomach.
Hi Linda, I have same problems, would like some help too?
I am delighted to find your web site. For 8 years I have had pseudomonas in my right lung. Have taken numerous rounds of Cipro and was on a regiment of taking Azromycin 3 times a week to help keep anything else at bay. A month ago I stopped taking that. Haven’t had Cipro since October. Am on Dr. Grundy’s Plant Paradox Diet hoping that my body will rid itself of the bacteria in my lung and probably all thru me. Recently i have had more diarreah than I did when I first started the Diet. I only weigh 79 pounds (have dropped about 4 lbs from when I was before starting the diet). I will get the pancrealipase to take, also I take green papaya caps, and probiotics am and pm. Thank you so much for sharing this information and I am most appreciative. Carol
I had loose stool, skin issues, ear infections, poor fat absorption for about a decade. My poop was a pity. It started getting worse. I went to a western med doc, what a complete joke. I went to a homeopathic doc, did a candida cleanse, went on bile acids, went on digestive enzymes. They worked kind of. I tried a couple candida cleanses, with appropriate diet, did the whole exclusion diet. Nothing really worked till I started eating sauerkraut. I make my own kraut now with purple cabbage. Its super easy and really makes a lot of meals taste better. I also drank a couple gallons of fresh cabbage juice over a month or so. It can kill off bad bacteria because it has a natural sulfur and chlorine in it. Anyway, my digestive system is fantastic now and I straight up give credit to sauerkraut. It worked in about a month and a half. I had a colonoscopy and endoscopy planned to see if I had some crazy stuff going on, but as the appointments got nearer my digestion got better. I went ahead with the procedure anyway, and everything looked good. What a relief that was. God bless the purple kraut!! MAKE YOUR OWN RED CABBAGE SAUERKRAUT!!!!!! LOTS OF BAD TO BONE PROBIOTICS THAT OVER THE COUNTER PROBIOTICS CANT REPLICATE!! let food be your medicine
I cant say enough. Sauerkraut and cabbage in general has L-Glutamine in it, a bad ass amino acid (protein) healer of the stomach and intestinal lining. It can cure leaky gut and kill the H. pylori. My poo at times was a foamy mess of non digested food. Steatorrhea was my usual symptom. Sauerkraut changed my life.
Also, i drink a lot of homemade bone broth. Pressure cooker, bones, water, love.
If I just want to make cabbage juice, how much did you dink daily? Did you add pink salt? Thx
How do you know cabbage is the healer if you do the bone broth? That stuff is disgusting. Thx
My symptoms started at the age of 47. My fingers on my left hand were stiff and were difficult to move. People noticed that my walk was not normal. I was often asked did I hurt. I noticed nothing different about my walk. It was difficult getting up from` a chair and getting out of a car. I was diagnosed a year later ,it was the onset of tremors starting in my right hand that caused my other symptoms to be recognized as Parkinson’s.. I am now 59. With the new herbal medicine i purchase from totalcureherbsfoundation .c om was my only way to get rid of my PD,the herbal formula effectively reverse my condition and alleviate all my symptoms.
I had by gallbladder out in 2001 and by 2002 I started having symptoms. Have nearly every GI and lab test under the sun and really nothing showed up. After reading this article, I’m again thinking BAM, but when my GI doc tried me on Colestipol, I had a terrible allergic reaction. So I’m gun shy over taking any other bile acid binders. BUT, you mentioned ox bile- and that shouldn’t cause me any problem. I’m seeing my doc again soon, and will see if she can also try me on some pancreatic enzymes first, and if that works, great, if not, I’ll try the ox bile. Fingers crossed one of these gives me relief! Being a farmer and artisan cheesemaker, I’m always on the go, and hate having to run like a mad woman to the bathroom because my guts are angry at me.