How Can Fat Malabsorption Despite Being On A Diet Free From Gluten And Milk Products Be Treated?

Posted on Wed, 21 Jun 2023

Question: I have been fat malabsorbing for the last five years. I have had a colonoscopy endoscopy,MRI, CT scan with nothing showing abnormal. I do not eat gluten or drink Milk products. I did a fecal fast test which determined I am absorbing at 19 g of fat per day. The gastroenterologist here in Canada have not been helpful. Please help!

Answered by Dr. Ramesh Kumar (35 minutes later)

Brief Answer:
External fat digesting enzyme supplementation.

Detailed Answer:

Hello,

Fat malabsorption results from poor digestion and specifically from one or more of these three causes-
Liver congestion – there is a problem with the synthesis of bile.Bile is secreted by the liver and help to break fat.

Poor quality bile – the gallbladder can't release thick, sticky bile. The amount of micelles in it is low.

Lack of pancreatic enzymes – these enzymes, along with bile, digest fat like pancreatin.

What can be done-
Enzyme supplementation can be done.
Request your gastroenterologist, to prescribe you with external bile salt supplementation.
Digestive enzyme containing papain lipase etc can be taken with each meal this would help in digestion of fat.

Ursodeoxycholic acid tablet should be taken. Helps to emulsify fat.

Take a small amount of fat every 3 hours to help your body tolerate it.

Hope this is helpful.

Follow-ups are welcome.

Regards,
Dr. Ramesh Kumar, Gastroenterologist

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ramesh Kumar (3 hours later)

Hi,

Thanks for the information.

I have taken enzyme supplementation and have tried bile salts. Both of which did not help stop the fat malabsorbing. Is there anything else that can cause fat malabsoprtion. Is it possible to have fat malabsorption with no underlying cause?

As I have stated previously, all the tests for an underlying cause of the syndrome came back negative. If you could please weigh on my certain condition.

Thanks,

XXXX

Answered by Dr. Ramesh Kumar (9 hours later)

Brief Answer:
Follow up.

Detailed Answer:

Hello,

There is a genetic defect in such individuals and hence they are genetically fat intolerant. It's very rare but it does occur.
All tests are negative and medicines are ineffective so the only thing which comes mind is genetically acquired syndrome.
The only test is the genetic DNA level analysis.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ramesh Kumar, Gastroenterologist

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Ramesh Kumar (9 hours later)

Hi,

Is there anything that can be done to improve the symptoms?

Also, where can I get this test done? Do I have to ask for the malabsorption syndrome test?

thanks

Answered by Dr. Ramesh Kumar (5 hours later)

Brief Answer:
Follow up.

Detailed Answer:

Hello,

To improve symptoms initially we have to be sure about the cause of the problem. Guesswork won't help.

Initially go for genetic testing at any quaternary centre hospital.
Yes, you need to tell the doctor that you want to get checked for this problem specifically.

Hope I have answered your query.

Regards,
Dr. Ramesh Kumar, Gastroenterologist

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Above answer was peer-reviewed by : Dr. Raju A.T