QUESTION: What are some clinical pearls for patients with fecal fat malabsorption?
ANSWER: When I see this I immediately support with enzymes and bile salts. Additionally, I think that when there are undigested fats in the stool there is incompetent bile formation or chemical composition. That can happen in subclinical cholestasis as well as in very toxic people and for other reasons. Oral doses of PTC, Spanish Black Radish and either whole beet juice (with the tops) or Betafood / Betaplex are a good start. Also if there is an inflammatory component we will use IV or Oral Glycyrrhizin. Eventually if the bile formation is chemically and quantity corrected the fat malabsorption should go away. It can take a while, especially in toxic folks.