Stacie,

I would suggest eliminating the nuts.  Nuts are high in omega 6s, as
jeanclaude mentioned, and harder to digest than pure fats.  There are
constituents in nuts that can cause or aggravate skin problems for many
people.  I really think it's the nuts that are the major problem.

If she is truly fat intolerant or has a fat digestion problem she would
typically have symptoms such as gas, bloating, food stagnation, and feeling
terrible after eating a high fat meal, such as a meal with pork sausage, and
she would have fat in her stools and clay colored stools.  If this is the
case, artichoke extract (sold in capsules in health food stores) can help.
The use of this herb is backed by clinical reserach.  I know of people
who've used it with great success.

It's possible that part of the problem is an omega-3 deficiency and omega-6
excess.  Eating more wild salmon would be good.  I'd also suggest giving her
2 teaspoons per day of Carlsons' Lemon Cod Liver Oil.  It's the most
palatable and highest quality I've found and tried; it does not smell or
taste fishy.  Be sure to keep it in the refrigerator AND fill the bottle
with filtered water as you use it, to prevent oxidation.  (The water will
displace air in the bottle).

It would be preferable to use a less processed meat and fats than are found
in pork sausage.  You can season ground beef, lamb, turkey, or chicken to
taste similar to sausage.   You might also consider cooking up steaks,
burgers, or lamb for breakfast, or leftover chicken or turkey.  If you buy
sausage, you might want to buy hormone and antiobiotic-free beef sausage,
which contains fewer PUFAs than pork sausage.

You might look for a source for grass fed beef, lamb, and pork in your area.
It may not cost much more (maybe 5 to 10% more) than you currently spend on
meat, particularly if you buy a 1/2 side of beef or a whole lamb, in which
case you can also get a lot of good bones.  If you cannot get grass fed, I'd
get hormone and antibiotic-free, preferably free-range.

The diet you've described that Zoe eats is not rich in zinc.  Zinc
deficiency can cause or contribute to many different skin problems, from
rashes to eczema to psoriasis, to acne.  You might want to give her a zinc
supplement as well.

I would not hesitate to use coconut milk or unrefined coconut butter.  I've
never heard of anyone having trouble digesting it.   In fact, coconut oil
derivitives are used in hospitals for tube feeding  of people who have fat
intolerance, because bile is not required for digesting and assimilating the
short and medium chain saturated fats that are the principle components of
coconut milk and fat.  Omega Nutrition makes an excellent coconut butter.  I
would not use Spectrum, which is refined, and says so right on the label.

I don't think an allergy elimination diet, rice feeding, etc., is necessary.

Good luck,

Rachel