<<Disclaimer: Verify this information before applying it to your situation.>> This is a quote from a Journal called Malabsorption and Nutritional Status and Support in an article entitled, "Dietary Therapy of Steatorrhea", "Steatorrhea is the presence of excess fat in the feces. [Do you get thick or spongish stools, etc.?] Weight loss is one of the symptoms commonly associated with steatorrhea. Depending on the cause of the malabsorption, it occurs in 50 to 100 percent of patients. The weight loss occurs because of a loss of nutrients and energy.... Diarrhea is the other major symptom associated with steatorrhea. It is present in 80-97 percent of patients with malabsorption. Diarrhea may be totally absent, however, even in the presence of severe steatorrhea. This is a rare occurrence, but one should keep it in mind. The type of diarrhea is often the first hint of steatorrhea. The patient may only state that there is an increased number of bowel movements, but may complain of large, pasty, malodorous stools that may float or be foamy in the toilet bowl." "Other symptoms due to vitamin deficiencies may be associated with long-standing steatorrhea. Osteomalacia related to calcium and vitamin D deficiency or anemia as a result of slective iron or B12 deficiencies is often associated with the malabsorption that occurs with steatorrhea." "All causes of steatorrhea can be classified into one of the following categories: (1) defects of gastric function due to altered anatomy or altered function of the stomach: (2)) defects of digestion due to biliary or helpatic deficiencies or to pancreatic secretory deficiencies: (3) defects of intestinal absorption due to primary mucosal disease...: and (4) systemic diseases that secondarily affect gastrointestinal function may cause steatorrhea." "Low-fat diets are part of accepted dietary managment for treatment of some steatorrhea conditions. High-fat diets are associated with losses of fluid, electrolytes, divalent cations [magnesium, manganese, calcium, etc.], and bile acids. Deconjugation of bile acids in the colon results in net water and sodium secretion. Steatorrhea of any etiology diminishes with decreased triglyceride intake, as does diarrhea partly caused by hydroxy fatty-acid formation in the colon. As fat calories are reduced, carbohydrate calories become the predominant energy source. Simple carbohydrates [i.e., short chain sugars such as galactose, glucose fructiose , lactose, maltose, sucrose, etc.] may induce diarrhea on an osmotic basis: therefore, special care should be given to incorporate more complex carbohydrate into the diet." [starches, etc.] "Patients with chronic steatorrhea are at high risk for the development of protein-calorie malnutrition and vitamin and mineral deficiencies." Disorders characterized by increased loss of cells or secretions, or decreased efficiciency of digestion or absorption will have increased protein losses. Such additional losses above the normal can range from 4 to 40g per day. ...Fat-soluble vitamins, folic acid, and vitamin B12 deficiency occur. Other water-soluble vitamin-deficiency states are rarely associated with malabsorption. Divalent cation status can be adversely altered by fatty-acid saponification. Calcium status can be further worsened by inadequate vitamin D absorption. Massive fluid and electrolyte losses can result in significatn imbalances that require correction. All of these potential deficiencies must be considered when a support plan is adopted." "The first approach to an oral regimen is to include higher protein and calorically dense foods while eliminating "'empty-calorie'" foods that provide only satiety. "An oral diet may be used as the main source of nutrition or in combination with tube feedings or parenteral nutrition. In many cases, it is advisable to incorporate even a small protion of enteral nutrients to stimulate intestinal growth and brush-border enzyme activity." "Steatorrhea can result in hyperoxaluria. Free oxalate binds iwth sodium, forming a salt, and is thus absorbed in the colon. This is because calcium is swquestered by unabsorbed fatty acids. Normally, oxalate complexes with calcium, and the salt is not absorbed." "A low-oxalante diet is often ineffective because only about 10 percent of body oxalate is derived from the diet. The oxalate content of food is available. Foods high in oxalate (more than 10 mg. per serving) are nuts, chocolate, green beans, green leafy vegetables, beets, celery, sweet potatoes, summer squahs strawberrikes, blueberries, and tangerines." "To minimize steatorrhea-induced formation of oxalate stones, general recommendations are a low-fat diet; increased calcium intake, often through supplementation; avoidance of excess ascorbic-acid supplementation: and a decreased dietary intake of oxalate." "When medium-chian triglycerides are the only form of fat administered, small amounts of long-chain triglyceride need to be provided to prevent essential-fatty-acid deficiency. This can be accomplished enterally with 1 to 3 percent of total calories as linolieic acid. Linoleic acid comprises approxiumately 70 percent of the fatty acids in safflower oil." "Medium-chain triglycerides may be of value in steatorrhea for several reasons: they are more readily hydrolyzed by pancreatic lipase (the need for pancreatic lipase may be obviated because partially soluble medium-chain triglycerides can appose the mucosal surface and undergo mucosal lipase hydrolysis): they do not require bile-acid micelle formation for absorption: and, finally, the hydrolysis products are absorbed directly into the portal vien instead of into the lymphatics. Medium-chain fatty acids decrease lipid and protein losses. Medium-chain fatty acids are oxidized rapidly in the liver. It is felt that medium-chain triglycerides can be used as a source of high concentrate Pls. note that none of the above substitutes for the advice given by your doctor. Good health! 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