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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! Laura



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