Fecal fat refers to the amount of undigested fat present in your stool. While a small amount of fat in stool is normal, elevated levels can indicate an issue with how your body digests and absorbs fats. This condition is known as steatorrhea. Your digestive system uses enzymes and bile to process fats, allowing them to be absorbed by your intestines and utilized by the body.
Symptoms of Elevated Fecal Fat
When fecal fat levels are elevated, several observable changes in stool characteristics. Stools may appear pale, bulky, greasy, and unusually foul-smelling. They might also float in the toilet and be difficult to flush.
People with elevated fecal fat often experience digestive discomfort. This can include frequent loose stools or diarrhea, abdominal pain, bloating, and gas. Unintentional weight loss can also be a symptom, due to inadequate nutrient absorption.
Common Causes of Elevated Fecal Fat
Elevated fecal fat results from impaired fat digestion or absorption, often due to issues with the pancreas, liver, or intestines. One common cause is pancreatic enzyme insufficiency, where the pancreas does not produce enough digestive enzymes, particularly lipase. Conditions such as chronic pancreatitis, cystic fibrosis, and pancreatic cancer can lead to this insufficiency.
Another factor is a deficiency in bile acids, which are produced by the liver and stored in the gallbladder. Bile is necessary for breaking down fats and aiding absorption. Liver diseases, bile duct obstructions (like gallstones or tumors), or changes after gallbladder removal can reduce bile flow, causing elevated fecal fat. Intestinal malabsorption disorders also interfere with the small intestine’s ability to absorb fats. Examples include celiac disease, Crohn’s disease, small intestinal bacterial overgrowth (SIBO), and short bowel syndrome. Certain medications, such as orlistat, a weight-loss drug that blocks fat absorption, can also increase fecal fat.
Understanding the Fecal Fat Test
To measure fecal fat, the 72-hour quantitative fecal fat test, also known as the Van de Kamer method, is a standard diagnostic tool. This test involves collecting all stool passed over a three-day period. Before and during the collection, individuals are asked to maintain a diet containing a specific amount of fat, often 100 grams daily for adults, to ensure accurate measurement of fat absorption.
During the collection period, stool samples are gathered in special containers, avoiding contamination. The collected samples are then analyzed in a laboratory to determine the total fat content. Normal results for this test show an excretion of 2 to 7 grams of fat over a 24-hour period, or up to 21 grams over 72 hours. Results higher than these ranges suggest fat malabsorption.
Approaches to Managing Elevated Fecal Fat
Managing elevated fecal fat depends on identifying and addressing the underlying cause. If the issue stems from dietary factors, modifications like reducing high-fat, processed, or deep-fried foods alleviates symptoms. Limiting alcohol intake may also be beneficial, especially for those with liver conditions.
For conditions causing malabsorption, medical interventions are necessary. Pancreatic enzyme replacement therapy (PERT) is a common treatment for exocrine pancreatic insufficiency, providing enzymes for fat digestion. Individuals with fat malabsorption may also require supplementation with fat-soluble vitamins (A, D, E, K), as these nutrients are not being absorbed properly. Treating specific conditions, such as using antibiotics for bacterial overgrowth or adhering to a gluten-free diet for celiac disease, addresses the root cause.