If you talk to your doctor or explore online discussions about this, you will encounter talk of malabsorption (i.e., inadequate digestive breakdown of various components of diet), pancreatic insufficiency (e.g., inadequate production of pancreatic digestive enzymes due to prior pancreatitis), lactose or fructose intolerance, or excessive consumption of sugars and/or carbohydrates that increase gas content of stools.
But an extremely common and important cause is rarely mentioned: small intestinal bacterial overgrowth, or SIBO. Recall that SIBO is an unhealthy condition in which bowel microorganisms have ascended up from the colon where they are normally confined and colonize the ileum, jejunum, duodenum, and stomach, a 30-foot infection. The organisms that characterize SIBO are mostly undesirable Enterobacteriaecea species such as E. coli and Campylobacter. Among the consequences of this are increased intestinal permeability and thereby appearance of new food intolerances, increased lipopolysaccharide entry into the bloodstream that potently triggers body-wide inflammation (e.g., fibromyalgia, autoimmune diseases), as well as intestinal symptoms such as bloating, excessive gas, and diarrhea.
But another effect of SIBO organisms is interference with bile acids. Bile acids are produced by the liver, stored in the gallbladder, then released upon consumption of fats in the diet under direction of the hormone cholecystokinin, or CCK. (CCK is blocked by wheat germ agglutinin in wheat, rye, barley, and rice, by the way, another cause of fat malabsorption, ineffective digestion, and SIBO.) Various bacterial species “deconjugate” bile acids, i.e., break them down and prevent normal reabsorption in the ileum. This means that fats are not efficiently digested and bile acid breakdown products can be visible in the stools (sometimes visible as green discoloration).
Because oils and fats are lighter than water, undigested fats in the stools can cause them to float, just as oil rises to the top when you mix oil and vinegar to pour on a salad. In addition to stools that float, you can also see other signs of fat malabsorption such as:
- Fat droplets floating in the water
- A rim of oil around the edge of the toilet water
- If not corrected over a long period, signs of fat soluble nutrient deficiencies such as vitamins A, D, E, and K1/K2.
Fat malabsorption is among the several telltale signs of SIBO along with intolerance to prebiotic fibers (gas, bloating, diarrhea, especially within 60 minutes of consuming them), unexplained skin rashes, new food intolerances, irritable bowel syndrome symptoms, fibromyalgia, psoriasis, restless or aching legs, struggles with sleep and mood.
And SIBO is surprisingly common. In my conversations with people, a day does not go by that someone doesn’t describe how their bloating, gas, diarrhea, and muscle/joint aches is unexplained by numerous doctors, or how their child can’t eat legumes or fruit without days of abdominal distress and diarrhea—it’s everywhere.
Once you suspect that you have SIBO, there is a logical and ordered way to deal with and manage it, including terribly common recurrences. If you’d like a deeper dive into how you can manage SIBO on your own and not subject yourself to the pooh-poohing comments of the doctor who doesn’t know what SIBO is, then consider joining our frequent conversations on SIBO in our Undoctored Inner Circle.