Fat Malabsorption in Health Optimization

Summary

When plasma fatty acid levels fail to respond to supplementation with oils rich in essential fatty acids, fat malabsorption is indicated, even when the symptoms of essential fatty acid deficiency are not yet reported.

This content was created by the Metametrix Institute

History

This 64-year-old man had come seeking ways to maintain health, having no significant symptoms at the time of the visit. Because of low-normal linoleic acid and low DGLA, the patient was started on 1 Tbsp flax oil/d, 1 Tsp fish oil/d, and 1 capsule of evening primrose oil 3/week.

Age

64

Gender

Male

Description of Results

The first plasma fatty acid profile shows alpha linolenic acid at the low limit and significantly low levels of both GLA and DGLA. The patient was advised to start supplementing the diet with flax, fish, and borage oils.

Such a change in dietary fatty acid intake is expected to produce significant shifts of plasma levels to higher concentrations. Patients with normal absorption of dietary fat frequently show elevated levels of those fatty acids that are most abundant in the supplemented oils, and they may need moderation or cessation of supplementation. Omega-6 rich oils may raise arachidonic acid through desaturation and elongation metabolism.

The second plasma fatty acid profile was performed five months later. Only EPA is increased, while ALA and DHA have dropped. In addition, there is no significant alteration in the n-6 family. A most unusual feature is the Triene/Tetraene (T/T or Mead/Arachidonate) ratio that is at the high limit, even though mead acid is well under its limit.

In addition to the fat malabsorption, this man shows signs of functional zinc insufficiency. The LA/DGLA ratio that was at the high limit initially went above the limit after borage oil supplementation. The extra dietary LA and GLA failed to raise either those plasma levels or the AA level. This is clear evidence of desaturase inactivity that is most often due to inadequate zinc cofactor status. The desaturase failure to convert LA into AA gives the AA value that is near the LOW limit, and causes a T/T ratio increase, even though mead acid was in the normal range. T/T elevation signals chronic overall essential fatty acid deficiency.

The high level of 11-Eicosenoic acid is a sign of increased endogenous monounsaturate formation by desaturase activity on the saturated family. This process is antecedent to the formation of mead acid. Elevated 11-Eicosenoate with normal mead is another sign of zinc insufficiency concurrent with essential fatty acid deficiency. Metabolic stimulation of endogenous desaturation is not sufficiently active to carry the monounsaturated 11-Eicosenoate on to the polyunsaturated Mead acid.

Recommendations

Use aggressive zinc repletion and continue the dietary oil supplementation with efforts to stimulate fat absorption. Bile acid supplements may be used along with the oil doses. This is a simple protocol for replacement of normal bile flow.

Weekly 1/4 cup dosing away from meals and daily dietary use of olive oil can provide cholegogue effects to stimulate gall bladder contraction. These procedures can result in expelling gall bladder congestion with moderately sized, soft "stones". Such stones frequently accumulate due to long term fat-restricted diets used in efforts to control weight or to keep blood lipids low.

Another plasma fatty acid profile after eight weeks of such a protocol will reveal the degree of success.

Other Comments

This patient had wisely come to a clinic that could find early evidence of a difficulty that is amenable to simple intervention to head off the multiple consequences of essential fatty acid deficiency. The patterns of fatty acids in these profiles are signals of fat malabsorption. The most likely scenario is cholestasis due to gall bladder congestion.

Plasma alpha linoleic acid is highly responsive to supplementation with flax oil, so when the diet is supplemented and there is a DECREASE in ALA, a red flag goes up saying fat malabsorption. Likewise, fish oils which generally contain DHA as well as EPA should increase plasma DHA levels. Also, increased intake of EPA stimulates the conversion to DHA, although this is a sluggish process in humans. But in this case the DHA dropped by 28%!