2+ Years In - Acute Diarrhea - BAM?

(John) #1

Hi All!

If I have a large serving of fat, I’ll have intense diarrhea within 2 hours, nearly every time. I’ve been zero carb - eating almost exclusively 85/15 ground beef or steak with added butter and tallow - for 2.5 years. Everything is great when I do that. However, if I suddenly introduce even just a bit more fat, I’d better be within rapid access to the facilities. Some examples include:

  • I ate a pound of burger patties using 80/20. Usually I don’t make patties, so most often far more fat is rendered out.
  • I was invited out for lunch so opted for a large portion of salmon, cooked in butter.
  • I had a tin of cod livers for a mid-day snack
    Each of these “experiments” had the same result.

I’ve tried adding an ox bile supplement before a high-fat food without success. Nor would I have expected low bile production to be the cause, given the length of time I’ve been eating exclusively fatty meat. Thoughts on that…?

I’m wondering if the bile production is fine but the reabsorption is the culprit. Anyone have any experience with that?

Again… 90% of the time, everything is great. BM’s are regular and consistent and I have no complaints after 2.5 years of a carnivore WOE. It’s just when I suddenly introduce something with a bit more fat than usual, even though I’m eating relatively high fat (somewhere close to 50/50 fat/protein) to begin with.

#2

Some people are more sensitive to fat than others. However, after 2.5 years, this seems at odds.

Maybe the dose of Ox bile is too low. I assume you still have your gallbladder? I have seen Ox bile do wonders with those who have no gallbladder.
I do remember my first experience with MCT oil. I consumed 2 tbsp in a single sitting. Not good. I then titrated over a period of 2 weeks, and there was no issue. Were you Keto before?

Do not ignore this situation, and it might be worth getting your gallblader checked out.

(John) #3

Thanks! I do still have my gallbladder, which is another reason I wasn’t too suspicious of bile production being the culprit. And since I can easily eat 1.5-2 lbs of 85/15 ground beef with a bunch of butter and tallow mixed in (even 80/20 with a bit less added fats), I figured the gallbladder seemed to be doing alright. But you’re thinking that I should have it checked out? My doc will probably tell me I don’t eat enough fiber :man_facepalming:

I wasn’t keto prior, per se. I’ve never measured ketones but for about 5 years before going zero carb, I was typically in the neighborhood of 15% of nutrition from carbs. Though my meats were primarily very lean and I was probably getting more fat from nuts. So, for sure, I’ve introduced way more fat but, again, it’s been 2.5 years since that change.

(Bob M) #4

That is very interesting, because those meals don’t seem that fatty.

I also have had an issue eating a lot of fat, but I was eating fat by itself. So, pork fat. I’d eat the pork fat first, then eat meat. I was aiming for a high fat diet.

Salmon with butter seems like it’s not a lot of fat.

I don’t really have any advice, and your idea of an absorption issue could be it. I don’t know how to solve that, though.

#5

Yes, you should not have this problem. The gallbladder’s role is to release bile from the liver into the small intestine, where it helps your body break down and absorb fats from food. This process appears to be not optimized in your case. Your doctor might be right in your case. Think of it as your system is giving you a message. Not everyone fits perfectly. After 2.5 years, this definitely should not be the case. Red flag.

(John) #6

Got it. I understood that to be the case but also recently learned that many people release and store bile just fine, but fail to reabsorb - Bile Acid Malabsorption (BAM) - which results in similar symptoms. But, unlike when the cause is from not enough bile, where the diarrhea is greasy, with BAM it’s very watery and with more “urgency”. Still learning though…

#7

John, we can all play Google Doctor; I am not a doctor; (I am married to one); you are not a doctor. Get it checked out. This is not the norm. Leave it to the experts.It could be something very simple in that your body is extra sensitive to fat. I have no experience with Carnivore as I have found no need to change from my current path. Your system is out of balance.

(Bob M) #8

I agree with @ffskier because the amount of fat in those meals really isn’t a lot.

Could you do something like buy very lean burger patties and have those one day, then buy the fattiest burger patties you can get and have that another day? You sound like you’ve tested a lot, but I’d be interested to see if you could really make sure it’s fat that causes this.

(John) #9

Yes. I’m going to do exactly that, in fact. I’m curious myself. A plate of salmon with some butter really isn’t super fatty. Could be an omega 3 thing, for example. Like I said, it happened with a tin of cod livers, too. But that doesn’t explain why it occurred when I made 80/20 burger patties :thinking:

#10

You do realize excessive fat can have that effect on anybody, right? How much fat are you averaging daily? I’m thinking a crapton that would probably have that effect on anybody if you’re normally eating nearly exclusively ground beef or steak then adding butter or tallow, your fat intake must be a crazy levels to begin with.

On the digestive enzymes, it’d be Lipase you’d want, not Ox Bile assuming your gallbaldder is still in there.

(John) #11

Like I said, I hover around 50/50, eating essentially 80/20 beef primarily. So somewhere in the neighborhood of 150 grams of fat daily.

And, as I was saying, I’m perfectly fine 95% of the time. It’s the odd occasion that I have more - at least that’s my premise right now - when it happens. Like when made 80/20 patties that didn’t render out all the fat that my usual ground meal renders out. Or a couple of times when I had a large ribeye with all the fat, whereas I might usually have a NY and maybe even trim some of the fat, and have no issues at all.

(Bob M) #12

It’s a very unusual issue. I wonder how you get something like this tested by a doctor? What are they going to look for?

Do you think it’s a meal thing – you only get this after particular meals – or could it be that you get to some daily limit of fat and that causes it? For instance, could you eat a fatty meal in the morning, then lean meats the rest of the day and be okay? Or would the one fatty meal in the morning cause an issue?

As a person who likes to do tests on themselves, it’s hard to think of how to test this. Particularly, the Omega 3 angle.

(John) #13

Ya. I’ve been trying various things now with intent for exactly that reason. I am going to try your lean vs fatty burger patties suggestion, for example. I eat the same thing every morning and I’m fine with it. When I eat something later that’s fairly lean - on Sunday I had a pound of NY strip and trimmed of half the fat (because I’m scared to eat it right now :laughing:) and had no issues. But a couple of weeks ago I did the same thing but it was the 80/20 patties where very little fat rendered out and I was on the toilet within a couple of hours.

(Bob M) #14

When I was eating a high (animal) fat diet, I was trying to recreate this:

The main benefit I found was more energy, which seems odd, since I was eating a lot of fat. The detriment, though, was stomach and digestive issues. At some point, I want to try this again, maybe with some ox bile (which I think you said didn’t help?).

I usually eat a much lower fat version of keto. So, ham and not pepperoni. Leaner beef instead of fattier (and often that’s because the leaner is cheaper). I also tend to like leaner meats better.

Even trying to eat high fat, though, I find something like pork fat is better than beef suet. I don’t know why. Suet causes me more issues than pork fat. So, I was thinking the issue for you might be the type of fat, but that doesn’t seem to be correct, as the meals you show have a variety of fats.

Let us know as you test if you find anything out.

#15

80/20 ground beef cooked to 135 (medium) should render out a lot of fat. I cook 80/20 burgers every week, and there is always a lot of fat rendered left in the pan, even at this temperature. What temperature are you cooking at? I believe you stated previously that you did not do keto first before moving to carnivore. This might suggest that your fat set point (if one exists) has not increased significantly to accommodate the additional fat. Having never done carnivore, most I know started first with keto and then moved to carnivore. 2 hours after the fact, I think would suggest something else going on. Most people, when they consume too much fat, the body makes it known within a short time, 30 minutes or less, not 2 hours later.

Do you drink bulletproof coffee? If not, I would try it with 2 tablespoons of MCT oil and see if anything happens. If nothing happens, add more oil. Your body will let you know pretty quickly if it is the extra fat.

Good luck!

#16

All I can come up with is a Lipase test, but you could also do the ghetto version and force in enough fat where he knows it’d cause a problem, and take a good amount of lipase with each meal and if nothing happens, there’s your workaround test done.

(John) #17

I was thinking the same, since my normal panels don’t include a lipase test. I’m looking into that.

(John) #18

I didn’t measure them but cooked them to about the same pink that my steaks, which I do measure, come out to at 135-140. And the amount of fat in the drip tray was considerably less than when I cook steak or cook the ground beef without making patties. That’s why I wondered if it was an issue of too much fat at one time.

I was previously at about 15% carbs for 4 or 5 years and never measured ketones. The difference was that I was eating considerably more protein than fat so highly unlikely that I was keto. I guess I just figured that after eating 50/50 fat/protein for over 2 years I would have acclimated to the fat by now. Pretty much everyone in the carnivore community says that it takes only a few months or so. Maybe 6 months at the most. But what I did come across is that if the issue occurs a couple of hours later (rather than, say, 30 minutes), it may be a bile acid absorption issue, rather than not releasing enough bile.

I don’t add fat to my coffee but could also try that as another experiment. Thanks!

#19

They never will, only an optimization doc and (sometimes) a GI doc may do them. The rest would rather tell you to eat less fat (just because).

If you’re in the US, way easier to just do it yourself rather than convincing a quack to do something they likely don’t even know they can order. $57 at privatemdlabs.

(You've tried everything else; why not try bacon?) #20

Even if you had no gall bladder, your liver would still be manufacturing bile.

One solution would be to cut back on the added fat. Perhaps your body is trying to tell you you don’t need it. Another thing to do is to look at your salt intake. If you have a lot of extra salt to excrete, it will be accompanied by water. A lot of carnivores find themselves gradually cutting back on the added salt, over time.

If salt on your food tastes a bit too salty, and most especially if it tastes terrible, it’s a good idea to cut back on the salt intake for a while.