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Fat Carbohydrate (Lactose) Vitamin (B12, D) Lactose Tolerance Test: Feed adult 50 g lactose and measure rise in blood glucose. An increase in BG < 20 mg/dL indicative of intolerance. Hydrogen Breath Test Feed 1.75 g lactose/kg BW; If present, undigested CHO will be fermented by colonic bacteria and produce large increase in Breath Hydrogen= Malabsorption Organs participating: Liver (Bile) and Pancreas (Lipases) Causes? Bile Salt Insufficiency Pancreatic Insufficiency Compromised function of intestinal mucosa (due to inflammation, infection, etc.) Certain Drugs Primary treatment: Fat-restricted diets Enzyme replacement supplements Water miscible vitamin supplements Medium chain triglycerides (MCTs) (8-12 carbon chain length don’t require lipase and bile for absorption) Refers to restriction of dietary triglycerides (TG) not other types of lipids (e.g., cholesterol) Commonly prescribed diets: 35 g or 50 g/ day Highlights: Nonfat dairy products, cheeses No added fat during food prep < 3 eggs per week < 6 oz lean meat or poultry/ day 3 servings of fat/ day 1 tsp butter/margarine 1 Tbs salad dressing 1 strip bacon 10 peanuts Pluses Minuses Provide equal kcal as LCT No essential fatty acids Can mix with nL liquids or use in baking Pt tolerates only 20-60 g/ day (< 500 kcal/ day) too much? N/v/d and distention Disorders Associated with Malabsorption Pancreatitis Cystic Fibrosis Acute and Chronic The Inflamed Bowel Blind Loop Syndrome (bacterial overgrowth) Crohn’s Disease Ulcerative Colitis Short Bowel Syndrome Celiac Disease