And not to be too gross or TMI -- but by pale do you mean white-ish/grayish or light yellowish? (Sorry -- just trying to give appropriate advice!)
I'm wondering this too
I too have had pale stools a while now, since right around the time the the most recent form of CFS I've had started six and a half years ago.
Unfortunately I haven't been able to fix them yet though it's what i'm currently focused on, so I can't tell you what fixed it but I'll give you below the tests I've run, the meds ive tried, and any other info that might be of use to you.
Stools are a pale golden brown for me, not white or anything. Betaine HCL and over the counter digestive enzymes fixed some serious constipation issues i had when I had CFS back 9 years ago or so and that is likely what fixed the CFS slowly over time a few months after i started supplementing them but stools weren't pale then. Trying enzymes/betaine hcl in the last 6.5 years hasn't done anything for me.
my biliruben used to always come up high but hasent for some years now
The following things haven’t made any difference for stool color, a few of them made me feel good for a week or few but the effects petered out: mastic gum, ghee butter, supplemental butyric acid, ox bile, bitters, artichoke hearts, milk thistle, aloe vera, marshmallow root, slippery elm, betts and beet juice, kefir, kombucha, elimination diet, and low fodmap diet
recently a gi doc did ultrasound and ct scan of abdomen to investigate possible causes of fat in stool without finding anything other than that the pancreas was poorly visualized on the ultrasound, the ct scan was to figure out if there’s anything going on with that but as I said there wasn't anything of interest in the ct scan. been on creon since then, strong Rx enzymes, without any results of any kind from it even after months and different doses. GI doc found fat in my stools and even after taking the creon it's still there on the Quest stool test.
From what Ive been reading bile gives stools its darker color and without it they can become pale. another thing that has come up a lot in my reading about fat in stools and i think about pale stools is that it can be caused by sibo, I've had multiple sibo tests but have yet to have one come back without SIBO being positive, probly because they always come back with methane and my old doc didn't know you need to use some special medications to treat methane predominant sibo according to what ive read from many internet sources.
The best results ive had from any meds in this illness were aimed at treating sibo/libo and were prescribed by functional medicine doctors, I think mainstream gi doc's don't buy into sibo/libo except in certain rare circumstances. Alinia for 5 or 6 days doubled my energy level after it had become consistently low for some months due to fevers, infections, and other issues months before, it treated LIBO but sibo remained positive when it was tested later, energy stayed improved after that until I had a bad fever half a year after the alinia treatment. Xifaxan made me feel real good after 16 days of treatment but that went away fast though the good feeling might have been due to alpha lipoic acid which i was taking around that time, and sibo remained positive.
Candibactin BR corrected my pale stools and gave them the old color for the first few days or so of use but I stopped it well before the course was through because i was getting pain in my lower gut and was worried the med might be causing damage, I figured shortly after it was promising enough to risk it again but no matter how many times i tried it or other berberine based herbal antibiotics i never got the same regular colored stools again or even the gut pain, something must have changed in my gut because I tried the same exact medicine again at the same doses but what changed in my gut I couldn’t say.
Mainstream medicine Gastroenterologist did the following to investigate occult blood in stool near two years ago, well before I knew about fat in stool, colonoscopy with biopsy/EGD with biopsy/small bowel xray, the test colonoscopy test reports ANCA screen, myeloperoxidase antibody, proteinase-3 antibody, saccharomyces cerevisiae AB (ASCA) (IGG and IGA) all of which are negative. colitis was found but treating it didn't fix pale stools or alter my cfs in any way though ive only tried mesalamine so far, colitis isn't crohns or ulcerative colitis
I've independently tested bile acids using lab tests I ordered online but they came up fine, around 13 umol/L, but the test said the updated guidelines that would go into effect in summer of last year, which is a few months after I took the test, would have 10 umol/L be the top of the range meaning my bile acids are high. Mentioned it to GI doc and he said that high bile acid isn’t a concern.
Cystic Fibrosis and Giardia tests which can cause fat in stool came back negative for me
There are also a number of other things that can cause fat in the stool, many affecting the gallbladder or pancreas
Anyway
Are your stools greasy/foul smelling? Often fat in stool causes those symptoms
Whatever turns out to be causing your stools to be pale I’d be interested to hear what you used to correct whenever you do manage to fix it, haven’t run into many other pwme’s with pale stools, the only other one I can remember was a person on a website called curezone and she found it was being caused by copper toxicity though I can’t remember if she had CFS or was just fatigued all the time
