Pale Stool and Bile Salts

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Does anyone have extremely pale stools? Ever since getting sick they have never been the right consistency and have completely lost it's brown color. My bilirubin is also ever so slightly high. I got an abdominal ultrasound and everything came back ok. I think I'm either not producing enough bile from my liver or my gallbladder is disfunctional and not spitting the bile out. Would taking ox bile supplements help with this? Does anyone else experience this? Thanks.
 

Booble

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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!)
 

overtheedge

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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
 
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@Booble @overtheedge

Thanks for that post. It was very informative. As to your questions it's not whitish of greyish but a pale yellow color ( I know gross sorry ). It's not light brown or anything. They aren't greasy or foul smelling.

I'm going to look into some of the testing you sent me.

Some people recommend me to eat lots of meat and fat to trigger the bile to be released by the gallbladder. I know that advice seems to be counterintuitive as people with gallbladder issues would get gallbladder attacks but I don't present like them. So I did recently been eating all beef for a couple of days and what do you know for the first time it came out brown. I was actually shocked when that happened. My diet consisted of eating lots of veggies and fruits so I think all the fiber wasn't triggering my gallbladder to release the bile it's been storing up ( even though it still should in healthy people )

I've suspected this for a while now but I don't think there is anything too wrong with my liver or gallbladder themselves. But I think the signal isn't getting through to allow them to work properly. I believe my vagus nerve is badly damaged in my neck as I've recently been shown to have severe neck instability. The vagus nerve is super important and tells your stomach, gallbladder, and gut to work properly. You can check if your vagus nerve is working right by doing a heart rate variability test.

On a side note I talked to my doctor about this but he thinks it's related to irritable bowel ( which I highly disagree with. ) I'm probably going to mention it more strongly next time I meet.
 

overtheedge

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My concern with testing beef specifically would be that the meat is so dark in color, I've noticed when i eat darker colored foods like beef at most meals for several days in a row all the following movements come out darker, though, for me, they are never as dark as back when I was healthy, and when i eat light colored meats like chicken they come out on the lighter end of the spectrum.

If I remember correctly some people don't do well on vegetarian diets while others do, and some people have issues because of the lack of certain things in a vegetarian diet, Vitamin B12 and Zinc I think it was, maybe iron too, though there might well be other nutrients/vitamins/minerals lacking and it might depend on the specifics of the diet.
 

BeADocToGoTo1

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@Booble @overtheedge
As to your questions it's not whitish of greyish but a pale yellow color ( I know gross sorry ). It's not light brown or anything. They aren't greasy or foul smelling.
..
Please check out the following thread in case it has some info:

https://forums.phoenixrising.me/thr...y-epi-and-chronic-fatigue-syndrome-cfs.62997/

Have you had the following tests done?:
  • MRI with MRCP of the abdomen with contrast - Gives a great picture of pancreas and ducts, gallbladder and ducts, liver, stomach, intestines.
  • Stool test pancreatic elastase
  • Stool test: fecal fat level and distribution (checks if you have issues with different types of fat intake and digestion). A 24 hour collection test is pretty standard.
  • Blood test fasting trypsin (to see if you produce enough enzyme for protein breakdown)
  • Comprehensive Stool test for parasites, pathogenes, dysbiosis
  • Stool test chymotrypsin (similar to, but not as accurate as elastase)
 
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@bread. I'm still trying to fix it

done a bunch of different sibo treatments and can get the hydrogen down but the methane always stays around 8 r higher which from a lot of what ive read 3-9 reading on methane can be quite symptomatic. Treating with xifaxan plus neomycin improved my overall energy and sleep and made it so prescription meds now affect me much more strongly such as sleep medications needing only 1/3rd or less a dose to get the same effects and in many cases producing different sort of effects than before the sibo treatment, but the color hasn't changed. Xifaxan plus metronidazole didn't change it either. Probably gonna start using alinia soon which really improved my health back near 2yrs ago when it had fallen very low from infections, only, i used it for 6 days back then, no change in color, and that might have been too short as im reading about some doctors using it for 30d.

Been on mesalamine suppositories for 10d r so without any effect on color so far, doc thought it might have more effect than oral mesalamine since the ibd is mostly around the rectal area but the ibd is mild so maybe it isn't the issue.

Haven't run any more tests aside from sibo tests, the new mainstream Gastroenterologist im seeing doesnt know of any more tests to run or treatments to try to figure out the pale stools/fat in stools other than the mesalamine suppositories he has me on now, the only other thing he said he could do is to keep going with antibiotic treatments. The old gastroenterologist who ran those tests (CT scan/Ultrasound/MRCP/others) didnt know what to do either and said there was nothing more he could do for me.

It could just be something caused by the CFS that cant be fixed without fixing the CFS or in your case getting it down to a less severe form
 
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Hi @bread. and @overtheedge

If your gastroenterologist, or even your family practice doctor is not willing (which is shocking in and of itself) to have you perform a super cheap, super easy fecal test then you can try taking pancreatic enzymes with your meals to see whether it helps with symptoms.

These two tests are super standard, and cheap:
  • Stool test pancreatic elastase
  • Stool test: fecal fat level
Please do not just 'accept' it is part of CFS. Fat in stool, pale yellow, sticky stool are all not normal and point in the direction of not digesting food properly. This in turn will cause nutrient deficiencies, which in turn can have CFS type symptoms.

Many doctors have no clue how to properly test for it, nor help sufferers holistically even after diagnosis. When the pancreas is not making enough enzymes to break down fat, carbs and protein it is not immediately apparent. Only when it is 90% impaired are many doctors willing to give it a diagnosis of exocrine pancreatic insufficiency (EPI). Which is ludicrous, as you will lose out on nutrients for the proper functioning of all your metabolic pathways, on far less of a percentage. It can be a slow decline, with many doctors scratching their heads as to the root cause of your symptoms.

Some gastroenterologists, like Steven D Freedman, do understand. He will even prescribe pancrelipase (contains pancreatic enzymes including amylase, protease and lipase) as a way to diagnose. If it helps reduce the symptoms....It can not hurt to try. On this thread, there were a few others that tried that approach with good results:

https://forums.phoenixrising.me/thr...y-epi-and-chronic-fatigue-syndrome-cfs.62997/

Yes, gallbladder function and SIBO are avenues to look at, but please do not dismiss (or let your doctor dismiss) the exocrine pancreatic insufficiency ( or even pre-EPI which I call <90% functioning) possibility without looking into it and trying. The whole idea that was mentioned above to just eat more meat is nonsense. If you cannot digest that meat, all you are doing is making things worse. With pancreatic enzymes (pancrelipase) breaking down meat into useful nutrients, then eating (high quality) meat is great for all the nutrients you can get from it.
 
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