Hey again Dan,
I just saw your message. I wanted to give a word or two about a couple things you said that sparked my attention this moment, but I’ll also keep in touch later about some other things that I want to mull over and see if I have anything else to write with further preparation.
Triglycerides and HDL-C:
Trigs are typically quite elevated in fat deficient patients (and HDL cholesterol, or HDL-c, rather low). Even in Kitavans, the healthy Polynesians who consume 20% of their calories as fat and 70% as carbs–the majority of those glucose/starch–triglycerides average about 150 mg/dL and HDL-c about 40 mg/dL. These numbers are kind of high and low, respectively. Eating fat of any kind would lower trigs and increase hdl-c (up to a point).
Fructose more so than glucose/starch increases trigs. My point here is that highish trigs and lowish HDL-c MAY only mean that your diet is highish in sugar and lowish in fat, and MAY NOT indicate any real pathology. Of course, many pathologies can also cause this, the most common of which, in my estimate, is hypothyroidsm (such as under eating), which is known to contribute to high trigs.
http://www.ncbi.nlm.nih.gov/pubmed/4341014
Fat Maldigestion
One of the first things that pops into most doctors heads when fat maldigestion comes up is the gallbladder. I don’t like how allopathic docs approach this, but IF you have a clogged bile duct, for instance, you would have pains with meals that could include any number of other weird symptoms (potentially even nerve related issues), and you would be unable to absorb most the fat and fat soluble vitamins you eat. This would lead to MANY deficiencies before long.
I think more likely, your fat digestion issues are just hypothyroidism, which is a known cause of bile excretion problems and the resultant fat maldigestion.
http://www.ncbi.nlm.nih.gov/pubmed/12660641
http://www.ncbi.nlm.nih.gov/pubmed/21086683
Supplementing lipase enzymes and/or the ox bile, as you say you’ve tried should theoretically help if you have a bile duct problem. The note you gave in a previous post about fish oil not seeming to cause the same symptoms as butter or olive oil or anything else is consistent with the fact that more bile is needed to help emulsify fat that is more saturated. Thus, for someone with bile issues, butter will give the most pain/symptoms, followed by olive oil, then (last) high PUFA fish oil or flax oil. I am NOT recommending you guzzle high PUFA oil like flax or fish oil, but am I simply mentioning this for diagnostic purposes. And yes, as a previous post of yours eluded to, various things (parasites, whatever) can theoretically live in the stagnant bile salts within the clogged duct.
You could set up an appointment with a GI allopathic doc (‘gastroenterologist’) and have them do an ultrasound of your liver and gallbladder which, I think, should verify whether or not the duct is clogged. The trouble with this is, that IF it is clogged, they may recommend removing the gallbladder which I WOULD NOT suggest doing. I am frankly unsure what the best course of action is regarding duct problems. Many people like to give input on this, but I am not sure what would be best. Nonetheless, I suppose at least the diagnosis could help narrow the search and focus the plan of action.
Calories
You’re a tall man, Dan. At 6’2″, some would say a recovery effort should involve much more than 2500 kcals. As in 3500+. Even if your bedridden.
http://www.youreatopia.com/blog/2011/9/14/i-need-how-many-calories.html
I know this is very hard to do without an ability to digest fat, but do your best. Easy to digest foods, like dried fruit, honey, rice syrup, whatever. Solving the fat digestion problem should help this part out tremendously.
I am NOT saying that the only hurdle to your perfect health is eating more. I think many people on here have come to believe that our inner anorexia is the cause of all our problems, and I don’t think that is always true. I DO believe, however, that you have many symptoms characteristic of hypothyroidsm/low metabolism AND that you have history of eating/absorbing far too little for the average person of your size. I do NOT think these things are purely coincidental. This does not prove one way or another what the initial CAUSE of your issues are, but I think it’s safe to say that many of us have found ourselves at a point where we are undernourished, and until that singular problem is fixed, nothing else will improve.
One thing I ran into a while back, and can’t locate off the wing right now, is a study showing that the retention of vitamins and minerals during prolonged under eating is poor, and that under eating can cause many micronutrient deficiencies. MANY of these deficiencies were reversed by adding calorie sources with ZERO additional vitamins (such as corn starch and/or cane sugar). The point here is that our body needs calories to help utilize vitamins/minerals, the same as it needs vitamins and minerals to help process calories. But under eating too long can cause deficiencies in things like niacin, zinc, or whatever. Would supplementing these nutrients help? Absolutely! But doing so would also jeopardize the balance they have with other nutrients which may also be low. How this shows up on Spectracell’s test is anybody’s guess.
In sum, I think it would be wise to solve for once and for all the underlying cause of your fat maldigestion. Is one or more bile duct(s) clogged? Can a clog be jarred free? Perhaps thyroid supplementation (t3 or desiccated thyroid) will help re-establish bile flow? Perhaps you know of other strategies to investigate in the event that a clog is diagnosed? And in the meantime, keep eating something. Consider supplementing whatever you think may help, but consider broader supplements over singular items (such as a b complex over straight niacin).
And, as always, keep in touch.