Q. I have read that loose, pale-coloured stools are a sign of fat malabsorption. I have had consistently yellow, foul-smelling stools (with undigested bits in them) for as long as I can remember. Also, after going to the toilet I often feel nauseous. What could be the cause? Does it mean that my body is deficient in "good fats" and vitamins?
A. When the intestine is unable to properly digest and absorb fats, the stools become pale, bulky and smelly. They usually float in the lavatory pan, and are difficult to flush away. Sometimes it is even possible to see floating oil droplets in the toilet water. Fat malabsorption can be caused by many different problems. If the pancreas or liver are not working properly, in conditions such as cystic fibrosis and liver disease, the intestine is unable to break down and absorb food. In conditions such as coeliac disease, which is caused by an abnormal reaction to wheat and other foods that contain gluten, the intestine loses its ability to absorb nutrients. If people with coeliac disease avoid all foods containing gluten, the intestine recovers and regains its ability to absorb food normally. Some vitamins, especially A, D and K, are fat-soluble vitamins: if you are not absorbing fat properly, you can become deficient in these vitamins. You need to have tests to see if you are suffering from malabsorption. If you are, then the cause needs to be identified and treated. Your first stop should be your GP. The next stop should be a gastroenterologist.
Q. I have been bothered for several years by carpal tunnel syndrome. It gives me severe "pins and needles" in one or both hands, but only during the night after about four hours of sleep. I either massage the hands or hang them out of the bed, but the condition keeps returning. Sleep disturbance is a problem. My GP offers no solution. My daughter had the same problem, and it was dealt with by surgery of the wrist. Is this the only option? What causes this, and why do I get it at night?
A. Carpal tunnel syndrome is caused by physical pressure on a nerve that runs just below the inner surface of the wrist. The nerve, which is called the median nerve, passes through a narrow stretch of tissue called the carpal tunnel, and this is where the condition gets its name. Your symptoms are absolutely typical. The pain and numbness is always worse at night, and it affects the thumb, index and middle fingers, and half of the ring finger. If it continues for a long period, it can cause permanent weakness in the hand. Surgery to relieve pressure is usually a last resort, and the condition sometimes resolves without it. It would be sensible for your GP to check that your thyroid gland is not underactive and that you do not have diabetes, as these can both cause the syndrome. If you are OK, I strongly suggest that you get a special wrist splint to wear at night. This often cures the problem without surgery.
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AP of London has a theory to explain dark circles under the eyes:
"One of the main factors is a mild insufficiency of cortisol in the blood. Cortisol helps to retain salt and water in the circulation. Any depletion will result in a partial collapse of the tiny blood vessels in the skin under the eyes."
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Send your questions and suggestions to A Question of Health, 'The Independent' 191 Marsh Wall, London E14 9RS; fax 020 - 7005 21 82; or e-mail email@example.com. Dr Kavalier regrets that he is unable to respond personally to questions