Fat Malabsorption, a.k.a. “Ballerina Syndrome”

We see many clients in our practice with a reduced ability to process fats, so consequently their body’s ability to process hormones is also compromised. We first began noticing this in our elite athlete clients, especially ballerinas, hence we have coined it “The Ballerina Syndrome”.  These clients were producing excess epinephrine resultant from their rigorous training schedules, often daily, for many hours at a time. This excess epinephrine was causing the tight junctions of their intestinal walls to be weakened and punctured, thus creating excess inflammation in the body.  In addition, the excess epinephrine was congesting the liver, making it harder for their bodies to process fats and other fat-soluble molecules, such as estrogen.  Epinephrine has been shown clinically to  decrease the tight junctions of the intestines and excess epinephrine can contribute to the rise of pathogenic bacteria in the gut (1).

Individuals more susceptible to fat malabsorption most likely have genetic SNPs (single nucleotide polymorphisms) or “changes in their DNA” that make them more prone to liver congestion and the inability to metabolize fats efficiently. Individuals with SNPs that impair methylation pathways will not make Choline and digestive enzymes as efficiently as others. Choline and digestive enzymes are needed to help metabolize dietary fats. Also, fat soluble hormones will contribute to the clogging of the liver. For example, excess estrogen will not be processed by the liver and will re-circulate in the body, causing additional problems such as weight gain and acne.

In addition, certain common prescription and over-the-counter drugs are anti-cholinergic, which can slow the liver’s function (2). These include certain anti-depressants, anti-histamines, anti-psychotics, gastro-intestinal medications, and urinary incontinence drugs. In order for the body to process these chemicals, the body needs to use Choline, which after continued use may result in a Choline deficiency. And thus, the body will have a harder time metabolizing fats in the presence of these drugs.

Indicators of fat malabsorption are bumps on the back of the arms, an itchy scalp, light colored or floating stools, referred pain from gallbladder in the right scapula, or pain in the right side near the liver.  Additional symptoms may be yellow coloring in the face or skin or the presence of acne near the face, milia and light sensitivity in the eyes. If you have fat malabsorption, it will be more difficult for your cells to produce energy, as the mitochondria needs triglycerides to provide energy and burn fat.

An additional condition resulting from fat malabsorption is ligament laxity. Connective tissues cannot get the essential fatty acids needed to form collagen because the body is not processing these fats efficiently. Therefore, ligaments are not as rigid as they should be resulting in possible knee or shoulder ligament tears. In extreme cases, a clogged fatty liver can put pressure on the thoracic lumbar junction which in combination with ligament laxity can pull other parts of your back or ribs out of alignment.

The kidneys are also play a role in fat malabsorption. The kidney nephrons are involved in clearing the lymphatic system but excess fats can remain in the lymphatic tissue causing swelling as the nephrons get overwhelmed.

By testing the individual, we are able to determine which types of fats the individual is capable of processing. The lipids in cell membranes are replaced about every 60 days so if diet is high in trans fats, the cell membranes will become more rigid and not be able to function as efficiently which may lead to a predisposition to disease and inflammation. Some individuals are so fat-sensitive that certain vegetables (e.g. swiss chard, carrots) containing high levels of vitamin A, vitamin K and beta carotene, which are all fat soluble, are too much fat for them to eat and process. Some individuals may have to also limit nuts and dairy.

The best fats to consume generally are the short chain fatty acids (for example avocados, coconut oil, and grass-fed butter). Grass-fed Butter (esp. Kerrygold) is better from cows that ancestrally have not been industrially-bred as they have healthier DNA. The butyric acid contained in this butter is healing to the gut, and the higher butterfat blunts the insulin response from the other foods it is eaten with. It also helps with colonic balancing that would normally be disrupted by milk. A2-casein cows produce easier to digest dairy proteins than A1. Butter can be added to milk to help you digest it and added to coffee to help dampen the epinephrine effects from the coffee.

Supplements aiding in fat malabsorption are L-Carnitine (furmerate version), TMG (Tri-Methyl Glycine), Choline, Yucca, and Spirulina. Spirulina supplementation improves exercise performance, fat and carbohydrate processing, and liver detoxification (3,4). Individuals with persistent mold issues should avoid Spirulina.


1) Cogan TA, Thomas AO, Rees LE, Taylor AH, Jepson MA, Williams PH, Ketley J, and Humphrey TJ. Norepinephrine increases the pathogenic potential of Campylobacter jejuni. Gut. 2007 Aug; 56(8): 1060–1065.

2) Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, Kirshner MA, Sorisio DA, Bies RR, Gharabawi G. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008 Jul;56(7):1333-41.

3) Kalafati M1, Jamurtas AZ, Nikolaidis MG, Paschalis V, Theodorou AA, Sakellariou GK, Koutedakis Y, Kouretas D. Ergogenic and antioxidant effects of spirulina supplementation in humans. Med Sci Sports Exerc. 2010 Jan;42(1):142-51

4) Fujimoto M1, Tsuneyama K, Fujimoto T, Selmi C, Gershwin ME, Shimada Y. Spirulina improves non-alcoholic steatohepatitis, visceral fat macrophage aggregation, and serum leptin in a mouse model of metabolic syndrome. Dig Liver Dis. 2012 Sep;44(9):767-74.

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