Can’t digest fat well?

Have you been experiencing unpleasant nausea and watery, oily diarrhea? Do you find that this is associated with your intake of fatty foods, or “heavy” meals?


Sonia Chartier

02 April 2016

The hallmark of fat malabsorption is steatorrhea

For those of you who aren’t familiar with this term, steatorrhea is the passage of pale, oily, malodorous stool. Digestion and absorption of fats may be impaired due to infection, inflammation, cancer, cystic fibrosis, cirrhosis, impaired bile secretion (e.g. gallstones), and enzymatic deficiency or inactivation. However long, this list is not exhaustive. This article sheds light on the process leading up to fat malabsorption.

While some conservative management options are discussed, it is very important that people experiencing symptoms of fat malabsorption speak with qualified health care provider before trying over-the-counter products. And please, do not feel embarrassed, rest assured that you’re not alone.

What is the fat digestion process? 

In order to understand fat malabsorption one needs to understand the proper biology behind this process, which is made possible by a series of reactions driven by enzymes. Enzymes are special molecules that catalyze a biological process. For fat digestion to occur, the pancreas produces enzymes (e.g. lipase) that chemically digest fats into smaller molecules (fatty acids), which can then be absorbed in the small intestine.

Once absorbed, fats are then combined with proteins, cholesterol and other molecules and are transported from the digestive tract and into the lymphatic circulation. Because fats are not soluble in water, their digestion can be a little tricky without help. This help comes with the liver and the gallbladder, which produce, store and secrete bile.

Bile acts as a biological “soap” that which dissolves the fat allowing them to come in contact more easily with the pancreatic enzymes.

Why we have trouble digesting fat? 

If pancreatic enzymes are not produced, large fat molecules cannot be broken down into the smaller pieces necessary for absorption. Think of these large molecules as $100 bills, and you trying to buy a pack of gum at a corner store—most likely the $100 won’t be accepted, but if you have a smaller bill, say $5, you can buy the pack of gum.

Your digestive tract works in a similar manner; it does not like large bills (i.e. fats). Further, if your liver isn’t producing bile, or if your gallbladder isn’t secreting, or if the biliary duct is blocked, then fats cannot be emulsified. What this means is that in the absence of bile pancreatic enzymes cannot digest fats into smaller bits.

Finally, your intestines aren’t static, and the foods you consume move along the digestive tract. Anything that is not digested properly continues to make its way out. However, the implications of this is that if large fats remain elsewhere in the intestines it changes the composition of contents.

The side effect is that fats, minerals and fat-soluble vitamins (e.g. A, D, E, K) that were not absorbed stimulate the secretion of water into the colon, thus resulting in diarrhea, and ultimately, deficiencies in such vitamins and minerals in the long run.

What are the symptoms of poor fat digestion? 

As stated earlier, symptoms of fat malabsorption may manifest as steatorrhea, or oily, pale, malodours stool. If the cause is due to biliary compromise, acholic stools may be present instead of steatorrhea—and they may be due to infection and/or obstruction. These presentations may also be accompanied by nausea, possible desire to vomit, distension of the abdomen, and mild abdominal discomfort. If you have noticed any of these changes recently, or over a period of time, speak with a qualified health care provider in order to get checked up.

What can be done?

It is important to understand that there are different forms of malabsorption and their manifestations may also differ, so when in doubt, seek medical advice to get to the root cause. Do not be afraid of getting your regular check-up. Just as you keep on top of your bank statements every month it is important to keep on top of the state of your health at least once a year.

So, what can be done? This depends on the cause of the malabsorption. We would also need to consider if the individual has had their gallbladder removed or if the gallbladder is still in place. Ox bile may be something to consider discussing with your healthcare provider if your gallbladder has been removed.

As we discussed earlier, there are many steps leading to the digestion of fats. We also learned that there are several factors that can trigger fat malabsorption. If we were to focus on the production and secretion of bile, in absence of disease, then herbs like artichoke and boldo may be helpful.

There is also some empiric evidence to suggest that fermented foods may help digestion in general. This may be due to their acidic nature, which enhances enzymatic activity, and help with absorption of nutrients like vitamins and minerals.

If you cannot differentiate between fat malabsorption and other forms of indigestion, like functional dyspepsia, and protein indigestion, do not hesitate to seek medical advice, and I cannot stress this enough because your treatment options may be very different, and other conditions may need to be ruled out (e.g. infection with H. pylori) in order to provide you with effective care and with lasting solution.

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