Understanding Fat Malabsorption and Dietary Strategies to Improve Digestion

While fat has been villainized in the past, fat digestion is actually a very important bodily function. Still, many people suffer from an inability to absorb fat properly, a condition known as fat malabsorption. This article explores the causes, symptoms, and dietary strategies to manage fat malabsorption and improve overall digestive health.

The Vital Role of Fats in the Body

Biologically speaking, the purpose of eating is to gain energy, nourishment, and building blocks for the body to continually renew itself. Fats are a great source of energy because, at 9 calories per gram, they have more than twice the energy potential of carbohydrates. Fats don't cause cardiac events. Fats are the building blocks of phospholipids, key components of cell membranes. Fats store energy, and their components serve as intracellular messengers and help to manufacture hormones. Most of the fat we eat is in the form of triglycerides, which are large molecules. The body uses lipase enzymes to break them down into smaller particles.

What is Malabsorption?

Malabsorption syndrome refers to any case where your body’s digestion process is broken and your body doesn’t absorb enough nutrients. Malabsorption is an umbrella term for a wide range of disorders that affect your ability to absorb nutrients from your food. Malabsorption can lead to indigestion and even malnutrition - not from a lack of eating enough nutrients, but from an inability to absorb them.

You can think of digestion as a three-part process. The first part is breaking down food into digestible pieces. The second part is absorbing all the nutrients in your food. And the third part is eliminating the waste that is left over when all the good stuff has been absorbed.

If you have digestive difficulties, the problem could be in any of these three stages (or several). Malabsorption disorders cover the second stage. They include specific food intolerances caused by enzyme deficiencies, as well as various gastrointestinal diseases that affect your digestive system.

Read also: Diet for Bile Salt Malabsorption

Initial Steps in Fat Digestion

When we eat fat, stomach emptying slows and a small amount of fat is treated by gastric lipase in the stomach. The liver produces bile, stored in the gallbladder, ready to be shot into the small intestine when the fat gets there. Your liver is integral to breaking down fats, carbs and protein during digestion. Bile acid malabsorption sometimes results from a lack of bile from diseases of the gallbladder, bile ducts or liver. But sometimes it results from another problem, leaving leftover bile acids in your small intestine and passing these on to your colon. This side effect is called bile acid malabsorption. Leftover bile salts trigger your colon to secrete water, causing chronic diarrhea.

Causes and Risk Factors of Malabsorption

Major causes and risk factors include malabsorption diseases (e.g. celiac disease), genetics (e.g. lactose intolerance), bacteria infections (e.g. Whipple disease), certain medications, or physical realities (e.g. a shorter intestine due to past surgery). Not all people make sufficient enzymes to handle dietary fats. When the flow of bile is sluggish or slow, the gut shifts to a state of dysbiosis, where unfriendly flora dominate over friendly/beneficial flora. Constipation is often a telltale sign of a sluggish liver and that your gut is in a state of dysbiosis. When this occurs, detoxification in the liver gets thwarted by the toxins made from pathogenic bacteria. Perhaps you’ve had your gallbladder removed. Food intolerances and food sensitivities, such as lactose intolerance or celiac disease, mean the digestive system cannot completely break food down into smaller components. When you don’t have enough stomach acid, you may not be digesting your food properly. People who have been on antibiotics for a prolonged period may find it leads to malabsorption.

Common Conditions Leading to Malabsorption

• Celiac Disease: A condition where the ingestion of gluten leads to damage in the small intestine.
• Lactose Intolerance: Approximately 65 percent of the population have trouble digesting lactose. In these persons, the body lacks an enzyme to digest lactose, a sugar present in milk, and bloating and diarrhea can result. The enzyme may be totally absent or present in reduced amount so that symptoms may vary depending on the amount of lactose ingested.
• Short Bowel Syndrome: If you have a problem with your small intestine due to birth defects, a disease or even an injury, you may need surgery.
• Whipple’s Disease: A rare bacterial infection that can affect multiple organs, including the digestive system.

Other Contributing Factors

• Medications: Some drugs may affect how your body processes and absorbs specific nutrients.
• Pancreatic Issues: Diseases of the pancreas can cause severe malabsorption of fats and carbohydrates. In conditions when insufficient bile reaches the intestine, fats are not absorbed and again diarrhea and weight loss occur.

Recognizing the Symptoms of Fat Malabsorption

Malabsorption syndrome symptoms and signs are inherently linked with various nutritional deficiencies. There are many symptoms associated with malabsorption. Chronic diarrhea is often the first symptom prompting one to seek medical evaluation, although diarrhea need not be present for one to have malabsorption. Steatorrhea, or fatty stools, is indicative of malabsorption.

For instance, if your stool is light in color, floats easily or sticks to the toilet, and is very soft, you may not be absorbing fats. This results in fatty stools with these fat malabsorption symptoms and characteristics. If you aren’t absorbing certain carbohydrates (such as fructose malabsorption), you may experience diarrhea, gas or bloating. If your body isn’t getting enough protein, you may notice hair loss, skin rashes or dry skin, or fluid retention.

What happens if you have malabsorption?

You can have general malabsorption, which affects your ability to absorb all nutrients, or you can have particular difficulties absorbing certain kinds of nutrients. Whatever you can’t absorb will pass undigested in your stools. People with malabsorption syndrome often have diarrhea as a side effect, which can make malabsorption worse. With diarrhea, food moves too fast through your bowels for nutrients to be absorbed.

Read also: Managing Fructose Malabsorption

In the short term, malabsorption will cause gastrointestinal distress from the inability to digest certain foods. Over time, your body will start to show signs of deficiency in those nutrients that you can’t absorb. Deficiencies in any of the macronutrients - protein, fats or carbohydrates - will cause signs of undernutrition, such as muscle wasting and reduced immunity. Deficiencies in micronutrients - vitamins and minerals - may affect your eyes, bones, skin and hair.

Diagnosing Malabsorption

Ask you about your symptoms and review your medical history. Order a blood or stool test. A stool test is one of the most reliable tests for malabsorption, especially when trying to test whether or not your body is absorbing fat. Your doctor may also look for signs of undigested food in your stool.

Conventional Tests

• Blood Tests: These can be used to identify suspected malabsorption and are usually the first tests done. They are not specific because low levels of certain substances could be due to disorders other than malabsorption e.g. Blood carotene levels are useful to screen for malabsorption. Low levels of carotene in the blood suggest deficient absorption of fat-soluble vitamins or dietary deficiency. Serum carotene levels are generally low in people with fat malabsorption. Vitamin B12 and folate levels may also be used to screen for malabsorption. Low calcium levels may result from either malabsorption of vitamin D or to binding of calcium to unabsorbed fatty acids. Vitamin K deficiency resulting from malabsorption may cause bleeding disorders. Anemia due to iron deficiency may be caused by malabsorption of iron in the first part of the small bowel. Another type of blood sampling can be used to test absorption. A substance can be administered orally and its concentration is then measured in the blood to provide a measure of absorptive capacity. The most commonly used test is the D-xylose test.
• Stool Tests: Tests of the fat content of stool may be used to determine if fat malabsorption is present. Stool is collected over a period of 72 hours with the person consuming a diet containing 100g of fat per day.
• Breath Tests: Breath tests are another method of detecting malabsorption. They are most often performed to test for lactose intolerance. Lactose is given by mouth and the subject’s breath is analyzed for the presence of hydrogen gas.
• Biopsies: Tests such as biopsies of the small intestine (usually performed using an endoscope passed through the mouth into the intestine) are used to diagnose certain malabsorptive conditions.

Dietary and Lifestyle Modifications to Improve Fat Digestion

With specific dietary and lifestyle modifications, it may be possible for many people to improve fat digestion. Conventional treatment for malabsorption syndrome depends on the underlying cause, as it’s important that your doctor deal with the root issue and not just the symptoms. (8) It’s critical to understand that occasional signs and symptoms of malabsorption, such as bloating and gas, are not immediate cause for concern. In cases where the underlying cause can’t be “cured”.

Dietary Adjustments

• Balanced, Fiber-Rich Diet: Eating a balanced, fiber-rich diet can help aid fat digestion. Fiber has many benefits for the general population, but especially those with malabsorption syndrome. By eating more fiber, you boost digestion and also slow down how long food stays in your digestive tract. (12) This gives your body more time to process and absorb key nutrients. A high-fiber diet has also been linked to a reduction in various digestive tract issues, including acid reflux and irritable bowel syndrome.
• Prioritize Liver-Supporting Foods: Fruits, vegetables and high quality protein generally help support liver function. Burdock root, cardamom, celery, cilantro, cinnamon bark, cruciferous vegetables (such as bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, garden cress, and kale), dandelion, eggs, garlic, ginger, green tea, licorice root, onions, parsley, sarsaparilla and other herbs will all help to regulate liver functioning.
• Low-Fat Diet: If fat is being malabsorbed, a low fat diet should be consumed. For a regular healthy diet, it is recommended that of the total calories eaten, no more than 30% should come from fat. However, certain diseases and medical conditions can make it difficult for the body to tolerate even that much fat, so a low-fat diet may help people with these conditions. Following a low-fat diet can be helpful for many different diseases such as gallbladder disease, delayed stomach emptying (gastroparesis), diarrhea, and fatty liver disease. In general, it is advised that all visible fat be trimmed from meats. All foods, including meat and fish, should be baked, steamed, or broiled rather than fried. In most cases, this diet provides all the nutrients required by the National Research Council’s Recommended Dietary Allowances (RDA). In some cases, however, the physician may prescribe supplements.
• Limit Specific Carbohydrates: For carbohydrate malabsorption, disaccharides, specifically lactose, often must be restricted. This involves limiting milk products or choosing many of the low lactose products now available. Lactase enzyme tablets may also be taken with milk products to digest the lactose.
• Incorporate Healthy Fats: Healthy fats and Omega 3s are in avocadoes, walnuts, coconut oil, ghee, and cold-pressed extra virgin olive oil. Eggs and fish (specifically fatty fish such as salmon, sardines, and tuna) to are other great healthy fats.. Slowly start to increase these foods in your diet to get their health benefits! The goal should be about 2 tablespoons of some form of healthy fat daily. All fats are not created equally, so continue to avoid saturated fats in your diet.
• Consider Medium-Chain Triglycerides (MCTs): Your body digests and absorbs medium-chain triglycerides (MCTs) faster and more efficiently than traditional dietary fat.

Lifestyle Practices

• Stress Management: Chronic stress can affect digestion, including how the body absorbs nutrients, and which nutrients the intestines absorb. You can’t see stress, but your digestive system can definitely feel its effects. To lower stress and improve digestion, Harvard Medical School recommends cognitive behavioral therapy, relaxation therapy or hypnosis.
• Mindful Eating: Meals should always be consumed while in a parasympathetic state in order to optimize digestion. Eating at a table, breathing deeply, taking small bites, chewing thoroughly, avoiding large quantities of water, and eating in community all help to optimize digestion by promoting being in a parasympathetic state. Not chewing your food well has been linked to a reduction in how many nutrients your body absorbs from your diet. When you chew properly, your mouth begins the important digestion process. Your teeth break down the food into easier-to-manage particles, and the enzymes in your saliva start to break down the fats and the carbohydrates in your food. Slow down. Avoid distractions. When you sit down to eat, focus simply on eating. Be mindful. Practicing mindfulness helps slow your eating pace, which in turn helps put less strain on your digestive tract.
• Time-Restricted Eating: Even a few hours of fasting (including a few hours between meals) may improve digestion. Time restricted eating has been the subject of some promising research in recent years.

Supplements and Additional Aids

• Digestive Enzymes: Digestive enzymes are active substances that assist your body in breaking down specific nutrients. Digestive enzymes are typically produced in your gallbladder and pancreas to break down foods. When you have inflammation in your gut for any reason, you may need more enzymes to help with digestion. The most effective enzymes to help with fat digestion and absorption include ox bile, lipase, and amylase. Find digestive enzymes with all three of these components to help with fat absorption while you improve your overall gut health.
• Hydrochloric Acid (HCL): Research shows that hydrochloric acids help increase stomach acidity and aid in digestion (4). A good start is to increase the amount of lemon and other citric fruits in your diet. I drink lemon water throughout the day, every day. Also, try drinking a tablespoon of apple cider vinegar diluted in one glass of warm or room-temperature water each morning on an empty stomach. As an alternative to dietary changes, you can also take a hydrochloric acid supplement to increase your levels.
• Probiotics: Your gut is like an ecosystem. For it to work effectively, it needs a balance of many healthy probiotics. for improved digestion of fats and other nutrients (5). One way to improve your gut’s diversity is by increasing fermented foods in your diet like homemade sauerkraut kefir, kombucha, and yogurt. It can be hard to get enough probiotics through your diet.
• TUDCA (Tauroursodeoxycholic Acid): TUDCA, tauroursodeoxycholic acid, is a secondary bile acid that can support digestion. The liver is a hardy organ, but it still may succumb to abuse. TUDCA supports healthy liver enzyme levels and supports the healthy flow of bile from the liver. TUDCA helps reduce stress at the cellular level, in the endoplasmic reticulum and Golgi body (organelles in charge of folding proteins). Distortions of these are implicated in neurological and neuromuscular disorders. Long ago, in Traditional Chinese Medicine, bear bile was harvested to acquire TUDCA from animals.
• Ox Bile: A valued partner to TUDCA in direct lipid digestion is ox bile, an aid in processing fats and fat-soluble vitamins.* Ox bile is remarkably similar to human bile, which explains its effectiveness. Supplemental ox bile is taken from the animal and sterilized using heat, taking care not to upset the product’s integrity.
• High-Calorie Diet: In conjunction with the advice of your doctor and a registered dietitian, you may benefit from a high-calorie diet. This gives your body extra vitamins, minerals, carbohydrates, proteins and fats. Even if your body isn’t absorbing enough of one of these key nutrients, a higher-calorie diet supplies excess amounts of your missing nutrients so you have a higher chance of hitting your basic nutritional benchmarks. Similarly, your doctor may suggest taking supplements so you get more of the specific nutrient you’re not absorbing.

Importance of Professional Guidance

Any specific regimen your health care provider has prescribed must be followed as recommended, of course. Malabsorption syndrome can lead to major complications, so immediate treatment is always necessary. You should always work with your doctor and dietitian. Speak with an expert integrative physician about fat malabsorption or other issues.

Read also: Managing BAM with Diet

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