Hard to digest fats – indigestion, lipid digestion disorders, diagnosis

Proven content

Eating a portion of fatty stew does not end with impunity for everyone. While the sporadic indigestion that disappears after drinking peppermint tea or taking a popular drug is not a cause for concern, prolonged problems with digesting fats should prompt us to see a doctor.

Digestion is nothing more than the reduction of high-molecular nutrients – proteins, fats and some sugars – into simple compounds that are absorbed from the lumen of the gastrointestinal tract into the blood. It begins in the oral cavity, although the main place of the whole process is the small intestine, or more precisely its initial part, i.e. the duodenum and the proximal part of the jejunum. In addition, the liver and pancreas play an important role in digesting food, producing bile and digestive enzymes, respectively.

The digestion of fats is more complicated than the rest of the nutrients. Firstly, because they are insoluble in water, and secondly – apart from the appropriate enzymes, they also require careful grinding in the presence of bile.

In the stomach and duodenum

The metabolism of lipids begins in the stomach. There, they are crushed and mixed with liquids and pre-digested (mainly milk and egg fats) by an enzyme called gastric lipase. In the duodenum, they are further broken down and digested by enzymes produced by the pancreas (pancreatic lipase, cholesterol esterase and phospholipases).

Their presence in the duodenum stimulates the secretion of bile into the lumen of the gastrointestinal tract. The latter, in turn, produced by the liver and stored in the gallbladder, contains acids composed of a water-soluble and fat-soluble part. Thanks to this property, bile acids together with the released fat breakdown products form droplets (micelles) in which the water-soluble components “stick out” to the outside, and inside there are fat digestion products, ie fatty acids, monoglycerides and cholesterol. Digested fats move over the surface of the brush border and gradually penetrate the intestinal epithelial cells.

The digestion of lipids is related to the transformation of bile acids produced by the liver. Approx. 90 percent of them are absorbed in the final section of the small intestine, after fulfilling their function in absorbing fats. The bile acids then travel through the bloodstream to the liver, where they are trapped and secreted back into the bile. This cycle, which bile acids undergo 6-10 times a day, is called the enterohepatic circulation.

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Indigestion, or dyspepsia

The term “dyspepsia” literally means poor digestion. Although it is equivalent to “indigestion,” in fact, dyspepsia is defined as pain or discomfort in the upper abdomen.

In common understanding, patients often mean a whole range of various ailments, such as the feeling of fullness and heaviness in the upper abdomen, flatulence, belching, the feeling of early satiety while eating a meal or heartburn, which occur relatively often in the course of many diseases, not necessarily the digestive system . Moreover, they are not so characteristic of any disease entity that a diagnosis can be unequivocally established only on the basis of an interview.

Indigestion may not only have many faces, but also its causes. Quite often, contrary to the original meaning of the word “dyspepsia”, it is not associated with poor digestion of nutrients, but is the result of dietary mistakes.

In addition, the possible causes of dyspepsia also include inflammatory diseases, cancer or functional disorders of the digestive system, i.e. of the stomach, intestines, liver, bile ducts and pancreas, the use of certain drugs, especially anti-inflammatory, analgesic, antipyretic or antibiotics, addictions (smoking, drinking alcohol). Often the causes of dyspeptic ailments are diseases of organs outside the digestive system, such as heart failure, hyperthyroidism and hypothyroidism, diabetes, chronic renal failure, connective tissue diseases, and even mental diseases and pregnancy.

Lipid digestion disorders

Disturbances in fat absorption can result from impaired digestion, absorption, or both. Incorrect digestion can be a consequence of difficulties in grinding and mixing food (chewing disorders, removing part of the stomach), congenital or acquired digestive enzyme deficiencies or excessive acidification of the duodenal contents, which results in inactivation, i.e. loss of the ability of digestive enzymes to function actively. The most common cause of impaired digestion of fats is deficiency of pancreatic lipase (in the course of chronic pancreatitis) or bile salt deficiency.

Due to the very important role of bile in fat digestion, all disease processes that cause changes in its composition and its reduction in the duodenal lumen, impede fat absorption. Possible causes include diseases of the liver and bile ducts and disturbances in enterohepatic circulation, e.g. as a result of excision of the final segment of the small intestine, Crohn’s disease, excessive multiplication of bacteria in the small intestine, or the use of certain medications.

When the amount of bile acid returned to the liver decreases, it replenishes by making it from cholesterol. In the case of significant deficiencies or impaired liver function, fatty diarrhea occurs. A similar situation occurs when there is an obstacle in the flow of bile into the duodenum, e.g. due to gallstone disease. Then bile acids do not enter the gastrointestinal tract, which leads to disturbances in the absorption of fats and vitamins A, D, E and K.

From suspicion to diagnosis

The appearance of ailments in the form of abdominal pain, nausea, flatulence after eating a fatty meal does not necessarily indicate impaired digestion of fats. These ailments are relatively common for a variety of reasons and are not always related to poor digestion.

The body primarily obtains energy from the consumed fats (1 g of fat provides about twice as many calories as 1 g of sugar or protein), therefore, in lipid disorders there is a reduction in body weight, cachexia and symptoms of deficiency of fat-soluble vitamins, e.g. prolonged bleeding, bruising, dry and keratinized skin, visual impairment, decreased bone mineralization, disturbances in the central nervous system. In addition, an excess of unabsorbed fatty acids binds with calcium and magnesium in the intestine, preventing their absorption.

Also, diarrhea and the appearance of fatty stools (pale, shiny, difficult to rinse, with a particularly unpleasant odor) raise the suspicion of impaired digestion of fats, which requires confirmation and determination of the cause by laboratory and imaging tests. One of the simplest tests to confirm the presence of fatty diarrhea is to test the lipid content of the stool. In addition, diagnostics can be supplemented with respiratory tests and other specialized examinations.

Home way

Fortunately, for most patients, indigestion is a minor symptom that occurs periodically and resolves after diet modification, such as restriction of fatty and flatulent foods such as beans, peas, cabbage and Brussels sprouts. It is also important to reduce the volume of meals – it is better to eat more often, but in smaller amounts. In addition, avoid heavy dinners and variable meal times. You should limit the consumption of alcohol, coffee, black tea and the use of hot spices. Some methods of preparing meals – frying and grilling – are also not recommended.

In many cases, relief is provided by the use of linseed, mint and herbal preparations containing St. John’s wort and artichoke extract. Occasionally, over-the-counter medications that help digest food by affecting the production and secretion of bile, gallbladder function or the amount of pancreatic enzymes in the lumen of the small intestine can help.

Appropriate supplementation will be helpful in digesting hard-to-digest products. At Medonet Market you can buy the Loclo dietary supplement with fiber obtained from apples and oat bran, which regulates the digestive system and prevents constipation.

Time to see a doctor

No improvement after the use of the above-mentioned methods and / or the appearance of disturbing symptoms, e.g. weight loss, fatty diarrhea, jaundice, abdominal pain that wakes up at night, vomiting, especially in a person over 45 years of age. should prompt you to visit a general practitioner or gastroenterologist who will order the necessary tests to establish the diagnosis.

The best results are obtained by treating the disease that has led to problems digesting fats. This requires, depending on the diagnosis, the intake of the missing digestive enzymes, drugs that increase the production and secretion of bile or, on the contrary, bind bile acids in the intestinal lumen. Agents that inhibit gastric acid secretion are sometimes helpful (pancreatic lipase is inactivated when the environment is too acid in the lumen of the gastrointestinal tract) and anti-flatulence preparations.

It is important to modify the diet, i.e. reduce the amount of fats, especially those containing long-chain fatty acids, and increase the proportion of short-chain and medium-chain fats, the so-called MCTs that are less complicated to digest and absorb from the gastrointestinal tract. In addition, you should increase your consumption of vegetable fats, which provide essential polyunsaturated fatty acids. Their rich source is corn, sunflower, soybean, rapeseed, beech oil, olive oil and fish (including salmon, cod, mackerel). Hard margarines are not recommended, as well as animal fats that contain a lot of cholesterol and saturated fatty acids that promote atherosclerosis. Among them, the best digestibility is shown by butter, which in addition to easily digestible fat contains a lot of vitamin A, carotenes and some amounts of vitamin D and E, but due to its atherogenic properties, its consumption should be limited in adults.

Worth knowing

Valuable fats

Fats (lipids) are water-insoluble organic compounds such as fatty acids, triglycerides, phospholipids, cholesterol, waxes, and carotenes. They are an important source of energy (they cover about 20-30% of the daily energy requirement) and provide essential unsaturated fatty acids and fat-soluble vitamins (A, D, E, K).

For the inquisitive

Digestion of sugars and proteins

An adult man consumes approx. 200-400 g of sugars (carbohydrates) every day, more than half of which are complex sugars. What’s next with them? They are digested first in the mouth with the help of saliva containing salivary amylase, which breaks down starch, and then in the small intestine, in the presence of pancreatic amylase. The resulting disaccharides, thanks to enzymes contained in the folded membrane of intestinal epithelial cells, are broken down into simple sugars and then absorbed into the bloodstream.

Protein digestion, by contrast, begins in the stomach, where an enzyme called pepsin breaks down 10-15% of the digestive tract. protein. Then, in the lumen of the small intestine, under the influence of pancreatic enzymes (trypsin and chymotrypsin), polypeptides are formed, which are converted into amino acids by the enzymes of the brush border. Indigestion is relieved by using linseed, mint, St. John’s wort and artichoke preparations. Medicines that affect the production and secretion of bile, gallbladder function or the amount of pancreatic enzymes may also be helpful.

Text: Dorota Ksiądzyna, MD, PhD

Source: Let’s live longer

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