Digesting fat and carbohydrate adequately is more important to avoid digestive issues. Tune in to learn more.

Digesting fat…Stool Impression 

Dawn (00:00):

Hello, welcome to the gastric health show. My name is Dawn Boxell, and we’re gonna have a quick conversation on a piece of digestion that you maybe haven’t considered to evaluate. And that is the digestion of fats and carbohydrates. And if you are struggling with digestion, it could be that one of these pieces. One, the carbohydrates or fats are being malabsorbed. So how would you know? There is a stool test you can do that can test for the elastase-one. And this is a pancreatic enzyme that we are evaluating And there’s also Steatocrit.

Steatocrit is really giving us an insight to how well you are absorbing and digesting fats And I will say, this is one thing that I hear frequently with bariatric patients is they are noticing that their stools are floating. They are noticing that they might have droplets in the, in the toilet.

Dawn (01:09):

So those are, those are signs that you are having some fat malabsorption. Typically bile is what is going to emulsify all the fats so that it can be broken down into little droplets. So then it can be utilized and digested and absorbed and processed appropriately. But when we are not capable of that, or we are lacking in areas, then that is when we are going to have some issues. And we’re going to, you would be able to identify on a stool test if you are seeing fat malabsorption. And it would be quantified. So whereas you can obviously see it visually on your end, but this would quantify it and tell us, is this something to be concerned about is this going to lead to you know, nutrient malabsorption like the fat soluble vitamins A D E and K.

Pancreatic enzymes to get your digestion on track 

Dawn (02:14):

I think you have to know, if you’re having digestive symptoms and if you’re having that issue with your stools floating or droplets, then you might want to dig a little deeper. Let’s kind of dig into these two tests.  This is a stool test and  you do one stool test. And it will give you this information off of the one test. And it will tell you the pancreatic elastase one, and it will give you that information if it’s adequate. We usually like it to be above 500, so it can be subpar. So we have lots of people that are, you know

Dawn (03:00):

Having poor pancreatic release of the enzymes. And that means they’re going to be less than the 500. So we might see that they just have some digestive symptoms that can be caused from the hypochlorhydria, which is a low stomach acid is one driver. Gallstones is another. So if you’re having issues with that so think gallbladder. You just have a suppression and pancreatic function, so maybe something is up with your pancreas. It needs to be evaluated. Also H. pylori. So H. pylori is a bacteria that resides in our stomach and most everybody has some level of it. Potentially. And it’s not harmful, but when it is out of control or in excessive amounts, that’s when it becomes problematic because that bacteria H. pylori is what suppresses stomach acid further. So if you already have low stomach acid or, or feel like you might have low stomach acid, you would want to be tested for H. pylori a stool test.

Ulcer in bariatric surgery patients. 

Dawn (04:13):

I use it also tests for the presence of the DNA of H. pylori. And this is even better than a breath test. So I know a lot of bariatric programs utilize a breath test prior, which is awesome. And I am super excited that they do this because we’re at least trying to capture and rule that out. If there is some bacteria, because they are known to cause ulcers. So I’ll back up a second. So if you do have a positive H. pylori Breath test prior to surgery. If that came back positive. Your surgeon’s team or your bariatric team likely put you on an antibiotic protocol and you’re on a PPI and you were on all kinds of medication…lots of pills prior to having surgery. And please do that, make sure that you complete that protocol because you are trying to kill off that bacteria so that you don’t have a risk of ulcers after surgery.

Dawn (05:14):

 If you are positive, then make sure you do the protocol for that.  If you have the low pancreatic elastase-one enzymes.  you could have hypochlorhydria, which is the low stomach acid, gallstones, H pylori, which is again, another low stomach acid indicator. And then it can also be found in vegans and vegetarians. So this is something that.. If that has been a practice, and that is something that you have followed for a number of years, this could be an additional reason of why maybe you don’t feel great when you eat foods. So the pancreas is gonna release the enzymes to break down carbohydrates,

Digesting fats

Dawn (05:57):

Proteins, and fats, but especially carbohydrates. So if you are having issues with that. That would be why. And then when it comes to this steatocrit. That is telling us more about fat. So we are looking at the fat that’s in the stool and the stool test will, would quantify that it would give us a number and let us know if we need to help you. We need to support you. And so that you can digest your fats better. But causes of this to be elevated is again, low stomach acid or hypochlorhydria, maldigestion, which could go back to the elastase. Where you’re not getting enough pancreatic enzymes. Malabsorption. So this goes along with bariatric surgery, you are having malabsorption with the gastric bypass. Your absorption is impacted to some degree with the sleeve gastrectomy as well, and then pancreatic insufficiency, which goes again, back to the pancreatic elastase. Bile insufficiency, so that you have to think about your gallbladder and liver, and then improper, chewing or not chewing your food very well. Is another thing that could contribute to fat in the stool. And then celiac disease.

Dawn (07:22):

So if you are having digestive issues and you are noticing that you have stools that are floating, or you are having some issues with droplets, then you want to explore that, do not dismiss it and disregard it. This is something you need to address. It will lead to further problems nutritionally, as well as metabolically, because we need those fats for hormones and that’s going to impact your thyroid and that’s going to impact your sex hormones. So it’s important to make sure you are absorbing the nutrition well. And fat is part of that. So if you struggle with digestive issues, make sure that you rule these out. Check into, click the link in my bio and check out how we can work together and work through some of those issues or those symptoms. Sometimes you don’t need a test. Sometimes we can, you know, identify it without it, but it is a really great way to know if you personally need to address some things differently. So I hope that helps have a great day bye-bye.

Listen, Learn, Enjoy…

1. 1. Exocrine pancreatic insufficiency after bariatric surgery: A bariatric surgery center of excellence experience
   2. Exocrine pancreatic function and dynamic of digestion after restrictive and malabsorptive bariatric: a prospective, cross-sectional and comparative study
   3. Update on the diagnosis and management of exocrine pancreatic insufficiency
   4. Exocrine pancreatic insufficiency: prevalence, management, diagnosis
   5. Meal-time supplementation with betaine HCL for functional hypochlorhydria: What is the evidence?
   6. Gastric re-acidification with betaine HCL in healthy volunteers with Rabeprazole-induced hypochlorhydria
   7. The pathophysiology of malabsorption
   8. Potential role of hypochlorhydria in the development of duodenal dysbiosis: A preliminary report
   9. Helicobacter Pylori virulence factors affecting gastric proton pump expression and acid suppression