Struggling with high fat meals? Deep dive into fat digestion and its impact on IBS symptoms.

1. Discover the potential hidden culprit—bile acid malabsorption—and its role in triggering diarrhoea predominant IBS.
2. Healthy fats versus fats to avoid. Explore the significance of monounsaturated and polyunsaturated fats, and their impact on inflammation, heart health, and digestion.
3. Valuable insights into essential fatty acids like omega-3 and omega-6 - best dietary sources
4. Practical tips. Shift your focus from meal-by-meal to an overall dietary pattern, emphasizing high fibre and healthy fats while minimizing processed foods.

Links

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/
• BLOG - Bile acid malabsorption - https://www.goodnessme-nutrition.com/gut-health/bile-acid-diarrhoea-a-forgotten-reason-for-ibs-d/

Do you struggle to eat fatty meals?

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Maybe you feel it sets off your dash

to the toilet, or you just feel really

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nauseous and like food sits really heavy

in your stomach for hours after eating.

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It's not 100 percent clear what the

link is between IBS and high fat meals,

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but that's what I'm going to explain.

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Explore today on this episode of the

Inside Knowledge, I'll run through the

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difference between healthy fats and fats

to reduce in our diet, as well as how to

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improve fat digestion, and we'll cover

how fats might be affecting your IBS.

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I'll also briefly talk about bile

acid malabsorption, which is a common

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cause of diarrhea predominant IBS.

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Welcome to episode 23 of the Inside

Knowledge with me, Anna Mapson.

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We're starting today

talking about fats for IBS.

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So, what kind of foods you can eat

more of, what kind of foods you

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should potentially avoid if you

have got a sensitivity to fats.

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But I'm going to explore a bit about

Why you may have that, and what

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fat actually does to our digestion.

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I first thought I'd start with

though, what fat does in our body,

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like why do we need to eat fats?

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And it is a really important

macronutrient in our dietary profile.

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So we need fats to help us make our

hormones, to keep all our cells healthy.

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A lot of our brain is made of fats,

and also we have fat soluble vitamins,

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which we can only absorb if we're

eating sufficient fat in the diet, and

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that's vitamin A, vitamin E, D, and K.

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So, there's really no doubt that

we do need some fat in our diet.

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We need a selection of dietary fats, which

can help us create these core biological

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processes, like keeping our hormones

going, making our cells function well.

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You know, these are important processes.

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However, We are surrounded by a food

environment that really promotes

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availability of high fat foods a lot and

so there's an opportunity, if we wanted

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to, to eat high fat foods all the time and

as humans we haven't really developed in

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order to, eat such a large amount of fats.

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Fat.

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When you eat it per gram has nine

calories compared to Carbohydrate and

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protein which is four calories per gram.

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So there's a lot more energy in fats

per Gram of the food rather than say

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compared to proteins and carbohydrates

I'm not going to go into the energy

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density of foods and, like, talk about

weight gain in this particular episode.

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I just want to talk about the

digestion of fats and how it

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might be affecting your IBS.

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So, high fat meals, we know,

are associated with IBS symptoms

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and particularly things like

diarrhoea, cramping and gas.

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Although, some people find that it

can also lead to a slower transit time

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and I'll explain a bit about that.

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Why and how that is from an evolutionary

perspective humans have needed to extract

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as much energy from foods as possible

and so We've got a slow digestion of

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fats in the small intestine in order

to allow that process to happen.

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The way that affects IBS is that when

your gut slows down to try and absorb more

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nutrients from the meal, It could mean

that your gas transport or the passage

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of gas through your gut is slowed down.

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This is probably worse in people

who have IBS because you have

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more gas, potentially, and also

more sensitivity to the gas.

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So that hypersensitivity, will mean

that you feel more pain and more

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Discomfort from the same amount of

gas that somebody else might have.

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But also because it's going slowly through

your small intestine, you can feel very

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bloated and feel very uncomfortable.

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You might also find that you get

more contractions of the small

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intestine as your muscles are trying

to move the food through the gut.

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So because of it slowing down to

try and absorb the calories or the

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energy out of the food, but then the

smooth muscle is like pushing and

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cramping trying to move it along.

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Now that could also increase your symptoms

and feelings that your IBS is flaring up.

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If we look at how fat is actually digested

in your gut, then we can talk about

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why that might not work so well if you

have IBS or other digestive conditions.

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So firstly, obviously, like you're

chewing it in your mouth, there's a

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little bit of lipase, which is the enzyme

that breaks down fats released in your

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stomach as the food travels down into

your stomach, it's mashed up and There's

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a little bit of lipase in your stomach,

but then, as your food goes into your

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small intestine, You will release bile

from your liver, well, your gallbladder,

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which then helps to emulsify the fats.

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Because fats aren't water soluble, and

we need them to be water soluble to

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get into cells and transport around

the body better, we want to break them

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down to their smallest components.

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And bile, it emulsifies them.

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So, a bit like when you have washing

up liquid, it, like, makes the fat

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globules smaller so that we can...

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wash them up a little bit the same that's

happening in your digestive system.

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So once you've got bile released into

the small intestine that's emulsified

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the fats which increases the surface area

and then you get some digestive enzymes

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which break them into smaller fatty acids.

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Lipase from your pancreas that

breaks down the fats from your food.

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Then It can be acted upon and help to

transport the fats into the cells so that

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we can actually start to use it . Now,

the bile that I mentioned just now, which

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comes from the gallbladder and helps to

break down the fats, it contains something

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called bile acids and these are normally

reabsorbed in the small intestine,

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so it It does its work, it emulsifies

the fats, helps us better absorb them.

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And then at the end of the small

intestine, we normally reabsorb

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the bile acids and they can go

back to the liver to be recycled.

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About 97 percent of them are

reabsorbed and recycled for use again.

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But, if some of them are not well absorbed

and they're left to get to the large

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intestine, then you get diarrhoea and

abdominal pain and very bad IBS symptoms

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and that is due to the irritation that

the bile salts are creating in the large

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intestine because they shouldn't be there.

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They should be reabsorbed into the small

intestine and then sent back to the liver.

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If they get to the large intestine,

they can cause a lot of irritation.

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And this happens often because of

small intestine bacterial overgrowth.

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So if you have got an overgrowth of

bacteria in your small intestine, it

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can interfere with this reabsorption

process and mean that you're getting

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a release of bile acids in a normal

way when you're eating your food.

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Then it doesn't get reabsorbed because

of SIBO, and then it can cause diarrhea.

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So this is one way that eating fats

may trigger IBS like symptoms in people

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who haven't got a good digestion.

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The other way that people may

malabsorb fats is if you're not

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producing enough of the enzymes.

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So lipase is the one

that breaks down fats.

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Again, in the small intestine, if your

pancreas is not producing enough of

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these enzymes, it may be the case that

you don't Break down the fat and then

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you have very fatty stools and you might

notice this by yellow or orangey looking

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poo that's very frothy, um, diarrhea

and sometimes a floating stool as well.

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Now that can sometimes be because you

haven't broken down the fibers as well,

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but if you think about fats, they always

rise to the top of the water and the

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same thing will happen if you've got a

lot of undigested fats in your stool,

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you will see it floating in the toilet.

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just to recap, the ways that high fat

meals can affect your digestion is

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either you don't have enough enzymes,

being produced in your pancreas, and

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this can be a condition which isn't IBS

called exocrine pancreatic insufficiency.

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Basically just means you're not producing

enough of your own digestive enzymes.

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It may be that you've got bile

acid malabsorption, so you're not

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reabsorbing your bile acids, and that's

irritating the colon on your large

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intestine as it's reaching there.

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Or it may be that a high fat meal

is slowing down the transit of gas

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through your digestion and that is

leading you to feel very uncomfortable

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after eating high fat meals.

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Now, let's have a little think about

good fats and bad fats and which ones

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we're encouraged to eat more or less of.

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When we're talking about healthy

fats, it's usually referring to

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monounsaturated or polyunsaturated fats.

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This is just relating to the size of the

chain of the fatty acids and how many of

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the bonds between the acids are saturated.

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Generally, we need to reduce

our saturated fat intake and cut

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down on the amount of butter.

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red meat with high fat

content and processed foods.

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These are not good for us and not

good for our heart, but also not

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particularly good for digestion either.

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Monounsaturated fats are found in

foods like olives, olive oil, nuts.

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And avocados.

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These fats are known to lower

inflammation throughout our body.

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They might help with lowering blood

pressure and might even reduce the

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likelihood of having heart disease.

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So this is foods that are rich

in the Mediterranean diets.

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If you think about, you know, nuts,

seeds, olives, these are great

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foods for including in your diet.

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And then we have.

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polyunsaturated fats and these

are essential fatty acids.

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That means our body cannot

make them but we need them.

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So in order to be healthy we need

a good reliable source in our

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diet of omega 3 and also omega 6.

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Now we get that from foods that we eat.

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The best source of omega 3 is oily

fish, and there's a little acronym

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called SMASH to help you remember

which fish are the good ones for oil,

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and that includes sardines, mackerel,

anchovies, salmon, and herring.

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Some omega 3 can be obtained from plant

based sources like flax seeds, walnuts,

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hemp, and sunflower seeds, but the

omega 3 in that is not as available

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to our body as the one from fish.

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If you are a vegan, a vegan omega

3 supplement made from algae, that's

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seaweed, because the way we get omega

3 supplements is because the fish eat

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the seaweed, and then people, catch the

fish, and take the oil from the fish.

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If you are vegan, what you can do

is, there's a supplement that's

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made from the seaweed, and it's

in a gelatine free capsule, and...

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will be suitable for vegans

because this omega 3 is really

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important for our overall health.

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And it helps with mood.

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It helps with mental

health, like cognition and

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concentration, that sort of thing.

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It's also been tested for, skin health.

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So thinking about the people who

have eczema and high levels of

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Dry skin, that sort of thing.

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So, if you're not eating oily

fish, I strongly suggest that you

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think about whether an omega 3

supplement is suitable for you.

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You don't even have to take it every

day, but just including it at some

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point throughout your week in your diet

because, as I said, it is an essential

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fatty acid and generally people tend to

be pretty low in it because those oily

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fish that I mentioned are not the ones

that people like to eat very often.

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Now, you might hear people talk about

omega 6, that we need to reduce our intake

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of the other polyunsaturated fat, omega 6.

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This is more freely available in things

like nuts and seeds, meats, and you can

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get omega 6 fairly easily from the diet.

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People will talk about reducing down

omega 6, especially plant oils, so

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things like sunflower seed oil, vegetable

oils, you might see them called.

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This actually isn't true.

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Obviously, we need to monitor the

overall levels of fat in our diet.

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As I mentioned at the beginning,

fat has a higher energy

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content per gram than protein.

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or carbohydrate.

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This means it's energy dense.

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If you're eating food with a lot of

fat in it, it will have a higher amount

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of energy than food without fat in it.

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So, We don't want to

just eat lots of fats.

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But there is really good evidence

for having less saturated fat in

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your diet and more plant based fats

including vegetable oils, omega 6

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fats, because it's anti inflammatory.

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This helps to reduce down the risk of

heart disease and swapping out things

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like butter for plant based margarines

can be very important if you have high

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cholesterol, if you have a history

or a family history of heart disease.

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You might also hear people saying

that you need to keep the ratio of

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omega 3 to omega 6 in balance, and

there's also zero evidence for that.

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There's no evidence that says

having a certain ratio of omega

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3 to omega 6 is better for you.

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Yes, people are eating more fat now.

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And that is true.

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And we're living, as I said, at the

top of the show, we're living in

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this environment where we have got

access to high fat foods and high

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energy density foods all the time.

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It doesn't necessarily

mean the ratio is wrong.

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We need to manage our overall energy.

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Intake and make sure that fat is

a controlled proportion of that in

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order to not eat too much fat which

has a negative impact on the rest

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of our body, not just digestion.

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Anyway, we're veering off digestion

a little bit here, but it is

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something I get asked about a lot

and including things like Is it okay

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to eat a certain amount of nuts?

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Is it okay to cook with vegetable oil?

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Um, and the answer to that is yes,

it is okay to eat nuts and it is

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okay to cook with vegetable oil.

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Anyway, let's finish up just

talking about what you can do.

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So if you feel that fat is a problem for

you and your diet, what kind of things can

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you change in order to get less symptoms?

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I expect that's why you're

listening to this episode.

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Overall, I'd like you to think about your.

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eating pattern as a whole

rather than meal by meal.

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When we're thinking about gut

bacteria, we're just looking at

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your overall dietary pattern.

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And people who eat a sort of typical

Western diet with high carbohydrate,

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high fat content, typically have

gut bacteria more associated with

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chronic disease, chronic low level

inflammation, and digestive complaints.

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So Overall, I want to try and modulate

that by trying to change it to a

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high fibre diet so you're eating more

fibre, less high fat, so looking at the

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overall dietary pattern, not meal by

meal, but just thinking How much fat

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would you say you're eating in a day?

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How much fiber would you

say you're eating in a day?

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Then, we also want to try and make sure

that you are including some of these

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healthy fats like avocados, nuts, oily

fish and trying to reduce down the

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other fats like, you know, processed

meats, burgers, chips and fried foods,

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those kind of things because they

tend to be higher in saturated fats.

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One of the other reasons that fibre

is so helpful is it does help remove

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bile salts and help to reduce the

impact of bile salt malabsorption.

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The other thing you can do is really

protect your liver and that is to help

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you, because they're making the bile salt

. We want to make sure that our liver is

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functioning as effectively as possible.

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So, reducing high alcohol intake.

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And if you're someone who has a

glass of wine every day or you

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drink a lot on the weekends, your

liver may be working overtime and

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may be struggling a little bit.

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So, just simple things you can do.

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You don't need to do any sort

of detox or cleanse or anything.

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But just simple things like you're

cutting down your alcohol to within

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the recommended guidelines or

lower and drinking lots of water.

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In terms of what you can take to help aid

fat digestion, there are digestive enzymes

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that include high levels of lipase.

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That's the enzyme breaking down fats.

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You could try taking a digestive

enzyme with high fat meals to see if

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it eases your symptoms the next time.

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Just carry them around

with you in your bag or...

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car or whatever and then when you need

them just take one with the high fat meal

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to see if it makes it easier to digest.

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The other thing you may do is talk to

your doctor about bile acid malabsorption.

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If you're someone who has frequent watery

diarrhea, , that is erratic and you

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don't know what's causing it, keep going

back to your doctor and make sure that

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they have run the right kind of tests or

considered the right kind of medication.

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If you do think bile acid malabsorption

is an issue for you, there is medication

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that you can get which helps to remove

the bile salts from your digestive system

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so that they don't irritate the colon.

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But this does have other health

complications because it can reduce

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down your cholesterol and if you're

not someone who needs to have

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their cholesterol reduced, this

can have negative consequences.

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So it does need doctor's

medical management.

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Okay, I hope that has been useful.

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I don't want people to be afraid of fats.

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Like I said at the beginning, we need

fats in our diet but we need more of the

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plant based fats ideally and the oily

fish and less of the saturated fats.

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Overall, to try and keep a healthy,

balanced diet and hopefully you can

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enjoy eating some of these fatty foods on

occasion and not worry about it as long as

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you are creating a good gut environment.

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Now that is.

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Easier said than done, I know.

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And if you want to work with someone

on your digestion, please get in touch.

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I run a three month gut reset, either on a

one to one basis or in a group, um, which

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is a slightly lower cost and you have

group coaching sessions, which people have

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been really like learning off each other

and enjoying some of the interactions,

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or there's like a private sessions

where you have one to ones with me.

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These all run for three months and

I find that is a good amount of

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time to really start to help people

understand what foods work for them.

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So if you're not sure and you

want to talk to me about it then

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please get in touch and we can

talk about what you need help with.

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All right, I'm going to

leave it there for this week.

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Thank you.

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Goodbye.