Are We Absorbing Enough Nutrients?

We Eat Enough. But Do We Absorb Enough?

We can calculate the protein, fat and calories in a menu with great precision. However, this describes what has been eaten, not necessarily what the body has managed to break down and absorb.

Between the food on the plate and the nutrients that reach the tissues lies a complex process. It involves stomach acid, digestive enzymes, bile and the lining of the small intestine. If any of these stages is impaired, even a well-planned menu may not deliver the expected result.

From food to absorption

Digestion begins in the mouth. Chewing breaks food down and mixes it with saliva, whose enzyme amylase begins breaking down starch. In the stomach, acid creates the conditions for pepsin to work – an enzyme involved in breaking down proteins.

The food then passes into the small intestine. There, the pancreas releases enzymes to break down proteins, fats and carbohydrates. Bile helps with the processing and absorption of fats. Enzymes on the surface of the intestinal lining complete the process just before absorption.

That is why we see digestion as a sequence of connected functions, not just a question of whether a person is taking enough enzymes.

When digestion becomes difficult

Bloating after meals is common, but it has no single explanation. It may be related to the composition and amount of food, intolerance to certain carbohydrates, gut sensitivity or another condition. Bloating alone does not prove an enzyme deficiency.

A more specific example is lactose intolerance. When the small intestine produces less lactase, some lactose remains undigested and can cause gas, pain or diarrhoea after dairy products. With this clear mechanism, lactase products can help some people.

Another, more serious problem is exocrine pancreatic insufficiency – a condition in which not enough pancreatic enzymes reach the small intestine for normal food breakdown. It can occur with diseases of the pancreas or after certain operations. Possible signs include diarrhoea, fatty stools, weight loss and nutritional deficiencies. These symptoms require investigation of the cause, because they are not specific to the pancreas alone.

What does faecal elastase tell us?

Faecal elastase is a stool test often used when exocrine pancreatic insufficiency is suspected. The result is interpreted together with the symptoms and other data:

The sample should come from formed or semi-formed stool. Watery diarrhoea can dilute the sample and produce a misleadingly low value. That is why a result between 100 and 200 μg/g should not automatically be read as “moderate insufficiency”.

Bile is part of the picture too

Bile is not an enzyme, but it plays an important role in the absorption of fats. The liver produces it, and the gallbladder stores it and releases it during meals.

After gallbladder removal, most people can eat normally. In some, however, persistent diarrhoea develops that needs to be investigated. It may be related to bile acids and does not automatically mean that bile supplements or digestive enzymes are needed.

When are enzymes a justified choice?

In confirmed exocrine pancreatic insufficiency, the standard approach is pancreatic enzyme replacement therapy, prescribed and monitored by a doctor. The aim is for food to be absorbed better, symptoms to decrease and nutritional status to stabilise.

With a specific intolerance, a targeted enzyme may make sense – for example lactase when eating food containing lactose. A universal enzyme blend for every case of bloating is a different decision, and improvement after taking it does not by itself prove that there was an enzyme deficiency.

Betaine HCl, bile supplements and various plant extracts are also often offered as part of a general protocol. They should not be seen as a mandatory next step for everyone with digestive discomfort. The choice depends on the cause, accompanying conditions and medications being taken.

Agaia's approach: first we find where the difficulty lies

When someone says they eat enough but have persistent digestive complaints, weight loss or suspected nutritional deficiencies, the question is not simply “Which enzyme should we add?”. It is more useful to look, step by step, at:

• what symptoms appear and after which foods;
• whether there are changes in stools and body weight;
• what the food intake is and how different products are tolerated;
• whether there are grounds for testing pancreatic function or for another assessment by a gastroenterologist.

Eating is the beginning of the process, and absorption is its result. To improve the latter, we need to understand which part of digestion really needs support.