Sarah Myhill, MD, is a UK-based fatigue specialist and clinical nutritionist. This article on the many factors that can starve the body of what it needs is reproduced with kind permission* from her educational website (DrMyhill.co.uk).
Malabsorption - Failure to Get the Goodness from Food
Sarah Myhill, MD
The job of the gut is to absorb the goodness from food. To do this:
• It first has to reduce food particles to a size which allows the digestive enzymes to get at them,
• Then it has to provide the correct acidity for enzymes to work, produce the enzymes, emulsifying agent (bile salts) and move the food along the gut.
• Finally the large bowel allows growth of bacteria for a final digestive / fermentative process and water extraction.
The gut has a particularly difficult job because it has to identify foods that are safe from potentially dangerous microbes (most are not dangerous but positively beneficial). This explains why 90% of the immune system is gut associated. The inoculation of the gut with the good microbes takes place in the gut in the first few minutes following birth - see Probiotics.
Anything which goes wrong with any of these processes can cause malabsorption. Malabsorption means that the body does not get the raw materials for normal everyday work and repair. This means there is the potential for lots of things to go wrong when there is malabsorption.
Malabsorption Can Occur for the Following Reasons
Failure to Chew Foods Properly
Gandhi said we should chew our liquids and drink our foods! It is essential to break foods down into small particles to allow quick and efficient digestion of them. Saliva contains amylase which starts the process of carbohydrate digestion. It also contains epithelial growth factor to prevent leaky gut.
Not Enough Acid in the Stomach
Acid is necessary to start off protein digestion and further digestion of protein takes place in the small intestine – see Hypochlorhydria. [This lack of stomach acid is often the real problem for people who mistakenly believe their problems are caused by too much acid, as in ‘heartburn’ or ‘GERD.’ Often helped by betaine HCL - essentially stomach acid, derived from beets.]
Failure to Produce Enough Digestive Enzymes
As in cystic fibrosis (hinders ability of the pancreas to produce protein and fat-digesting enzymes, makes maintaining normal weight difficult). See Digestive enzymes are necessary to digest food. [Supplemental digestive enzyme formulations may contain plant-based enzymes such as papain (from papaya), betaine (beets), or bromelain (pineapple), and animal-based enzymes such as pepsin and pancreatin.]
Failure to Produce Enough Bile
Blocked bile ducts, eventually causes jaundice, poor liver function. See Gall bladder disease and gall stones.
Inflammation in the Gut
Caused by gut dysbiosis (i.e. the wrong bugs) or gastroenteritis (temporary bugs in the gut). See Fermentation in the gut and CFS.
Inflammation in the Gut Caused by Allergy
Celiac disease, multiple food allergy, ulcerative colitis and Crohn's.
Insufficient GI Transit Time
Food passing through the gut so quickly that there is not time for digestion to take place. Causes can include:
• Overuse of laxatives;
• Being very nervous;
• Excessive exercise;
• Autonomic neuropathy (nerve disorder that affects involuntary body functions including heart rate, blood pressure, perspiration and digestion);
• Thyrotoxicosis (excessive thyroid hormones in the bloodstream).
[Interestingly, when things are functioning normally, different food materials move at different rates through the digestive system, and do not leave segments of the digestive tube in the same order as they arrive.]
Poisons or Toxins in the Diet Such as Lectins
See Lectins. [See also: "The Dark Side of Wheat... Genes, Epigenetics & Chronic Illness."]
Absorption Blockers - Unabsorbable Substances that Bind with Minerals
For example, tea drinking causes malabsorption of minerals because tannins in tea bind with minerals to form insoluble tannates which cannot be absorbed.
Wheat bran is high in phytic acid, which blocks absorption of minerals. One example of this effect can be found in an area in Iran where wheat is a staple part of the inhabitants' diet. As a result they are zinc deficient. Zinc is necessary for growth and many of these people do not achieve their full potential height and remain as dwarfs.
Cancer in the Gut
This rarely presents with malabsorption, but in its advanced stages it can certainly cause malabsorption.
Where sections of the gut have been removed.
Complications of Poor Gut Function
There are two common complications of poor gut function.
Malabsorption of Vitamin B12
The first is malabsorption of B12. B12 requires a special carrier protein called "intrinsic factor" to be produced in the stomach. B12 binds on to intrinsic factor and is carried to the gut, where it is absorbed in the last section of the small intestine, the terminal ileum. There is lots of potential for things to go wrong and B12 deficiency is common.
The problem is that the normal range for B12 is set so low that many of these B12 deficiency cases are not picked up. I like to see blood levels for B12 running at at least 600, and I often recommend injections of B12 in order to get levels up around 2000, where it has other beneficial effects over and above its physiological reactions.
[See also <a href=" http://www.prohealth.com/library/showArticle.cfm?libid=14192&site=articles">“Could a Common B-12 Deficiency Be Causing Your Symptoms?”</a>]
Leaky Gut Syndrome
Another problem of poor gut function is leaky gut syndrome. The problem with leaky gut is that molecules get from the gut into the blood stream before they have been fully digested. These large, antigenically interesting molecules in the bloodstream can activate the immune system leading to allergy or possibly autoimmunity.
Furthermore, many of these molecules can mimic the action of hormones in the blood stream and have other profound effects. For example, ‘leaked’ food molecules can mimic the actions of the hormone vasopressin which controls blood pressure, thereby causing profound fluctuation in blood pressure. See the blood test for short chain polypeptides from <a href="http://www.drmyhill.co.uk/wiki/Short_chain_polypeptides" target="_blank">BioLab in the UK</a> [Short chain polypeptides are small molecules that can easily pass through the gut wall, are often so small that they aren’t recognized as foreign substances, and can mimic hormones & disrupt many metabolic processes].
Symptoms of Malabsorption
Almost any symptom could result from malabsorption, from failure to thrive, weight loss, fatigue, to organ failure.
• Diarrhea often reflects the disease process causing the malabsorption.
• Stools may have undigested fat in them causing large, offensive, pale, greasy stools which float and are therefore difficult to flush away.
• Blood or excessive mucous in the stool.
• Wind, gas and bloating as a result of fermentation in the gut.
• Offensive wind points to a fermenting gut. See http://www.drmyhill.co.uk/wiki/Fermentation_in_the_gut_and_CFS.
Tests of Malabsorption
Any or all of these tests may be needed to work out the cause (see links to online test info, appended below):
Fecal fat: measures the level of fat in stools.
Pancreatic elastase: an indicator of pancreatic function.
Comprehensive digestive stool analysis: CDSA - this looks at digestion and absorption of fats and proteins, gives us an idea of fermentation in the gut, together with microbial content of the gut. It also looks at fecal occult blood and short chain fatty acid profile. As an extra you can ask for fecal calprotectin (which is a good indicator of gut inflammation), fecal elastase (pancreatic function) and bile salts.
Short chain polypeptides: This looks at proteins which have leaked from the gut into the blood stream and therefore gives us an indication of leaky gut. I don't do this test very often as it doesn't narrow down a diagnosis very much, but can be useful to help explain otherwise inexplicable symptoms.
Vascular endothelial growth factor: Salivary test for hypochlorhydria [lack of digestive juice].
Treatment of Malabsorption
Ideally this needs to be overseen by an experienced physician, but not many are conversant with all of the above issues.
Identify the cause of the malabsorption - by going through the above check list and the tests listed below.
Correct any nutritional deficiencies which may have arisen from years of malabsorption. This would initially be achieved through taking my standard regime of nutritional supplements [multi vitamin/mineral; vitamin C; the essential fatty acids omega 6 & omega 3 in a 4 to 1 ratio; sunshine/vitamin D; some sea salt if not eating salted processed foods] - backed up by nutritional screening tests such as B12 and folic acid, ferritin (to test for anemia) and calcium levels (low calcium is an indication of vitamin D deficiency), all of which can be easily done by blood testing – National Health System testing, in the UK.
If the patient does not feel completely restored by these interventions then one would consider more sophisticated tests of nutritional status, such as antioxidant status, B vitamin profile, fat soluble vitamins including vitamin D and essential fatty acids.
Links to Find Related Tests
In the UK, for information see Dr. Myhill’s index of tests here (www.drmyhill.co.uk/wiki/Category:Tests). In the US and elsewhere see sites such as Lab Tests Online (http://labtestsonline.org/understanding/conditions/malabsorption/start/2).
• Full blood count
• Elastase - a new test for pancreatic disease
• Comprehensive Digestive Stool Analysis
• Vascular endothelial growth factor (VEGF) - salivary test for hypochlorhydria
• Short chain polypeptides
* This article is reproduced with kind permission from Dr. Sarah Myhill’s educational website (DrMyhill.co.uk)® Sarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198.
Note: This information has not been reviewed by the FDA. It is general information, based on the research & opinions of Dr. Sarah Myhill unless otherwise noted, and is not meant to replace the personal attention of a medical professional. It is not intended to prevent, diagnose, treat or cure any condition, illness or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.