Do you often have stomach problems? Do you sometimes feel full and gassy? Or do you often suffer from flatulence? Sometimes we think that these are normal things, something that happens when food is a little spicy. However, if these symptoms persist, it may be because your body is not absorbing the nutrients it needs from the food you eat. In medicine, we call this condition (Malabsorption).
What is this (Malabsorption)?
Simply put, malabsorption is a general term for the inability of your body to properly absorb nutrients from the food you eat. This is not a single disease, but a condition that can be caused by many factors. Think about it, when we eat food, in order for it to provide energy and nutrition to our bodies, it needs to be properly digested and absorbed, right?
We can divide the process of digesting food into three parts:
1. Part One: Chopping food well and breaking it down into digestible pieces.
2. Part two: Absorbing all the nutrients the body needs from the digested food.
3. Part Three: Excreting the waste products that remain after absorbing all the good things.
Now, if you have digestive problems, the problem could be at any of these stages. Malabsorption is part of the second stage . This means that even though food is digested, the nutrients are not absorbed into the body. This can be caused by conditions such as enzyme deficiencies that prevent the body from digesting certain foods (for example, some people cannot digest milk) and various intestinal diseases that affect your digestive system.
What happens when there is malabsorption?
If you have malabsorption, you may have trouble absorbing all nutrients, or you may have trouble absorbing only a few specific nutrients. The things you can't absorb are passed out in your stool without being digested. Many people with malabsorption also have conditions like diarrhea, which can make this absorption problem worse. This is because when you have diarrhea, food moves through your intestines too quickly, so nutrients don't have time to be absorbed.
In the short term, malabsorption can cause stomach upset and discomfort because some foods cannot be digested. But over time, your body will start to show deficiencies in the nutrients you are unable to absorb. If you are deficient in macronutrients – such as protein, fat, and carbohydrates – you will start to see signs of malnutrition, such as muscle wasting and a weakened immune system . Similarly, if you are deficient in micronutrients – such as vitamins and minerals – your eyes, bones, skin, and hair can be affected.
What are the main types of malabsorption?
Some intestinal diseases, such as Celiac Disease and Inflammatory Bowel Disease (IBD), can cause problems with the absorption of all types of nutrients. In other cases, you may have problems absorbing only a specific nutrient. Here are some of the types:
Carbohydrates are not absorbed properly by the body.
Some people are sensitive to one or more carbohydrates (sugars). You may notice this primarily as gas, bloating, and pain in your stomach . Carbohydrates that are not properly absorbed in your small intestine are fermented by bacteria in your large intestine. These bacteria turn them into gas and short-chain fatty acids. That gas causes gas in your stomach, and the short-chain fatty acids can make your stools fattier.
Fat is not absorbed properly by the body
This is also a common type of malabsorption. It can have many causes. Fat that is not absorbed in the small intestine passes into the large intestine, causing fatty, diarrhea-like stools. We also call this steatorrhea. This type of stool is oily, watery, and foul-smelling . It may be light in color and float in water. Because fat is not absorbed properly, the absorption of fat-soluble vitamins (vitamins A, D, E, and K) is also impaired.
Bile acid malabsorption
Sometimes fat cannot be absorbed because the gallbladder, bile ducts, or liver do not produce enough bile. But sometimes the cause is something else. Then, the unabsorbed bile acids remain in the small intestine and pass into the large intestine. This side effect is called Bile Acid Malabsorption. The bile salts that remain in this way increase the secretion of water from the large intestine, causing prolonged diarrhea .
Protein is not absorbed properly by the body
Generally, unless you have an intolerance to a specific type of protein, that is, an inability to digest it, it is rare to have problems absorbing protein alone. Examples of this are the inability to digest the protein in milk and the inability to digest foods containing gluten.
What are the symptoms if there is malabsorption?
At first, malabsorption may seem like simple indigestion. Symptoms may include:
- Stomach pain.
- Bloating, filling the stomach.
- Frequent passing of air (gas).
- Nausea and vomiting.
- Diarrhea.
- (Steatorrhea) - Fatty, oily, sometimes discolored, floating stools.
Over time, signs of malnutrition begin to appear.
Malnutrition of key nutrients can look like this:
- Unintentional weight loss .
- Muscle wasting, weight loss.
- Frequent illnesses (due to low immunity).
- The skin turns blue even with a small bruise.
- Dry skin, skin lesions.
- Dry hair, hair loss.
- Dehydration (lack of water in the body).
- (Edema) - Swelling of the body (due to fluid retention).
- Anemia - paleness, weakness, dizziness.
- Constant irritability, lack of interest, fatigue.
- Cessation or irregular menstruation in women (Amenorrhea).
- Delayed development in children.
Micronutrient malnutrition can look like this:
- Reduced vision at night (Vitamin A deficiency).
- Weak bones, bone pain (Vitamin D deficiency).
- Bleeding gums, nosebleeds (Vitamin K deficiency).
- Red tongue, tongue sores (Vitamin B12 deficiency).
- Paleness, weakness, dizziness (vitamin deficiency anemia).
What are the main causes of malabsorption?
Malabsorption can be temporary, like when you have a stomach bug or the stomach flu. But long-term malabsorption is caused by an underlying medical condition that you have had for a long time. There are many causes of malabsorption, but they generally fall into a few categories.
Damage to the lining of the small intestine
Most of your nutrients are absorbed in the small intestine (some is also absorbed in the large intestine). The mucous lining of your intestinal walls is involved in both secreting digestive enzymes and absorbing liquid food into your bloodstream. However, this mucous lining can be damaged by inflammation (enteritis) and injury. This damage can be temporary (acute) or long-term (chronic). There are several reasons for this:
- Infectious diseases like Whipple's Disease and Tropical Sprue.
- Inflammatory Bowel Diseases (IBD) like Ulcerative Colitis and Crohn's Disease.
- Autoimmune diseases like Celiac Disease.
- Excessive use of certain medications.
- Alcohol Use Disorder.
- Radiation therapy and chemotherapy.
- (Short Bowel Syndrome) - Shortness of the small intestine.
- (Small Intestinal Bacterial Overgrowth - SIBO) - Overgrowth of bacteria in the small intestine.
- Excessive production of stomach acid in conditions like Zollinger-Ellison Syndrome.
Pancreas, gallbladder, liver diseases
Your pancreas, liver, and gallbladder work together with your small intestine to help you digest food. The pancreas produces important digestive enzymes. The liver and gallbladder produce and store bile. This bile is essential for digesting fats. When food is eaten, these organs release their secretions into the small intestine. However, if these organs are not working properly due to some disease, the small intestine cannot properly digest and absorb food. Examples:
- Pancreatic insufficiency.
- (Cystic Fibrosis).
- Bile Duct Blockages.
- Gallbladder Diseases.
- Liver Disease.
Lymphatic System Diseases
Fat is absorbed from your small intestine into your bloodstream through lymph vessels. If these vessels become blocked due to diseases of the lymphatic system, fat absorption can be impaired. Intestinal Lymphangiectasia and Lymphoma are two examples of this.
Inability to digest certain foods (Food Intolerances)
The inability to digest certain carbohydrates or proteins can be a side effect of intestinal diseases. (An example is the inability to digest fructose). But sometimes people are born without the enzymes needed to digest certain nutrients. (The best example of this is the inability to digest lactose - Lactose Intolerance).
How do you know if you have malabsorption?
Like many intestinal diseases, diagnosing malabsorption is a somewhat gradual process. Your doctor will first examine you and consider your medical history and symptoms. Malabsorption may be suspected if you have a history of chronic intestinal disease or have had surgery.
Malabsorption and malnutrition can be strongly suspected if certain symptoms, such as the aforementioned steatorrhea (fatty stools) and persistent diarrhea, or obvious anemia and muscle wasting, are present. However, in some cases, this is not so obvious. Your doctor will perform the appropriate tests to determine the exact cause of your discomfort.
What tests are used to diagnose malabsorption?
- Breath Tests: A hydrogen breath test can help diagnose conditions such as lactose intolerance, specific carbohydrate digestion problems, and SIBO (small intestinal bacterial overgrowth).
- Stool Tests: A stool test can measure the amount of fat in your stool and can help diagnose fat malabsorption. It can also detect things like parasitic infections and pancreatic dysfunction.
- Blood Tests: These can show signs of specific nutrient deficiencies that can be caused by malabsorption and specific medical conditions such as Celiac Disease.
- Sweat Test: This is a special test to diagnose the condition (Cystic Fibrosis).
- Imaging Tests: Your doctor may want to look at the organs of your digestive system to see if there are any symptoms. This may include a GI X-ray Exam, Endoscopic Ultrasound, or Video Capsule Endoscopy.
- Small Intestinal Biopsy: Your doctor may want to take a sample of tissue from your small intestine for testing in a lab. This biopsy can look for evidence of damage to the lining of your intestine (mucosa). This sample may be taken during an endoscopy.
How is malabsorption treated?
There are many possible underlying causes of malabsorption, and the range of effects it can cause is wide. Your treatment will be determined based on these factors.
To treat the effects of malabsorption, you may need nutritional supplements . They can be given as liquids by mouth, through a tube (tube feeding), or into a vein (IV - intravenous). You may also need to take special digestive enzymes. This may be because you can't digest a certain food or because your pancreas is not working properly. If you have bile acid malabsorption, you may be given something called a bile acid sequestrant to help prevent diarrhea.
Treating the underlying cause of malabsorption can be a bit more complicated. If it's simply a food intolerance, you may just need to change your diet. Simple infections can be treated with antibiotics. But long-term conditions require more specialized treatment. Sometimes there's no immediate cure, but lifestyle changes can help control symptoms.
Will malabsorption be cured?
This depends on identifying the exact cause and treating it properly. Some causes are easier to treat than others. Once you have been diagnosed, your doctor will explain the details of your condition. In many cases, lifestyle changes can help you treat the condition (malabsorption) and its symptoms.
Many people experience occasional bouts of indigestion, bloating, gas, and diarrhea. If something you eat doesn't work for you, you may experience temporary symptoms, but they usually go away on their own. This type of indigestion is nothing to worry about. But if you have these symptoms on a regular basis, it could be a sign of something more serious. Diarrhea that persists is something you should always be concerned about.
Malabsorption can be a hidden cause of malnutrition. Because malnutrition develops slowly, you may not notice it until it is very severe, especially if you are a well-nourished person. This is especially dangerous for children. They need more nutrition for growth and development, and they may not be able to tell you about their symptoms. If your child is showing signs of repeated stomach upset, especially loose stools, it is important to see a doctor to make sure that they do not have a malabsorption condition.
What is the message we want to take home from this article?
Okay, so now we know that malabsorption is a general term for the inability of the body to absorb nutrients from the food we eat. There can be many causes for this, and the symptoms can vary from person to person.
- If you are experiencing symptoms such as frequent stomach upset, diarrhea, bloating, and unintentional weight loss , don't just dismiss it as indigestion.
- Malabsorption can cause malnutrition , which can have many adverse effects on the body.
- If you or your child continue to have these symptoms, be sure to seek medical advice .
- If diagnosed correctly and treated appropriately, this condition can often be controlled.
Remember, it's important to listen to what your body is telling you. Even though it may seem like a small thing, sometimes it can be the start of something big. Therefore, taking care of your health is the most important thing.
` Malabsorption, nutritional deficiency, digestion, diarrhea, malnutrition, vitamin deficiencies, stomach upset
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