The causes of malabsorption are not always readily apparent, yet the effects can be devastating as our body does not have the nutrients it needs to function properly. There are certain chronic illnesses that are more susceptible to malabsorption, and many patients require supplementation in one form or another.
In this article, we will take a look at what malabsorption is, what its causes are, how it impacts our bodies, and potential solutions to combat nutrient deficiencies.
*Note: Whilst this post is sponsored by Spectra Spray, all opinions expressed are my own. Please note that I am not a medical professional, but have done meticulous research from credible sources for this article. Nothing should be taken as medical advice. Always be sure to check with your doctor before you start on any new treatment or protocol. This post might contain affiliate links. It will cost you nothing to click on them. I will get a small referral fee from purchases you make, which helps to keep this blog running (approx. $100/month). Thank you!
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Table of Contents
What is Malabsorption?
From the Merck Manuals:
“Malabsorption syndrome refers to a number of disorders in which nutrients from food are not absorbed properly in the small intestine.”
When we consume foods, they are normally broken down into macronutrients and micronutrients in the small intestine. The body then absorbs them into the bloodstream from there.
This process is interrupted when malabsorption occurs, where the body is unable to digest or absorb these nutrients. Causes include: autoimmune disease, surgery, infection, congenital or a genetic defect.
Causes of Malnutrition in Chronic Illness Patients
Certain chronic illnesses are particularly susceptible to malabsorption, such as: Irritable Bowel Syndrome, IBS, Crohn’s Disease, Ulcerative Colitis, Celiac Disease, Mast Cell Activation Syndrome (MCAS) and Short Bowel Syndrome (SBS).
“Existing data suggest that malnutrition affects a large portion of patients with inflammatory bowel disease (IBD), estimated in 65–75% of patients with Crohn’s disease (CD) and in 18–62% of patients with ulcerative colitis (UC).”
In these diseases or disorders, the cell linings in the intestines might be inflamed, destroyed or unresponsive. Small intestine inflammation can result in problems with digesting food and absorbing nutrients. Large intestine inflammation (including the colon and rectum) can result in problems with water and electrolytes absorption.
In patients with IBD, inflammation tends to occur in the intestines, which can lead to ulceration of bowel surfaces. This in turn leads to malabsorption from chronic blood and protein loss.
Alternatively, patients are unable to eat due to symptoms such as nausea, vomiting, diarrhoea and abdominal pains. They may have limited food choices as well. This lack of food, and therefore, nutrient intake, plays a major role in malnutrition.
Medications as a Factor in Malabsorption
Medications taken to control and manage chronic illnesses can also cause malabsorption. For example, glucocorticosteroids are notorious for interfering with calcium absorption. This can lead to osteoporosis and other health problems. In fact, osteoporosis is often overlooked until a fracture occurs, yet is the most common bone disease in the U.S..
Sulfasalazine is a DMARD (disease-modifying anti-rheumatic drug) that doctors sometimes use in patients with UC or IBD. It is also a folic antagonist. The aim is to control and treat bowel inflammation, diarrhoea, rectal bleeding and abdominal pain. Side effects, ironically, can mirror the symptoms of the disease.
Some of the Consequences From Malabsorption
Depending on the type of nutrient loss or malabsorption, a wide range of symptoms can occur, such as:
- Anaemia
- Chronic fatigue
- Sleeping disorders
- Female infertility
- Osteoporosis or osteopenia
- Hypertension
- Cardiomyopathy
- Poor wound healing
- Night blindness
- And more
Some common vitamin and nutrient deficiencies in IBD patients include:
- Iron
- Calcium
- Selenium
- Zinc
- Magnesium
- Vitamins (especially vitamin A, B12, Folic Acid, D and K)
Surgery & Malnutrition in IBD Patients
Up to 50% of patients with Crohn’s Disease need surgery within the first 10 years post diagnosis. And up to 85% of patients awaiting surgery suffer from malnutrition.
What’s worse is that malnourishment in itself can have an impact on the surgical outcome. This is especially true for those with chronic diseases, who already have other risk factors and a faulty immune system.
The rates for malnutrition in IBD patients range from 25 – 69%. It is especially common in Crohn’s Disease, as it can affect any part of the gastrointestinal tract. Compare that to UC, where inflammation is limited to the colon.
The Rise of Obesity & The Need for Bariatric Surgery
Another major problem in modern society is morbid obesity. The numbers are climbing and will reach close to one million over the next few years. Nutritional deficiencies such as Vitamin B12 and iron are common in this population.
Over 100,000 bariatric (weight loss) surgeries are performed annually. This surgical procedure alters the anatomy of the regular digestive system. These alterations mean that the body will no longer have the time or space to break food down for absorption and utilisation ‘as per usual’. Malnutrition can occur on top of other health issues such as metabolic problems and ulcers.
In general, fat-soluble vitamins A, D and K will be deficient in two-thirds of such patients within 4 years of surgery. This leads to other health problems such as easy bruising, rashes, osteomalacia and more, depending on the type of nutritional deficiency.
Bacterial Overgrowth (SIBO)’s Impact on Malabsorption
SIBO (small intestinal bacterial overgrowth) is a common cause of malabsorption. Whilst probiotics are generally good for intestinal flora, some contain prebiotics such as fructooligosaccharides or inulin. These carbohydrates provide food for gut bacteria. But they can also lead to overgrowth and aggravate gastrointestinal (GI) symptoms.
Intestinal hyperpermeability (aka leaky gut) and SIBO are also common symptoms faced by people with Celiac Disease, who are on a strict gluten-free diet.
Other acute causes of SIBO include antibiotic use, which wipes out or disturbs intestinal flora, and narcotic use, which can slow down intestinal transit (motility). Rotaviruses, Astroviruses and Noroviruses are some transient causes for SIBO as well.
Intestinal bacteria also loves iron, and sometimes absorb it before the body is able to utilise it, leading to iron deficiency.
Microbial Infections That Can Cause Malabsorption
Protozoal and Helminth infections can cause malabsorption, and also intestinal tuberculosis and chronic pancreatitis. These happen especially in the tropics, and is known as ‘tropical malabsorption’. There have also been a rise of IBD and Celiac Disease in the tropics that have lead to malabsorption.
In Conclusion
Malabsorption is a complex topic that often isn’t given enough attention. It is also often not picked up early enough, even by medical professionals. This can have a detrimental effect on the patient. Sometimes the effects of malabsorption are not readily apparent, and further testing needs to be done.
As detailed above, there are many root causes that can lead to malabsorption. Regardless of the cause, it is vital to replenish and nourish the body with nutrients. They are essential for optimal health and wellbeing in any person.
Whilst many patients do take supplements to support their health, the body is often unable to absorb them properly for a variety of reasons.
Oral Spray Vitamins as a Potential Solution for Supplementation
There are a few methods to take your vitamins or supplements. In order of slowest to fastest absorption rate:
- Pills
- Gel capsules
- Transdermal patches
- Sublingual liquids
- Intramuscular injections
- Oral spray vitamins
The use of oral spray vitamins is a quick, easy and ingenious way to provide your body with nutrients. The absorption rate is up to 3 times faster than traditional pills and capsules.
This is because the vitamins have already been emulsified (broken down) in oral spray vitamins. The body does not need to waste time or effort breaking down binders, fillers and inorganic materials that often come with pills and capsules. Some chronic illness patients such as those with MCAS might also be allergic to these binders or fillers.
Oral spray vitamins might be a potential solution to explore if patients are struggling with pill or capsule supplements for any reason. Or if such supplements have proven to be ineffective for them. They can also be used to boost the health of the general population.
Spectra Spray Global is a spray vitamin company based in the USA with a mission to provide easy to use, highly effective, on-the-go health products that change lives everyday.
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Sources:
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- Ensari A. (2014). The Malabsorption Syndrome and Its Causes and Consequences. Pathobiology of Human Disease, 1266–1287. https://doi.org/10.1016/B978-0-12-386456-7.03804-1
- Billeter, A. T., Fischer, L., Wekerle, A. L., Senft, J., & Müller-Stich, B. (2014). Malabsorption as a Therapeutic Approach in Bariatric Surgery. Viszeralmedizin, 30(3), 198–204. https://doi.org/10.1159/000363480
- Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology, 3(2), 112–122.
- Ramakrishna, B. S., Venkataraman, S., & Mukhopadhya, A. (2006). Tropical malabsorption. Postgraduate medical journal, 82(974), 779–787. https://doi.org/10.1136/pgmj.2006.048579
- Grass, F., Pache, B., Martin, D., Hahnloser, D., Demartines, N., & Hübner, M. (2017). Preoperative Nutritional Conditioning of Crohn’s Patients-Systematic Review of Current Evidence and Practice. Nutrients, 9(6), 562. https://doi.org/10.3390/nu9060562
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- Shpata, V., Prendushi, X., Kreka, M., Kola, I., Kurti, F., & Ohri, I. (2014). Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer. Medical archives (Sarajevo, Bosnia and Herzegovina), 68(4), 263–267
This makes me wonder. I had the Nissen Procedure done to stop acid reflux. Since then, my stomach has been on FIRE. However, once I stopped dairy and gluten this past year, it’s been 80% better. I wonder if the procedure caused issues with absorption of nutrients.
Thank you for writing this! It took forever for Al to be diagnosed with autoimmune pernicious anemia for the reasons you mentioned above. In his case, his immune system has been attacking the intrinsic factor, which is what takes B-12 from the stomach and intestines into the blood stream. Eating B-12 does him no good because the problem is in his digestive system. He’s getting monthly injections of B-12 now, which does the trick, but it took quite a few doctors to figure out what was wrong, especially because usually there are other symptoms of B-12 malabsorption, but they were masked by the symptoms from his TBI several years earlier.
I’m using the sleep spray now, and like it – though unfortunately one of my cats bit one of my tubes and punctured it!
Thanks again for discussing this – malabsorption definitely is one of those things pretty low-down on doctor’s priorities to test for!
Hi Alison, yes it’s surprising how difficult malabsoption can be to diagnose sometimes, no?
That’s kind of funny about the cat but am sorry to hear that happened! 🙁 Does it work for you like it works for me?
And agreed, we definitely need more awareness on malabsorption. Sometimes a simple few tests are all that’s needed, even.