The gastrointestinal tract plays a key role in absorbing fats, proteins, carbohydrates, and micronutrients. When the processes necessary for digestion and absorption do not function properly, food particles may not be fully assimilated, potentially leading to malabsorption. The small intestines are primarily involved in this absorption process.
A well-functioning digestive tract is important for nutrient absorption. This article will discuss malabsorption syndrome and a functional approach to testing and management.
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What is Malabsorption Syndrome?
A digestive tract that functions optimally will take the foods you eat, break them down, and then absorb the nutrients. Malabsorption Syndrome occurs when your small intestine does not absorb nutrients effectively due to various digestive system challenges. Digestion involves three steps: breaking down the food, assimilating the nutrients from the food, and eliminating waste. Malabsorption occurs during the second step. You might be able to break down foods into their nutritional components, but if your body cannot effectively take in the macronutrients and micronutrients, it may lead to malabsorption and nutritional challenges.
What Are The Different Types Of Malabsorption Disorders?
Carbohydrate Malabsorption
A disruption in sugar digestion can lead to carbohydrate malabsorption. When foods high in carbohydrates, like grains, are not broken down and absorbed through the small intestines, it may lead to digestive complications. Unabsorbed sugars can become a food source for bacteria residing in your colon. As these bacteria feed on the sugar, fermentation occurs, which produces gases like hydrogen and methane. Another by-product of fermentation is short-chain fatty acids, which pass through the gastrointestinal tract and may cause fatty stools. Conditions that may contribute to carbohydrate malabsorption include:
Fat Malabsorption
Challenges in digesting and absorbing fats are among the most common forms of malabsorption. Processing lipids for absorption occurs via emulsification. The combination of chewing and enzyme release in the mouth begins the process. As food moves down the digestive tract, the stomach and pancreas release lipolytic enzymes. Bile salts then add to the process by increasing pH, which helps transform the lipid particles into micelles. The absorption of fat particles in the form of micelles happens in the jejunum (proximal small intestines). Disruption can occur during the process of transferring fat to micelles, potentially affecting the body's ability to absorb this macronutrient. Conditions that may lead to this include:
- Decreased pH in the small intestines
- Crohn's disease
- Celiac disease
- Resection surgeries like bariatric surgery
- SIBO
- Bile acid insufficiency
- Ulcerative colitis (UC)
- Liver disease
- Cholestasis
- Pancreatic insufficiency conditions
- Cystic Fibrosis
- Gallbladder diseases
- Whipple disease
Protein Malabsorption
Protein malabsorption occurs when the small intestine cannot break down or transport certain amino acids across its brush border. Someone with this condition may have a food protein intolerance such as gluten, casein, or other milk proteins. Other conditions that may put someone at risk for protein malabsorption include:
- Chronic pancreatitis
- Cystic fibrosis
- IBS
- Bowel resection
- Intestinal Lymphangiectasia
Bile Acid Malabsorption
When there is a lack of bile secreted from the liver and gallbladder, it can lead to bile salts triggering water secretion. This may result in chronic diarrhea as a result of bile acid malabsorption.
Conditions associated with this type of malabsorption include:
- Gallbladder disease
- IBS with Diarrhea (IBS-D)
- Surgical resection
- Crohn's Disease
What are The Symptoms of Malabsorption Syndrome?
Initial Symptoms may include:
- Indigestion
- Abdominal pain
- Abdominal distension
- Bloating
- Gas
- Diarrhea
- Steatorrhea
If not addressed, malabsorption syndrome can lead to symptoms of malnutrition due to micronutrient depletion, which may include:
- Dry skin and lesions
- Frequent infections
- Muscle wasting
- Unintentional weight loss
- Dehydration
- Edema
- Bleeding gums and nosebleeds
- Night blindness
- Amenorrhea
- Growth delays
- Irritability
- Fatigue
- Anemia
- Dizziness
What Causes Malabsorption Syndrome?
Food Intolerances
Gastrointestinal processes can increase malabsorption when exposed to macronutrients or food components your body cannot tolerate. These foods are called food intolerances. For example, individuals with Celiac disease cannot tolerate gluten protein. Eating this may cause inflammation, an immune response, and malabsorption. Other common intolerances include foods for which someone lacks the necessary enzymes to break them down.
A good example would be fructose and lactose intolerance. Honey and dairy, foods high in fructose and lactose, can cause malabsorption if you lack the necessary enzymes. Some individuals may have food intolerances that are non-immunological and non-enzymatic but cause gastrointestinal distress due to other food composition or underlying processes.
Small Intestinal Damage
Inflammation and injury to the mucus membranes of the small intestines can affect the absorption of nutrients. The mucous lining of your intestines releases enzymes to break down food while simultaneously being the medium for nutrient absorption from the food. Inflammatory conditions like Ulcerative Colitis (UC) and Chron's, as well as autoimmune Celiac disease, can damage the intestinal lining, potentially leading to malabsorption. Other conditions affecting the small intestines include Whipple's disease, short bowel syndrome, SIBO, Zollinger-Ellison syndrome, radiation therapy, chemotherapy, and the overuse of certain medications.
Organ Dysfunction
Pancreatic, liver, and gallbladder conditions can all contribute to malabsorption. To break down food, your body needs to produce and release digestive enzymes from your pancreas. Those enzymes work with bile that is stored and released from your liver and gallbladder. Conditions like gallbladder disease, liver disease, cystic fibrosis, and pancreatic insufficiency can all affect these organs' functions. This may ultimately impact the breakdown of macronutrients and the small intestines' ability to absorb them.
Lymphatic Conditions
Your lymphatic system helps move nutrients into your bloodstream. If there is stagnant lymphatic flow, your body may not be capable of absorbing fats effectively. Two specific conditions that impact lymphatic function are lymphangiectasia and lymphoma. Complications within the lymphatic system can also result in protein malabsorption, which can lead to symptoms such as edema and ascites.
Functional Medicine Labs to Test for Root Cause of Malabsorption Syndrome
CBC
Obtaining a complete blood count (with differentials) test can help assess for anemias and infections that may result from malabsorption.
Comprehensive Metabolic Panel
Malabsorption syndrome can disrupt the body's electrolyte balance, involve hepatic and renal systems, or cause protein depletion. Getting a CMP can reveal if your minerals are imbalanced, whether or not these organ systems are in distress, and if your protein status is adequate.
SIBO Breath Test
Genova Diagnostics offers a 3-hour breath test that analyzes methane and hydrogen gas levels after ingesting a lactulose solution. Levels of these gases can help determine if Small Intestinal Bacterial Overgrowth is contributing to your malabsorption. Common conditions that may benefit from results and management include Crohn's or Celiac disease.
Reactive Food Testing
Working with a functional medicine provider can help determine appropriate testing depending on whether a food intolerance, food sensitivity, or food allergy is suspected. Currently, there are a few enzymatic-related food intolerance breath tests that can be ordered. Commonwealth Diagnostics International offers Fructose, Lactose, or Sucrose Malabsorption Breath tests. While there is no mainstream comprehensive food intolerance test, there are food sensitivity and allergy tests. Alletess Laboratory offers a 184-item Food Sensitivity test that evaluates IgG immune-mediated reactions. Infinite Allergy offers a test measuring 88 common food antigens to test for IgE-mediated Food Allergies. Working closely with your healthcare provider can help determine which of these avenues provides you the most value.
Comprehensive Stool Analysis
Combining a comprehensive stool test with a food sensitivity panel can provide an overall picture of gut health. The GI-Map + Zonulin test by Diagnostic Solutions can detect a microbial imbalance and identify microbes contributing to illness. This test can also objectively measure digestion, absorption, inflammation, and immune function. Zonulin, the marker for leaky gut, is a useful indicator of intestinal permeability. High Zonulin levels may indicate changes to the intestinal wall tight junctions, which can impact absorption.
Micronutrient Testing
Chronic malabsorption can lead to nutrient deficiencies. Utilizing a comprehensive test can help evaluate what nutrients you may be deficient in. This is a useful way to identify and target nutraceutical support while addressing the root cause of malabsorption.
Other Lab Test to Check
If all avenues have been investigated, and/or symptoms of Cystic Fibrosis are present, the next step would be a referral to a medical doctor who can evaluate you and run the proper test, such as a Sweat test.
Testing for Bile Acid Malabsorption involves a fecal bile acid test for stool acid levels or a Serum 7aC4 test. Both of these can be done by your primary care provider.
Endoscopy, with or without biopsy, is a valuable assessment tool to visualize the upper gastrointestinal tract. Anytime persistent pain, nausea, bloating, diarrhea, or indigestion occur, obtaining visualization can aid in proper diagnosis and management.
Gastrointestinal X-Ray is an additional first line of testing that can be done through your primary care provider to rule out any obstructive or inflammatory concerns of the gastrointestinal tract.
Functional Medicine Management for Malabsorption Syndrome
Nutrition
Depending on the cause of malabsorption, your dietary considerations could vary. For someone who is lactose intolerant or has Celiac disease, avoiding the offending foods may be helpful. If food sensitivities are the concern, it is best to work with a holistic practitioner to do food sensitivity testing, implement an elimination diet, work on gut health, and then slowly reintroduce foods. If an inflammatory-based condition like Crohn's or Ulcerative Colitis is the primary contributor, you might explore the Specific Carbohydrate Diet (SCD). One study of 400 IBD patients suggested that one-third of those who followed SCD experienced symptomatic improvement two months into this nutrition plan.
Supporting bile flow from the liver and gallbladder may be beneficial if you experience challenges in these organs. Functional foods like Artichokes and bitter foods like dandelion may support bile flow and liver health.
Herbs & Supplements
Althea Officinalis, also known as Marshmallow root, may have benefits in supporting inflamed and damaged mucosal tissue. The antioxidant-rich mucilaginous component of this botanical is known to add a layer of protection over mucous membranes, which may help soothe the small intestines during the healing process.
Milk Thistle is a botanical that may be used for its antioxidant and liver-supporting properties. Incorporating this into a plan for someone with liver concerns may help support liver health.
Taking exogenous digestive enzymes to help your GI tract break down macronutrients may assist absorption. Enzyme supplementation is especially considered in cases of Pancreatic Insufficiency and Cystic Fibrosis.
Lifestyle Changes
Massage Therapy: Professional lymphatic drainage massage may be a helpful tool to support lymphatic flow. While there is limited evidence-based research on the topic, it is known that this type of massage is not recommended for those with Lymphoma, as you do not want to disrupt the affected lymph nodes.
Stress Management: A stress reduction practice may influence the gut-brain axis and help relieve some symptoms. A review on the topic discusses how episodes of stress in conditions such as IBD can alter intestinal permeability and affect healing.
Exercise and Gut health: Research suggests that gut microbiome diversity has a positive correlation with aerobic exercise. Getting in a daily walk or a minimum of 150 minutes of weekly aerobic exercise is ideal. Other evidence suggests that Yoga may help mitigate some of the symptoms associated with IBS, which may impact your malabsorption.
Summary
Malabsorption syndrome can be a result of one or multiple malabsorption conditions. Considering your symptoms, medical history, and how your symptoms have progressed are all essential factors in determining if a challenge in your ability to absorb nutrients is occurring. Getting the basic testing done, such as a CBC, CMP, and X-ray, can help rule out some diagnoses. Further investigation into specialty labs and functional testing can provide more insight into the root cause. Considering your symptoms and labs, holistic approaches may help relieve symptoms or support your path to wellness.
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