Malabsorption occus when the body can't properly absorb nutrients from food. This condition can affect digestion, energy production, and overall health. Several factors, including digestive disorders, infections, and nutrient deficiencies, can contribute to malabsorption. Early diagnosis and targeted treatment can help restore nutrient absorption and support long-term wellness.

What is Malabsorption?

Malabsorption is defined as an inability to absorb nutrients from foods. Nutrients typically reach the bloodstream via the mucosal membrane of the small intestine.

Symptoms such as gas and bloating, fatty stools (steatorrhea), as well as diarrhea and cramping, are caused by both a decrease in nutrients in the bloodstream, as well as the increased passage of all that is unabsorbed through the digestive tract.

Some report unusually foul smelling stool that is lighter in colour and 'sticky', meaning it will stick to the side of the bowl, difficult to flush. Stool may or may not also contain undigested food. Individuals who suffer from malabsorption, know it can be extremely uncomfortable and, due to explosive and or urgent diarrhea, how greatly it can impact all aspects of an individual's life.

Key Causes of Malabsorption

Various conditions can cause malabsorption disorders. Malabsorption reflects an underlying gastrointestinal problem rather than a diagnosis itself. Disorders preventing adequate mixing of food with digestive enzymes are one example. Diseases of the pancreas, such as cystic fibrosis or chronic pancreatitis, can cause a significant decrease in enzymes such as lipase, protease and amylase, essential for the breakdown of fats, proteins, and carbohydrates/sugars. High stomach acid levels can affect digestion and nutrient absorption. Reduced bile production can also impair nutrient absorption. Imbalanced gut flora may further disrupt food breakdown. As with lactase deficiency, an individual produces insufficient lactase enzyme to break down lactose (a sugar) found in many dairy products.

Malabsorption can also be caused by injuries to the lining of the small intestine. The small intestine has small projections called villi lining its walls. Each villus has its own set of small projections called microvilli. These serve in exponentially increase the surface area with which the small intestine can absorb nutrients. Celiac sprue is one example of a disorder that impairs this process. In celiacs, tests reveal that the villi are flattened, no longer functioning to increase absorption. Some drugs, like neomycin (an antibiotic), and even alcohol, can also destroy the villi of the small intestine, greatly impacting our ability to absorb nutrients from our diet.

Some conditions slow the muscle contractions (peristalsis) of the intestine. Contents then pool in one place, allowing excess bacterial growth (and fermentation, which also produces gas). This throws off the delicate balance, and what was once healthy bacteria, supporting digestive processes, becomes 'bad' due to overgrowth and can impact the nutrients we are able to extract. Conditions such as IBS can cause bouts of increased contraction (spastic colon) alternating with decreases in peristalsis. This is why individuals with IBS have the characteristic diarrhea – constipation – diarrhea cycle. When contractions are increased and food is pushed through too quickly, there is again malabsorption.

Symptoms of Malabsorption & Testing Protocols

Several tests can help identify malabsorption and its causes. Doctors may use imaging and endoscopic procedures to examine the digestive tract. These tests include barium X-rays, upper endoscopy, and colonoscopy. Doctors can also collect biopsies during these procedures. A fecal fat test often serves as an initial screening tool. More than 7g of fat daily may indicate malabsorption. Additional tests help determine the underlying cause. Stool tests for elastase and chymotrypsin can distinguish pancreatic and gastrointestinal causes. Doctors diagnose irritable bowel syndrome after excluding other conditions. People with IBS often experience gas, bloating, cramping, diarrhea, or constipation. Symptoms may alternate between diarrhea and constipation.

The Food Allergy Connection

Something else to consider is that food allergies/sensitivities can cause essentially the same symptom picture or exacerbate another existing malabsorptive condition. If there are foods that you know make symptoms worse, you may want to do an elimination challenge. Eliminate suspected foods for three to four weeks. Then reintroduce them one at a time. This process can identify food allergies or sensitivities. Symptoms often improve or disappear after removing trigger foods. In the case of sensitivity, after a period of avoidance, you may be able to slowly bring some of these foods back into your diet, in moderation, without reaction.