“All disease begins in the gut.” – Hippocrates

Monday, October 4, 2010

On Malabsorption

This post is the second in a series of posts on vitamin supplementation for people with IBD. See my first post here. I do tend to sprinkle other topics in between posts in a series. This is mainly because I can’t stand to write on any one topic too many days in a row. I need variety. What can I say, Google has shaped my mind. So, without further adieu…
There is a lot out there on malabsorption. My job in this series is to distill it down to the essentials for those with IBD—what do I need to know? View this series as an executive summary on on vitamin supplementation for IBD, this post being the executive summary for malabsorption.
The term malabsorption covers more than 25 diseases and syndromes; I’ve focused here on IBD.
The most common cause(s) of malabsorption is inflammation or lesions of the intestinal mucosa. This inflammation breaks down the mucosal wall, decreasing the gut’s ability to digest and absorb nutrients. Diarrhea associated with IBD also increases transit times, which decreases absorption.
Think of it this way: Your gut is like an energy capture processing center—take food in, use it as efficiently as possible, spit out the waste. With diarrhea, the machinery is moving too quickly. With inflammation, the machinery itself isn’t functioning properly. So your plant is operating at partial capacity.
In the name of making this post as readable and usable as possible, I’m going to rely on bullet lists—remember, executive summary.

Common Symptoms of Malabsorption:
Higher stool volume (because your processing center is working at partial capacity)*
Cramping and abdominal pain, esp. before a bowel movement
Bloating and gas**
Weight loss
*A normal stool mass averages 100-200 grams per day in an adult. (What is normal?)
**Gas and bloating occur mainly because the flora in the large intestine ferment (feed on) the undigested matter, typically carbohydrates (these leftovers are what the SCD tries to decrease). One product of this fermentation is gas. This is why it is so dangerous for folks with active diarrhea due to IBD to take Imodium. With decreased motility, gas builds up in the large intestine, and puts pressure on the intestinal wall, drastically increasing your chances for toxic megacolon—For more on this, see my post on Imodium.
Below I list some common deficiencies from malabsorption along with (in parentheses) some common symptoms of them. I will go into greater detail on each deficiency as we progress through this series on vitamins. Remember, the goal is to build the case for vitamin supplementation, and to provide the basic tools for choosing a supplement regimen that is right for you and works with your stage of healing IBD.
Common deficiencies associated with Malabsorption (and some frequent symptoms):
Note:   Neither the list nor the parenthetical symptoms are exhaustive. I’ve just hit the major deficiencies and a few of the common symptoms associated with that particular deficiency. These deficiencies are usually more prominent in those with inflammation of the small bowel, as most absorption occurs in the small intestine.
Iron (anemia, lethargy, etc.)
Zinc (loss of taste)
Folate (abnormal red blood cell growth…)
Vitamin B12***
Vitamin B6***
Vitamin A (night blindness, dermatitis)
Calcium (bone loss, muscle cramps, heart rhythm irregularities)
Vitamin D (works in synergy with calcium)
Fat malabsorption (soapy stool, vitamin A, D, E deficiency)
Protien (adema of lower extremities)
Vitamin K (blood thinning, increased healing time)
Potassium (affects neuromuscular conductivity…potassium is involved in just about every physiological process you can think of, and some you can’t.)
***Vitamin B deficiencies can alter nerve cell function, and can cause peripheral neuropathy. Both vitamin B6 and B12, and folate deficiencies can accelerate arteriosclerosis (inflammation of the arterial walls (read: heart attack)). B12 deficiency can be one of the first to appear as uptake in the ileum is frustrated by inflammation.
Why can’t I get what I need from a healthy diet, like the SCD?
I went into some of this in my first post.
Dr. Bill Misner, PhD writes about athletes (who typically have a better diet than the average American), [Healthy] “athletes today ingest only 11% of the organic nutrients from their food sources that the athletes of the 1940’s enjoyed.” This is largely due to soil depletion, and modern farming practices such as green harvesting.
Bruce Ames, professor of biochemistry and molecular biology at the University of California, Berkeley, implies that micronutrient deficiency may eventually deteriorate the quality of whole human cell health.
Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer.1
Also remember, your processing center is not functioning properly. The SCD is perfectly nutritious, and in theory, you should indeed be able to get what you need from the food in the SCD. However, with a damaged gut, and if you are on medication, your chances of deficiencies are high. In this series, we’ll look at the major categories of vitamins, some of the causes for specific deficiencies, and what levels of supplementation is recommended for those with IBD.
Onward to Health.
1REFERENCE: Ames BN, Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage, Proc Natl Acad Sci USA, 2006; 103 (47): 17589-94. (Address: Nutrition and Metabolism Center, Children's Hospital of Oakland Research Institute, Oakland, CA 94609, USA). www.ncbi.nlm.nih.gov/pubmed/17101959?dopt=AbstractPlus


  1. Nice blog I ever seen this type post any blog good information points in your blog keep it up and post latest updates.
    Thanks You.
    Beauty Tips

  2. Hey Matt,

    Great Post! I like the executive summary style. I can't wait to see the rest of the series, what are your thoughts on Magnesium? I see you didn't include it in the list above.

    Low Zinc can indicate a loss of smell as well :) only know cause I had it.


    Steve Wright

  3. IBD patients with severe diarrhea (electrolyte imbalance) and poor absorption from the small intestine could indeed become magnesium deficient. They are at a higher risk.

    So, You're right to mention it; however, it's difficult to assess a magnesium deficiency. Common symptoms include muscle weakness, irritability, anorexia, and growth failure (failure to thrive).

    I didn't include it (perhaps mistakenly) because this is a series on supplementation, and the best way to get magnesium is to eat more fruits and vegetables. Excess supplementation of magnesium can cause more diarrhea.

    You can make sure your multivitamin has a modest amount of magnesium (~200mg). But beware of taking too much.

    Good comment, Steve, thank you.

  4. Hi Matt,
    I just stumbled across your blog - it's great to find another SCD writer. I've been on it for 5 years, with a lot of success. I also live in the DC area, and will have to pick your brain for good SCD-friendly restaurants, if you've found any.

  5. Ah! That sounds great! I've moved the site to wordpress, so you can catch me there from now on.