Malabsorption

What is malabsorption?

Malabsorption is an umbrella term for a wide range of disorders that affect your ability to absorb nutrients from your food. Malabsorption can lead to indigestion and even malnutrition — not from a lack of eating enough nutrients, but from an inability to absorb them.

You can think of digestion as a three-part process. The first part is breaking down food into digestible pieces. The second part is absorbing all the nutrients in your food. And the third part is eliminating the waste that is left over when all the good stuff has been absorbed.

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If you have digestive difficulties, the problem could be in any of these three stages (or several). Malabsorption disorders cover the second stage. They include specific food intolerances caused by enzyme deficiencies, as well as various gastrointestinal diseases that affect your digestive system.

What happens if you have malabsorption?

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You can have general malabsorption, which affects your ability to absorb all nutrients, or you can have particular difficulties absorbing certain kinds of nutrients. Whatever you can’t absorb will pass undigested in your stools. People with malabsorption syndrome often have diarrhea as a side effect, which can make malabsorption worse. With diarrhea, food moves too fast through your bowels for nutrients to be absorbed.

In the short term, malabsorption will cause gastrointestinal distress from the inability to digest certain foods. Over time, your body will start to show signs of deficiency in those nutrients that you can’t absorb. Deficiencies in any of the macronutrients — protein, fats or carbohydrates — will cause signs of undernutrition, such as muscle wasting and reduced immunity. Deficiencies in micronutrients — vitamins and minerals — may affect your eyes, bones, skin and hair.

What are the different types of malabsorption disorders?

Some gastrointestinal diseases, such as celiac disease and inflammatory bowel disease, cause general malabsorption of all kinds of nutrients. In other cases, you may have particular difficulties absorbing a particular kind of nutrient. Some of these types include:

Carbohydrate malabsorption

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Some people are sensitive to one or several carbohydrates (sugars). You may experience this primarily as gas pain and abdominal bloating. Carbohydrates that aren’t fully absorbed in your small intestine get fermented by the bacteria in your colon. The bacteria break them down into gasses and short-chain fatty acids. The gasses cause intestinal gas, and the short-chain fatty acids cause fatty stools.

Fat malabsorption

This is a common type of malabsorption, possibly because it has so many causes. Fats that aren’t absorbed in your small intestine pass to your colon, causing fatty stools (steatorrhea). Fatty stools are greasy and runny and particularly smelly. They may be light-colored and float. Fat malabsorption also leads to the malabsorption of fat-soluble vitamins (A, D, E and K).

Bile acid malabsorption

Sometimes fat malabsorption results from a lack of bile from diseases of the gallbladder, bile ducts or liver. But sometimes it results from another problem, leaving leftover bile acids in your small intestine and passing these on to your colon. This side effect is called bile acid malabsorption. Leftover bile salts trigger your colon to secrete water, causing chronic diarrhea.

Protein malabsorption

Protein malabsorption doesn’t usually occur by itself unless you have a particular intolerance. Examples of this include milk protein intolerances and gluten intolerance.

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