Malabsorption - failure to get the goodness from food

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The job of the gut is to absorb the goodness from food. To do this, it first has to reduce food particles to a size which allows the digestive enzymes can get at them, then it has to provide the correct acidity for enzymes to work, produce the enzymes,emulsifying agent (bile salts) and move the food along the gut. Finally the large bowel allows growth of bacteria for a final digestive/fermentative process and water extraction.

The gut has a particularly difficult job because it has to identify foods that are safe from potentially dangerous microbes (most are not dangerous but positively beneficial). This explains why 90% of the immune system is gut associated. The innoculation of the gut with the good microbes takes place in the gut in the first few minutes following birth - see Probiotics


Malabsorption can occur for the following reasons:

  • Failure to chew foods properly.
  • Not enough acid in the stomach (acid is necessary to start off protein digestion and further digestion of protein takes place in the small intestine) - see Hypochlorhydria.
  • Failure to produce enough digestive enzymes (as in cystic fibrosis) - see Digestive enzymes.
  • Failure to produce enough bile (blocked bile ducts, eventually causes jaundice, poor liver function). See Gall bladder disease and gall stones.
  • Inflammation in the gut caused by gut dysbiosis (i.e. the wrong bugs) or gastroenteritis (temporary bugs in the gut). See Fermentation in the gut and CFS
  • Inflammation in the gut caused by allergy (coeliac disease, multiple food allergy, ulcerative colitis and Crohn's).
  • Food passing through the gut so quickly that there is not time for digestion to take place: drugs; overuse of laxatives; being very nervous; excessive exercise; autonomic neuropathy, thyrotoxicosis.
  • Poisons or toxins in the diet, such as lectins - see Lectins.
  • Blockers
  • Cancer in the gut. This rarely presents with malabsorption, but in its advanced stages it can certainly cause malabsorption.
  • Surgery - where sections of the gut have been removed.

Complications of poor gut function

There are two common complications of poor gut function.

  • Malabsorption of vitamin B12
  • Leaky gut syndrome
Another problem of poor gut function is leaky gut syndrome. The problem with leaky gut is that molecules get from the gut into the blood stream before they have been fully digested. These large, antigenically interesting molecules in the bloodstream can activate the immune system leading to allergy or possibly autoimmunity. Furthermore, many of these molecules can mimic the action of hormones in the blood stream and have other profound effects. For example, "leaked" food molecules can mimick the actions of the hormone vasopressin which controls blood pressure, thereby causing profound fluctuation in blood pressure. See the test for Short chain polypeptides

Symptoms of malabsorption


  • Diarrhoea often reflects the disease process causing the malabsorption.
  • Blood or excessive mucous in the stool.
  • Offensive wind points to a fermenting gut. See Fermentation in the gut and CFS.

Tests of malabsorption

Any or all of these tests may be needed to work out the cause:

  • Faecal fat: measures the level of fat in stools.
  • Pancreatic elastase: an indicator of pancreatic function.
  • Comprehensive digestive stool analysis: CDSA - this looks at digestion and absorption of fats and proteins, gives us an idea of fermentation in the gut, together with microbial content of the gut. It also looks at faecal occult blood and short chain fatty acid profile. As an extra you can ask for faecal calprotectin (which is a good indicator of gut inflammation), faecal elastase (pancreatic function) and bile salts.
  • Vascular endothelial growth factor - Salivary test for hypochlorhydria

Treatment of malabsorption


Identify the cause of the malabsorption by going through the above check list and the tests listed below.

Correct any nutritional deficiencies which may have arisen from years of malabsorption. This would initially be achieved through taking my standard regime of Nutritional Supplements, backed up by nutritional screening tests such as B12 and folic acid, ferritin and calcium levels (this is an indication of vitamin D deficiency, all of which can be easily done by NHS blood testing). If the patient does not feel completely restored by these interventions then one would consider more sophisticated tests of nutritional status such as Antioxidant status, B vitamin profile, fat soluble vitamins including vitamin D and Essential Fatty Acids.

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