Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
12 September 2007

MALABSORPTION

            The lady was 52-years old and had been seen in the clinic on multiple occasions.  Over the previous year, she had lost approximately 30 pounds in spite of no effort at all on her part.  I asked her about the weight loss and she said that she didn’t know why she was losing weight but she surely wasn’t trying.  I pointed out to her that there are many individuals that would give priceless rewards if they could lose 30 pounds.  She said she knew that but she didn’t know how it was happening.  I asked her if she was eating normally and she said that she actually was eating more than normal and she was always hungry.  I asked about her bowel habit and she indicated it had changed and she now had multiple stools per day and they were frequently loose.  When she had a movement, there was also a great deal of gas that was passed.  She was afraid of passing gas if she wasn’t on the toilet because of the potential for accidents.

            Further history was taken at that time and it was learned that she had had gallstones removed three years before.  At the time she had her gallbladder surgery, she had the very severe complication called pancreatitis.  This is a condition in which the gallstones block the exit tube from the pancreas.  When that tube gets blocked up, the pancreas cannot empty its digestive juices into the intestine normally.  The pancreas then gets over-distended and those pancreatic juices that are designed to digest food begin to digest the person.  This is a very painful and severe complication she had at the time of her gallbladder surgery.  X-rays were taken of her abdomen and it was seen that she had calcifications into dead areas of her pancreas that had been damaged in the past.  She was already diabetic because of the pancreatitis but now it was recognized that she also had inadequate pancreatic function to digest her food.  Several other tests were done and the diagnosis of malabsorption because of inadequate digestive juice was made.

            Malabsorption is a medical word with two parts.  Mal- is a prefix meaning “bad”.  Absorption has to do with food getting out of the intestine into the blood so the nutrients can be used by the body’s cells.  Thus, malabsorption simply means the person is doing a “bad” job of absorbing their food.  It can be due to a generalized problem of intestinal disease or a problem of not enough digestive enzymes to digest the food.    

            Very fortunately, this condition is relatively easy to treat.  At the meat packing plants where hogs are harvested, the hog pancreas is also used.  It can be processed and dried into a pill.  That pill is still very potent with the hog’s digestive juice capacity.  We all know that a hog can digest anything.  So if we give the person pills of hog pancreas with their meals, that person can then digest their own food normally with the hog pancreas.  When this was started with this lady, her weight went from 108 pounds back up to about 130 pounds which is about the weight that she wanted to be. 

            If anything good can be said about this situation, she now has a built-in weight control program.  If she starts to gain too much weight, she can just stop taking her hog pancreas pills, develop a little diarrhea and her weight will either stabilize or come down again.

             Not having enough digestive enzymes is only one form of malabsorption.  The other is to have the intestinal wall diseased to the point where the food cannot go through the intestinal wall into the body.  An example of this type of problem was written about several years ago in a column entitled “What do you mean, I can’t eat wheat?”  There are individuals who are allergic to one of the components of wheat germ.  Some individuals actually become allergic to the wheat germ protein called gliadin and it inflames the intestinal wall to the point where they cannot absorb food normally.  The result is the same picture of what happened to the lady above.  The individuals lose weight and have a great deal of diarrhea and gas.  In this case, there is usually substantial abdominal cramping in addition. 

            Other conditions that can cause malabsorption include individuals who have had surgery to remove portions of the bowel.  Normally a person has 26 feet of intestine as an adult.  When problems occur and surgery is done to remove portions of the intestine, malabsorption problems usually begin when the intestinal length is decreased to 6-8 feet.  When the bowel left is only 4 feet or less, the person usually cannot maintain nutrition because there is just not enough area to absorb the food.

            There are also special situations in which the person cannot absorb certain necessary nutrients.  While these are not malabsorption syndromes as above, there are none-the less a form of malabsorption.  Examples of this would include:  pernicious anemia in which the person develops a vitamin B-12 deficiency.  In the past this required injections to correct.  Now there are tablets that can be put under the tongue and avoid the necessity of B-12 injections.  Some people are unable to absorb iron normally and that provides a form of malnutrition for iron.  In this situation, sometimes added vitamin C can help but often the person has to have iron injected intravenously on a periodic basis to maintain their iron stores.  Perhaps one of the most common malabsorption syndromes in the United States is milk intolerance.  It is especially common in women.  For reasons not known, they lose the ability to absorb milk sugar causing “lactose intolerance”.  Fortunately, there is an easy way to overcome that today by simply using a pill to digest the milk sugar before it is used. 

            The healthcare providers at your local clinics are well aware of these types of problems and can help both diagnose and treat them as they occur.

This and other columns available at www.macpierre.com.