Absorbing Facts

Poor absorption of food in underweight people

When we look at an underweight person, we might guess that they may have trouble absorbing the nutrients from their food.

One cause of such malabsorption is celiac disease. (As with most illnesses, we doctors give celiac disease other names. Celiac disease is also called non-tropical sprue, or celiac sprue. You might think we do this to confuse you. Actually these multiple names result from the confusion of those who described the illnesses. New and different names are applied as we learn more about the illness, but the old names never quite die away.) Celiac disease affects about 1 in 300 Caucasians, is often underdiagnosed, and results in poor absorption of many nutrients. Doctors are taught in medical school that people afflicted with the condition do not gain weight in childhood. Actually, many of them do gain weight and grow into adults with chronic gastrointestinal disorders or other chronic illness.

In overweight people

Many of our overweight patients tell us "I must be absorbing fat, Doc. Look at my spare tire."

The fact of the matter is that we can make a spare tire out of potatoes and corn on the cob. If you have any doubts about that, take a careful look at a pig.

Many overweight people, however, are low in essential fatty acids. They have dry skin, joint problems and other consequences of poor fat absorption. Just as some fats can be harmful, some fats are required for life, and therefore called essential fatty acids. For us to absorb these fats and get any good out of them our intestine has to be working properly.

The job of an intestine ain't easy

The intestinal wall, as you might imagine, has an interesting job. Along one side are the precious tissues of our body, which need to be protected from infection and outside insult. On the other side of the intestinal wall is yesterday's lunch, chewed up many hours ago and chock full of bacteria. From this the intestinal wall needs to absorb the vital nutrients that we require and eliminate the bacterial toxins and other substances that could kill us.

So it is not true that whatever goes into our mouth automatically gets into our body. It has to make its way through the secure gateways in the intestinal lining. Essential oils are no exception. For these to be assimilated:

• Stomach acid has to be adequate
• Bile juices are important
• Pancreatic enzymes are essential.

What to do?

• You can undergo testing for stomach acid production or, under your doctor's supervision, take a therapeutic trial of replacement.
• In general, if your stool is mahogany or dark colored you are probably making enough bile. Usually the gallbladder stores bile between meals so it can release it during meals to emulsify fats to prepare them for absorption. If your gallbladder is missing, your bile is released bit by bit all day. In this case, you may benefit from ox bile supplements at mealtime to enhance fat absorption.
• We can test for pancreatic enzymes in the stool. Alternatively, you may undertake a therapeutic trial. They are available in a capsule form. Doses vary from 1 to 6 capsules per meal. Your dose depends on how much function is left in your pancreas and how strong the enzyme is that yore taking.

Minerals and Vitamins

Just as our intestinal system does not automatically absorb fats and oil, it does not automatically absorb minerals and vitamins. Especially in a person with a chronic health problem, we must always consider the possibility that they are not absorbing vital nutrients.

We can test your levels of nutrients

The good news is that we can perform laboratory testing to measure levels of

• Vitamins: Researchers measured vitamin levels in the blood of 228 people in a nursing home. Each of these people had a good diet, and had taken a multiple vitamin every day for three months. Even so, 40% of them had decreased levels of at least one vitamin. Those with decreased levels were given a vitamin injection. Three months later they were tested and found in most cases to have normal levels. This study was published in the Journal of the American Geriatrics Society in 1980 and shows that despite taking vitamins by mouth, many elderly people do not absorb them.
• Minerals: Many people with chronic illness are deficient in one or more mineral. Most commonly we test for heavy metals, chromium, selenium, zinc, magnesium, manganese, copper, potassium, and iron.
• Fatty acids: Deficiencies can affect the skin, the joints, mental function, and many other aspects of health.
• Amino acids
• Carnitine, biotin, lipoic acid, coEnzyme Q10 and many other nutrients.

The bad news is that accurate tests of these nutrients are very expensive, and may or may not be worthwhile depending upon your situation.