Short answer: Malabsorption occurs when the body is unable to properly absorb nutrients from the gut. Gastrointestinal causes include coeliac disease, pancreatic insufficiency, Crohn’s disease and an overgrowth of gut bacteria. An investigation into persistent fatigue, weight loss and vitamin deficiency begins with a consultation with a gastroenterologist.
Many people live for years with unexplained tiredness, hair loss or recurrent iron deficiency, without realising that an absorption disorder of the digestive system may be the underlying cause. Malabsorption – the medical term for this condition – means that, despite a balanced diet, the body is unable to absorb the necessary vitamins, minerals and nutrients.
This condition is rarely painful, which is why it often goes undetected for a long time. The symptoms develop gradually and can easily be mistaken for everyday fatigue or the effects of ageing. The article below explains in simple terms what causes malabsorption, which vitamin deficiencies may accompany it, and when it is advisable to consult a specialist.
What happens in the body when there is a malabsorption disorder?
Malabsorption refers to the inadequate utilisation of nutrients, caused by a disturbance in digestion, absorption or transport. Medical science distinguishes between two closely related concepts:
- Digestive disorder (maldigestion): The breakdown of nutrients is impaired in the gut, for example due to a lack of digestive enzymes.
- Malabsorption: Nutrients that have already been broken down cannot be absorbed through the intestinal mucosa.
The process may affect proteins, carbohydrates and fats, as well as the absorption of vitamins and minerals. The disorder may be generalised, affecting almost all nutrients, or it may be an isolated form, limited to a single nutrient.
What gastrointestinal causes might underlie malabsorption?
Malabsorption can be caused by a number of gastrointestinal disorders. The most common causes are as follows.
Gluten intolerance (coeliac disease)
Coeliac disease is an autoimmune disorder in which gluten (a protein found in wheat, rye and barley) damages the lining of the small intestine. The villi become flattened, leading to a drastic reduction in the absorption surface area. This leads to deficiencies in iron, folic acid and vitamin B12, as well as a vitamin D deficiency, which causes weak bones. In younger women, a deterioration in nutritional status may even manifest as a missed period.
Pancreatic insufficiency
The pancreas produces digestive enzymes to break down fats, proteins and carbohydrates. In cases of chronic pancreatitis or atrophy of the pancreas, these enzymes are lacking. Typical symptoms include fatty, voluminous, foul-smelling stools (steatorrhoea) and unexplained weight loss.
Crohn’s disease and other inflammatory bowel diseases
Chronic inflammation of the intestinal wall directly damages the mucous membrane and reduces the absorptive surface area. In Crohn’s disease affecting the small intestine, supplementation with calcium, vitamin D, iron, vitamin B12, zinc and potassium is often necessary. When the ileum is affected, the reabsorption of bile acids is also impaired, leading to impaired fat absorption.
Small Intestinal Bacterial Overgrowth (SIBO)
Bacteria proliferating in the small intestine ferment nutrients prematurely and break down bile acids. This results in impaired fat absorption and a deficiency in fat-soluble vitamins (A, D, E, K). A characteristic laboratory abnormality – elevated folic acid levels accompanied by low vitamin B12 levels – may raise suspicion of this condition.
Lactose intolerance and other enzyme deficiencies
A deficiency of the lactase enzyme in the brush border of the intestinal mucosa (lactose intolerance) is the most common carbohydrate malabsorption disorder. In this condition, milk sugar is not broken down, leading to bloating, abdominal cramps and diarrhoea.
What vitamin deficiencies may be associated with malabsorption?
The most tell-tale signs of malabsorption are often the symptoms of vitamin and mineral deficiencies. The table below summarises the most common deficiencies and their characteristic symptoms.
| Nutrient deficiency | Typical symptoms |
|---|---|
| Iron | Pallor, fatigue, microcytic anaemia |
| Vitamin B12, folic acid | Macrocytic anaemia, glossitis, mood disorder |
| Vitamin D, calcium | Bone weakness, muscle spasms, bone fractures |
| Vitamin A | Night-time blindness, dry skin |
| Vitamin K | Increased tendency to bleed, easy bruising |
| Magnesium, calcium | Muscle cramps, tremors |
| Protein, albumin | Oedema |
Deficiencies in fat-soluble vitamins (A, D, E, K) are particularly common in conditions that interfere with the digestion or absorption of fats. Iron deficiency is often the only visible sign of a milder malabsorption disorder.
What symptoms indicate a malabsorption disorder?
The symptoms of malabsorption can be varied and develop gradually. The combined presence of the following signs warrants further investigation:
- chronic diarrhoea or fatty, pale-coloured stools,
- bloating and increased gas production,
- unexplained weight loss despite a balanced diet,
- persistent tiredness and weakness,
- recurrent iron deficiency that does not respond to treatment,
- bone and muscle pain.
These symptoms can, in themselves, be attributed to a wide variety of causes; it is therefore important to undergo a specialist examination to identify the underlying cause.
How does Endomedix gastroenterology relate to this?
An accurate diagnosis of malabsorption disorders is always a matter for a specialist, as there may be a number of underlying conditions. Endomedix’s gastroenterology team has been treating disorders of the digestive system for many years, including the investigation of malabsorption and vitamin deficiencies. The first step in the process is usually the consultation with a specialist in gastroenterology, where the specialist reviews the patient’s symptoms and laboratory results, and decides what further tests are required.
During the consultation, we take a holistic approach to identify not just the symptom, but its underlying cause. The specialist explains the results in plain language, so you’ll never leave feeling uncertain.
What tests can help with the diagnosis?
An internal examination of the intestinal tract is often required to determine the cause of a malabsorption disorder. For a combined gastrointestinal assessment, the gastroscopy and colonoscopy under anaesthesia It provides an accurate picture: both the upper and lower digestive tracts can be examined during a single anaesthetic, and tissue samples can also be taken, for example to confirm coeliac disease.
Many people are afraid of these procedures, so it is important to know that, for professional reasons, at Endomedix we use general anaesthesia rather than sedation. This means that you will sleep undisturbed throughout the entire procedure, under the constant supervision of a specialist anaesthetist, so you will experience neither pain nor any unpleasant memories. Thanks to modern carbon dioxide technology, post-procedure bloating is also minimised.
Summary and next steps
Malabsorption is an insidious condition that often manifests itself only through the symptoms of vitamin deficiencies. Coeliac disease, pancreatic insufficiency, Crohn’s disease and an overgrowth of gut bacteria may all be underlying causes. The good news is that most causes can be reliably identified and treated if you seek professional help in good time.
If you recognise any of the above symptoms, don’t delay getting checked out. Book an appointment for a gastroenterology consultation at Endomedix and take the first step towards identifying the real cause. Your health, your decision.
Frequently asked questions
What is the difference between a digestive disorder and a malabsorption disorder?
Digestive disorder (maldigestion) is a failure to break down nutrients in the gut, for example due to an enzyme deficiency. In the case of malabsorption, nutrients that have already been broken down cannot be absorbed through the intestinal wall. The two processes often occur together.
Can a malabsorption disorder cause anaemia?
Yes. Impaired absorption of iron, vitamin B12 and folic acid causes anaemia. Persistent iron deficiency that does not respond to treatment is often the first sign of a malabsorption disorder, so it is always worth having the underlying cause investigated.
Is a colonoscopy or a gastroscopy painful?
At Endomedix, endoscopic procedures are carried out under general anaesthesia, under the supervision of a specialist anaesthetist. The patient remains asleep throughout the entire procedure and therefore experiences neither pain nor any unpleasant memories. After the procedure, they can return home following a short rest.
Which vitamin deficiency is most commonly associated with malabsorption?
A deficiency in fat-soluble vitamins (A, D, E, K) typically indicates a problem with fat absorption. Iron deficiency, as well as deficiencies in vitamin B12 and folic acid, are also common warning signs, particularly when accompanied by persistent tiredness and weight loss.
When should I see a specialist?
If you experience unexplained weight loss, persistent diarrhoea, fatty stools, recurrent iron deficiency or constant tiredness, it is advisable to book a consultation with a gastroenterologist. Taken together, these symptoms may indicate a malabsorption disorder.
