Digestion – When Absorption Goes Wrong

By Marcelle Pick, OB-GYN NP

Many conditions can cause nutrient malabsorption: celiac disease/gluten sensitivity, lactase deficiency, infection,parasites, chronic diarrhea, and others. If your body doesn’t absorb nutrients well, you could experience nutrient deficiencies or improper absorption — taking in too much or too little of certain nutrients. Possible reasons for poor nutrient absorption include a damaged mucosal barrier, absence of certain enzymes, poor circulation of bile or related acids, defective detoxification or ion transport, or pancreatic insufficiency.

There may be additional complications, such as anemia, gallstones or kidney stones, osteoporosis, malnutrition, or a weakened immune system. Inadequate nutrient absorption can contribute to other systemic problems such as inflammatory joint disease, chronic dermatological disorders, chronic inflammation and sensitivities.

If you suspect a problem, there are a variety of tests that determine how well you absorb nutrients. The one used most often is a hydrogen breath test. Other tests for digestive problems look at stool composition and enzyme production, and some involve advanced imaging techniques.

Chronic GI Support Nutritional Supplement System

Improving absorption

Functional medicine adopts a combination approach for restoring good nutrient absorption. I suggest you work with a motivated functional medicine practitioner to accomplish what’s referred to as the “5 R’s”.

  1. Remove. Isolate and remove whatever is triggering the problem.
  2. Replace. Put back the nutrients, electrolytes, and fluids you’ve been losing. Consider digestive enzyme supplementation and dietary modification. Use an elimination diet to figure out which foods trigger an immune response.
  3. Re-inoculate. Reestablish a healthy balance of gut microflora, especially during and after antibiotic treatment.
  4. Repair. Heal and regenerate GI mucosal tissue using nutritional and supplemental support.
  5. Rebalance. Consider what you’ve been eating to determine whether you could make different food choices that promote better digestion.

This five-step approach has worked wonders for many of my patients with absorption issues.

When you have that gut feeling

Ever wonder why your stomach feels queasy when you’re upset? It’s not your imagination. Your emotions are deeply linked to a sophisticated neural network known as the enteric nervous system (ENS), which controls digestion. The ENS (which some say is part of the autonomic nervous system [ANS] while others think it’s independent) can even operate autonomously from your brain. It’s a lot like your central nervous system (CNS) — the small intestine contains as many nerve cells (neurons) as your spinal cord! But much of the function related to the ENS is still mysterious to us.

The ENS, ANS, and CNS continually exchange information related to gut function and sensory output, while relaying messages to the brain. This explains why just seeing a plateful of delicious food can trigger secretions in your stomach. Sometimes the foods you crave end up interfering with the smooth flow of communication between your gut and your brain. Hormonal and immunological pathways are also involved in the delivery of digestive information to the brain, including details about hormonal shifts and disruptions caused by certain foods.

That lump in your throat and those butterflies in your stomach…

Just about everyone knows from experience that nervousness, tension, or other types of psychological distress can disrupt the digestive system. Emotional stress can set off intestinal inflammation, even in an otherwise healthy person — and if the disturbance is ongoing, the inflammation could become chronic. Even when you’re not upset your gut may get used to behaving a certain way after you eat specific foods. The dietary choices you make when you feel vulnerable or blue are called “comfort foods” for a reason. Patterns of emotional eating are also heavily influenced by the communication between the brain and GI system.

The ENS employs many types of neurons to regulate gut functions, starting with peristalsis andcatastalsis, the wave-like muscle contractions that push food through the GI system. The ENS also commands the circular movements that churn up intestinal contents, and initiates the secretion of critically important digestive enzymes.

How your emotions might be influencing your gut

  • Fear. The vagus nerve raises serotonin (a neurotransmitter) levels, which accelerates gut motility, sometimes causing diarrhea.
  • Anger. Fury and rage can cause “stomach churning” and a burning sensation.
  • Sadness/happiness. That “lump in your throat” feeling is actually highly stimulated esophageal nerves.
  • Nervousness. The feeling of “butterflies in your stomach” is possibly a result of blood being redirected from the stomach to the peripheral muscles as part of the fight-or-flight response.
  • Stress. Heartburn can be caused by signals the CNS sends to the ENS that alter nerve and smooth-muscle function; irritable bowel syndrome (IBS) is likely connected to the brain in a similar way.
  • Depression. In some cases, depression may be related to a non-emotional condition in the gut, such as vitamin B12 deficiency, or malabsorption caused by low levels of stomach acid. (NOTE: While depression has many different causes, functional medicine practitioners always recommend a full GI work-up as the initial treatment step).

Check out the fascinating work of Candace Pert, PhD to learn more about the chemistry behind these and other mind-body connections.

But our modern lifestyle often “confuses” the sensitive ENS. When you gulp your food down, or stand up while you eat, or when you eat too much or too little, it can disrupt your digestion. Even eating at the wrong time of day can derail normal digestion, with weight gain, absorption problems, reflux, and insomnia among the common symptoms.

What goes in must come out

When I work with patients on digestive issues, I try to help them “connect what they’re eating with what they’re excreting.” It’s just a natural fact: when nutrients are broken down and absorbed, the waste that’s left over must be removed.

No one likes to talk much about excretion, but regular “mass movements” in the large intestine/colon are central to good GI function and overall health. If you don’t leave time for toileting every day because you are too rushed, establish a new routine. That can really help if you have frequent constipation. If you have the opposite problem, the mere act of eating can make you run to the bathroom with diarrhea. In both cases, the ENS is sending signals in response to your emotional input, so take notice.

For healthy bowel function, eat a balanced diet, and avoid eating foods that make you feel bad afterwards. Managing stress helps reduce the sudden gut reactions that create bathroom “emergencies.” And adding more fiber gradually, especially soluble forms found in fruits, vegetables, whole grains, beans, nuts, and seeds, will help regulate your bowel movements.

Good digestive health is a reason for celebration!

I hope you’re realizing that communication in your body does not just flow from your brain down. The two-way messaging between body and mind is especially significant when it comes to gut function, which is influenced by emotional signals, and vice versa. Ask your practitioner to partner with you to improve digestive health as foundational support for your overall wellness. Just conveying this goal can start a worthwhile dialogue.

The speed with which your emotions affect your digestion is proof-positive that the mind-body link is strong — and unbreakable. Keeping the principles discussed in this article in mind, I encourage you to create better digestive wellness with the following suggestions.

  • Set a calm, peaceful table for all your meals.
  • Allow plenty of time for adequate elimination.
  • Eat healthy, balanced meals.
  • Choose fiber-rich fruits and veggies.
  • Select adequate amounts of — but not too much — lean protein.
  • Drink lots of pure water, especially early in the day.
  • Stay away from foods that trigger allergy-like reactions or cause digestive after-effects.

You might also consider working with your provider to evaluate the status of your body’s digestive enzyme production and regulation. And I almost always advise women to start taking a good probiotic supplement to improve digestive function.

Think about these guidelines for a few days — then consider starting fresh next week. Your gut function will surely improve, and so will your overall health. Go for it!