Malabsorption & IBD
‘The New Eating Right for a Bad Gut’
The Complete Nutritional Guide to Ileitis, Colitis, Crohn’s Disease, and Inflammatroy Bowel Disease,
by James Scala
NUTRITIONAL CHALLENGES FOR PEOPLE WITH IBD.
You know when an inflamed intestine doesn’t function correctly because it hurts and you have diarhoea – possibly bloody diarrhoea. Particles of food eaten within twenty-four hours often appear in the watery stools, proving they weren’t completely digested. These observations are the source of nutritional challenges in IBD.
MALABSORPTION OF VITAMINS AND MINERALS
Malabsorption, literally “sick absorption”, occurs during inflammation when absorption of nutrients is impaired or nonexistent, and it may even persist after the flare-up has subsided.
Malabsorption of specific vitamins and minerals depends upon where the small intestine is inflamed. Most vitamins and many minerals are absorbed throught our the small intestine, and some vitamins are even partially absorbed from the stomach. For example the absorption of vitamin B12 occurs in the lower 4 feet of the small intestine and depends on the secretion of an intrinsic factor by the stomach. Therefore, if the most severely inflamed portion is the terminal 4 feet, or if that portion has been removed, B12 absorpton is empaired or non- existent, and the only means of meeting the B12 requirement is by injection. Likewise some minerals, such as zinc, are absorbed from the large intestine, if it has been damaged or removed, a similar malabsorption problem exists, which can be solved by injection. Meeting the requirements for all other vitamins, and minerals, can be dealt with by a process chemists call ‘mass action’ and nutritionists call supplementation.
Mass action and its nutritional application, supplementation, are simple concepts you’ll easily grasp. Think of your intestine, as a long tube through which nutrients pass into the blood. The recommended daily intake (RDI) takes into account normal human absorption and other factors, and tells us how much of each nutrient we need to maintain good health.
Suppose you have malabsorption because of IBD, and that only about 60% of your normal absorption is working, we can apply some high-school algebra and correct the situation by supplementation: hence, malabsorption is a controllable challenge:
If you need ‘A’ amount of a nutrient and you only absorb 60% because of IBD malabsorption, how much of the nutrient do you need to meet your special requirement? The solution is: A=0.6x: by transposing terms, x=A/0.6. Suppose you’re a 15 year-old girl and your calcium RDI is 1.000 mg daily, substitute 1.000 mg for A in our equation. the answer is : 1.000/0.6 = 1.667 milligrams (rounded off), or about twice the RDI for calcium. You can calcium-fortified orange juice,(which also supplies potassium) and take calcium supplements, (calcium citrate) to get at least 1.500 mg daily.
While calcium is a special nutrient that you can take as a calcium supplement, the same concept applies to the other nutrients, all of which can be put into two single tablets taken daily. The easiest way to solve the malabsorption challente is to take one extra tablet daily. So, instead of taking two tablets which the label declares as a serving, take three to compensate for malabsorption.
Vitamin K is a special case, We rely on food for part of our vitamin K need and on intestinal microbes for the rest. Impaired absorption is likely to reduce the vitamin K absorbed from food, coupled with other intestinal problems, such as diarrhoea, or removal of some of the intestine, we’re likely not to get enough vitamin K – perhaps none – from our intestinal flora. This deficiency can cause bruises or excessive bleeding from cuts or scrapes, however, the deficiency may not show up until something serious happens. That’s why it’s important to raise the issue with your physician. A special vitamin K supplement can be prescribed to ensure that the problem never occurs.
Thanks to technology, we have the means to make up any nutrient shortfall with sensible supplements so that malabsorption does not have to led to malnutrition.
Updated July 2003