Malabsorption, Nutrient Deficiencies, Pancreas Damage, Exocrine Pancreatic Insufficiency (EPI)

Resource Malabsorption, Nutrient Deficiencies, Pancreas Damage, Exocrine Pancreatic Insufficiency (EPI)

Malabsorption, Nutrient Deficiencies, Pancreas Damage, Exocrine Pancreatic Insufficiency (EPI)

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Malabsorption, Nutrient Deficiencies, Pancreas Damage, Exocrine Pancreatic Insufficiency (EPI)

Practical actions to consider for anyone...

Often Overlooked and With Recovery Actions to Consider

For those struggling with Chronic Fatigue Syndrome (ME/CFS) and ailments that are wide ranging and difficult to diagnose, pancreas dysfunction and malabsorption are hardly ever considered as a possible link to many symptoms, both by doctors and sufferers.

Everyone is aware of the diabetes crisis, but the pancreas has another crucial but far lesser known function, the exocrine side, which produces the enzymes we need to...
Read more about this resource...
 
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This post is to continue on from the resource mentioned above.

Nutrient Deficiencies

Many symptoms (in my case many dozens) can have a possible root cause in chronic nutrient deficiencies causing subsequent issues with your metabolism and mitochondrial functioning. When you have any issues with nutrient deficiencies it is worthwhile to dig deeper.

Malabsorption and maldigestion are not to be taken lightly. Issues such as low stomach acid, acid reflux, silent reflux, gastritis, bloating, excess gas, stool issues, food sensitivities, stomach and intestinal pains, small intestinal bacterial overgrowth (SIBO), Candida overgrowth, gallbladder issues, electrolyte imbalances, pancreas issues including (pre)diabetes, pancreatitis and exocrine pancreatic insufficiency (EPI), Chrohn's, celiac, IBD, leaky gut, microbiome dysbiosis, to name a few, can all be related to malabsorption.

Tests to Consider

Of course there are many more, but here is a selection of tests to consider in this case:
  • Nutrient level and Organic Acid testing such as Genova FMV or Great Plains Lab Organic Acid Test (OAT). Beside nutrient markers, there are markers that check for both bacterial and fungal dysbiosis, and malabsorption. It also has a section pertaining to neurotransmitter markers. The 'Essential and Metabolic Fatty Acids Markers' add-on is also very helpful.
  • Comprehensive Stool test for parasites, pathogenes, dysbiosis: E.g. Genova Diagnostics - Comprehensive Digestive Stool Analysis 2.0 with Parasitology (microbiome dysbiosis indicators), and
    • Fecal Fat Distribution (checks if you have issues with different types of fat intake and digestion)
    • Elastase (for EPI, pancreas enzyme marker)
    • Chymotrypsin (for EPI, pancreas enzyme marker).
    • Doctor's Data has similar tests.
  • SIBO and Candida overgrowth: With SIBO, both methane and hydrogen ones should be tested and tackled. A breath test for SIBO and something such as Genova FMV or Great Plains Lab Organic Acid Test (OAT) can be helpful here.
  • Fasting blood sugar tests: e.g. HbA1c, triglycerides, c-peptide, insulin, ketones, glucose. These are also a good indicator of diet quality and excess carbohydrates and sugars in the diet.
  • Lactose intolerance: Easy to test yourself.
  • Food sensitivities: Any food allergy and sensitivity tests as well as gluten allergy tests
  • Stool test pancreatic elastase: A standard test for exocrine pancreatic insufficiency
  • Blood test fasting trypsin: to see if you produce enough enzyme for protein breakdown
  • Stool test chymotrypsin: similar to, but not as accurate as elastase
  • Intestinal permeability: Intestinal permeability (a.k.a. leaky gut) is worth checking.
    • Cyrex Laboratories - Intestinal Antigenic Permeability Screen. It measures intestinal permeability to large molecules, which can cause autoimmune reactions, inflammation, food sensitivities, malabsorption, etc.
  • Gallbladder function: Yet another element that is important in breaking down food and thus any gallbladder issues can cause malabsorption. For example MRI of the abdomen with MRCP.
  • MRI of the abdomen with MRCP with contrast: It gives a 3D picture of the gallbladder and high resolution liver, pancreas, gallbladder, ducts, stomach intestines. Amazing test.
  • Stomach acid: Is your pH low enough to start digesting food? If it is too high this will exacerbate any SIBO, candida overgrowths, and malabsorption. Are you taking antacids or PPI as these only cover symptoms, do nothing about root cause, and can make things much worse. Have you tried the following simple selftest:

    A simple unscientific test to approximate acid level is by drinking a quarter teaspoon of baking soda (sodium bicarbonate) mixed in a glass of water on an empty stomach in the morning. This creates bubbles within two to three minutes when mixed with the hydrochloric acid in your stomach. If after five minutes nothing happens, there is a very good chance the pH of your stomach acid is too high (i.e., low stomach acid).
 
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Food and Drink Quality

And of course, with any nutrient or malabsorption issues, an honest and hard look has to be taken at everything that is put into your mouth. I always thought I ate healthily, but little did I know until many years of slow creeping damage ended with my pancreas damaged beyond repair, SIBO and Candida overgrowth, acid reflux, gastritis, systemic inflammation, nutrient deficiencies, and an endless list of symptoms.

It is one of the few things you have complete control over, yet it is very difficult to navigate through the noise, marketing power, pseudo medical organization messages, pseudo research news, blatant misinformation, lack of affordable access, chemical, herbicide, hormone, pesticide exposure, poor nutrition education (that includes doctors b.t.w.) starting from the food pyramid (tainted by the food industry) taught to children onwards, and just sheer lack of knowledge. Add to that your own personal sensitivities (which can take a while to determine) and preferences, and it turns out it is not that easy.

Some questions to ask yourself are:
  • Have you kept a food diary for a while and note how you feel and whether there are correlations?
  • Do you still eat in restaurants or cafes as there is no control on quality and ingredients that could be impacting you?
  • How many grams of carbs do you eat and drink per day and per meal?
  • Do you consume a lot of processed, refined, packaged, canned, non-organic food and drinks?
  • What is the quality of the protein?
  • Do you eat enough healthy fats?
  • How much starch, potato, rice, legumes, pasta, grains, cereals, bread, etc. do you eat?
  • Do you east highly processed, partially hydrogenated GMO oils (canola, corn, soy, etc.) and trans-fats?
  • Do you drink any calories? If so, any sugar of any kind, chemicals, or unrecognizable ingredients in them?
  • Of course smoking and alcohol are no-brainers when you are not doing well.
  • What is the quality of your water? Are you drinking, e.g. mineral, well, tap, bottled (plastic or glass), chlorinated (all US tap water), fluoridated (all US tap water), reverse osmosis, reverse osmosis with minerals added back in, filtered (what kind?), restaurant or cafe water, etc.?
 
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Larry

Member
As someone who recovered and did every one of those tests, I applaud your efforts.

This is likely to be overwhelming to people and kinda scary.

Here's some cliff notes:
All of these tests show the body under a prolonged stress response. A body functioning optimally will self correct all of those issues, and sometimes within days.

So what do you do?
Eat a diet of unprocessed natural food, become aware of your emotions and express them and move in complex ways. Once the brain becomes the source of the stress response, it's up to us to shut it down. It no longer matters much what the original stressor was because it has traveled to the brain where it is being perpetuated. This isn't mental illness. It's a normal physiological response to overwhelming and continued stress. Remove the stressors one by one.
 

Not dead yet!

Well-Known Member
I had several of these problems. Then I was diagnosed with Celiac Disease. Treatment for CD hasn't fixed my ME/CFS problems entirely, but it did stop a lot of the organ damage,a nd the physical pain I was in. It can take 3 years to recover from CD, and most people don't really feel well again for 5 years or more. Especially if you're like me and it was missed for a decade or longer.

The resource mentions gluten allergy, which technically doesn't exist. IgE mediated allergies to wheat, barley or rye do exist. When people test you for "gluten allergy" they're testing gliadin allergy which is only wheat. This is per Labcorp, when I called to ask.

The probability of IgE allergy to those three plants, even taken together is far less than the chances that someone has active Celiac disease.

Whenever you see thyroid issues, gut issues, malnutrition despite adequate calories, and organ damage to the liver or any digestive organs, it should trigger a screening for CD. If the person is a woman and she is anemic, Celiac testing should be automatic. Such recommendations have already been made in scholarly journals. But clinical practice remains spotty on the issue.

I like the direction you've taken to discuss rarely discussed dangers, especially to the pancreas, but I wish it had included the much more likely CD possibility, and even more likely, the non-IgE and non-Celiac gluten sensitivity which is still being researched, and hotly debated.

We can't survive without our liver or pancreas, and unlike the thyroid, if we lose the pancreas, there is no hormone substitute, it's completely fatal. Anything that puts the basal cells at risk is extremely serious. And even systemic inflammation will do that.

The two best studied associations in CD are Diabetes Type 1 (especially when developed in later life), and Thyroid problems. However, there are many more. Inability to absorb nutrients causes all sorts of problems. Diabetes Type 1 means the basal cells are dead and can't produce insulin. The other functions of the pancreas may still be OK or may be reduced in T1D.

Another possibility, though much less likely than Celiac, is Crohn's or UC. The usual, old school, clinical expectation is that Celiac is less likely than Crohn's, but that's exactly backwards. The prevalence of Celiac is 1% roughly, and the prevalence of Crohn's is around 0.2%. Not much is known about SIBO, but there is a drug specifically for it called xifaxan. I've taken it and it helped. In my case Celiac was causing SIBO due to too much nutrition sitting around in my gut.

As far as fixing nutrient deficiencies, you must find the cause. I wasn't absorbing Vitamin D at all until after my gut healed some. I could've taken a handful of Vitamin D and it would've helped nothing. Because there are cofactors for making it from sunshine, I even got zero tan from tanning beds!! Or even the sun. I looked pale and sicky because even my skin couldn't produce the precursors. That's what I mean by wierd effects if you have nutrition problems.

However, fixing that won't guarantee a recovery from ME/CFS. Or at least it hasn't yet, for many. We should also use caution when recommending diet/supplements/self care types of remedies for a serious illness. The patient can feel as if they are overwhelmed by the demands of a strict diet and self care regimen. Such steps are needed to maintain health, but they shouldn't be used as a substitute for medical care, in case of illness. ME/CFS is an illness that has a long history, well documented, but largely ignored. It makes it easier for people to dismiss the illness if they can claim that the person didn't care for themselves enough or didn't eat the right things.

These ideas are helpful, as long as they're not meant to imply that people with ME/CFS are causing their own problem. Instead they are meant to give people a roadmap to better self care to support their medical recovery.
 
...
I had several of these problems. Then I was diagnosed with Celiac Disease. Treatment for CD hasn't fixed my ME/CFS problems entirely, but it did stop a lot of the organ damage,a nd the physical pain I was in. It can take 3 years to recover from CD, and most people don't really feel well again for 5 years or more. Especially if you're like me and it was missed for a decade or longer.

The resource mentions gluten allergy, which technically doesn't exist. IgE mediated allergies to wheat, barley or rye do exist. When people test you for "gluten allergy" they're testing gliadin allergy which is only wheat. This is per Labcorp, when I called to ask.
Hi @Not dead yet!

Thanks for the detailed reply. Sorry to hear about your struggles with Celiac Disease (CD) and the late diagnosis. I am glad to read you figured it out and are hopefully getting stronger.

In Primal Pancreas I do recommend ruling out Celiac disease and Chrohn's (and many more) and mention a few Celiac panel tests I had done, as well as info on the potential impact of gluten, even for those that do not have CD. The post above is really just a brief subset.

In a temporary reset diet for any intestinal or autoimmune issues, skipping gluten is worth trying. I ended up with temporary non-celiac gluten sensitivity (NCGS) as I could not tolerate it (amongst many other things) for a while. Not until overall inflammation (gluten can be mistaken for an invader) was lower, my microbiome was better balanced (as some bacteria help digest gluten) and my mucosa layer was healthier was I able to slowly reintroduce gluten. I still eat it in limited amounts and mostly in the form of organic sourdough bread.

Regarding the SIBO, Candida yeast overgrowth and reflux, I dedicated a whole chapter to it since there were a lot steps that were required in my case. I also used Xifaxan, but in combination with Neomycin because Xifaxan (a.k.a Rifaximin) alone is not as effective for methane related SIBO. But there were quite a few other supplements, food actions and steps I had to take, not to mention determination and patience.

All these elements related to malabsorption and nutrient deficiencies cause vicious cycles causing so many wide ranging symptoms, which often throws doctors for a loop. And because metabolomics and biochemistry is so complex and often with personal influences, (genetics, epigenetics, sensitivities, diseases, damage, location, exposure, age, etc.) figuring it all out is quite tough. That is why I recommend anyone who has any nutrient deficiencies to dig deeper and keep asking why it is happening to try to get to a root cause.

...
However, fixing that won't guarantee a recovery from ME/CFS. Or at least it hasn't yet, for many. We should also use caution when recommending diet/supplements/self care types of remedies for a serious illness. The patient can feel as if they are overwhelmed by the demands of a strict diet and self care regimen. Such steps are needed to maintain health, but they shouldn't be used as a substitute for medical care, in case of illness. ME/CFS is an illness that has a long history, well documented, but largely ignored. It makes it easier for people to dismiss the illness if they can claim that the person didn't care for themselves enough or didn't eat the right things.

These ideas are helpful, as long as they're not meant to imply that people with ME/CFS are causing their own problem. Instead they are meant to give people a roadmap to better self care to support their medical recovery.
I completely agree with you. My post and Primal Pancreas is only an avenue to look into, as there are so many ways to end up in this predicament. And many, if not most causes are unknown or little understood at this time. I hope it did not come across as implying anything and will just be seen as an additional data point for use in anyone's personal quest to feel better.
 

Edie

Active Member
This article is extremely important! I was lucky enough to have found an excellent Naturopath Doctor who guided me through these life changing steps. I cannot digest anything on my own. Vitamins, supplements and digestive enzymes (Panplex-2-phase by Integrative Therapeutics) were of great help, but it wasn't till my ND had me tested for Amino Acids (done by Doctor's Data) and was put on a replacement prescription (Done by a compounding Pharmacy) for the ones I was lacking, that my health greatly improved.
 

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