Here's my plea. If you are a health care provider who has a patient whose severe diarrhea has caused sustained and serious weight loss, please for the love of god work that patient up for malnutrition. Especially if she's lactose intolerant, has been taking a proton pump inhibitor nearly ever day for the last 20 years, says that her stools are oily, and has such a low triglyceride level it'd make a starving model blush (and she insists she eats a totally fat filled diet).
Oh yeah, and if she's complaining of aches and pains and saying things like "I'm so tired all the time. Even limited activity makes me exhausted," "I have a hard time concentrating and staying focussed on tasks I used to be able to attend to easily," "I've had to go back to therapy because I've been going around basically picking fights with people," and "My left hand and my foot are tingling now and then. It's a little disconcerting." Because it is entirely possible that your patient might have a vitamin deficiency. Like I do.
(From the NIH's Office of Dietary Supplements)
Vitamin B12
When is a vitamin B12 deficiency likely to occur?
Results of two national surveys, the National Health and Nutrition Examination Survey...and the Continuing Survey of Food Intakes by Individuals...found that most children and adults in the United States (US) consume recommended amounts of vitamin B12....
A deficiency may still occur as a result of an inability to absorb vitamin B12 from food and in strict vegetarians who do not consume any foods that come from animals....
As a general rule, most individuals who develop a vitamin B12 deficiency have an underlying stomach or intestinal disorder that limits the absorption of vitamin B12....
Sometimes the only symptom of these intestinal disorders is subtly reduced cognitive function resulting from early vitamin B12 deficiency. Anemia and dementia follow later....
Vitamin D
When can vitamin D deficiency occur?
- when usual intake is below recommended levels
- when there is limited exposure to sunlight
- when the kidney cannot convert vitamin D to its active hormone form
- when someone cannot adequately absorb vitamin D from the digestive tract
(Vitamin D deficient diets are associated with...lactose intolerance)
So now I have something like reason #5 to feel less bad about "firing" my last GI doctor - "Doctor considers significant short term weight loss as being only confirmation of reported diarrhea without bothering to consider what it might mean in terms of the nutritional status of his patient"
