Bloating? Gas or IBS? These aren’t topics most people like to discuss. Loose stools or diarrhea – these matters are even more taboo.
One in 10 people suffers daily from bloating, gas, and stomach pain. Between 35-45 million people are diagnosed with IBS. What if, in some cases, a common form of sugar was to blame?
Sucrose intolerance is a condition that is gaining attention as one cause of gas, bloating, and diarrhea. For people with sucrose intolerance, learning about it and treating it can be a game-changer.
What is Sucrose?
Sucrose is another name for table sugar-common white or brown table sugar.
Sucrose is a disaccharide, which means it is two sugars linked together. Understanding this bit of scientific information is essential.
To be absorbed, those two linked sugars must be pulled apart and broken down to be absorbed by the body.
Breaking apart the sugar is done by an enzyme, which digests the sugar. The enzyme makes the sugar small enough to be absorbed.
But what if the enzyme is missing or levels are low?
When the enzymes are low or missing, trouble begins.
What Is Sucrose Intolerance?
Sucrose intolerance (SI) is the inability to eat sucrose-containing foods without symptoms.
When a person is missing or low in the enzymes needed to digest sucrose, they are sucrose intolerant.
Sucrose intolerance has two forms:
- Acquired sucrose intolerance: Inflammation, disease, or other factors can damage your gut lining. When problems with the gut lining occur, the level of enzymes used to digest sucrose drops. The total amount of digestive enzymes decreases because the enzymes live in the gut. When the gut is damaged, enzyme stores reduce. This form of sucrose intolerance is seen in conditions such as inflammatory bowel disease, SIBO, celiac disease, and other illnesses that may damage the gut lining.
- Congenital Sucrase-Isomaltase Deficiency (CSID): A person is born with this type. They do not have the genes to make the enzyme. From infancy, this person must follow a low-sucrose diet. The symptoms for this form typically begin when a baby starts eating or drinking foods that contain sucrose. Babies are not usually symptomatic when nursing.
Other names for Sucrose Intolerance: Congenital sucrose intolerance, Congenital sucrose-isomaltose malabsorption, CSID, Disaccharide intolerance, SI deficiency, Sucrase-isomaltase deficiency
Sucrose Intolerance Symptoms
Symptoms of sucrose intolerance usually occur after eating.
The symptoms are due to the intestine containing bacteria and other organisms ( part of our microbiome) that like sugar. When offered a buffet of sugars in foods, these organisms eat!
Gasses are produced when the bacteria that usually live in our gut consume the sugar. This causes someone to feel gassy and bloated and often have pain. Diarrhea is also common because of the sugar’s effect on the intestine.
Common Symptoms Of Sucrose Intolerance
- Smelly stools and gas
- Abdominal pain
Symptoms Mimic Lactose Intolerance
The digestive symptoms are similar to the symptoms of lactose intolerance.
Lactose intolerance is the inability to digest the milk sugar called lactose. Lactose intolerance affects most of the world’s population ( 65%). Both sucrose and lactose intolerance cause bloating gas and diarrhea.
The enzymes for both sucrose and lactose digestion live in the intestine. When damage to the intestine occurs for any reason, such as infection or illness, the levels of both types of enzymes drop.
Which Foods Are High in Sucrose?
Sucrose is found in various fruits, vegetables, and sweeteners (1).
Tolerance of these foods is dependent on the amount of food eaten. A person with SI can typically tolerate small amounts, but with larger quantities, symptoms occur.
- Honeydew melon
- Sweet pickles
- Brown sugar
- Cane sugar
- Maple sugar
- Table sugar
- Breakfast cereal
- Granola bars
How Common Is It?
Some estimates suggest 1 in 5000 people have sucrose intolerance.
In specific populations, it may be as high as 5%.
Anyone with underlying digestive problems can develop the acquired form. The frequency of this form is unknown (2).
Diagnosing Sucrose Intolerance
Step One: Eliminating other Causes
Your doctor will typically start looking for answers by eliminating other possible causes of symptoms. They may look for conditions such as infection, celiac disease, SIBO, or other bowel disorders. If the underlying problem is corrected first, and sucrose intolerance is present, symptoms and SI often improve. If this is the case, further testing will not be needed.
Sucrose intolerance is suggested by symptoms such as the timing of symptoms in relation to eating, diarrhea, bloating, and gas.
The most accurate test to diagnose SI is an intestinal biopsy. This is rarely done because it requires anesthesia and has risks (as any procedure does). It is more likely to be done for the congenital form since this is a lifelong condition.
A few tissue samples are taken from your small intestine and tested for the presence of the enzymes needed to digest sucrose. However, there are less risky ways to test for SI. Somebody can typically answer the question of SI without the need for a biopsy.
Sucrose Intolerance Breath Test
When sucrose gets to the small intestine and is not absorbed by the body, gut bacteria have a free lunch! They eat sugar and produce gases. The gas they produce can be measured with a breath test. Neither test is perfect, there are pitfalls with both, but they are often used to diagnose SI.
There are two options for Sucrose intolerance breath testing.
- The Hydrogen Methane Breath Test – this is not specific for sucrose intolerance.
- 13C- Sucrose Breath Test. -this is more specific for sucrose intolerance
*PROBLEM: Both tests have limitations beyond the scope of this article. That being said, they are still frequently used for diagnosis, as all methods of diagnosis for sucrose intolerance have limitations. (3)
Sucrose Elimination Diet
Someone can try this to determine improvement.
It isn’t easy to maintain long-term. No studies address how accurate this is in diagnosing sucrose intolerance. For more detailed information on the sucrose elimination diet. CLICK HERE
The 4-4-4 Challenge
This is a simple way to screen for sucrose intolerance.
A conversation with your doctor about the next steps is warranted if the test is positive.
- Dissolve four tablespoons of table sugar (which is pure sucrose) in 4 ounces of water and then drink.
- Drink this mixture on an empty stomach
- Monitor for the next 4 hours. Did this cause symptoms? If so, you might be on track to a diagnosis – time to chat with your doctor (4).
This test is not definitive, but it can help you understand your symptoms in your detective work.
Note: This test is inappropriate for babies, young children, or people with diabetes.
Other Tests to Diagnose Sucrose Intolerance
There are a few other methods available to aid in diagnosing sucrose intolerance.
s The truth is, we don’t yet have a consensus on the most accurate, least invasive strategy to diagnose this condition.
These additional tests include trying the enzyme supplement, monitoring urine for sucrose and genetic testing. (5).
IBS and Sucrose Intolerance
Research found sucrose intolerance to cause 35% of cases of IBS with diarrhea.
That is potentially over 10 million people!
Because most GI doctors think of sucrose intolerance as something that only occurs in babies, they may not be looking for the acquired form, which can occur in both children and adults (6).
Step 1: Treat any underlying digestive problem, and sucrose intolerance might resolve. Depending on the clinical history, consider tests for celiac disease, SIBO, inflammatory bowel, infection, and any others your doctor may feel are necessary.
Step 2: Breath test.
Step 3: Low sugar diet vs. Low Sucrose diet
Step 4: If symptoms improve, but some continue after eliminating sucrose, starch may also have to be eliminated. Some people with sucrose intolerance do not tolerate both sucrose and starch.
Step 6 Consider medication-Sucraid is a prescription enzyme to digest sucrose. It is costly and challenging to get covered by insurance.
Regular digestive enzymes may help w starch digestion.
A low-sucrose diet is the dietary treatment of choice.
Many people with sucrose intolerance may have tried a low FODMAP diet as it is the diet most commonly used to treat IBS.
People with sucrose intolerance may see partial improvement on a low FODMAP diet but not complete symptom improvement. This may be a clue that sucrose intolerance is present.
For a more detailed explanation of the diet, CLICK HERE.
A medication named Sucraid exists to help with sucrose intolerance.
It is an enzyme replacement that is taken with meals.It offers improvement of symptoms but is very expensive and difficult to get covered by insurance. Some insurance companies require a biopsy for diagnosis to get the medication covered. It is derived from yeast and should not be used in cases of yeast allergy.
Note: Some medications contain sucrose. Speak to your pharmacist if you have questions about your medications.
We are now beginning to understand that sucrose intolerance is far more common than previously thought. If you have symptoms such as bloating gas or diarrhea and haven’t considered SI, now is the time.
If you have been diagnosed with IBS with diarrhea, please consider sucrose intolerance. Remember that over ⅓ of people with IBS with diarrhea are sucrose intolerant. That is a lot of people!
Partial improvement with diets such as low FODMAP, dairy-free, or gluten-free may also be a clue that sucrose is to blame. Sucrose intolerance may be the explanation you have been searching for.