If you’re among the ~25-30% of people with irritable bowel syndrome (IBS) who doesn’t get much symptom relief from following a low FODAMP diet (1), and you’ve ruled out other underlying conditions (with help from your treatment team), you could possibly be suffering from a sucrose intolerance – aka an inability to break down, digest, and absorb sucrose from foods.
A sucrose intolerance is caused by a deficiency in sucrase-isomaltase, the digestive enzyme responsible for breaking down sugar in the gut.
Read on to learn more about what sucrose is, the signs and symptoms of a sucrose intolerance, how to tell if you have it, what you can do about it, and more.
Disclaimer: This article was written for general educational purposes, not to replace medical or nutritional advice. Make sure to consult with your doctor and a gut health dietitian nutritionist to receive custom guidance and recommendations tailored to your individual needs!
Table of Contents
What is sucrose?
On the molecular level, sucrose is a type of simple sugar which is made up of equal parts glucose + fructose. (In other words, “sucrose” is just a fancy chemical name for “sugar”!)
Sucrose vs sugar
From a food science lens, sucrose and sugar are one and the same.
They both take on many different forms, and can be called different names, which is why it can get confusing. But if you see “sugar” listed on a nutrition label, you can bet that it’s sucrose – and vice versa!
For example, the term “sucrose” is interchangeable with (including, but not limited to) any of the following types of sugar which you may know and love:
- Beet sugar
- Cane sugar
- Domino sugar
- Brown sugar
- Granulated sugar
- Turbinado sugar
- Sugar in the Raw®
Hidden sucrose in the diet
Unfortunately, finding sucrose on a nutrition label isn’t always that cookie-cutter or black-and-white.
Most other types of sweeteners (such as maple syrup, molasses, and coconut sugar) still contain some sucrose – but unlike the above sweeteners, they’re not 100% sucrose since they may also contain fructose, glucose, fibers, micronutrients, and other constituents.
- For example, real maple syrup is only made up of about 60-66% sucrose (2) and coconut palm sugar is about 70-80% sucrose. (3)
High FODMAP sweeteners (such as honey and agave nectar) are made up of mostly fructose, so these would be considered “low sucrose” or even “sucrose-free” foods/sweeteners.
Sucrose in the diet also isn’t limited to the form of sugars and sweeteners – it’s also naturally occurring in certain fruits, veggies, legumes, starches, and more.
But before we dive into that, let’s unpack what it means to have a “sucrose intolerance” since it’s such a common but little-known underlying culprit of IBS.
Sucrose intolerance: what is it?
A sucrose intolerance is very similar to a lactose intolerance, except instead of being unable to break down lactose (milk sugar), your gut is not able to break down sugar in the form of sucrose, or starch (which gets broken down into sucrose during digestion). (4)
While a lactose intolerance is caused by a missing lactase enzyme (which breaks down lactose in the gut), people with a sucrose intolerance are lacking enough sucrase enzyme (a type of digestive enzyme which breaks down sucrose into glucose + fructose in the gut).
- In my world of functional nutrition, you may also hear a sucrose intolerance often referred to as a “sucrase isomaltase deficiency.”
Unfortunately, in most of these cases, chronic digestive symptoms have likely been lifelong.
These people may have also been among the many with IBS who have received colonoscopies and were told everything was “fine.”
For the above reasons, it’s probably no surprise that an estimated ~25-35% of adults with IBS-D / IBS-M and/or hydrogen-dominant small intestinal bacterial overgrowth / “SIBO” actually have an underlying sucrase isomaltase deficiency. (4)
Types of sucrase isomaltase deficiency
There are two types of cases in which you can develop a sucrose intolerance:
- Genetic/congenital (primary) sucrase isomaltase deficiency (“CSID”)
- Acquired (secondary) sucrase isomaltase deficiency
While both of these entail lacking the digestive enzyme “sucrase isomaltase” which leads to the inability to properly break down sucrose in the gut, there are two different reasons it can happen.
What causes sucrose intolerance?
Genetic/congenial (primary)
People with a genetic or “primary” case of sucrase isomaltase deficiency were born with one or more gene mutations which block their body’s ability to naturally produce this enzyme in their intestines. (4, 5)
The result is an inability to break down sucrose from sugars and starches in the intestines, leading to a cascade of symptoms that masquerade as IBS.
People with a genetically-inherited (“primary”) sucrose intolerance are more likely to test negative for SIBO via a breath test, anecdotally based on clinical case study experiences, despite presenting with all the classic symptoms. These people are also more likely to have struggled with this lifelong.
While congenital sucrase isomaltase deficiency isn’t yet curable (since we can’t change our genetics), the good news is it’s treatable and manageable!
But first, let’s review the second type of sucrase isomaltase deficiency, which is the result of a mismanaged or neglected case of SIBO.
Acquired (secondary)
In cases of “acquired” or “secondary” sucrose intolerance, you likely haven’t had these issues for your entire life – your symptoms most likely developed in your body over time, following a case of small intestinal bacterial overgrowth (SIBO), celiac diseasae, or Crohn’s disease left unchecked for too long.
- SIBO is another type of gut disorder which often masquerades as IBS, and which also flies under the radar way too often!
- Celiac is an autoimmune inflammatry bowel disease caused by an allergy to gluten. If you have celiac disease, your intestinal cells will attack themselves when you consume gluten (a protein) or anything that has come in contact (“cross-contamination”) with gluten.
- Learn more about wheat versus gluten here.
- Crohn’s disease is an autoimmune inflammatory bowel disease in which the lining of your intestines and/or colon becomes very inflamed.
In any of these cases, the intestinal inflammation caused by the overgrowth of unhealthy, pathogenic microbes in your intestines interferes with the natural enzyme production in the brush border of your intestines.
This leads to poorly digested sugars/starches followed by a subsequent a cascade of unwanted symptoms if you eat anything containing sucrose or starch.
Signs and symptoms of a sucrose intolerance
Sucrose intolerance symptoms are very similar to those of a lactose intolerance, except that they will occur within ~30-60 minutes of eating foods high in sucrose (instead of lactose).
Much like a lactose intolerance or fructose intolerance, the signs and symptoms of a sucrose intolerance (boh primary or secondary types) can manifest as any of the following IBS/SIBO-like symptoms, usually within a few hours after eating:
Physical
The most common physical signs and symptoms of a sucrose intolerance may likely include a cluster of the following:
- Frequent diarrhea
- Stomach aches
- Gas
- Bloating
- Stomach cramping
- Nausea
- Indigestion
- Feeling worse on a low FODMAP diet
If you have IBS-C (the constipation-predominant sub-type of IBS without diarrhea), you’re less likely to have a sucrose intolerance compared to people with IBS-D or IBS-M. (6)
Mental and emotional
People experiencing that level of physical discomfort on a regular basis may also be more prone to the following mental and emotional symptoms:
- Anxiety and fear about eating (you’re scared of food cause it seems like everything you eat is making you sick)
- Confusion & overwhelm (you have no idea what to eat or how to manage your symptoms – the low FODMAP diet doesn’t work, and may even make you feel worse!)
- Depression, frustration and hopelessness (no matter how “healthy” you eat or how hard you’ve tried, nothing seems to help)
- Embarrassment (you find yourself mapping out routes to bathrooms when you go out in public)
- Feeling misunderstood (most family and friends may not be able to empathize with what you’re going through)
- Isolation and loneliness (you might find yourself opting out of certain food-centric events like restaurants, holidays and birthday parties)
How to tell if you have it
In my world of clinical and functional nutrition, there are always two ways to tell if you have something: testing or guessing.
Neither of those options is inherently better or worse, but there are definitely pros and cons to consider on both sides.
Opinion 1: Guessing
If you’re feeling savvy and you’d like to boot-strap your way to Gut Clarity, embarking on a low-sucrose elimination diet (alongside keeping a meticulous food-symptom journal via an IBS food diary) is an exponentially more cost-effective way to determine whether or not you can tolerate, digest and absorb sucrose from food.
The downside of this approach is it can create a lot of burdensome dietary restrictions, and it can also be a slow process (especially if you’ve got other issues such as food sensitivities, which are common among people IBS-D & IBS-M).
- This option is probably not the best way to go if you’re already prone to disordered eating, nutritional deficiencies, a very clinically complex case, and/or unintentional weight loss.
Option 2: Run a sucrose intolerance test
Elimination diets aren’t always appropriate, and some people would rather just spare themselves a bunch of time throwing things at the wall to see what sticks.
While the gold standard for ruling out sucrase-isomaltase deficiency is to do a “sucrase enzyme assay of duodenal biopsies” via an endoscopy, that method is also very invasive, and more expensive than the alternative testing method which is to rule out sucrose malabsorption via breath testing. (4)
Running a sucrose intolerance home breath test to measure your degree of potential sucrose malabsorption may be more expensive than just food journaling alongside an elimination diet, but it’s also more affordable and less invasive compared to the biopsy. This route is also easier from the lens of saving time and unnecessary stress.
How to address it
Okay, so you’ve uncovered that you do in fact have a sucrose intolerance… Now what?!
The good news is it’s manageable and figureoutable; the bad news is the entire process of addressing your sucrose intolerance likely won’t be a cake-walk…
Holistic sucrose intolerance treatment plan (step-by-step)
Step 1: Consultation and diagnosis
Consult your doctor and confirm your diagnosis, via testing. You can confirm sucrase-isomaltase deficiency via a disachharide intestinal biopsy (this is the “gold standard” clinical test for confirming it), or via a sucrose breath test.
Uncover underlying root causes
It will be important to know whether your sucrose intolerance was inherited or acquired. Your doctor can help you in determining this.
If you have an acquired sucrose intolerance, I also recommend to ruling out and any other underlying root-cause issues (i.e. SIBO, inflammatory bowel disease, dysbiosis, candida overgrowth, food sensitivities, etc.) which could be impacting the state of your intestinal brush border enzyme production.
Step 2: Dietary modification
Begin eliminating foods high in sucrose, and work with a registered dietitian to get help backing into a sucrose intolerance diet.
Step 3: Food-symptom tracking and customization
Keep a detailed food-symptom journal.
Review your food logs with a registered dietitian to determine your sucrose tolerance level (or “threshold”) to various foods containing sucrose.
Step 5: Enzyme replacement therapy
Consult your doctor about getting a prescription for Sucraid® (sacrosidase) to help your body digest sucrose more efficiently, alongside dietary modification.
You may also benefit from additional digestive enzymes such as Starchway (for helping to break down the maltose in starch) and/or Digest Gold, as a broad-spectrum brush border digestive enzyme supplement.
The 5R’s
Removing foods from your diet and supplementing with enzymes is going to be very helpful for managing symptoms.
However, chances are your gut microbiome may not be in balance, and your gut lining may be “leaky” and in need of repair after everything your body has been through.
This is where a functional dietitian nutritionist can help! A functional dietitian can help you move through something called the 5R protocol for gut repair so you can address and optimize your digestive health from all angles, at the cellular level.
The 5R’s of gut repair are as follows:
- Remove (foods that your body doesn’t tolerate well)
- Replace (i.e. enzyme replacement therapy, vitamin/mineral supplements, and nutritive herbs as needed)
- Reinoculate (optimize your gut microbes via probiotic and prebiotic foods, supplements, and herbal antimicrobials as needed)
- Repair (nourish and support your gut lining with functional foods and supplements such as colostrum, zinc carnosine, demulcent herbs, and/or bone broth)
- Rebalance (reduce stress, improve sleep, etc.)
You may have noticed that The first step in a 5R approach is to “Remove” – so the low sucrose elimination diet is a great place to start.
Let’s zoom in on this!
Removing foods high in sucrose: how to get started
As a reference, below is a list of high-sucrose foods which you can refer back to as-needed, if you decide to move through a sucrose intolerance diet. (Or better yet – download a free copy of my printable PDF Sucrose Intolerance Food List, here!)
Foods high in sucrose (AVOID)
A food is considered high in sucrose based on the number of grams of sucrose it contains per serving.
If you have a sucrose intolerance, referring to and avoiding/reducing/limiting the following list of high-sucrose foods will likely help you to improve your IBS symptoms (7):
Fruits
- Apples
- Apricots
- Bananas
- Cantaloupe
- Citrus: oranges, grapefruit, clementines, tangerines, mandarin oranges, tangelos, etc.
- Dates
- Guava
- Honeydew melon
- Mango
- Passion fruit
- Pineapple
Peaches - Passion fruit
Veggies
- Beets
- Butternut squash
- Carrots
- Green peas
- Onions
- Parsnips
- Pumpkin
Legumes / proteins
People with a sucrose intolerance can generally eat any type of meat, poultry, or fish/seafood as long as it isn’t made with a high-sucrose type of sauce/seasoning (i.e. garlic, or barbeque sauce which contains a source of added sugar).
Only the following plant-based protein sources naturally contain significant amounts of sucrose:
- Black beans
- Black-eyed peas
- Chickpeas (“garbanzo beans”)
- Edamame
- Kidney beans
- Lentils
- Lima beans
- Navy beans
- Pinto beans
- Soybeans
- Split peas
- Tofu (sometimes)
Starches
- Cassava
- Corn / corn flour products
- Grains (rice, wheat, oatmeal, rye, barley, etc.)
- Breads, bagels, pastries, crackers, croutons, breadcrumbs, flour, etc.
- Popcorn
- Potatoes
- Sweet potatoes
- Tapioca starch
- Yams
Other
- Garlic
- Nuts
Sweeteners
- Real maple syrup
- Coconut palm sugar / “coconut sugar”
- Beet sugar
- Cane sugar
- Brown sugar
- Domino sugar
- Granulated sugar
- Turbinado sugar
- Sugar in the Raw®
Highly processed foods
- Any food containing starch (flour), and/or “sugar” or “sucrose” or “maple syrup” or “coconut sugar” as an added ingredient
- Desserts
- Candy
- Pastries
- Pancakes/waffles
- Sauces (i.e. barbecue sauce, tomato sauces with added sugar)
- Dressings
Additional resources
If you’d like to learn more about how to navigate our complex modern-day food & healthcare system from a holistic lens (according to someone who has been there and done that first-hand), feel free to check out the following resources depending on what’s most relevant for you:
- Sucrose Intolerance Foods List – What to Eat & What to Avoid (Free PDF Download)
- Sweet Relief: When and How to Take Sucraid (Sacrosidase) for Sucrose Intolerance
- Acquired Sucrose Intolerance: How to Navigate Sucrase-Isomaltase Deficiency in Adults
- Understanding Congenital Sucrase-Isomaltase Deficiency (CSID): Causes, Symptoms, and Treatment
- Navigating the Sucrose Intolerance Diet: A Step-by-Step Guide
- A Comprehensive List of Foods High in Sucrose (Article)
- Low Sucrose Foods List (Article)
- IBS and Sugar – A Holistic Perspective
- Spilling the Tea on Splenda (Sucralose) and IBS
Conclusions
A sucrose intolerance (or inability to break down sucrose and starches in the gut) is a common underlying root-cause of IBS symptoms, silently impacting millions of people worldwide.
It is caused by a sucrase isomaltase deficiency, which could be lifelong due to certain genetic mutations, or it can also be acquired secondary to an underlying case of SIBO, left unchecked for too long,
Either way, most people with this condition have flown under the radar for many years/decades because sucrose and starch are in so many foods, and because so few practitioners (even in the holistic health space) are familiar with sucrase isomaltase deficiency.
A sucrose intolerance can be identified via a combination of food logging, a low-sucrose elimination diet, a sucrose malabsorption breath test, and/or a sucrase enzyme assay of duodenal biopsies” via an endoscopy, alongside working with your doctor and a functional dietitian who specializes in this.
The best way to address a sucrose intolerance is not just to avoid sucrose-containing foods, but to address and resolve any potential underlying root causes (such as SIBO/dysbiosis) and to lean on sucrase enzymes and/or other types of supplements, as needed.
Since this information is not well-known, and it could make a huge difference for someone suffering from IBS, please share this article! (Knowledge is power, when we have the right mindset and tools to take aligned action based on what we learn.)
XO – Jenna
