What is sucrose intolerance?

It is a digestive disorder caused by an inadequate metabolism of sucrose known as table sugar in our intestine.

This is due to the lack, or dysfunction, of the enzyme sucrose-isomaltase, which is responsible for metabolizing sucrose into glucose and fructose, as well as starch.

The consequence of not being able to digest it will be the accumulation of this starch and sucrose in the colon. Fermentation will occur with bacteria leading to:

• Gastrointestinal symptoms such as gas, bloating, and abdominal pain

• Diarrhea

• Malnutrition

This intolerance can be acquired, as a result of intestinal diseases or infections that influence the intestine's ability to produce the enzyme, or it may be due to the presence of predisposing genetic variants.

What about sugar substitutes?

We can find many cases of patients who cannot tolerate a specific type of sugar but do not show any adverse reactions to certain substitutes such as the following sweeteners:

• Xylitol

• Stevia

• Saccharin

• Aspartame

It is important to consider the health implications these substitutes may have, so their recommendation should be evaluated on a case-by-case basis.

Why should we consider how we tolerate sucrose?

There is a close relationship between poor tolerance to sucrose and intestinal dysbiosis. In this sense, it can influence the effectiveness of a low FODMAP diet.

In the case of sucrose intolerance, an increase occurs in the intestine, serving as a substrate for the bacteria in the colon producing short-chain fatty acids and potentially causing an imbalance in the microbiota and bacterial overgrowth.

It is essential to consider sucrose tolerance when designing a low FODMAP diet, as, although sucrose is not categorized as FODMAP, in people with intolerance, it is crucial to make specific adjustments in carbohydrate consumption to also avoid and/or reduce it.

It is recommended to keep track of symptoms, as well as to consider if the patient could benefit from enzyme supplements for sucrase or supporting therapies for intestinal microbiota.

How do I interpret the results provided by the N·GENE platform?

Using the genotyping technique, we can analyze the genetic variants that influence the level of genetic predisposition each patient has to have a higher or lower activity of the sucrase-isomaltase enzyme. It has been shown that patients predisposed to lower activity are also predisposed to have irritable bowel syndrome.

If it shows a predisposition to normal enzymatic activity but presents symptoms, it could be an acquired intolerance arising from other inflammatory diseases such as SIBO or celiac disease. These usually result in a decrease of enzymes in the body. In that case, sucrose should be considered when prescribing one diet or another.

If they show a predisposition to have normal enzymatic activity and no symptoms after consuming foods with added table sugar, they will have a better response to a low FODMAP diet in case it is needed at some point.

Other ways to detect this intolerance are:

• Intestinal biopsy: a much more invasive technique with risks.

• Urine analysis

• Enzyme supplement

The N·GENE DNA tests provide an advanced tool for professionals that help identify genetic predispositions, allowing professionals to adopt a more precise and personalized approach to health. It will be advisable to contrast our N·GENE results with previous test reports that the patient may have, if any. This will help us guide ourselves and confirm our suspicions.