What is Congenital Sucrase-Isomaltase Deficiency (CSID)?

by Valerie Polley | Jan 15, 2019 | 10 comments

I attended a three day GI conference at the University of Michigan in September. It was an amazing conference packed full of presentations from some of the best GI doctors and dietitians. One presentation was on a topic I had never heard of, so I was intrigued and ready to learn more about it.

​Congenital Sucrase-Isomaltase Deficiency (CSID) is a rare disorder that causes individuals the inability to digest certain sugars due to an absence or low levels of two digestive enzymes, sucrase and isomaltase. Both of these enzymes are involved in the digestion of sugar and starch. Table sugar is broken down into glucose and fructose with the help of the sucrase enzyme. Isomaltase is one of the several enzymes that help digest starches.

Both sucrose (found in fruits, and known as table sugar) and maltose (sugar found in grains) are disaccharides, which means they are made of two simple sugars. During digestion, intestinal enzymes break these down into simple sugars called monosaccharides. Sucrose=glucose + fructose and maltose=glucose + glucose. An individual with CSID has difficulty breaking down the disaccharides into monosaccharides that the body uses for fuel. These disaccharides are too large to be absorbed in the intestines by the microvilli (known as the brush border).

Starch can be a simple or complex carbohydrate. Simple carbohydrates have one or two sugar molecules, and complex carbohydrates have three or more sugars linked together.

Multiple enzymes are needed to properly digest starch. Digestion begins in the mouth with an enzyme in the saliva called amylase. Digestion continues in the stomach by further breaking down the food. In the small intestine, starch is processed by an enzyme called pancreatic amylase and converted into maltose and sucrose. The brush border contains numerous enzymes (sucrase, lactase, maltase) to continue the breakdown of digested food into smaller particles that can be better absorbed. The isomaltase enzyme breaks the bonds linking sugars into glucose, which can't be broken down by amylase or maltase. This is one of the final steps in the digestion of starch to glucose.

To sum it up, those with CSID lack the sucrase and isomaltase enzymes to properly break down the food to a simpler form, so the body can absorb it.

Without the proper enzymes, digestion can't take place correctly and individuals can have symptoms, such as:
-Chronic Diarrhea
-Abdominal Pain
-Abdominal Distention
-Excess Gas
-Weight Loss
-Constipation
-Acid Reflux
-Burping

So, what do you do if you suspect you have CSID?
Visit sucroseintolerance.com to take their quiz. On that site there is also an "ask your doctor" form to take to your physician. A sucrose breath test can help with the diagnosis. This can be ordered by your doctor or I can order a complimentary sucrose breath test to be sent to your home.

What if you have a positive breath test?
You will do a two-week elimination diet of sucrose and starch, followed by a gradual reintroduction of both. The reintroduction will help identify how much of these foods you can tolerate. Many like the guidance of a dietitian familiar with this deficiency to help them navigate through the elimination and reintroduction phases. Others also do the diet along with a test of the sucrase enzyme, Sucraid® (sacrosidase) Oral Solution. The sucrase enzyme can be purchased through One Patient Services, a subsidiary of QOL, Medical, LLC, the manufacturer of Sucraid® Oral Solution, at SucraidASSIST.com.

Please consult with your doctor regarding your symptoms and for a final diagnosis.

If you have any questions regarding Congenital Sucrase-Isomaltase Deficiency, please feel free to call or text me at 410-963-4782 or email at valerie@bluetreenutrition.com.

With summer here, many people are getting excited about upcoming vacations. But for people with digestive issues, symptoms like constipation and bloating are often unwelcome travel companions. Traveling disrupts our body's natural rhythms and daily habits, which can lead to digestive chaos.

This article will help you understand how sudden changes in hydration, diet, and airplane cabin pressure impact the gut, as well as provide practical, evidence-based tips for keeping your gut happy on the road.

The Perfect Storm for Constipation: Fluid and Fiber Drops

One of the biggest contributors to digestive issues like constipation when you're traveling is a change in your normal hydration and fiber intake patterns. Here's how each affects your gut.

Inconsistent Hydration

Disrupted routines often lead to forgetting to drink water. Plus, strict airport security rules mean you can't carry a full water bottle through security checkpoints. Travelers often intentionally avoid drinking to skip using tiny airplane toilets or unfamiliar public restrooms. Finally, plane cabins are incredibly dry, which can quickly lead to dehydration.

The result: When the body is dehydrated, the colon absorbs more water from food waste, leading to hard, dry, and difficult-to-pass stools.

Reduced Fiber Intake

Most people in the United States don't get enough fiber at the best of times, and traveling only makes this worse. Convenience foods at airports, gas stations, and roadside stops are typically highly processed, high in sodium, and low in fiber. Experiencing local cuisines often means prioritizing rich restaurant meals over fresh fruits, vegetables, and whole grains.

Not getting enough fiber quickly contributes to constipation because fiber is essential for adding bulk to stool and keeps things moving through the digestive tract. A sudden drop in fiber stalls peristalsis (the wave-like muscle contractions in the gut), leading to less frequent bowel movements. 

The Combined Effect

The simultaneous drop in both fluid and fiber creates a "logjam" effect in the intestines. Not having enough fluid and fiber slows the movement of waste through your gut. This leads to more water being absorbed from the stool, resulting in hard, difficult-to-pass stool. The traffic jam effect makes acute constipation one of the most common (yet preventable) gut-related travel complaints.

Cabin Pressure and Bloating

Have you ever noticed that you get more bloated during air travel than other forms of travel? No, you're not imagining things. This is due to a law of physics called Boyle's Law. Simply put, this law of physics states that as atmospheric pressure decreases, the volume of a gas naturally increases.

Here's how that works with your gut and air travel. Airplane cabins are pressurized to simulate an altitude of around 6,000 to 8,000 feet. Because of this shift, the gas that's already present in your gut expands during flight. This rapid gas expansion stretches your intestinal walls, leading to pain, cramping, and bloating often referred to as "airplane belly."

Additionally, several common travel habits can aggravate this trapped gas. Drinking carbonated beverages before or during the flight, chewing gum (which leads to swallowing excess air), and remaining stationary for hours on end all trap and intensify the expanding gas.

Tips for a Happy Travel Gut

Fortunately, a few small tweaks to your travel routine can make a huge difference in whether you end up constipated and bloated while traveling.

Pre-Flight and In-Transit Tactics

  • Hydrate on the go: Bring an empty, reusable water bottle through airport security and fill it once you reach the departure lounge (most airports now have water bottle filling stations). Aim for consistent sipping throughout your journey to keep hydrated.
  • Be mindful of foods that can worsen bloating: Avoid fizzy drinks, heavy or fried foods, and gas-producing foods like beans, broccoli, and cabbage, for at least 24 hours before your flight. This can reduce the amount of gas present in your gut, which can reduce the bloating associated with a drop in cabin pressure.
  • Pack smart snacks: Since airport snacks are typically high in sodium and low in fiber, bringing your own high-fiber, travel-friendly snacks can help boost your fiber intake. Consider packing dried chickpeas, almonds, dried fruit, or on-the-go fiber supplements to bridge the gap.

On-Arrival Habits

  • Prioritize fiber: While there's nothing wrong with enjoying the local cuisine wherever you're traveling, try to prioritize fiber at your destination whenever possible. I recommend starting your day with a high-fiber breakfast, such as oatmeal with fruit, nuts, and seeds.
  • Get moving: Try to avoid being sedentary on arrival. Going for a leisurely walk helps stimulate intestinal motility and releases trapped gas (there's a reason a short walk after meals is commonly called a "fart walk"!).
  • Keep a regular sleep schedule: Vacation can throw a serious wrench into your routine, but wherever possible, try to maintain it. Gut issues can be worsened by poor sleep, so sticking to your routine can help support gut comfort on vacation.

Final Thoughts

Travel naturally changes our dietary habits and challenges our digestive system through abrupt changes in cabin pressure, but digestive discomfort doesn't need to ruin your vacation. By being mindful of your fluid and fiber intake, staying active, and making strategic changes in pre-flight eating habits to minimize the effects of cabin pressure changes, you can keep your digestion on track and enjoy every minute of your vacation.

If you're worried about an upcoming trip and need personalized strategies for managing your digestion on vacation, I'd love to help. You can get in touch with me at Blue Tree Nutrition to book your appointment with a registered dietitian.

10 Comments

  1. Edy Trujillo

    Valerie,
    I have suffered with an unhealthy gut for years and much likely due to my bad eating habits, I’m slowing improving. Y food choices but get discouraged easily when I can’t pinpoint the cause of my problems. Reading your article makes me think I have CSID. Can I do the complimentary hydrogen test? Thank you

    Reply
    • Valerie Polley

      Edy,
      There can be many reasons for gastrointestinal issues. I will email you at Remeeedy@gmail.com so we can talk more about it.
      Valerie

      Reply
  2. Robin

    I had an endoscopy last Sept. It said CSID. I haven’t really received much more help to live with this beast. I’m on the toilet more than I’m not. I weigh 92 lbs and sad at my body appearance. Saw Rochester Mayo Dr and he is making me take the breath test AND a fructose test too whenever they get in touch with me, because he thinks the biopsy was wrong last Sept. I’m a true mess. I know I do have Sucraid and it seems to help some, if I remember to take it.

    Reply
    • Valerie Polley

      I am sorry you are dealing with this. I see clients with varying degrees of SID. Some have SID with other things on top, such as IBS. Once you get the results of the breath tests, then you can go from there. There are dietitians that can help and I am happy to help as well depending on what state you live in. I would try to use the Sucraid now to see if it gets control of some of your symptoms. You are welcome to reach out to me at valerie@bluetreenutrition.com or 410-963-4782.

      Reply
  3. Vanessa

    Does anyone know of any CSID cookbooks?

    Reply
    • Valerie Polley

      I have never been asked this question, so I did some searching. I found one on Amazon called A Place to Start Without Sugar and Starch. It is for those with CSID. That is the only cookbook I found. Pinterest has some ideas as well. This looks like something that is lacking, but could be very helpful as more individuals are diagnosed with it.

      Reply
  4. Andrea

    My 13 year old daughter was diagnosed last July with CSID and lactase deficiency. She is on sucraid and lactaid. She lost 20 pounds the first few weeks when cutting many sugars and saw improvement. Now she’s back to cramping, bloating. Where can I find directions on how to do the 2 week elimination diet? Any help will.be appreciated. She is very frustrated and sad about her condition.

    Reply
    • Valerie Polley

      I am sorry your daughter is dealing with this. I know it can’t be easy for any of you. I am not sure what you mean by the 2 week elimination diet. Is that for SID or something else? Some individuals with SID also deal with other issues, such as IBS. I would need to evaluate what she is eating now and go from there. I am happy to help out or find another dietitian closer to you. You can reach out to me at valerie@bluetreenutrition.com or 410-963-4782.

      Reply
  5. Christin Firestine

    I live in western nc do you see clients with CSID tele- health or can you recommend someone near me that went to that conference about CSID. Not many are educated in that field.

    Reply
    • Valerie Polley

      I am sorry I am just seeing this now. I have no idea why it didn’t alert me. Every state has different licensure laws and NC is one of those states, so I can’t legally see someone from NC.If you have not found someone there is a great dietitian in your state that can help. Her name is Erin Skinner and I am including a link her website.
      https://www.empowerednutrition.health

      Reply

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.