If you have been diagnosed with disaccharidase deficiency and told that you need to avoid all lactose, maltose and/or sucrose, and you have been told your days of enjoying almost any food are all over, often this is not the case. Reversing non-congenital disaccharidase deficiency is something that can often be accomplished by paying careful attention to your symptoms and making necessary lifestyle changes.
Being born with disaccharidase deficiency is very rare. So, if you made it past the first few years of life without having debilitating disaccharidase deficiency, then you stand a great chance to be able to recover if you have developed the condition later in life.
According to Pierre Russo in Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas (2nd Edition, 2009), disaccharidase deficiencies are “often secondary, resulting from diffuse mucosal damage caused by infectious gastroenteritis, gluten-sensitive enteropathy, or other food allergies.”
If you got lost in the terminology, Russo state that disaccharidase deficiency is most often secondary to inflammation of the intestines.
The two major causes he notes are infection and food allergy.
WARNING: Some of this information below can have pretty complex terminology. I will simplify it throughout yet give enough information so you can begin your healing journey.
Mucosal Barrier Damage
The mucosal barrier is the innermost layer of your digestive tract.
Mucosal barrier damage is common in many conditions like Crohn’s disease where inflammation damages all layers of the intestinal lining in a patch like formation. It is also found in ulcerative colitis where inflammation is on the innermost mucosal layer of the intestinal lining with more general inflammation throughout rather than “patches”.
When there is significant inflammation of the mucosal barrier an imbalance between the breakdown of the barrier and rebuilding of the mucosa occurs. When the breakdown rate exceeds the restoration rate, then you develop micro-erosions in that barrier and you can begin to develop intestinal permeability aka leaky gut. (For more on leaky gut and intestinal permeability, read my free ebook here.)
Making Disaccharidase Enzymes
The walls of your intestine are composed of a single layer of epithelial cells. These cells provide a protective barrier between the inside and outside of your body as well as supporting proper absorption of nutrients and breakdown of sugars like disaccharides. This single layer of epithelial cells have finger-like protrusions that make up something called the brush border of your intestines.
The three major enzymes made by the brush border include sucrase-isomaltase, maltase-glucoamaltase and lactase. For simplicity’s sake in this article and in your mind, its easiest to call them sucrase, maltase and lactase eyzmes. (There are also protein enzymes and fat enzymes released by the brush border that we won’t cover here.)
Lactase – Digests lactose to glucose and galactose. Most patients that enter my office with significant digestive complaints experience some form of lactose intolerance. Or in other words if I asked them to drink a large glass of milk, they would refuse. The main source of lactose in the diet is products containing milk, cheese, yogurt, etc. Lactose intolerance and lactase enzyme deficiency occurs primarily because of 3 major reasons.
The first reason is because the mucosal brush border is damaged and thus cannot create as much lactase enzyme. When this brush border is damaged the production of lactase enzyme decreases. The brush border can be damaged from GMOs, prescription drugs, stress and much more. In general it seems that as we age we product less lactase enzyme, but it is unclear whether this is truly a genetically derived “normal” process or whether it is due to decreased gut health with age.
The second reason is due to infrequent consumption of dairy. If you do not consume lactose on a frequent basis, then you brush border will make less lactase, thus when you go to consume a large glass of milk (or ice cream) then you will feel digestive distress regardless of whether you are truly lactose intolerant or not.
The third reason is a true lactose or casein intolerance, known as a food sensitivity or a food allergy. In this case, dairy is the root of the inflammation that is destroying the mucosal lining and decreasing enzyme production. In this case, strict avoidance of dairy, including low-lactose products like cheese and yogurt is absolutely necessary for long-term health. You cannot take enzymes for this and you cannot buy “lactose-free” dairy products in this situation as it is rare to be lactose intolerant and casein tolerant. Casein is one of the proteins found in dairy products.
Maltase – Digests sucrose to glucose and fructose. While there aren’t many foods in your diet that contain maltose, your body creates it all day long.
Starchy carbohydrates including grains, rice, potatoes, corn and peas are broken down from large units of starch into smaller units of maltose. Once maltose has been created, then maltase is required to break it down into an even smaller molecule that is absorbable by the body.
Maltase deficiency from birth is the least common form of disaccharide deficiency, which only makes practical sense because the body creates it in high quantities. Although, if you have damage of your mucosal barrier, you can absolutely experience maltose intolerance symptoms if your consumption of starchy carbohydrates is high.
Sucrase – Digests sucrose to glucose and fructose. Common sources of sucrose (common table sugar) in the diet include the vast majority of plants, but it is most commonly seen in the standard diet as refined sugar beets and refined sugar cane.
The standard American diet can be overwhelmingly full of refined sugar. If your brush border is under functioning and your diet is overconsuming sucrose, then you may have problems with nearly all sugar. It is not uncommon for patients to enter my office with the complaint that they cannot consume any carbohydrate or added sugars without significant GI distress.
Functional, Natural & Holistic Approach to Disaccharidase Enzyme Deficiencies
Now that we are better educated on disaccharides, lets take a close look at what I eluded to in the first part of the article above.
Disaccharidase deficiency is most often SECONDARY to intestinal inflammation. What this means is that if you can adequately decrease the inflammation of your intestinal lining, it is more than likely that you should be able to consume disaccharides again.
Causes of Mucosal Damage
What Foods Destroy The Mucosal Lining?
From my clinical experience, food allergies and food sensitivities are the strongest destroyers of the mucosal lining and brush border. The most classic example of mucosal destruction from a food is seen in celiac disease. As the damage occurs to the cells of the gut lining, the production of disaccharidase enzymes decreases. So, while you initially may have begun with journey with a gluten intolerance, over time you can develop disaccharidase deficiency if you don’t properly avoid gluten.
In my office the 2nd most common irritant to the mucosal lining that results in disaccharidase enzyme deficiencies is corn. The protein in corn, zein aka maize can be very problematic to the intestinal lining. In fact, this research article suggests that many people may experience a celiac-like immune response from corn consumption.
A unique factor with corn intolerance or sensitivity is that most people only have mild reactions and experience low-grade inflammation that progresses with time. One study I recently read, reported that only 37% of patients tested that had confirmed IgE allergic reaction to corn ever experienced symptoms. That means that if we have 100 people with a corn allergy, 63 of them will never guess that it is corn causing the problem because they won’t experience noticeable symptoms.
In fact, many patients come in to my office and they are both gluten-free and dairy-free, but they have substituted corn and or popcorn in their diet and they continue to suffer. But they surely do not experience any direct symptoms from the consumption of corn. This hidden low-grad inflammation can lead to a decreased release of disaccharides.
Other foods that commonly create problems include dairy, nightshades, soy and eggs. I often suspect diary or eggs if the patient is under the age of 12 and suspect corn or gluten if the patient developed GI issues later in life, but to be sure, in-office testing using my A.S.K. method (Anderson Specific Kinesiology) allows me to further evaluate possible culprits.
Understanding Stealth Infection
It is well documented that one of the major locations of destruction for viral infections is the gut mucosa. The gut mucosa is also a major site for viral replication as well as T-cell (immune regulating cells) destruction. Essentially viruses can in large destroy the gut lining that can lead to decreased enzyme production.
It is unlikely that you know you have a stealth infection like a virus or bacteria because they don’t produce the typical symptoms of infection such as fever or heat that can be noted on the outside of the body. Viruses, bacteria, fungi and parasites can all wreak serious havoc on your mucosal lining, but your only symptom may be fatigue or food intolerances. If you have already been diagnosed with disaccharidase deficiency, my experience would suggest that you have a high probability of suffering from a stealth co-infection.
My ebook (get it here) covers how to properly address the gut lining and what herbs I don’t recommend, but to cut it short here, my most common anti-viral herb is Neem Leaf by AMG and my second most common anti-viral is Coptis. Both Neem and Coptis can kill a large variety of organisms and provide significant relief from irritating stealth infections in the digestive tract.
Disaccharidase Diet – Elimination Diet
If you are going to go on a disaccharidase diet, the most important clinical aspect is to treat stealth infections at the same time. If you do not treat infection at the same time as food sensitivities, then improvements will be less and symptoms may remain largely the same. The second part I want to note again is that the majority of the enzyme deficiency is caused by inflammation of the gut lining which is more often caused by a food protein than an actual disaccharide molecule.
With disaccharidase deficiency, the easiest food to eliminated first is dairy. Begin with a complete diary elimination diet that will help you avoid lactose, the sugar and also whey and casein the proteins.
If you have tried dairy elimination, your next option is to remove all refined and added sugar from your diet. You can still consume most starchy vegetables but added table sugar in any shape or form must be removed. This can help you assess the sucrase enzyme status.
Lastly, avoidance of maltose comes down to eliminating consumption of most grains and even sweet potatoes. Grain elimination can often give a lot of relief as it also can decrease the irritation of the gut lining in general regardless of your enzyme status.
If you are able to find a disaccharidase diet that gives relief from your symptoms, then I recommend sticking to it while you address your infection and food protein sensitivities. Once your digestive symptoms are gone and your inflammation is decreased adequately, most people can slowly introduce all disaccharides into their body.
Disaccharidase enzyme deficiency can be a debilitating problem. Fortunately, as these brush border enzymes are critical to human metabolism and energy production there are very few individuals that have a genetically caused deficiency and rather most individuals suffer do to sustained long-term inflammation of the digestive tract. The two major causes of irritation to the mucosal layer are infection and food intolerances. Environmental toxins including everything from your make-up to your laundry soap can also create irritation of your intestinal lining but do so more indirectly.
Making the necessary dietary changes and finding a qualified holistic practitioner can be the key to restoring your quality of life and improving long standing GI discomfort.
To read my ebook on effectively addressing infection and food sensitivities, go here.
If you need help finding a functional doctor that can help you with restoring your tolerance to disaccharides, please don’t hesitate to send us an email at [email protected]