Congenital Sucrase-Isomaltase Deficiency (CSID)
Parent Support Group

NORD Registered

For those individuals with CSID there are a number of sweeteners which contain sucrose that should be eliminated from the diet and a number of natural sweeteners which can be substituted. Finally we have included information regarding artificial sweeteners. You will find a section below for each.

Sweeteners to Avoid

Sucrose or Sugar is a crystalline, water soluble sugar obtained from Sugar Cane and Sugar Beets.  Maple sap, palm sap, and sorghum are less common sources.  Granulated or white sugar is the most common form of sucrose. Superfine sugar also known as Castor or Caster Sugar (Britain and some parts of Europe), Confectioners' sugar or powdered sugar, decorating or course sugar, rock candy (largest crystalline form), brown sugar (combination of white sugar and molasses), raw or Turbinado sugar, spun sugar or cotton candy, maple syrup (forms the greater part of maple syrup), and course sugars like Demerara and Barbados sugar are all different forms of sucrose and should be eliminated from the diet.

Molasses produced as a part of the refining process of beets, sorghum or sugar cane.  After the table sugar crystals are removed molasses is what's left.   When processed the first time the result is light molasses frequently found in pancake syrup.  The second time it is refined dark molasses is the result.  This is usually found in gingerbreads, baked beans and pumpernickel breads.  The third time it is refined the result is Blackstrap Molasses.  Although this form of molasses has been effectively marked as a health food ingredient due to slightly higher amounts of calcium, phosphorus and iron; it is still a sucrose sweetener and should be avoided. 

Substitute Sweeteners (use only upon advise of your physician)

Brown Rice Syrup is a polysaccharide starch sweetener made by combining brown rice and water.  It is used in some health food cookies, candies and nutritional food bars.   A request has been made to the University of Washington Dietary staff to determine if Brown Rice Syrup can be included as a substitute sweetener for patients with CSID.  Until we have a definitive answer for those who have significant problems with isomaltase especially in infants and children under three you may want not want to consider this as an alternate sweetener.   We have one documented case of a child three years old who uses this alternative sweetener on an occasional basis in health food bars for school lunches.  This child has severe sucrose symptoms and minimal isomaltase symptoms unless eaten alone or in large quantities.

Dextrose same as glucose below.

Fructose  or Fruit Sugar also called Levulose is naturally occurring in most fruits and some vegetables.   A crystalline form was developed in the late 1970's and early 80's which is marked today as both crystalline fructose and crystalline fructose syrup (crystalline fructose plus water).  Both contain almost pure fructose and a minute amount of dextrose.

Glucose is one of the simplest sugars, its most common form is dextroglucose which occurs naturally in foods.  Glucose is sometimes referred to as Dextrose.   It is most commonly found in honey and natural grape juice.  Corn syrup is a form of glucose made from cornstarch. 

High Fructose Corn Syrup  also known as High Fructose Syrup or HFS is comprised of fructose (42% to 55%), dextrose and small amounts of oligosaccharides. NOTE: Because HFS is predominately derived from corn starch, and corn contains different ratios of amylose and amylopectin per corn variety may explain why corn syrups in general have been listed on the do not use list for most CSID patients  (requiring varying amounts of isomaltase for digestion.) The dent corn used in HFS usually contains 30% amylose. The manufacture of HFS requires the depolymerization of starch to dextrose through two processes called saccharification (breaking the starch polymer to oligomers) and liquefaction (the final breaking of di- and oligomeric products of amylase a-1,4 and a-1,6 bonds that join consecutive dextrose units).  Finally the dextrose is subjected to an isomerization process resulting in fructose.  (Refer to Hanover, L. Mark, and John S. White, Manufacturing, composition, and applications of fructose, am J Clin Nutr 1993;58 (suppl):724S-32S Printed USA, Copyright 1993, American Society for Clinical Nutrition.)

A request has been made to the University of Washington Dietary staff to determine why HFS is included on the exclusion list for patients with CSID.  Until we have a definitive answer for those who have significant problems with isomalose especially in infants and children under three you may want to consider the total elimination of all HFS from the diet as well or consult your physician for advise. 

Honey is comprised of 1.5% sucrose, 7% maltose and the remainder nearly equal parts of fructose and dextrose but unlike sucrose where the fructose and dextrose are linked together by a glycosidic bond forming the disaccharide sugar sucrose; honey consists of fructose and dextrose unlinked as monosaccharides.  Honey is about twice as sweet to the taste as sucrose. About 25% of our membership uses honey without sucraid the other 25% with Sucraid. about half Group A & D do not use Honey.  

Lactose or milk sugar as it is sometimes called is a naturally occurring sugar found in milk and milk products. 

Maltose is also referred to as malt sugar.  It is a disaccharide created when enzymes react with starches such as bread flour to produce carbon dioxide gas (the stuff that makes your bread rise).  You may wish to consult you physician before inclusion in your child's diet.

Artificial Sweeteners and Sugar Substitutes frequently used in place of table sugar as a sweetener.  You can usually find Aspartame, Acesulfame-K and Saccharin in your local grocery store under a number of marketing brand names.  Since some individuals are concerned about the long term use of these products especially introducing them to small children at an early age as a sugar substitute you may want to consult your physician for information regarding the current research and other products like Alitame and Sucralose currently being developed.