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6. Lactose and sucrose are the most common disaccharides in the diet. Here is a one-day sample CSID diet menu that is low in sucrose and starch: Breakfast: spinach omelet, blueberries, and milk Snack: plain Greek yogurt sweetened with dextrose and topped with sliced strawberries Lunch: no-noodle lasagna with a tossed salad Snack: cottage cheese and grapes Dinner: grilled pork chop, steamed broccoli, and cherries Are additional laboratory studies available; even some that are not widely available? Your physician and registered dietitian can use the food composition tables on this website to begin to build an appropriate CSID diet for you. The sugars remaining unabsorbed move into the large bowel and are fermented For sucrose deficiency, Infants and Children =15 kg: 8500 international units (1 mL) per meal or snack; Children >15 kg and Adults: 17,000 international units (2 mL) per meal or snack. If available a nutritional consultation may be beneficial. The most common symptoms of disaccharidase deficiencies include abdominal pain, bloating, and flatulence. This test can identify a specific unabsorbed sugar in the stool unless it has been fully fermented by the colonic bacterial flora. Have you found out what kind of inflammation he has? pitfalls and approach to management. In addition to sugars and fibers, starch is a component of some carbohydrates. Developmental disaccharidase deficiencies occur in pre-term infants. We have an update with the doctor next Tuesday to see where we go from here. 0000020664 00000 n These common symptoms are frequently misdiagnosed as a food allergy or intolerance. In the long-term elimination of all dairy products can result in decreased calcium intake. vol. 0000044436 00000 n 0000009914 00000 n Working with a registered dietitian is crucial to dietary success. Good choices of these types of dietary starch are whole grain breads or those made with stone-ground flour instead of processed and refined white breads. Perman JA. For people with primary (permanent) deficiencies, or those who need to follow the diet for an extended period of time, the following supplements should be considered: Trehalase deficiency is less common and presents when mushrooms are ingested. The human lactase gene is located on chromosome 2q21-22. 0000018035 00000 n Most individuals with CSID can eat dairy products such as cows milk, ricotta cheese, plain cottage cheese, sour cream, butter, cream, whipping cream, and hard cheeses like cheddar, Colby, mozzarella, Swiss, parmesan, and provolone. This has relatively low activity before 32 weeks of gestation and rises progressively thereafter to high activity levels in term infants. <<06E783B5A772D64DBD765FF42D03F1F7>]/Prev 398468/XRefStm 1706>> Connect with thousands of patients and caregivers for support, practical information, and answers. Malabsorption can affect macronutrients (eg, proteins, carbohydrates, fats) read more . However, because the degree of lactose malabsorption varies greatly, many . Here's what you can expect at your child's first visit. ), Rasinpera, H., Savilahti, E., Enattah, N. S., Kuokkanen, M., Totterman, N., Lindahl, H. A genetic test which can be used to diagnose adult-type hypolactasia in children. In: Stanbury JB, Wybgaarden JB, Fredrickson DS, Goldstein JS, Brown MS eds. All 5 disaccharides were low (like half of what they should be). In general, if an individual is consuming a wide range of the allowed foods and the condition is a secondary (temporary) deficiency, nutritional supplements should not be necessary. A plain abdominal x-ray demonstrating gaseous distension of the large intestine can be seen in disaccharide malabsorption. They are hoping this helps in case of a bacterial or parasite infection and also it has an anti inflammatory property. Disaccharidases are enzymes that break disaccharides down into monosaccharides for digestion. @kanaazpereira Thank you for the information! 541-6. I wonder if they could still do the breath test for SIBO since he has already started Flagyl? *The GI doctor doesnt think it is Crohns but is not ruling it out. fraction of milk and other dairy products. An affected adult may have watery diarrhea, bloating, excessive flatus, nausea, borborygmi, and abdominal cramps after ingesting lactose. The parents of a child with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Sucrose, or plain white table sugar, is the most commonly known disaccharide. 1983;58:246-252. Begin with a complete diary elimination diet that will help you avoid lactose, the sugar and also whey and casein the proteins. 1910 0 obj <>stream Diet Diet Therapy Ethnic Groups Food Supply Galactosidases / metabolism* . The diet should include salmon, baked beans, spinach, leafy vegetables, shrimp, green peas, oysters, broccoli and fresh fruits. The lactose composition of her milk will remain constant, regardless of whether she consumes milk and dairy products. If there is a deficiency in the enzymes that split these linkages, free glucose molecules will not be released and absorbed, and the remaining undigested starch or sugar will be pass into the large bowel where bacteria ferment it. The test also does not reflect the absorptive capacity of small intestine for the individual sugars and the results can be misleading in cases where the intestinal mucosal abnormality is patchy, as for example, in celiac disease. Drugs, inflammatory diseases and pathogens can cause direct damage to the enterocytes or adversely affect cell turnover in the small intestine. Exclude any processed foods from your diet that have added sucrose. There are multiple other conditions and diseases leading to similar symptoms. Gasbarrini A, Corazza GR, Gasbarrini G, et al: Methodology and indications of H2-breath testing in gastrointestinal diseases: The Rome Consensus Conference. However, gold . Visit www.FDA.gov/medwatch or call 1-800-FDA-1088. Accessed February 13, 2020. https://testdirectory.questdiagnostics.com/test/test-detail/19701/disaccharidases?cc=MASTER. Lactose-intolerant patients develop diarrhea, abdominal bloating, and discomfort within 20 to 30 minutes, and their serum glucose levels do not rise to > 20 mg/dL (< 1.1 mmol/L) above baseline. ), (The molecular difference between lactase persistence and nonpersistence is caused by the mutation at position -13910), (Intestinal glucoamylase deficiency can be the cause of chronic diarrhea. This enzyme is needed to hydrolyse sucrose, as well as limit dextrins from starches. Sweetened sodas should only be tried under the advice of a registered dietitian or physician. The most frequent cause of mucosal damage is celiac disease that can affect 1% of the population. A small number of individuals do not produce hydrogen or methane and hence will give a false negative result. I am learning that the liver loves vegetables specially raw and once fed that it removes inflammation. You may also find sucrose hidden in your breakfast cereal or yogurt. There are several types of carbohydrate malabsorption, including: Our experts are available to consult with you or your physician on second opinion requests. *Artichokes, asparagus, broccoli, brussels sprouts, cabbage, and cauliflower can cause gastrointestinal gas in all individuals, not just individuals with CSID. Poor weight gain (occasional and controversial). 1967 Sep;53(3):371-374. The important thing is to determine a persons capacity to handle the sugar. Rats were assigned to zinc deficient (ZD), control (C) or pair-fed (PF ) groups and fed for 40 d a zinc deficient (1 mg/kg) diet (ZD rats) or a similar diet supplemented with 50 mg Zn/kg (C and PF rats). Maltose tolerance is determined by consuming starch in the form of white grains and flours white bread, white rice etc. Symptoms include diarrhea, abdominal distention, and flatulence. The disadvantage is that it requires an endoscopy and biopsy of the small intestinal mucosa. The specificity of the LTT ranges from 7796% and sensitivity from 7694%. A single-nucleotide polymorphism (SNP) -13910 T/C upstream of the coding gene has been found to be involved in the regulation of enzyme activity. The genetically programmed down-regulation of lactase in children. Usually the mother reports watery diarrhoea, generally after the first feeding of breastmilk, but at the latest by age 10 days7. Monosaccharide sugars are normally efficiently absorbed in the small intestine. 1998. pp. Since milk foods are rich in lactose, having milk or other dairy product, may aggravate your digestive tract. Inherited (Congenital) Disaccharidase Deficiencies. Infections in the digestive tract with parasites such as amoebae, helminths, nematodes, microorganisms such as Giardia lamblia, and viruses such as the rotavirus group Carbohydrate intolerance is a malabsorption syndrome Overview of Malabsorption Malabsorption is inadequate assimilation of dietary substances due to defects in digestion, absorption, or transport. Mucosal damage also occurs with graft versus host disease, immunodeficiencies, chemotherapy, radiation injury. That's a pretty standard dose of Prednisone for a flare, and". After ingestion of sucrose or maltose, an affected child will typically experience stomach cramps, bloating, gassiness, and diarrhoea. She said that she has never had someone have all 4 levels low. These individuals would most likely have normal levels of maltase and isomaltase (palatinase) activity. Disaccharidase deficiency was demonstrated in the intestinal mucosa of a variety of malabsorption states, especially adult celiac disease (nontropical sprue). 0000019174 00000 n For example, it is suggested that you chew a bite of the food item 30 times before swallowing. They are hoping to keep him on Prednisone for a while and then taper off of it, then hopefully the Apriso is able to maintain the inflammation. The starch content of fruits and vegetables is an important variable to consider when introducing dietary starches. Carbohydrate malabsorption. Intestinal bacteria metabolize some undigested disaccharides, producing gases that cause distention and flatus. Congenital Sucrase-Isomaltase Deficiency The treated food usually will be tolerated. 1571-6. In cases of congenital lactase deficiency (CLD)6, symptoms are obvious from birth. Parents and caregivers have noticed a few trends that have helped raise tolerance levels when adding starch to a CSID diet. xref Please login or register first to view this content. Our mission is to provide practice-focused clinical and drug information that is reflective of current and emerging principles of care that will help to inform oncology decisions. 0000045786 00000 n Sucraid(sacrosidase) Oral Solution is an enzyme replacement therapy for the treatment of genetically determined sucrase deficiency, which is part of congenital sucrase-isomaltase deficiency (CSID). 0000028403 00000 n Even though it might be difficult to find registered dietitians who have experience with CSID, they will be able to demonstrate how to effectively write and manage a food log or diary and how to add foods by trial to the diet. Congenital or primary disaccharidase deficiencies require life-long management. While limiting disaccharide carbohydrates in your diet may seem difficult, there are a variety of foods you can still enjoy. This results in abdominal bloating, pain, and flatulence (wind). Following an overnight fast and a basal collection of exhaled breath, the test substrate is ingested. His lactase is now zero, all of the other ones are very low as well. You are encouraged to report negative side effects of prescription drugs to the FDA. This increases the amount of fermentation products in the colon, which perpetuates the cycle. The most common form of disaccharidase disorder is lactase deficiency, when . You can read the full article here: http://wb.md/2hNQBcj. Disaccharides are normally split into monosaccharides by disaccharidases (eg, lactase, maltase, isomaltase, sucrase [invertase]) located in the brush border of small-bowel enterocytes. *Our current doctor is addressing the low Disaccharidase levels, it was the first GI doctor that never really addressed them. Tell your doctor if you are allergic to, have ever had a reaction to, or have ever had difficulty taking yeast, yeast products, papain, or glycerin (glycerol). 0000024002 00000 n 3(Yogurt a well-tolerated source of milk for lactase-deficient persons. A breastfed baby will ingest significant quantities of lactose in the mothers milk. When beginning a diet, you could start with the food items that most individuals with CSID can tolerate and then add other food items over time, as tolerated. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. *For now she is having him take the Flagyl for 2 weeks and then we are going to see how he responds Because the small intestine and large intestine are getting smaller amounts of starch at any given time, you may be better able to tolerate the dietary starch. Foods made from milk will contain specific quantities of lactose, depending on the amount of whey in their composition, Hard cheeses are mainly casein; the whey (liquid) is removed in their manufacture. Lactose intolerance can usually be diagnosed with a careful history supported by dietary challenge. PPTwordPPTwordwordword 0000030173 00000 n DrBerg.com have a lot of nutrition inf. 0000010898 00000 n I removed breads, flour products, sugars, and carbohydrates from my diet. We do not control or have responsibility for the content of any third-party site. Tell your doctor if you have diabetes, as your blood glucose levels may change if you begin taking Sucraid. Primary and Secondary Disaccharidase Deficiency. 36(Lactase persistence genotype data is currently insufficient to explain lactase persistence phenotype frequency in various parts of the world. I put My Crohns in remission by taking Liver Support Factors pills manufactured by Country Life and a diet of vegetables with chicken, fish, or meat. 0000037251 00000 n [CtmmvVSEzVzvS 5sJF@A_ WeB\#$]wV^fm"q\! If the deficiency is a result of an inherited tendency, it is likely that the intolerance will be lifelong. The test is not very sensitive and a positive result merely indicates the presence of an unabsorbed sugar in the stool but cannot identify the specific sugar. Most people with lactase deficiency can tolerate up to 250 to 375 mL (8 to 12 oz) of milk; symptoms that occur after consuming much smaller amounts may suggest another diagnosis. Pediatrics (1966) 38 (1): 127-141. lactase-phlorizin hydrolase gene. Thanks again & if you know of anyone who has dealt with low disaccharidase pI would love to talk with them & see what ended up being helpful for them. 1998-2023 Mayo Foundation for Medical Education and Research. Carbohydrate malabsorption is readily controlled by avoiding dietary sugars that cannot be absorbed (ie, following a lactose-free diet in cases of lactase deficiency). Human milk does not contain sucrose, maltose, or starch, so intolerance of other disaccharides is not a problem for the baby during breastfeeding. Disaccharidases are enzymes that break down complex sugars, such as lactose, into simple sugars, like glucose, so the nutrients can be absorbed in the intestine. The smallest carbohydrate units, the monosaccharides, are the building blocks for more complex sugars and starches. The human trehalase gene (TREH) is located on chromosome 11 at locus 11q23. The most common form of disaccharidase disorder is lactase deficiency, when your small intestine doesnt produce enough of an enzyme (lactase) to digest milk sugar (lactose). The dietary carbohydrates of quantitative importance are the polysaccharide starch and the disaccharides sucrose and lactose. 0000032824 00000 n Jarvela I, Enattah NS, Kokkonen J, Varilo T, Savilahti E, Peltonen L. Assignment of the Cheese contains lower amounts of lactose than milk and is often tolerated, depending on the amount ingested. 0000010370 00000 n Carbohydrate intolerance is the inability to digest certain carbohydrates due to a lack of one or more intestinal enzymes. 1. Disaccharidases are enzymes that break down complex sugars (like lactose) into simple sugars (like glucose) so that the intestine can absorb the nutrients. 1995-2023 Mayo Foundation for Medical Education and Research. 1972 Jun;60(6):478-82. Lactose and other disaccharides intolerances - Dr Janice Joneja. It has been noted that some individuals with CSID are able to increase their starch tolerance as they age and their digestive tract grows longer. Digestion, Diet and Disease. Congenital mucosal abnormalities manifesting in the newborn period include microvillus inclusion disease, Tufting enteropathy, and genetic defects such as congenital glucose-galactose malabsorption and congenital chloridorrhea. In the case of margarines, it is always a good idea to read labels carefully for potential starch or sucrose content. Several other variants have been identified very close to the -13910 position, which are associated with lactase persistence in the Middle East and Africa. endstream endobj 1909 0 obj <>/Filter/FlateDecode/Index[105 1762]/Length 60/Size 1867/Type/XRef/W[1 1 1]>>stream Sucrose restricted: vitamin C Yogurt is usually tolerated because it contains an appreciable amount of lactase produced by intrinsic Lactobacilli. It is the result of a programmed reduction of lactase synthesis after three years of age and affects approximately half of the worlds population. Trehalase enzyme digests trehalose the disaccharide found in mushrooms, yeast and algae. Processed cheeses and processed cheese products are made from normal cheese, but may include other unfermented dairy ingredients, emulsifiers, extra salt, food colorings, or whey. The test is offered by only a few laboratories in the United States and worldwide. I will look into the things you mentioned, I appreciate your help. Started having severe diarrhea & a lot pain for a day (5-25 times in a 12 hour period) this would happen 1 month. The enzymes maltase and isomaltase then split maltose into individual glucose molecules, which are absorbed through the intestinal wall into circulation. vol. Thus, the more a starchy food item is chewed, the greater the exposure the starchy food has to this necessary digestive enzyme. When starting a diet, it is recommended that you use few other spices or seasonings in order to more clearly determine your tolerance levels since many spices contain sugar or starch fillers. Clinitest tablets cannot detect sucrose, lactulose, sorbitol, and mannitol as these are non-reducing sugar or sugar alcohols. 2. Congenital sucrase-isomaltase deficiency usually becomes apparent after an infant is weaned and starts to consume fruits, juices, and grains. Publication types . Disaccharidase deficiency J Am Diet Assoc. Sucrase: Abnormal Range is less than 25 U* Twenty to 40% is regulated by the disaccharidase (enzyme), maltase-glucoamylase. Distribution of disaccharidase activities in the small bowel of normal and lactase deficient subjects. Sucrose digestion is a problem for most individuals with CSID. Usually this disorder occurs in babies and children tend to outgrow it as they age. Once your levels of tolerance of foods containing sucrose and starch have been established, you may introduce additional dairy items to determine your tolerance. While limiting disaccharide carbohydrates in your diet may seem difficult, there are a variety of foods you can still enjoy. Strong drugs and antibiotics Sucrose, a carbohydrate, is typically table sugar or white sugar, which can be an additive in many prepared foods. We want you to take advantage of everything Cancer Therapy Advisor has to offer. Dietary restriction is usually adequate treatment. This enzyme complex (sucrase-isomaltase) assists in the breakdown of a certain sugars (i.e., sucrose) and certain products of starch digestion (dextrins). 0000040856 00000 n Pain may reveal palpable gas or fluid in the RLQ overlying the cecum and illicit characteristic borborygmi. One doctor only advised me of eating everything fresh and no processed foods or any soft drinks. 10. Thus, combining a high-fat food with a starch increases the time the foods remain in the small intestine and allow the starch to have more exposure to pancreatic amylase, isomaltase, and maltase in the small intestine. This is called a primary deficiency. Recovery from the underlying disease is followed by an increase in activity of the enzyme. Patients with disaccharidases deficiencies in the duodenum can experience intolerances to foods containing complex sugars, resulting in a range of gastrointestinal symptoms including diarrhea, constipation, abdominal pain and cramping, gas, bloating, and nausea. Identifying an often overlooked diagnosis, Advanced testing to pinpoint disaccharidase deficiency. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088. ApH of >5.6 suggests carbohydrate malabsorption is not the only cause of diarrhea. However, because the degree of lactose malabsorption varies greatly, many patients can ingest up to 375 mL (18 g of lactose) of milk daily without symptoms. What laboratory studies should you request to help confirm the diagnosis? 7. 1306-9. However, this is a non specific finding and hence imaging studies have no role in the diagnosis of disaccharidase deficiencies. They decided to treat him for a parasite because of symptoms and that he was working at the zoo when symptoms began. The activity of the enzyme is then calculated by measuring the amount of glucose released from each substrate, since all of the disaccharides contain glucose which is released by the action of the enzyme on the disaccharide. Gastrointestinal symptoms often result when disaccharides cannot be properly digested due to a deficiency of the corresponding disaccharidase. The NIH (National Institute of Health) has excellent information about this disorder, its various forms, treatments, clinical trials and research, and I would truly encourage you to read it, here: http://bit.ly/2hsXd0o. What caused this disease to develop at this time? Once the intestinal cells start to heal, you will gradually resume production of the disaccharidase enzymes. After doing bit of research, heres what I found: Disaccharidases are enzymes that break down complex sugars (like lactose) into simple sugars (like glucose) so that the intestine can absorb the nutrients. The pills actually is helping if I eat the wrong things otherwise I dont need any medication. The enzyme that breaks down sucrose, sucrose alpha-glucosidase, or sucrase, splits sucrose into the two monosaccharides or single sugars: glucose and fructose. Be assured that over time and by paying close attention to specific foods and related symptoms, the list of acceptable foods grows substantially. Other spices may be added later, once sucrose and starch levels have been established through food diaries or logs. EGD and Colonoscopy that was normal, except for his disaccharidase levels being low- the GI doc we were seeing didnt really think this was a big deal. Maltose is the disaccharide which results when the starches in grains and starchy vegetables are digested. Once sucrose and starch levels have been established, you may introduce additional dairy items to determine your tolerance. Contents Front Matter Section 1 Patients and their treatment Section 2 Background to medicine Section 3 Cell biology Section 4 Immunological mechanisms He was scoped for a 3rd time by our new GI doc and she found inflammation in the duodenum, where the disaccharidase enzymes are, his disaccharidase levels are now extremely low. Duodecim. Consult a physician and registered dietitian to see if test results indicate you are expected to tolerate milk products. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. N Engl J Med. Some starches are digested more slowly in the small intestine and will slow gastric emptying, the rate at which food moves from the stomach into the small intestine and the rest of the digestive tract. Performed on tissue sample biopsies during upper endoscopy, the activity panel is the gold standard test for detecting disaccharidase deficiencies. Starch and sugar components for different varieties of nuts can be found in the food composition tables on this website. Thank you for the information. Do Not Sell/Share My Personal Information. Every item you eat or drink should be recorded, along with the time of ingestion. But it appears not to be the same for diagnosing lactase deficiency. 1987. pp. 2004;20(2):162-167. Algorithm for the diagnosis of the most frequent disaccharidase deficiency: lactose malabsorption. Pain increased and he would sit on the toilet with just globs of mucus coming out. 2004. pp. Connect with thousands of patients and caregivers for support and answers. Almost all those with CSID have decreased sucrase activity, even if such sucrase activity is not entirely absent. Table I.). 2009;125(7):766-770. Most individuals with CSID can tolerate tofu. Thats a pretty standard dose of Prednisone for a flare, and the Apriso may help for maintaining some remission over time. ), (Lactase persistence genotype data is currently insufficient to explain lactase persistence phenotype frequency in various parts of the world. The disaccharides activity panel examines tissue samples, which have been taken as part of endoscopy, to gain quantitative values of lactase, sucrase, maltase, palatinase, and glucoamylase. et al. DISACCHARIDASE DEFICIENCY IN INFANCY AND CHILDHOOD. Reintroduction. Exclude any processed foods from your diet that have added sucrose. CCFA.org a lot of information is available. BMC Evol Biol. https://testdirectory.questdiagnostics.com/test/test-detail/19701/dis, Do Not Sell/Share My Personal Information. DSAC | Disaccharidase Activity Panel, Tissue. Knowing the level of lactase activity is also valuable, because dairy foods can be an important source of dietary calories for those with CSID who are not lactose intolerant. The foods that cause the problem must always be avoided. Since milk foods are rich in lactose, having milk or other dairy product, may aggravate your digestive tract. American cheese slices and Velveeta cheese products are examples of processed cheese products. 0000044025 00000 n Complete dietary elimination of the symptom causing disaccharidase is curative. Some individuals with CSID have normal levels of lactase activity, while others are deficient in the lactase enzyme. Curr Opin Gatroenterol. After childhood, 80% of the adult population of the world starts to experience varying degrees of lactose intolerance. hb```b``f`c` @QGL&``3KW;8$ Breakfast cereals or grains that contain whole oats, barley, or bran are better options than more-processed, refined cereals. Some with CSID tolerate no dietary starches at all. This test is time consuming and expensive and hence is seldom used. Will your som always be on a steroid or is something he starts when a flare up begins? Thank you for any help you can provide. I appreciate any information you find! If the infant is allergic to cows milk proteins an extensively hydrolyzed sucrose-free casein formula such as Enfamil Nutramigen (Mead Johnson) and Enfamil Pregestimil (Mead-Johnson) is recommended.. A convenient way to manage disaccharide intolerances is to conduct the diet in three phases:3. When introducing new food items, it is recommended that you wait at least three days before introducing an additional food item. If lactose is ingested with high fat meal the symptoms may be less severe due to slower gastric emptying. In determining your capacity to digest various fruits and vegetables, they can consult the food composition tables to determine acceptable food items within your sucrose and starch dietary limits. ease than previously thought? If you or your child has problems with normal disaccharide absorption, consult a registered dietitian. Transient secondary disaccharidase deficiency may be caused by mucosal damage, such as from acute viral enteritis. References Disaccharidase Deficiency. These enzymes are localized in the brush border membrane of the small intestinal epithelial cells. Carbohydrate malabsorption is detected by testing a childs stool and finding a pH less than 5.5, which is caused by carbohydrate fermentation from malabsorption. hA 04Fq\GczC. ), Troelsen, J. T., Olsen, J., Moller, J., Sjostrom, H. An upstream polymorphism associated with lactase persistence has increased enhancer activity. Most affected patients have an increase in expired hydrogen of > 20 parts per million over baseline. Lactase levels are high in neonates, permitting digestion of milk; in most ethnic groups (80% of blacks and Hispanics, > 90% of Asians), the levels decrease in the post-weaning period rendering older children and adults unable to digest significant amounts of lactose. Childrens Hospital of Philadelphia is a charitable 501(c)(3) nonprofit organization. trailer Our son is so behind in school as he has is spending so much time in the bathroom pooping. Every time I eat carbohydrates I get pain now but vegetables is saving my health. 0000021870 00000 n Maltase: Abnormal Range is less than 100 U* Continuing Medical Education (CME/CE) Courses.