Most people think of digestion as a function that takes place in the stomach, but it actually begins as soon as you start chewing. Saliva helps break down what you’re eating; then, at various points along the way, your body releases enzymes to help the process. To better understand what’s happening, Bottom Line Health turned to Andrew W. DuPont, MD, board-certified gastroenterologist at The University of Texas Health Science Center at Houston.
What are digestive enzymes?
Digestive enzymes are proteins that your body makes to facilitate the breakdown of the food you eat as part of the digestive process. This, in turn, enables the body to extract and use the nutrients in those foods.
- Amylase, produced in the mouth and pancreas, breaks down complex carbohydrates
- Lipase, produced in the pancreas, breaks down fats
- Protease, produced in the pancreas, breaks down proteins
- Lactase, produced in the small intestine, breaks down lactose, the sugar in milk and other dairy foods
- Sucrase, produced in the small intestine, breaks down sucrose, the natural sugars in foods as well as added sugars in food products
- Isomaltase, produced in the small intestine, break down starches
- Cellulase, produced by the bacteria in the gut rather than by an organ, breaks down cellulose, a major component of fiber
Conditions resulting from a lack of digestive enzymes
Among digestive enzymes, the one most people are familiar with is lactase, and the consequences of not being able to process lactose. Lactase deficiency (low enzyme level) vs lactose intolerance (low enzyme level with symptoms). People missing it are lactose-intolerant and develop symptoms when they ingest dairy. Lactose intolerance can develop at almost any time in your life. Over-the-counter lactase pills may be enough to help you digest dairy.
Some people who have a hard time digesting sugar as well as starches were born with a condition called congenital sucrase-isomaltase deficiency. This causes GI symptoms from a young age. IMPORTANT: Having GI symptoms like bloating, cramps and diarrhea doesn’t automatically mean you have a disease. Such symptoms can happen to anyone who doesn’t break down food as well as they should. And they can happen anytime over the course of someone’s life.
There are prescription medications, notably Sucraid, with the appropriate enzymes that, taken before meals, can help with sucrose absorption, though it’s not effective for digesting starches and you may need to avoid them.
A more complex condition that has been gaining in awareness recently is exocrine pancreatic insufficiency or EPI. That’s when your pancreas can’t make the amylase, lipase, and protease needed to digest carbohydrates, proteins, and fats. Eating almost any food, but especially high-fat foods, can lead to extremely unpleasant symptoms such as cramps, bloating, gas, diarrhea, and/or oily stools. EPI can be caused by conditions that directly affect the pancreas, such as chronic pancreatitis and cystic fibrosis (which leads to scar tissue on the pancreas that stymies the release of enzymes), or from gastrointestinal surgeries, such as gastric bypass. Fortunately, it can now be corrected. The best digestive enzymes for EPI are pancreatic enzyme replacement therapy or PERT, medications that contain pancrelipase, a combination of lipase, protease, and amylase.
What are the best digestive enzyme supplements for other conditions?
Research that looked into digestive enzymes as a cause of irritable bowel syndrome (IBS) has yet to find actionable connections, but over-the-counter supplements with enzymes are helpful for some people. Alpha-galactosidase, for instance, available in products like Beano, can aid with the digestion of galactooligosaccharides (GOS). GOS (and fructans) are subtypes of fermentable oligosaccharides, one of the FODMAPs, along with disaccharides, monosaccharides and polyols—short-chain carbohydrates that are poorly absorbed in the small intestine in some people.
FODMAPs have been implicated in triggering IBS symptoms including cramps, diarrhea, and/or constipation. While eating a low-FODMAP diet can help, it’s highly restrictive unless you can isolate the specific foods that bother you the most (it may not be all of them). This is a specific condition that supplements may help. For instance, FODZYME is a digestive enzyme blend that targets fructan, GOS, and lactose. It’s sprinkled on your food before you take your first bite.
A blend of digestive enzymes may help manage small intestinal bacterial overgrowth or SIBO. Though it’s normal to have tons of bacteria in your large intestine, if you have too many bacteria in the upper part of your small intestine, they can create different gases as they break down food and cause bloating and other issues. As with other over-the-counter products, there’s no hard-and-fast research proving they help, but it may be worth a try.
Not all the dots have been connected between foods high in plant enzymes, such as the papain in papaya and the bromelain in pineapple, and improved digestion, and eating them can actually cause symptoms in some people. However, there’s some scientific data that papaya may help improve stomach emptying and studies have been done on supplements made with papaya enzymes, such as Caricol, which was found to help support GI tract health and ease some IBS symptoms.
Bromelain has anti-inflammatory and digestive properties, but well-designed clinical trials are needed to better understand how it works and how supplements should be used. Bromelain supplements also carry potential side effects and drug interactions.
If you want to consider digestive enzymes
First and foremost, work with a gastroenterologist to diagnose the cause of any digestive issues. Testing is likely to involve taking fecal samples with an at-home kit and mailing the kit to a lab. Some digestive enzyme treatments are available only by prescription, and your progress should be monitored.
It’s also important to work with a registered dietitian who can help you find which specific foods are the triggers for your symptoms, avoid the need for a totally restrictive diet, and avoid developing nutritional deficiencies. He or she may also be able to guide you to the most potentially helpful OTC digestive enzyme supplement for your situation.
Diet and digestive enzymes
Unless you’ve been diagnosed with an enzyme insufficiency or have a condition that leads to digestive symptoms, there’s no real health benefit to taking digestive enzyme supplements, despite all their marketing claims. A diet based on whole foods should encourage your body to make the enzymes it needs. What could hurt is an abundance of very highly processed foods with added fats and sugars—these don’t support good health even for those without GI issues.
