Stomach problems are common. About two-third of Americans surveyed in a large population study reported having gastrointestinal symptoms—such as heartburn, diarrhea, nausea, bloating, abdominal pain, constipation, or bowel incontinence. This could be a possible reason for the growing demand for digestive enzyme supplements. These pills, when taken regularly, may help those conditions. Here is what the experts have to say about the role of digestive enzyme supplements in digestive system health.
What are digestive enzymes?
When you eat, food travels through your digestive tract. The gastrointestinal system (mainly the pancreas) produces digestive enzymes to break down your meal into fats, proteins, and carbohydrates that your body can absorb. This then helps your body generate energy, stimulate growth, and aid in repair functions. Digestive enzymes also aid the absorption of nutrients from food into your bloodstream, where they are transported to the different parts of your body.
These are the major types of digestive enzymes:
- Amylase: Secreted by the pancreas and salivary glands (in your mouth), amylase breaks down carbs into simple sugars like glucose.
- Lipase: Secreted by the pancreas, lipase is the main enzyme responsible for the breakdown of fats into fatty acids and glycerol. Plus, it aids the absorption of the fat-soluble vitamins—vitamins A, D, E, and K.
- Protease: Produced in the pancreas, protease helps break down protein into amino acids.
- Lactase: Produced in the walls lining the small intestine, lactase digests lactose, a sugar present in milk and other dairy products.
The three enzymes amylase, lipase, and protease produced by your pancreas make up the pancreatic enzyme products found in most digestive enzyme supplements. These enzyme supplements are available as prescription or over-the-counter medications.
If you are not producing enough digestive enzymes, your healthcare provider may recommend digestive enzyme supplements. “Individuals with pancreatic insufficiency, lack of stomach acid, limited natural production of digestive enzymes (such as lactose intolerance), or those that have undergone gastric bypass [may] need digestive enzyme supplements,” says Amy Davis, RD, LDN, of Amy Davis Nutrition. “Also, those who experience frequent gas, bloating, or other GI issues after eating certain foods may benefit from supplemental digestive enzymes. ”
Like any supplement, you should check with your healthcare provider before taking digestive enzymes. Natural digestive enzymes can be found in foods like pineapples, papayas, mangoes, bananas, avocados, kiwifruit, and ginger. Other digestive enzymes like cellulase and invertase are found almost exclusively in plants.
How long does it take for digestive enzymes to work?
They are two types of digestion—mechanical and chemical digestion. Mechanical digestion begins in the mouth when you chew your food. In comparison, chemical digestion uses digestive enzymes to break down food into smaller absorbable units. Pancreatic enzymes like protease break down proteins into smaller units (called peptides), while peptidase breaks down peptide bonds in these smaller units to make single amino acids that can be absorbed. Amylase breaks down carbohydrates and starches into simple sugars.
That said, for digestion to occur, both processes must function correctly. Any problem with either—or both—may lead to gastrointestinal issues. In such cases, you may need digestive enzymes to mimic the role of your natural digestive enzymes.
“Since digestive enzymes work to break down the individual meals we eat, they should start working immediately,” says Davis. “A high-quality digestive enzyme suited to your specific digestive issues should alleviate gas, bloating, heartburn, and other GI symptoms after the meal. If it does not, there could be other reasons for GI issues, or the specific digestive enzyme may not have been a great fit for the individual.”
Supplementation is safe daily, especially for impaired digestive enzymes, says Amanda Lane, MS, RDN, founder of Healthful Lane Nutrition. And, the supplements can be taken before, during, or after your meal depending on treatment recommendation.
However, for these digestive enzymes to work, it is important that:
- It retains its active ingredients.
- It dissolves and mixes with your food.
- It is released at the right time, which is during gastric emptying, and it enters into the duodenum and small intestine, where the breakdown products of food are absorbed into the bloodstream.
Your stomach acid can be a barrier to the above requirements because it can degrade the enzymes before they can do their work. This is why most digestive enzymes are enteric-coated—covered with materials to protect them from stomach acid.
Just like probiotics, digestive enzyme supplements improve digestive health. However, they do not heal the gut because they do not solve the root cause of the problem. “Digestive enzyme supplements help replace missing enzymes to ensure that the gut is properly breaking down and absorbing nutrients,” Lane explains.
Who should take digestive enzymes?
First, to determine if you need these supplements, your healthcare provider will evaluate your medical, family, and dietary history to find out the root cause of your digestive issues. A physical exam (checking for bloating, abdominal pain or tenderness) will likely be performed, and some specific medical tests such as blood work or imaging tests may be required.
After medical examinations, people diagnosed with the following conditions may be treated with digestive enzyme supplements.
- Exocrine pancreatic insufficiency: Your pancreas is the primary organ that produces digestive enzymes including lipase, amylase, elastase, trypsin, and chymotrypsin. If your pancreas is damaged or malfunctioning, it may lead to enzyme deficiency—a condition known as exocrine pancreatic insufficiency (EPI). Chronic pancreatitis, pancreatic cancer, cystic fibrosis, diabetes, gastrointestinal surgery, celiac disease, and inflammatory bowel disease are health conditions that can cause exocrine pancreatic insufficiency—and individuals with the named conditions may require treatment with digestive enzyme supplements. Creon, Pancreaze, Pertyze, and Viokace are digestive enzyme supplements that are currently FDA approved and may be recommended for exocrine pancreatic insufficiency.
- Congenital sucrase-isomaltase deficiency: This is a rare genetic condition that occurs due to a lack of production or reduced activity of the enzyme sucrase iso-maltase—an enzyme that digests the sugars sucrose and isomaltose. People affected present with diarrhea, bloating, and other symptoms of malabsorption when they eat sucrose-containing foods (many fruits and vegetables). Treatment can include oral digestive enzymes such as Sucraid (sacrosidase), which is different from the enzymes used for EPI.
- Food intolerance: Davis also suggests that digestive enzymes can be a component of a plan to improve gut health. This would be an option for those with food intolerances, indigestion, or autoimmune diseases that impact digestion, such as lactose intolerance, Celiac disease, or inflammatory bowel disease.
Digestive enzymes side effects
You should also check with your healthcare provider if you experience any unwanted symptoms when you take these supplements. Some common side effects include:
- Diarrhea
- Nausea
- Abdominal cramps
- Gas
- Bloating
Digestive enzymes like Sucraid may also cause allergic reactions—including rash, itching, swelling of the face, tongue, and throat, trouble with breathing, or chest pain.
“In my clinical experience, most people tolerate digestive enzymes well with no adverse side reactions,” says Kaytee Hadley, MSc, RDN, owner of Functional Medicine Dietitian.
Some people should not take digestive enzymes, including:
- Patients taking blood thinners or with a low platelet count
- People taking acarbose, calcium, or magnesium salts
- Those with allergies to certain enzyme ingredients
“Women who are pregnant or breastfeeding should always check with their healthcare provider before taking supplements,” explains Davis. People with conditions such as gout, hypoglycemia/hyperglycemia, recurrent gastrointestinal obstruction, Crohn’s disease, or short bowel syndrome should be properly monitored by their healthcare provider.
Digestive enzymes benefits
Hadley explains that “not only do digestive enzymes help alleviate symptoms of cramping, pain, and bloating two to three hours after a meal, but they also support healthy digestion, increase nutrient absorption, and prevent leakage from the gut.”
Digestive enzyme supplementation is beneficial as replacement therapy for the following conditions.
Exocrine pancreatic insufficiency (EPI)
According to experts, pancreatic enzyme replacement is the primary treatment for EPI. In one population-based study, researchers found that pancreatic enzyme replacement increased the survival rate in pancreatic cancer patients when used to treat pancreatic exocrine insufficiency.
Lactose intolerance
People with lactose intolerance experience reduced production of the enzyme lactase, an enzyme that digests lactose (found in milk and its products). Such people experience symptoms like abdominal pain, bloating, gas, and borborygmi (stomach rumble). According to research, a lactase enzyme supplement may be suitable for improving the symptoms of lactose intolerance.
Irritable bowel syndrome with diarrhea (IBS-D)
A 2018 study published in the Journal of Digestive Diseases provides a narrative review of various studies that investigated the role of digestive enzymes in treating the symptoms of IBS-D. The researchers suggest that the symptoms of IBS-D in some of the patients were a result of the low secretion of a pancreatic enzyme, elastase-1. In one of the studies reviewed, about 6.1% of patients diagnosed with IBS-D had low levels of elastase-1, and after supplementation with digestive enzymes like Creon—those patients saw an improvement in bowel habits, stool consistency, and abdominal pain.
If your healthcare provider has recommended digestive enzyme supplements, you can save up to 80% off your medications with SingleCare. Paying for these supplements out-of-pocket without insurance is quite expensive. But, SingleCare offers free coupons that enable you to get your medication at a lower cost and save about 80% off your prescription prices when you use the SingleCare discount card.
