Welcome back to another gut health post! Today we’re focusing on digestive enzymes, which are often lumped together with probiotics when people talk about digestion. I’ll be giving you the 101 on these guys and help you figure out if you need to supplement with them. As a bonus, I’ll also include a list of natural enzymes that are found in food! Sounds good? Then let’s get started!

Digestive Enzymes 101

In the body, enzymes work to break down food for us to absorb their nutrients. We make them in our mouth (i.e., saliva), stomach, small intestine, and pancreas (which does most of the work). There are three main enzymes to remember- protease (well, peptidases, too- for proteins), lipase (for fats), and amylase (for carbs). After enzymes break down food into little bits, they go through the small intestine and into the bloodstream where they can be delivered throughout the body. [1]

However, people are now supplementing with digestive enzymes, including other enzymes that are not produced in the body (such as papain and bromelain- you’ll find out about those later!). Supplemental enzymes are often used in cases of irritable bowel syndrome (IBS) and general GI discomfort. However, in more severe cases, they are prescribed in patients with functional disorders like pancreatitis or cystic fibrosis (Creon, Zenpep). Most people who supplement with digestive enzymes get them over the counter. Sometimes, they’ll have a broad-spectrum digestive enzyme or one that contains only one enzyme, such as Bean (alpha-galactosidase) or Lactaid (lactase). Like probiotics, digestive enzymes are a multi-billion-dollar market, estimated to reach $1.6 billion by 2025. [1] [2] 

The Pro & Cons

Digestive enzymes have their benefits as well as drawbacks.

On the positive side, they…

• Reduce gas and bloating
• May help to manage IBS
• Prevent nutrient deficiencies
• Are helpful in cases of IBD (inflammatory bowel disease), low stomach acid, gallbladder removal, dysbiosis(bacterial imbalance), and SIBO

But on the negative side, they…

• Do not treat the cause(s) of digestive disorders (i.e., SIBO, IBS, IBD); only helps with the symptoms
• Are not regulated by the FDA
• Have very little research to support their use
• Interfere with oral medications and blood thinners
• Can be expensive

[3] 

More Drawbacks…

Some interesting things to note about digestive enzymes. Because the market itself is so huge, you have many companies out there that are trying to convince you that you need their product. However, none of them is required to provide any proof. All they have to do is avoid making any claims or use words such as “cure, treat or prevent”.

After I did some investigating, I was shocked to find out that some of them are downright lying! Some brands got into huge trouble after claiming their digestive enzyme helped to break down gluten. Independent testing on their supplement proved otherwise- their supplements did NOT break down gluten! Yikes! Many companies like to act smart and cite research showing the efficacy of digestive enzymes. What they’re counting on is you taking their claims (and apparent “knowledge”) at face value. Because when you read the actual study, it’s based on medical-grade enzymes that can only be obtained as a prescription. It’s nowhere near the same as their over-the-counter ones! [4] [5]

And there’s a difference between the digestive enzymes sold online and those that are prescribed. Over-the-counter enzymes aren’t only dysregulated. They’re also less potent compared to the prescription ones. Prescription enzymes are very strong. Plus, they’re used in a clinical setting (so doctors are monitoring their effectiveness) and are regularly tested for heavy metals and toxicity. Most manufacturers do not live up to those standards.

“But Zuzka, the reviews show that they work!” Not so fast! Don’t believe everything you read online. Those are anecdotal claims. And for all you know, they may have been paid to give a good rating. We’re also looking into a small window in someone’s health. We don’t know their lifestyle, genetics, health history, or whether or not they actually have a digestive disorder. It could all be a placebo effect. You just never know.

Then again, if they’ve worked for you, by all means, keep using them. But most experts (and doctors) will agree that the majority of people don’t need them. Which reminds me- don’t fall for the age trap that many companies set up. There’s a myth going out there that the older you get, the less digestive enzymes your body creates. That’s not quite what happens. It’s not that we’re releasing fewer enzymes. Often, it’s that people generally start letting themselves go. Their diet falls apart, they drink more, they become sedentary and often take many prescriptions and over-the-counter drugs that both can alter digestion. Older adults are prone to more constipation, but that’s likely because of their lifestyle and poor bowel habits- not a lack of enzymes. [3] [6] [7] [8]

Natural Alternatives

Should we throw out digestive enzymes out with the bathwater? Not yet! Generally speaking, most of us don’t need to supplement. If you see changes in your poop like weird, funky colors (yellow, green, white, or red), foul smells, or pieces of food, then talk with the doc. Outside of that, you can support digestion using a whole-foods approach. Consider the following alternatives to suspicious (and expensive) supplements:

• Apple Cider Vinegar
• Swedish or Herbal Bitters (also known as digestive bitters)
• Fermented Foods (kimchi, sauerkraut, kefir, yogurt, miso, pickles, etc.)
• Bitter Foods (arugula, radicchio, mustard greens, grapefruit, etc.)
• Spices (ginger, black pepper, cayenne, wasabi)
• Sour Foods (lemon, lime)
• Soothing Herbs (peppermint or spearmint, licorice root, slippery elm bark, marshmallow root, chamomile, fennel, caraway, etc.)

Or, go for foods that do contain enzymes, including:

• Papaya (papain)
• Pineapple (bromelain)
• Mango (amylase)
• Avocado (lipase)
• Kiwi (actinidain- breaks down proteins and is often used as a meat tenderizer)

[9]

To further improve digestion, make sure that you’re properly preparing your food. Soak beans legumes overnight and wash them before cooking (other tips for them here). Thoroughly cook your meat, as well as problematic veggies like broccoli. With a few simple tweaks, you can fix many digestive problems without having to supplement. But as always, talk to your doctor if things start getting severe. No amount of soaking or digestive enzymes is going to help if there’s a deeper issue going on!

Sources:

[1] https://www.health.harvard.edu/staying-healthy/gut-reaction-a-limited-role-for-digestive-enzyme-supplements
[2] https://www.health.com/digestive-health/digestive-enzymes
[3] https://www.health.harvard.edu/staying-healthy/gut-reaction-a-limited-role-for-digestive-enzyme-supplements
[4] https://www.ncbi.nlm.nih.gov/pubmed/26030273
[5] https://www.ncbi.nlm.nih.gov/pubmed/10489912
[6] https://www.ncbi.nlm.nih.gov/pubmed/8866735
[7] https://www.webmd.com/digestive-disorders/features/digestive-health-aging#1
[8] https://www.health.com/digestive-health/digestive-enzymes
[9] https://www.healthline.com/nutrition/natural-digestive-enzymes#section11