Do you need to take digestive enzymes?
According to Global Market Insights, the market for over the counter digestive enzymes was valued at more than USD 530 million in 2021. That is a LOT of money and shows a demand for these products, likely related to the rise in gastrointestinal conditions (like IBS), trends towards gut health and fewer gut symptoms, and the rise in more “natural” approaches to these symptoms by practitioners + influencers online.
Regulation of supplements
Before we get into what these products actually are and how they are best used, it’s important to note that the supplement industry in the US is not regulated.
This means that we rely on companies that make supplements to pay for and do their own third party testing so that we can trust that what they say is in the bottle is actually in the bottle. Marketing and claims are also VERY under-regulated, meaning that you can’t fully trust what you see online.
Does this dietitian use digestive enzymes?
My hope for this article is to break down what enzymes are, when they’re low and how to test that, and how to best utilize enzymes that have more research behind them. This isn’t 1:1 guidance because I’m not your personal dietitian, but I do aim to empower you with knowledge to make your best decisions with your money.
And yes, I do use enzymes myself, so I’m not anti-enzymes. I’m just pro-using them correctly.
So what are digestive enzymes anyway?
These are proteins made and released by your body to break down molecules in food into even smaller molecules that can be absorbed in the process of digestion.
Think of your food like a structure of legos put together. Enzymes take the legos apart so they can be properly sorted and used to create something new in the body, typically energy and tissue.
Enzymes can be found in saliva and stomach acid, and they are released in your small intestine by the liver, pancreas, and gallbladder, primarily the pancreas.
Each enzyme is specific in that it breaks down specific molecules.In broader groups, enzymes that break down carbs are amylases, proteins are proteases, and fats are lipases.
Common enzymes you may be most familiar with or are talked about more:
Salivary amylase = in saliva for carbs
Pepsin = in stomach acid for proteins
Lactase = in small intestine for lactose
Maltase = in small intestine for maltose (starches)
Sucrase = in small intestine for sucrose (sugar)
While the body is created to produce and release enzymes as you eat the foods that the enzymes are meant to break down, some people don’t have enough enzymes, or their bodies don’t release the enzymes as they should. This means they can’t break down certain foods, which can then lead to malabsorption of those nutrients.
A few types of digestive enzyme insufficiency include:
Congenital sucrase-isomaltase deficiency = you don’t have enough sucrase or maltase to digest sugar and some starches
Exocrine pancreatic insufficiency (EPI) = when your pancreas doesn’t produce enough of the enzymes necessary to digest carbohydrates, proteins and fats
This form most often leads to malabsorption due to a widespread deficiency of enzymes
Lactose intolerance = your body doesn’t produce enough lactase, so you struggle to digest the sugar naturally found in milk and dairy products (aka lactose)
There can also be a decrease in enzymes if you aren’t producing saliva or stomach acid adequately, either due to stress, medications, or overlapping conditions. This can also be a problem if you have damage to tissues that are making or releasing the enzymes, including inflammation of the pancreas and small intestine.
When food molecules aren’t broken down properly in the small intestine, they enter the large intestine in tact, which then leads to an osmotic effect in the colon, meaning water is pulled in. This can lead to bloating, distention, pain, cramping, and diarrhea.
In some cases, poor breakdown of molecules can also lead to constipation. This is less common, but still possible, and may be due to a slowdown at the ileocecal valve (separates small intestine from large), or the impact of increased gas production on motility in the large intestine.
With EPI, overall nutrient absorption can be low, so there may be more symptoms present including weight loss and nutrient deficiencies. Stools may also be more oily and post meal symptoms may be more consistent versus IBS symptoms that typically occur a few hours after a meal.
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What causes this in the first place?
Some disorders or medical treatments can lead to pancreatic enzyme insufficiency:
Chronic pancreatitis - aka inflammation of the pancreas
This can be caused by many things, but is common with chronic + high alcohol intake
Cystic fibrosis
Gastrointestinal surgeries
Pancreatic cancer
Any condition or treatment that disrupts your pancreas
This includes cancer treatments, like radiation and chemotherapy
When it comes to lactose intolerance and sucrase isomaltase deficiency, we can group these as disaccharide deficiencies. These can be genetic and also secondary to tissue damage where these enzymes are released.
The most common causes of this include celiac disease and Crohn’s disease, where there is significant inflammation in the small intestine. For many, lactase production also declines with age.
How to test for insufficiency:
Sucrase isomaltase deficiency: either disaccharide assay or breath test (more widely used)
Lactose intolerance: breath test
Fructose intolerance: breath test
EPI: fecal elastase test
Should you take enzymes?
EPI - must be prescribed high dose enzymes - typically Creon
OTC enzymes - ideal to target the enzymes with the molecules you’re trying to break down. Not one size fits all and general enzymes without a targeted reason are rarely worth it
If you don’t have a true insufficiency, but you do fear that your body isn’t producing enzymes adequately, causing more gut symptoms related to meals, it’s possible to improve your own production of enzymes. This can be true while you supplement enzymes and also before you supplement.
Ways to do this:
Produce saliva and chew thoroughly
Produce more stomach acid by slowing down with meals, relaxing before meals, and decreasing stress overall
Correct any nutrient deficiencies
Eat more regular meals and meet nutrition needs
Now for the magic question… should you be taking enzymes with your meals?
If you have EPI, you will be prescribed very high dose enzymes to take with meals. This is the treatment for the condition because your body isn’t producing enough enzymes to begin with, and likely won’t, so you need the support of enzymes.
If you have an intolerance to a specific nutrient or an enzyme deficiency, you can take specific enzymes to target the need you have. These include:
Lactase for lactose
Very well researched and effective for lactose intolerance
Sucraid for sucrose
Well researched and effective for sucrase isomaltase deficiency
Alpha-galactosidase for GOS foods (beans)
Well researched and effective for symptoms related to these foods
Glucose isomerase for fructose
Less researched but shown to be effective for fructose intolerance
The value of taking enzymes in these cases is to avoid unnecessary diet restriction, so you can have more freedom in your diet without the symptoms. In addition to these targeted enzymes, there are many combination enzymes on the market.
There is not much research to suggest the need for many of these enzymes, including high dose proteases and lipases, outside of true pancreatic insufficiency.
However, your personal reaction to products does matter and is valid. If you are responding well to enzymes with meals and you know the product you are purchasing has been both third party tested and considered safe for you by your trusted healthcare provider… there is likely no harm in it.
If you’re taking it without noticeable benefit, you may see more benefit from targeted enzymes with specific foods (those listed above) or simply improving your own production of enzymes as you support your digestion with the guidance of your healthcare team.
Which enzymes do I personally use and recommend the most?
As someone with IBS, I use FODZYME (see how I use FODZYME here). This is a combination of lactase, alpha-galatosidase, and fructan hydrolyse, their proprietary enzyme that breaks down fructans (common FODMAP trigger). This blend targets the lactose, GOS, and fructan FODMAP groups, which are common IBS triggers.
For me personally, I struggle with dairy, beans, and onions, so this enzyme targets all of that in a powder form that starts working in my food before I take a bite. I’m not saying that this is exactly what you need, but could be something to discuss with your trusted healthcare team.
Note: FODZYME is a brand partner due to my love for the quality and effectiveness of their product, so you can save 20% on your order if you do try it with code ERINJUDGERD.
Do you want clear guidance to manage your IBS so you can feel confident in your body again?
