If you’ve suffered from a faulty gut, you may have been prescribed or come across digestive enzymes while seeking relief. The two common questions people ask are:
- Could enzyme supplementation help Irritable Bowel Syndrome (IBS), or non-IBS related gas and bloating?
- Could digestive enzymes help with digesting fermentable oligosaccharides, disaccharides, monosaccharides and polyols sugars (FODMAPs) better?
Let's kick things off with what enzymes actually are:
Most individuals produce a variety of enzymes in their digestive tract that help them to digest the food they eat.
- Saliva contains the enzyme amylase, which starts to break down starch into simple sugars as you chew your food.
- The stomach produces the enzymes pepsin and gastric lipase, which help break down protein and fat into smaller components that can be absorbed by your small intestine.
- Our pancreas produces more amylase and lipase plus proteases that break down starches, fats and proteins into smaller parts that can be absorbed and turned into fuel for your body.
- Some other common enzymes are made in the small intestine, including lactase and sucrase, that break down lactose and fructose respectively.
But what if you lack sufficient amounts of these enzymes? What exactly is digestive enzyme insufficiency?
It refers to a the state where our bodies fail to produce enough enzymes needed for digestion. This results in the inability of breaking down certain foods and absorbing their nutrients.
Some examples of digestive enzyme insufficiency include:
Lactose intolerance: Your body doesn’t produce enough lactase, so you might have problems digesting the sugar naturally found in milk and dairy products.
Exocrine pancreatic insufficiency: EPI occurs when your pancreas doesn’t produce enough of the enzymes necessary to digest carbohydrates, proteins and fats.
Congenital sucrase-isomaltase deficiency: You don’t have enough sucrase to digest certain sugars.
Many people, mostly of East Asian, African, or Latin American decent gradually or suddenly lose the ability to digest lactose as they mature, due to a lack or gradual deficiency in the enzyme lactase. The same may happen to individuals with poorly managed coeliac disease, due to damage of their intestinal villi, normally where lactase is produced. This leads to digestive issues after consuming lactose-containing foods.
Individuals with pancreatic or gallbladder disease, as well as individuals with hereditary or genetic mutations may as well suffer from digestive issues related to deficiency of certain enzymes.
Wha are the common symptoms of digestive enzyme insufficiency?
- Belly pain or cramps
- Fatty stools (bowel movements)
- Unexplained weight loss
If you do experience any ongoing symptoms, then it is definitely worthwhile paying your doctor a visit. These could be signs of your gut being irritated or may indicate a more serious condition. Digestive enzyme insufficiency can lead to malnutrition if left untreated.
FODMAPs & digestive enzymes
There are several obstacles that may get in the way of the proper breakdown and digestion of FODMAPs, due to their chemical structure. In case you haven't come across the term, FODMAPs is a term given to a group of poorly digested, rapidly fermentable carbohydrate food molecules. The term FODMAPs stands for Fermentable Oligo-, Di- and Mono-saccharides And Polyols. Examples of these carbohydrates include fructose (e.g. sugar found in fruit), lactose (found in milk) and xylitol (artificial sweetener). If consumed in large amounts, FODMAPs are believed to increase the volume of liquid and gas in the small and large intestine, resulting in abdominal pain, gas and bloating. FODMAPs are not the cause but controlling them in your diet will help reduce symptoms.
Digesting the “O” in FODMAPs, such the oligosaccharide fructose, can be impaired due to transportation challenges, rather than enzyme production issues per se, when foods have excess fructose as compared to glucose. Breaking down other oligosaccharides like raffinose and stachyose, galacto-oligosaccharides (i.e. GOS, found in beans, peas, cabbage, some whole grains, broccoli, and some other vegetables) can be also challenging, as there is no human-produced enzyme able to break these into smaller pieces for proper digestion, so galactans are passed along to the large intestine mostly whole.
Digesting the “D” in FODMAPs, such as the disaccharide lactose, is compromised by insufficient production of the lactase enzyme.
While following a low FODMAP diet to avoid unpleasant symptoms and discomfort of irritable bowel syndrome, individuals may face difficult food restrictions, nutrient deficiencies or even gut dysbiosis. Adding supplemental digestive enzymes could allow eating a larger variety of nutritious foods high in FODMAP by reducing the symptoms following their consumption. Supplementation with Alpha-galactosidase and beta-galactosidase (known as lactase) in particular could help digest the “O” and “D” in FODMAPs respectively.
If you suffer from IBS, completing all three phases of the low FODMAP diet before introducing digestive enzymes, is recommended. This way you can identify which FODMAPs are the most problematic for you, allowing you to then experiment with using enzymes to increase your threshold of tolerance.
In addition to following the supplementation directions mentioned on the package, noting both the quantity of enzymes taken and the quantity or type of FODMAPs consumed could help you personalise your enzyme supplementation dosage.
What does research say about IBS and digestive enzyme supplementation?
In terms of the science, the limited evidence regarding the effectiveness of using digestive enzymes in IBS symptom relief is useful but controversial.
In GOS-sensitive IBS patients, alpha-galactosidase (AG) supplementation may lead to a significant reduction in abdominal pain, bloating and overall IBS symptoms, so trying AG supplements would be worth a try. This digestive enzyme may also be helpful for vegans or vegetarians following a low FODMAP diet, often consuming greater amounts of beans and starchy or cruciferous vegetables, by decreasing gas and bloating after their consumption.
Pancreatic lipase has been found useful in reducing symptoms of cramping, bloating, pain and urge to defecate, while increasing stool firmness on post meal IBS-D (with diarrhoea) patients in a pilot study of 2010. However, the rest of the evidence supporting this observation comes from animal studies, so more human studies are needed.
And last but not least, lactase is the most studied and widely used digestive enzyme. Lactase supplementation has been proven to work and has been used by IBS and non-IBS individuals with mild to moderate lactose intolerance for decades. That might not be the case for extremely lactose sensitive individuals, who usually need to avoid all naturally occurring lactose-containing products and/or choose products that are clearly labeled “lactose free.”
What does experience say for the effectiveness of digestive enzymes?
Anecdotally, digestive enzymes can provide significant relief for some individuals, but may also result in no change for others depending on the supplement used and the intolerance(s) targeted.
Working with an experienced dietitian will help you identify the right enzyme combination and dosage for you.
The bottom line is:
IBS cases may greatly differ between individuals. Signs, symptoms, severity, and subsequently the required treatment vary from person to person.
Currently, the existing evidence is not enough to support the use of digestive enzyme supplements as a conventional therapy in treating IBS. Several small studies have revealed some promising results, but more research is needed.
Before considering a digestive enzyme, your doctor, dietitian or registered nutritionist can be your point of reference so head on over to our appointments page if you're thinking of digestive enzymes to fix your gut!