Based on the jars full of probiotics and prebiotics, cartons of fiber supplements, and even bottles of kombucha cluttering pharmacy shelves, it seems we’re living in the golden age of gut health. In fact, nearly half of U.S. consumers say maintaining good digestive health is key for your overall well-being, according to Fona International, a consumer and market insight company.
Alongside the growing market of good-for-gut products is an increasing interest in digestive enzyme supplements, which tout the ability to boost your body’s natural digestive processes. But can you pop them the same way you pop probiotics? And are they all that necessary for the average person? Here’s what you need to know.
What are digestive enzymes?
Think back to your high school biology class, and you may remember that enzymes are substances that kickstart a chemical reaction. Digestive enzymes, specifically, are special proteins made primarily in the pancreas (but also in the mouth and small intestine) that help break down food so the digestive tract can absorb its nutrients, says Samantha Nazareth, M.D., F.A.C.G., a gastroenterologist in New York City.
Just like there are three main macronutrients to keep you fueled, there are three key digestive enzymes to break them down: Amylase for carbohydrates, lipase for fats, and protease for protein, says Dr. Nazareth. Within those categories, you’ll also find digestive enzymes that work to break down more specific nutrients, such as lactase to digest lactose (the sugar in milk and milk-based products) and alpha galactosidase to digest legumes.
While most people produce enough digestive enzymes naturally, you do start to make less as you get older, says Dr. Nazareth. And if your levels aren’t up to par, you may experience gas, bloating, and burping, and overall feel as if food isn’t moving through your digestive system after eating, she adds.
Most commonly, though, people with cystic fibrosis, chronic pancreatitis, pancreatic insufficiency, pancreatic cancer, or who have had surgery that altered the pancreas or part of the small intestine struggle to produce enough digestive enzymes. And the side effects aren’t too pretty. “In those conditions, the individuals have weight loss and steatorrhea — which is basically stool that looks like it has a lot of fat and is sticky,” she explains. Fat-soluble vitamins also be affected; levels of vitamins A, D, E, and K can all go down long-term, she says. That’s where digestive enzyme supplements and prescriptions come into play.
When are digestive enzyme supplements and prescriptions used?
Available in both supplement and prescription form, your doctor may recommend a digestive enzyme medication if you have one of these aforementioned conditions and your enzyme levels are lacking, says Dr. Nazareth. To be sure, your doctor may test your stool, blood, or urine and analyze the amount of digestive enzymes found within it. As for other medical conditions, a small study on 49 patients with diarrhea-predominant irritable bowel syndrome found that those who received a digestive enzyme medication experienced reduced symptoms, but there still aren’t any strong guidelines from medical societies recommending digestive enzymes as a way to manage IBS, she explains.
So what, exactly, are in these meds? Digestive enzyme supplements and prescriptions typically contain the same enzymes found in human pancreases, but they are sourced from the pancreases of animals — such as pigs, cows, and lambs — or are derived from plants, bacteria, fungi, and yeast, says Dr. Nazareth. The animal-derived digestive enzymes are more common, but studies have shown that the ones sourced from bacteria, fungi, and yeast may have the same effect at a lower dosage, according to a study in the journal Current Drug Metabolism. They don’t replace the digestive enzymes you already produce, but rather add to them, and to get the digestive perks of the prescriptions if you have low levels, you’ll typically have to take them before every meal and snack, per the U.S. National Library of Medicine. “It’s kind of like vitamins,” she explains. “Your body makes some vitamins, but if you need a little boost, then you take a vitamin supplement. It’s like that but with enzymes.”
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Should you take digestive enzyme supplements?
Even if you’re getting older and think your enzymes are running low or you’re dealing with a major case of gas and bloating after you wolf down tacos, you shouldn’t start popping digestive enzyme supplements willy nilly. “For some patients, these supplements have been effective in reducing these symptoms, but you should be evaluated by a doctor because there are a lot of other conditions that can overlap with these symptoms and you don’t want to miss those,” says Dr. Nazareth. For example, similar symptoms may present as part of a condition called gastroparesis, which affects the stomach muscles’ ability to move and can prevent it from emptying properly, but it’s treated differently than how you would manage low digestive enzyme levels, she explains. Even something as simple as indigestion — caused by eating too much too fast or inhaling fatty, greasy, or spicy foods — can have the same not-so-pleasant effects.
There isn’t any real harm in amping up your digestive enzyme levels via supplements — even if you already produce enough naturally, says Dr. Nazareth. However, she cautions that, since the supplement industry isn’t regulated, it’s tough to know exactly what’s exactly in them and in what amount. This is especially important for people who take blood thinners or have a blood disorder, because a supplement with bromelain — a digestive enzyme found in pineapple — can interfere with platelet levels and ultimately affect the ability to clot, she says.
TL;DR: If you can’t stop breaking wind, your dinner feels like a rock in your stomach, and bloating is the norm post-meal, talk to your doc about your symptoms *before* you add digestive enzyme supplements to your vitamin regimen. They’re not like, say, probiotics, which you can decide to try on your own for general gut maintenance. “It’s not really up to someone on their own to figure out that their stomach issues are due to the fact that they don’t have as many digestive enzymes,” says Dr. Nazareth. “You don’t want to miss something else out there, and that’s why it’s important. It’s not specific to the supplement taking, it’s really about getting down a reason for why you have stomach issues in the first place.”