The Role of Enzymes in The Body
An enzyme is a protein molecule that works as a biological catalyst to speed up chemical reactions in the body.
To put that into perspective, the most enhanced biochemical reaction goes 1017 (one hundred quadrillion) times faster in the presence of a specific enzyme!
Whilst the effects aren’t always that extreme, every naturally occurring enzyme is absolutely essential to your health because without them vital processes would occur far too slowly to sustain life.
Enzymes are involved in thousands of different reactions in the human body. But you are likely most familiar with ‘digestive enzymes’.
Digestive enzymes break down nutrients from food into smaller and simpler molecules that you can then absorb through the wall of your small intestine.
Different enzymes are responsible for helping breakdown each of the macronutrients:
- Amylases break down carbohydrates
- Lipases break down fats
- Peptidases and proteases break down protein
The vast majority of digestive enzymes are produced in your pancreas. Your salivary glands, stomach and small intestine also secrete some, too.
Digestive Enzyme Supplements: Are They Necessary?
We’ve already established that digestive enzymes are crucial for health. If they’re that important, though, should we be boosting our supply through the use of supplements?
In recent years, the market for over-the-counter (OTC) digestive enzymes has skyrocketed, with manufacturers claiming benefits for all sorts of ailments and health conditions.
Side Note: Prescription Vs. Over-The-Counter
Now, there are certain individuals who cannot produce sufficient quantities of digestive enzymes, particularly those who suffer from conditions such as cystic fibrosis, chronic pancreatitis or pancreatic cancer.
For these patients, there are a select number of FDA-regulated, prescription pancreatic enzyme products (PEPs) to promote digestion, prevent malabsorption and nip nutrient deficiencies in the bud. And there’s no question that these individuals can benefit from enzyme therapy.
But what about individuals with other digestive conditions? People who are buying over-the-counter (OTC) digestive enzymes, rather than those prescribed by a doctor? Is this also helpful?
Well, that depends.
For one, it depends on the supplement itself. See, unlike prescription digestive enzymes, OTC digestive enzymes (like those in your health food store) are not strictly regulated.
The FDA considers these types of digestive enzymes dietary supplements, which means that they do not have to undergo the same rigorous clinical testing that prescription digestive enzymes do.
This is because, according to the FDA, “supplements are not intended to treat, diagnose, prevent of cure diseases.” So, no one needs to prove that they can!
Yet, even the quickest internet search reveals tons of companies market these products to people hoping to treat or prevent diseases. And there are plenty of customers who are willing to invest their hard-earned money to do just that.
So, is there scientific evidence to suggest supplementing with OTC digestive enzymes helps prevent or treat gut disorders?
Let’s look at three common digestive conditions and see how the evidence stacks up!
Individuals with lactose intolerance have a decreased ability to digest lactose, a naturally-occurring sugar in milk and dairy products. The condition affects up to 75% of the population.
Common symptoms of lactose intolerance include bloating, gas, diarrhoea and abdominal pain.
The exact symptoms, and their intensity, are highly variable from person-to-person, though. For example, some people are able to tolerate small quantities of lactose-containing products with no symptoms. Others must be 100% lactose-free or suffer severe gastrointestinal upset.
Since lactase is the enzyme that drives the breakdown of lactose into easily digested, simple sugars, one of the most logical ways researchers and doctors have suggested to treat lactose intolerance is by adding lactase to the digestive tract with a supplement. And actually, it appears to work.
Several studies have demonstrated a potential benefit of administering a lactase supplement prior to the consumption of milk and dairy products in those with lactose intolerance.
This suggests that OTC digestive enzymes could prove useful for lactose intolerant individuals who don’t want to completely cut milk and dairy products from their diet!
Celiac disease is an autoimmune disorder characterized by tissue damage in the small intestine triggered by ingestion of gluten-containing products.
Individuals with this condition suffer from a range of gut-related symptoms and may also be at risk of malnourishment as a result of insufficient nutrient absorption.
Currently, a total gluten-elimination diet is the only widely recognized treatment for the condition . Unfortunately, this type of diet can be extremely difficult to adhere to because there are just so many products that contain gluten.
Several manufacturers claim their enzyme supplements aid gluten degradation and market them as a remedy for celiac patients. But do they?
A study analyzing five commercially-available digestive enzymes found that the preparations were ineffective in degrading gluten at the suggested dose. This suggests that, despite the health claims, many OTC digestive enzymes are not effective at reducing celiac symptoms.
But, that doesn’t necessarily mean all enzyme supplements are useless in the management of celiac disease. Some supplements have shown promising results. For example, a supplement containing pure AN-PEP — an enzyme derived from the fungus Aspergillus Niger — has demonstrated significant gluten degradation abilities, suggesting it could be effective in reducing celiac symptoms.
So why might different enzymes have such different effects on celiac symptoms?
A large part of the difference may stem from the enzyme supplement’s coating.
Well, since enzymes are proteins, they are susceptible to denaturation (losing their ability to function), through changes to factors such as temperature and pH. The stomach is a very acidic environment. So, any supplements that you swallow must be able to withstand the pH change if they are to be effective.
Some digestive enzyme pills have a special coating to ensure they maintain function on reaching the stomach, whilst others do not. This may potentially explain some of the discrepancies seen in study results.
While many more clinical trials are needed before these drugs are used as treatment options in clinical settings, it’s likely reassuring to many celiac patients that new and effective therapies could be on the horizon.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common digestive condition with varying symptoms. In some people, the effects are tolerable. Others have more extreme gut-related symptoms and experience a seriously decreased quality of life.
The condition is extremely difficult to treat, and current strategies are largely based on diet and lifestyle modifications.
Many individuals with IBS look to OTC products to help to reduce their symptoms. But is there any evidence that they work? Maybe a little.
There have been two key studies looking at IBS and digestive enzymes that both show a potential effect.
The first was a clinical trial investigating the effect of one product marketed for this use. It found that some IBS symptoms improved in the supplementation group, whilst others didn’t.
The study was small-scale and the supplement contained a mixture of digestive enzymes, inositol (a vitamin-like molecule) and sugars known as beta-glucans. As a result, it’s difficult to say which ingredient was responsible for the positive health effects observed in some individuals.
The second was a study looking at a-galactosidase, a digestive enzyme that breaks down fiber and may be able to reduce fermentation and excess gas production in the colon (which can cause the common IBS symptoms of bloating and flatulence).
Whilst the group taking the enzyme generally reported lower symptom severity scores compared with the placebo group, the enzyme did not appear to improve quality of life scores. A few patients even reported negative gut-related side effects.
The researchers concluded that there was not enough evidence to promote the use of a-galactosidase for IBS symptoms.
Other Common Gut Problems and General Improvements in Digestion
The evidence for the use of digestive enzymes for other common gut problems — such as indigestion or acid reflux — is even less convincing.
Based on the current data, healthy people who simply wish to boost their digestion are unlikely to reap health benefits. That’s because their bodies already have adequate supplies of specific enzymes. So, any excess is unlikely to improve digestion and will simply pass through your body.
Are Digestive Enzyme Supplements Safe?
When taken at the recommended dose, it’s unlikely that digestive enzymes will directly cause adverse effects.
However, if you take certain medications or have certain medical conditions, digestive enzymes could potentially cause problems. For example, bromelain, a protease in many OTC preparations, may have anti-platelet effects. If you take bromelain with blood-thinning medication, it could put you at higher risk for excess blood-thinning and bleeding.
Additionally, many people take more than the recommended dose of due to the misconception that larger amounts will work better. This certainly isn’t the case and could potentially be harmful.
Because OTC digestive enzymes are not regulated, and because the specific enzymes and the quantity vary from product to product, it’s difficult to generalize about the risks of exceeding the recommended dose. For example, at high doses, protease digestive enzyme supplements that contain the enzyme papain may be able to cause esophageal perforation — the formation of a hole in the esophagus which requires urgent medical attention. Other proteases may not have this effect.
With a lack of scientific studies, we simply don’t know what the effects of other enzymes may be, so if you are going to go ahead and take them anyway, be sure to stick with the recommended dose.
You should also know that researchers know little about the effects of digestive enzymes on pregnant or breastfeeding women.
Take Home Message
The scientific evidence for the use of enzyme therapy in the treatment of enzyme-deficient individuals is strong. In such cases, patients take clinically-tested, well-regulated drugs under the direction of medical professionals.
OTC digestive enzymes are not subject to the same regulations. The quantities of enzymes and other ingredients differ depending on the product, and some simply do not live up to claims made by their manufacturers. Nevertheless, OTC digestive enzymes could prove useful in the treatment of some conditions.
Lactose intolerant individuals may experience improvements in symptoms if they take a lactase-containing product prior to eating dairy products.
Other digestive enzymes may be beneficial for celiac and IBS patients, though the evidence for the latter is significantly lacking. Far more research is needed for both conditions before these supplements can confidently be recommended as a treatment option.