Digestive Enzymes: EP Wellness Functional Medicine Clinic

The body makes digestive enzymes to help break down food carbohydrates, fats, and proteins. Healthy digestion and nutrient absorption depend on these enzymes, a protein that speeds up chemical reactions in the mouth, pancreas, and intestines. Certain health conditions like pancreatic insufficiency and lactose intolerance can cause low enzyme levels and insufficiency and may need replacement digestive enzymes to help prevent malabsorption. That’s where digestive enzyme supplements come in.

Digestive Enzymes

Digestive enzymes are a vital part of digestion; without them, the body can’t break foods down, and nutrients can’t be fully absorbed. A lack of digestive enzymes can lead to gastrointestinal/GI symptoms and cause malnourishment, even with a nutritious diet. The result is unpleasant digestive symptoms that can include:

• Poor absorption of nutrients
• Bloating
• Stomach pain
• Nausea
• Vomiting

Digestive enzyme supplements have been used for treating common forms of gut irritation, heartburn, and other ailments.

Enzyme Types

The main digestive enzymes made in the pancreas include:

Amylase

• It is also made in the mouth.
• Breaks down carbohydrates, or starches, into sugar molecules.
• Low amylase can lead to diarrhea.

Lipase

• This works with liver bile to break down fats.
• Lipase insufficiency causes decreased levels of fat-soluble vitamins A, D, E, and K.

Protease

• This enzyme breaks down proteins into amino acids.
• It also helps keep bacteria, yeast, and protozoa out of the intestines.
• A shortage of protease can lead to allergies or toxicity in the intestines.

Enzymes made in the small intestine include:

Lactase

• Breaks down lactose, a sugar found in dairy products.

Sucrase

• Breaks down sucrose, a sugar found in fruits and vegetables.

Insufficiency

When the body does not produce enough digestive enzymes or doesn’t release them correctly. A few types include:

Lactose Intolerance

• The body does not produce enough lactase, making digesting the natural sugar in milk and dairy products difficult.

Exocrine Pancreatic Insufficiency

• EPI is when the pancreas does not produce enough of the enzymes necessary to digest carbohydrates, proteins, and fats.

Congenital Sucrase-Isomaltase Deficiency

• The body does not have enough sucrase to digest certain sugars.

Symptoms

Common digestive enzyme insufficiency symptoms:

• Bloating
• Gas
• Stomach aches and pains.
• Cramps
• Diarrhea
• Oily bowel movement stools 
• Unexplained weight loss

Talking to a doctor if symptoms persist is recommended, as these could be signs of gut irritation or indicate a more serious condition.

Supplements

Prescription Enzymes

Individuals diagnosed with enzyme insufficiency may need to take prescription digestive enzymes, depending on the severity. These supplements assist in food breakdown and nutrient absorption. The most common enzyme replacement therapy is pancreatic enzyme replacement therapy or PERT. PERT is a prescribed medication that includes amylase, lipase, and protease. Individuals with cystic fibrosis often have pancreatic enzyme insufficiency, as the body can’t release the enzymes properly. And individuals with pancreatitis require PERT because their pancreas develops mucus and scar tissue over time.

Over-The-Counter Enzymes

Over-the-counter digestive enzyme supplements can contain amylase, lipase, and protease and can help with acid reflux, gas, bloating, and diarrhea. Some contain lactase and alpha-galactosidase. Alpha-galactosidase can help break down a non-absorbable fiber called galactooligosaccharides /GOS, mostly found in beans, root vegetables, and certain dairy products.

Certain foods contain digestive enzymes, including:

• Honey
• Avocados
• Bananas
• Pineapples
• Mangos
• Papayas
• Ginger
• Sauerkraut
• Kiwi
• Kefir

Supplementing the diet with some of these foods can help with digestion.

Functional Nutrition

References

Beliveau, Peter J H, et al. “An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST.” Journal of manipulative and physiological therapeutics vol. 42,5 (2019): 353-365. doi:10.1016/j.jmpt.2018.11.015

Brennan, Gregory T, and Muhammad Wasif Saif. “Pancreatic Enzyme Replacement Therapy: A Concise Review.” JOP: Journal of the pancreas vol. 20,5 (2019): 121-125.

Corring, T. “The adaptation of digestive enzymes to the diet: its physiological significance.” Reproduction, nutrition, developpement vol. 20,4B (1980): 1217-35. doi:10.1051/rnd:19800713

Goodman, Barbara E. “Insights into digestion and absorption of major nutrients in humans.” Advances in physiology education vol. 34,2 (2010): 44-53. doi:10.1152/advan.00094.2009

Vogt, Günter. “Synthesis of digestive enzymes, food processing, and nutrient absorption in decapod crustaceans: a comparison to the mammalian model of digestion.” Zoology (Jena, Germany) vol. 147 (2021): 125945. doi:10.1016/j.zool.2021.125945

Whitcomb, David C, and Mark E Lowe. “Human pancreatic digestive enzymes.” Digestive diseases and sciences vol. 52,1 (2007): 1-17. doi:10.1007/s10620-006-9589-z