There’s little evidence to support their use for common digestive distress like heartburn.
Image: © Julia_Kuleshova/Getty Images
Digestive enzyme supplements promise to fix everything from bloating and flatulence to heartburn and gut health. The supplements are so popular that global sales are expected to reach $1.6 billion by 2025, according to recent marketing research. But don’t be too quick to reach for them. “Some of them are clearly beneficial, in certain situations. But enzyme supplements also are often used in situations where there is little evidence that they do any good,” says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.
What are digestive enzymes?
Naturally occurring digestive enzymes help break down food so we can soak up nutrients. Your mouth, stomach, and small intestine make some digestive enzymes. However, the majority come from your pancreas, which floods the small intestine (when food arrives there) with enzymes such as
lipase, which breaks down fats
amylase, which breaks down carbohydrates
proteases and peptidases, which break down proteins.
Once nutrients are broken into small enough molecules, they are absorbed through the wall of the small intestine into the blood and then delivered throughout the body.
Sometimes the body doesn’t make enough digestive enzymes. This can slow the digestion process and lead to uncomfortable symptoms. For example, if you don’t make enough of the enzyme lactase, you’ll have a hard time digesting lactose — the sugar in milk and milk-based products. “If you don’t have lactase, the undigested lactose goes to the colon, which leads to more fluid entering the colon and more gas produced by bacteria in the colon. That creates bloating, flatulence, and diarrhea,” explains Dr. Staller.
Various health conditions can lead to low levels of digestive enzymes. Examples include cystic fibrosis, chronic pancreatitis (inflammation of the pancreas), and pancreatic cancer.
Replenishing enzyme levels
Digestive enzyme replacement comes from two sources: prescription enzyme medications and over-the-counter supplements. Prescription enzymes (Creon, Zenpep, and others) contain pancrelipase, a mixture of the digestive enzymes amylase, lipase, and protease, and has a special coating on the pill so it will survive stomach acid and make it to the small intestine. These enzymes are typically made from the pancreases of pigs, and are regulated and approved by the FDA.
Over-the-counter digestive enzyme supplements — available in health food stores and drugstores and on the Internet—are not medications. The FDA does not regulate them. Therefore, you can’t be sure what the pills are really made of or the exact amounts of enzymes they may contain. “It’s buyer beware,” warns Dr. Staller.
The enzymes may come from animal pancreases (pigs, cows, or lambs) or from plants. Common plant sources are fruit, molds, yeasts, and fungi. Examples include bromelain, derived from pineapples; papain, derived from papayas; and lactase, obtained from purified yeasts or fungi.
When to use them
For people who can’t make enough digestive enzymes because of a health condition such as chronic pancreatitis or cystic fibrosis, doctors prescribe enzyme pills to substitute for the lack of natural enzyme production. “People with known deficiencies clearly get a benefit” from the drugs, says Dr. Staller.
Taking a nonprescription lactase supplement (such as Lactaid or Lactrase) can help people manage lactose intolerance, and taking an alpha-galactosidase supplement (such as Beano or Bean Relief) may reduce gas and bloating if you have a hard time digesting the sugars in beans.
But for other common gut problems, like heartburn or irritable bowel syndrome, there is little evidence that digestive enzymes are helpful.
What you should do
Tests can measure the levels of some pancreatic enzymes in the blood, but these are used only to diagnose pancreatitis, not for a measurement of digestive function. Tests claiming to identify all enzyme deficiencies you may have aren’t accurate, notes Dr. Staller. But what if everything you’ve tried for digestion issues hasn’t worked, and you’d like to try a digestive enzyme? Would it hurt? “In most cases, these are unlikely to be harmful. But I don’t recommend spending a lot of money on them. And don’t take them if you see signs of bleeding or a change in stool color. Report that to your doctor,” says Dr. Staller.
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