Do you really need more digestive enzymes?

With everyone now latching onto the power of the gut, including supplement manufacturers, there are more pills than ever out there claiming to optimise your digestive health. Vitamin and mineral supplements are putting nutraceutical companies on the map (think nutrition and pharmaceutical combined). These companies are offering multivitamins, special combinations for particular purposes (e.g. ‘supporting’ your digestive system), probiotics and new generation categories such as adaptogens (which claim to protect you from stress). 

With all these new products flooding the market, do you find it hard to navigate the maze of different products and claims to know which preparations are best for you? If so, you’re not alone! From our experience at The Gut Health Clinic, people with gut health issues are generally confused about the products on offer, and looking for straight answers and effective solutions. Cue Dr Google…

One of the most common misdiagnoses and points of mismanagement we see in clinic is self-diagnosed ‘digestive enzyme deficiency’. Due to misinformation being spread, people have often tried this increasingly popular over-the-counter broad spectrum digestive enzymes which claim to include various — usually plant-derived forms — of amylase (to break down carbs), proteases (break down proteins) and lipases (break down fats) in the hope of relief. The convincing marketing for these supplements typically targets those suffering from symptoms of bloating, heartburn or irritable bowel syndrome (IBS). To help safeguard you against the inevitable marketing claims, let’s start by busting a couple of popular misconceptions:

How do digestive enzymes work?

Enzymes are a type of protein our bodies produce that helps to break down food. They play a critical role in digestion. In fact, without them, we’d malabsorp our food, leading to malnutrition and typically loose and smelly stools.

Now, when we eat, the first enzymes food encounters are in the mouth. When we chew, we produce saliva, which contains amylase, an enzyme that breaks down complex carbohydrates into glucose, the simplest form of sugar. As food progresses through your stomach and small intestine it encounters lipases (enzymes that break down fat), proteases (that break down protein), and lactase (that breaks down lactose in dairy products).

These enzymes enable food to be digested into smaller molecules so your body can absorb nutrition from it. The whole process is remarkable and, in the vast majority of people, there are more than enough digestive enzymes to do the job.

What is digestive enzyme deficiency?

True multi-digestive enzyme deficiency is rare — it accounts for only 0.0001% of situations. In exocrine pancreatic insufficiency, as it’s called, food isn’t absorbed properly and its nutritional value is effectively lost. Symptoms include stomach upset, bloating, diarrhoea and other types of gut discomfort. If you had this condition, you would know about it – you would be losing weight, suffering from malnourishment and failing to thrive in any meaningful way. True multi-digestive enzyme deficiency is serious.

It rarely occurs in isolation but is more often secondary to another condition, such as pancreatitis (an inflamed pancreas) or cystic fibrosis. In these circumstances, doctors prescribe a high-dose combination of multi-enzymes to take with every meal and ensure the body can break down food in the gut while eating.

A more common type of genuine digestive enzyme deficiency is lactose intolerance. This is where levels of the enzyme, lactase, which is produced in the gut lining, is in short supply. This is one situation in which over-the-counter digestive enzymes might actually be justified as lactase enzymes are generally effective in relieving symptoms of lactose intolerance. That being said, in clinic, we typically recommend people continue to have small amounts of lactose-containing foods spread across the day without lactase enzymes. This is because research shows that this can help build lactose tolerance. This can be helpful in cases where you might accidentally have lactose (say at a friend’s house), as it will mean that your symptoms should be more manageable.

There are some other cases where we would recommend taking enzyme supplements, but again, these should be specific, single digestive enzymes such as for fructose intolerance and for those who struggle with legumes such as beans and pulses.

So the fact of the matter is that, unless you have been diagnosed with a specific food intolerance or pancreatic insufficiency, you should have no need for digestive enzyme supplements. However, if you are experiencing gut symptoms, there are some basic ways to support good digestion.

Some simple steps to support your digestion