Digestive enzymes are critical for breaking food down into its nutritional components in our gastrointestinal (GI) tract. And if this process is disrupted, common GI symptoms like bloating, diarrhea, and stomach pain can ensue. It's for this reason that digestive enzyme supplements have been getting attention lately—there is speculation that they boost those processes and help relieve symptoms of indigestion. But clinical evidence shows little support for this claim, and results suggest that these supplements are only proven effective for certain medical conditions.
We dove deeper into what the experts and research have to say about digestive enzyme supplements and their efficacy—so you don’t have to.
Digestive enzymes break down food for absorptionDigestive enzymes help to break down the food we eat into molecules small enough to be absorbed by the small intestine and enter the bloodstream—a process that is critically important for converting food into nutrients that the body can use. Digestive enzymes are produced by the glands in the mouth, stomach, gallbladder and small intestine, though the majority come from the pancreas. Several types of digestive enzymes exist, each of which plays a distinct role in the body. The main digestive enzymes include:
- Amylase: Breaks down carbohydrates. Found in saliva, as well as pancreatic and stomach juices.
- Lipase: Breaks down fats. Found in the stomach and pancreas.
- Protease: Breaks down proteins. Found in the stomach, pancreas, and intestines.
And there's been speculation about digestive enzyme supplements' ability to ease GI symptomsImpaired breakdown of food compounds can lead to common (as in 70-million-affected-Americans common) issues such as bloating, gas, diarrhea, and constipation, so there has been increased speculation that supplements and other exogenous (meaning, from sources outside of the human body) versions of these enzymes may help to alleviate these ailments. But despite this sudden increase in popularity, the question as to whether or not these supplements actually work remains open to interpretation.
Exogenous digestive enzymes can come from medications, supplements, or even foods
Prescription enzyme medicationsPrescription digestive enzymes are the established standard of care for individuals with chronic health conditions. These medications contain pancrelipase, a mixture of amylase, lipase, and protease, and are encapsulated in a special coating so they can survive stomach acid and enter the small intestine. These enzymes are typically animal-derived and are regulated and approved by the Food and Drug Administration (FDA).[2,5] A clinical study in 65 patients with chronic pancreatitis found that prescription pancreatic enzyme supplementation was successful in relieving abdominal pain.
Over-the-counter supplementsOver-the-counter digestive enzyme supplements are widely available in health food stores and drugstores, as well as on the internet. These types of supplements are not classified as medications and are not regulated by the FDA. Just like with other supplements found in these common public locations, you cannot be entirely certain of their ingredients, nor the exact amounts of enzymes they may contain.
Natural food sourcesA variety of digestive enzymes are derived from the foods we eat such as fruit, molds, yeasts, and fungi. Here are some examples of foods with naturally occurring digestive enzymes.
- Pineapple: Contains a group of digestive enzymes called bromelain, which helps break down proteins into amino acids.
- Papaya: Contains papain, which breaks down proteins into amino acids. Make sure to eat papayas uncooked, as high heat can destroy their digestive enzymes.
- Mango: Contains amylase, which helps break down carbohydrates.
- Honey: Contains a variety of digestive enzymes. Make sure to purchase raw honey, as this guarantees it is not exposed to high heat which can denature enzymes.
- Bananas: Contain amylases and glucosidases, two enzymes that digest complex carbohydrates. They are more active as bananas ripen, which is why yellow bananas are much sweeter than green bananas—the enzymes break down complex starches into sweet, simple sugars.
- Fermented foods such as kimchi and sauerkraut: The fermentation process incorporates digestive enzymes such as amylase, lipase, and protease. Kefir, a fermented milk product, also contains digestive enzymes that help break down fat, protein, and lactose molecules.
But research shows digestive enzymes may only help a subset of peopleIn some cases, digestive enzyme production can become dysfunctional, resulting in an insufficient supply of enzymes, which can lead to slowed digestion and symptoms of gastrointestinal discomfort.[1,2] For example, those with lactose intolerance do not generate enough of the enzyme lactase, and therefore have trouble breaking down and digesting lactose (a sugar found in dairy products). Failure to digest lactose can lead to symptoms like bloating, flatulence, and diarrhea. Taking a nonprescription lactase supplement (such as Lactaid or Lactrase) can help people manage lactose intolerance.[3,4]
Other health conditions may also result in low levels of digestive enzymes, creating symptoms similar to lactose intolerance. The most common related diseases include inflammatory bowel disease, chronic pancreatitis, cystic fibrosis, and pancreatic cancer.[1,2,5] Individuals with these conditions are commonly prescribed enzyme pills by doctors to substitute for the lack of natural enzyme production.
For other common gastrointestinal problems such as irritable bowel syndrome, heartburn, bloating, and gas, there is little conclusive evidence that supplemental digestive enzymes are useful.[1,2] Despite anecdotal accounts of temporary pain relief from their use, current research does not support the use of supplemental enzymes to treat common GI symptoms [1,2,5,6].
It's best to consult a clinician before starting digestive enzyme supplementsMany commercial companies market tests that approximate blood levels of some pancreatic enzymes. However, these tests do not measure digestive function—in fact, they are only useful for diagnosing pancreatitis! So buyer beware: tests available to the general public that claim to determine digestive enzyme deficiencies have yet to be tested in clinical trials for their accuracy and efficacy [1,2].
If you're still determined to give digestive enzyme supplements a try, it's best to raise the conversation with a GI specialist or Registered Dietitian—both can provide additional clarity and insight based on your individual circumstances. Recommendations will likely vary widely between patients due to the complexity of the human GI system and the individuality of symptoms.
In addition, it is important to be aware that digestive enzyme supplements may come with side effects that you're ultimately looking to treat, such as bloating, nausea, diarrhea, and stomach pain. As always, alert your doctor if you are taking these supplements on a regular basis, particularly if you're experiencing side effects.
Should you take a digestive enzyme supplement? A summary of the evidence
- Digestive enzyme supplements may play an important role in alleviating several clinical digestive and malabsorption disorders, such as lactose intolerance, inflammatory bowel disease, and pancreatitis.
- Currently, animal-derived enzymes are the standard of care for chronic health conditions. However, a growing body of evidence supports plant-based digestive enzyme therapy.[1,5]
- Well-designed studies with sufficient power are needed to further characterize the role of digestive enzyme supplements in health promotion and disease treatment.
- Despite anecdotal claims, current clinical evidence does not advocate the use of supplemental enzymes to treat common gastrointestinal tract symptoms including bloating, gas, and irritable bowel syndrome. [1,5].
- The likelihood of over the counter digestive enzyme supplements causing harm is minimal, but it is always recommended to consult your physician before incorporating new supplements into your regimen.
References1. Ianiro, Gianluca, Silvia Pecere, Valentina Giorgio, Antonio Gasbarrini, and Giovanni Cammarota. “Digestive Enzyme Supplementation in Gastrointestinal Diseases.” Current Drug Metabolism 17, no. 2 (February 1, 2016): 187–93.
2. Publishing, Harvard Health. “Gut Reaction: A Limited Role for Digestive Enzyme Supplements.” Harvard Health. Accessed August 12, 2020. https://www.health.harvard.edu/staying-healthy/gut-reaction-a-limited-role-for-digestive-enzyme-supplements.
3. Montalto, Massimo, Valentina Curigliano, Luca Santoro, Monica Vastola, Giovanni Cammarota, Raffaele Manna, Antonio Gasbarrini, and Giovanni Gasbarrini. “Management and Treatment of Lactose Malabsorption.” World Journal of Gastroenterology 12, no. 2 (January 14, 2006): 187–91. https://doi.org/10.3748/wjg.v12.i2.187.
4. Montalto, Massimo, Valentina Curigliano, Luca Santoro, Monica Vastola, Giovanni Cammarota, Raffaele Manna, Antonio Gasbarrini, and Giovanni Gasbarrini. “Management and Treatment of Lactose Malabsorption.” World Journal of Gastroenterology 12, no. 2 (January 14, 2006): 187–91. https://doi.org/10.3748/wjg.v12.i2.187.
5. Varayil, Jithinraj Edakkanambeth, Brent A. Bauer, and Ryan T. Hurt. “Over-the-Counter Enzyme Supplements: What a Clinician Needs to Know.” Mayo Clinic Proceedings 89, no. 9 (September 1, 2014): 1307–12. https://doi.org/10.1016/j.mayocp.2014.05.015.
6. Zubarik, Richard, and Eric Ganguly. “The Rosemont Criteria Can Predict the Pain Response to Pancreatic Enzyme Supplementation in Patients with Suspected Chronic Pancreatitis Undergoing Endoscopic Ultrasoun.” Gut and Liver 5, no. 4 (December 2011): 521–26. https://doi.org/10.5009/gnl.2011.5.4.521.