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How do digestive enzymes work?

The Role of Digestive Enzymes in Gastrointestinal Disorders

Overview

Naturally occurring digestive enzymes are a vital part of your digestive system. Without them, your body can’t break foods down so that nutrients can be fully absorbed.

A lack of digestive enzymes can lead to a variety of gastrointestinal (GI) symptoms. It can also leave you malnourished, even if you have a healthy diet.

Certain health conditions can interfere with the production of digestive enzymes. When that’s the case, you can add digestive enzymes before meals to help your body process food effectively.

Keep reading to learn more about digestive enzymes, what happens when you don’t have enough, and what you can do about it.

What are digestive enzymes?

Your body makes enzymes in the digestive system, including the mouth, stomach, and small intestine. The largest share is the work of the pancreas.

Digestive enzymes help your body break down carbohydrates, fats, and proteins. This is necessary to allow for the absorption of nutrients and to maintain optimal health. Without these enzymes, the nutrients in your food go to waste.

When a lack of digestive enzymes leads to poor digestion and malnutrition, it’s called exocrine pancreatic insufficiency (EPI). When that happens, digestive enzyme replacement may be an option.

Some digestive enzymes require a doctor’s prescription and others are sold over the counter (OTC).

How do digestive enzymes work?

Digestive enzymes take the place of natural enzymes, helping to break down carbohydrates, fats, and proteins. Once foods are broken down, nutrients are absorbed into your body through the wall of the small intestine and distributed through the bloodstream.

Because they’re meant to mimic your natural enzymes, they must be taken just before you eat. That way, they can do their work as food hits your stomach and small intestine. If you don’t take them with food, they won’t be of much use.

 

Types of digestive enzymes

The main types of enzymes are:

  • Amylase: Breaks down carbohydrates, or starches, into sugar molecules. Insufficient amylase can lead to diarrhea.
  • Lipase: Works with liver bile to break down fats. If you don’t have enough lipase, you’ll be lacking in fat-soluble vitamins such as A, D, E, and K.
  • Protease: 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.

Enzyme medications and supplements come in many forms with varied ingredients and dosages.

Pancreatic enzyme replacement therapy (PERT) is available only by prescription. These medications are usually made from pig pancreases. They are subject to the Food and Drug Administration’s (FDA) approval and regulation.

Some prescription enzymes contain pancrelipase, which is made up of amylase, lipase, and protease. These medications are usually coated to prevent stomach acids from digesting the medication before it reaches the intestines.

Dosage varies from person to person based on weight and eating habits. Your doctor will want to start you at the lowest possible dose and make adjustments as needed.

OTC enzyme supplements can be found wherever dietary supplements are sold, including online. They may be made from animal pancreases or plants such as molds, yeasts, fungi, or fruit.

OTC digestive enzymes are not classified as medications, so they don’t require FDA approval before going on the market. Ingredients and dosages in these products may differ from batch to batch.

Who needs digestive enzymes?

You may need digestive enzymes if you have EPI. Some of the conditions that can leave you short on digestive enzymes are:

  • chronic pancreatitis
  • pancreatic cysts or benign tumors
  • blockage or narrowing of the pancreatic or biliary duct
  • pancreatic cancer
  • pancreatic surgery
  • cystic fibrosis
  • diabetes

If you have EPI, digestion can be slow and uncomfortable. It can also leave you malnourished. Symptoms may include:

  • bloating
  • excessive gas
  • cramping after meals
  • diarrhea
  • yellow, greasy stools that float
  • foul-smelling stools
  • weight loss even if you’re eating well

Even if you don’t have EPI, you can have trouble with certain foods. Lactose intolerance is a good example of this. A nonprescription lactase supplement can help you digest foods that contain lactose. Or if you have trouble digesting beans, you may benefit from an alpha-galactosidase supplement.

Side effects

The most common side effect of digestive enzymes is constipation. Others may include:

  • nausea
  • abdominal cramps
  • diarrhea

If you have signs of an allergic reaction, contact your doctor immediately.

The environment in the digestive system requires a delicate balance. Enzymes may not work well if the environment in your small intestine is too acidic due to a lack of bicarbonate. Another issue can be that you’re not taking the right dose or ratio of enzymes.

Certain medications can interfere with digestive enzymes, so it’s important to tell your doctor about any medications and supplements you’re currently taking.

If you’re taking enzymes and having problems, see your doctor.

Natural sources of enzymes

Certain foods contain digestive enzymes, including:

  • avocados
  • bananas
  • ginger
  • honey
  • kefir
  • kiwi
  • mangos
  • papayas
  • pineapples
  • sauerkraut

Supplementing your diet with some of these foods may aid digestion.

When to see a doctor

If you’re experiencing frequent or persistent digestive problems, or have signs of EPI, see your doctor as soon as possible. You may not be getting all the nutrients you need to maintain good health.

There are many GI disorders that can be causing your symptoms. Trying to guess which enzymes you need and in what dose can lead to problems. For these reasons, it’s important to get a diagnosis and discuss options with your doctor.

If you need digestive enzyme replacement, you can discuss the pros and cons of prescription versus OTC products.

Takeaway

Digestive enzymes are essential to nutrition and overall good health. They help your body absorb nutrients from the foods you eat. Without them, certain foods can lead to uncomfortable symptoms, food intolerances, or nutritional deficiencies.

Certain GI disorders can lead to a lack of enzymes, but enzyme replacement therapy may be an effective option.

Talk to your doctor about your GI symptoms, potential causes, and whether enzyme replacement is a good choice for you.

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