What are digestive enzymes, and what do they do?

Naturally occurring digestive enzymes are proteins that your body makes to break down
food and aid digestion. Digestion is the process of using the nutrients found in food to
give your body energy, help it grow and perform vital functions.

“When you eat a meal or a snack, digestion begins in the mouth,” explains Denhard.
“Our saliva starts breaking down food right away into a form that can be absorbed by
the body. There are a lot of different points in the digestive process where enzymes are
released and activated.”

Your stomach, small intestine and pancreas all make digestive enzymes.
The pancreas is really the enzyme “powerhouse” of digestion. It produces the most
important digestive enzymes, which are those that break down carbohydrates, proteins
and fats.

Types of Digestive Enzymes

There are many digestive enzymes. The main digestive enzymes made in the pancreas
include:

 Amylase (made in the mouth and pancreas; breaks down complex

carbohydrates)
 Lipase (made in the pancreas; breaks down fats)
 Protease (made in the pancreas; breaks down proteins)

Some other common enzymes are made in the small intestine, including:

 Lactase (breaks down lactose)

 Sucrase (breaks down sucrose)

What is digestive enzyme insufficiency?

Some people don’t have enough digestive enzymes, or their bodies don’t release the
enzymes as they should. This means they can’t break down certain foods and absorb
nutrients.

A few types of digestive enzyme insufficiency include:

 Congenital sucrase-isomaltase deficiency:  You don’t have enough

sucrase to digest certain sugars.
  Exocrine pancreatic insufficiency: EPI occurs when your pancreas
doesn’t produce enough of the enzymes necessary to digest
carbohydrates, proteins and fats.
 Lactose intolerance: Your body doesn’t produce enough lactase, so
you might have problems digesting the sugar naturally found in milk and
dairy products.

Symptoms of Digestive Enzyme Insufficiency

Digestive enzyme insufficiency can lead to malnutrition or gastrointestinal irritation.
Common symptoms include:

 Belly pain or cramps

 Bloating
 Diarrhea
 Gas
 Oily stools (bowel movements)
 Unexplained weight loss

Talk to your doctor if these symptoms are persisting. These could be signs of gut
irritation or could indicate a more serious condition.

Digestive Enzymes vs. Probiotics: What’s the difference?

Sometimes people confuse enzymes and probiotics. Both affect your digestion, but in
very different ways. Probiotics are live organisms that make up the good bacteria in
your gut. They help keep your digestive tract healthy, so they support the work your
enzymes do. Unlike enzymes, probiotics do not have the ability to break down or digest
food components.

Without good gut bacteria, you might experience symptoms similar to those of an
enzyme insufficiency, such as bloating or gas, due to abnormal bacterial overgrowth or
imbalance in your intestines.

What conditions can cause digestive enzyme insufficiency?

Some enzyme insufficiencies are genetic, which means they’re the result of an
abnormal gene. Such a gene might be inherited from a parent, or a mutation can occur
without a known cause. Enzyme insufficiencies can be congenital (present at birth) or
develop over time.

Some disorders or medical treatments can lead to pancreatic enzyme insufficiency:

  Chronic pancreatitis
 Cystic fibrosis
 Gastrointestinal surgeries
 Pancreatic cancer
 Any condition that disrupts your pancreas

Are there external sources of digestive enzymes?

Prescription digestive enzymes

People diagnosed with an enzyme insufficiency often need to take prescription digestive
enzymes. These supplements help the body process food and absorb nutrients better.
The most common and the only FDA-regulated enzyme replacement therapy is
pancreatic enzyme replacement therapy (PERT). PERT is a medication your doctor
prescribes that includes amylase, lipase and protease. It helps break down carbs, fats
and proteins.

“About 90% of my patients with cystic fibrosis have pancreatic enzyme insufficiency.
Many of them need PERT because their pancreas develops mucus and, over time, scar
tissue. So it can’t release the enzymes as it should,” explains Denhard. “We also
prescribe enzymes for patients with frequent pancreatitis. There’s ongoing research
about the role of digestive enzymes in treating irritable bowel syndrome, but so far
there’s no definitive evidence to suggest that enzymes can help with this condition.”

Over-the-counter digestive enzymes

Many people take over-the-counter digestive enzyme supplements for problems such
as acid reflux, gas, bloating and diarrhea. These might contain amylase, lipase and
protease. Some contain lactase and alpha-galactosidase (an enzyme the body doesn’t
make, even in healthy people without enzyme insufficiency). Alpha-galactosidase can
help break down a type of non-absorbable fiber called galactooligosaccharides (GOS),
mostly found in beans, root vegetables and some dairy products. GOS is known to be
beneficial, but it can cause gas and bloating in some individuals.

Denhard says it’s important to keep in mind that these over-the-counter digestive
enzyme supplements aren’t regulated by the FDA. So the dosage, ingredients and
enzyme concentration aren’t guaranteed, and their side effects are unknown. Some
supplements make claims that aren’t supported by evidence, such as enzymes to
promote weight loss or a flatter stomach.
“Overall, a healthy person really doesn’t need to take digestive enzyme supplements,”
Denhard explains. “The best digestive enzymes are the ones our bodies make naturally,
and they work best when you eat a whole food diet.”

Can I get digestive enzymes from the

food I eat?
There’s no real evidence to suggest that enzyme-rich foods such as pineapples and
avocados help your digestion. You’re better off building a well-balanced diet that
contains fresh fruits and vegetables, lean proteins and whole grains. These foods will
naturally help support the work your digestive enzymes are already doing.

Denhard suggests cutting highly processed, fatty foods from your diet, especially fried
foods. “It’s much more likely that someone will have GI irritation or other problems
because of unhealthy foods, not an enzyme insufficiency,” she says.