Digestive Enzymes 101

by Anne Salazar, Clinical Herbalist

Digestive enzymes play a critical role in your digestion. They help break down macronutrients (fats, carbohydrates, proteins) into smaller molecules that your body can absorb. These are then able to be used as essential building blocks to create new cells, neurotransmitters, and other needed molecules. Adequate digestive enzyme activity paired with a healthy gut microbiome is critical for normal gastrointestinal function and overall health (1) Together, they synergistically create efficient digestion and elimination.

There are three main enzymes involved in the digestion of macronutrients - amylase, protease, and lipase. Intestinal mucosal enzymes, including sucrase, lactase, maltase, protease with dipeptidyl peptidase IV activity are also important for complete digestion and assimilation of nutrients.

At Remedy we see many people that have GI symptoms and get questions related to digestion frequently. Depending on the situation, digestive enzyme supplementation is a common strategy we recommend. Keep reading for more information on how to best use digestive enzymes.

Common signs of inadequate digestive enzyme activity

When foods are NOT completely digested, due to decreased activity of digestive enzymes or otherwise, byproducts of partially digested and undigested food can cause symptoms of occasional gas, bloating, belching, or nausea. In addition, undigested food molecules can cause inflammation. Conversely, inflammation can cause indigestion. If you are experiencing these symptoms, it may be worth trying out a digestive enzyme supplement to see if your symptoms improve.

Conditions that cause reduced digestive enzyme activity

There are some serious conditions which are associated with enzyme insufficiency, like cystic fibrosis, diabetes, and pancreatic cancer. These conditions reduce your body's ability to produce adequate AMOUNTS of these enzymes. However, what is more common is GI environments that don’t support the optimal ACTIVITY of the enzymes. That is because digestive enzymes require specific pH conditions for optimal activity. For example, pepsin activity in the stomach requires normal gastric acidity, whereas pancreatic enzymes are optimally active only in neutral to alkaline intestinal conditions. This means that anything that throws off your body’s ability to create the correct pH in the correct area can reduce the effectiveness of digestion. Also, people with lactase deficiency may have genetic factors that lead to reduced amounts of specific enzymes to ensure complete breakdown of certain nutrients found in dairy.

Leading causes of pH imbalance

Research has shown that production of bicarbonate, needed to alkalinize the upper small intestine, and gastric acid, needed to activate pepsin in the stomach, can decline with age (2,3,4). Other big contributors are acid suppression medications, like proton pump inhibitors, and unbalanced microbiomes which are very common. Having the correct bacteria in your gut can be a big factor in pH levels and digestive enzyme levels. 

Picking the right digestive enzyme

There are a few things to look for in a digestive enzyme. You first need to make sure that the enzymes will be ACTIVE. There are two main types of digestive enzymes.  The first are animal-based, which are typically called pancreatic enzymes.  These enzymes are taken for specific conditions of the pancreas such as pancreatic disease and/or surgery. Because these types of enzymes can be degraded in the high acidity of the stomach, look for an enteric-coated version.  The other option for enzymes are ones that are synthesized from microbial sources. These are used most frequently, and will work fine in the acidic environment in the stomach. (5,6). Studies have shown that microbe-derived enzymes require a lower dosage to be effective and a broader pH range of activity than animal-based counterparts (7). These microbe-derived enzymes also are suggested for anyone who is vegan or vegetarian. At Remedy we stock microbe-derived, vegetarian-friendly enzymes

Another factor to consider when selecting digestive enzyme products is if you would like a formulation with only the enzymes or if you need to get a formula that also contains acid. As we previously reviewed, even if you have an adequate amount of enzymes if you do not have enough natural acid production to create the correct pH you may not be getting the full benefit of the digestive enzymes. The acid in digestive enzyme products is typically referred to as betaine HCl. At Remedy, we stock a version of digestive enzymes with betaine and enzymes without betaine HCL as well as betaine HCL by itself.

How to take your digestive enzyme

It is important to take digestive enzymes at the same time food is consumed - so for best results they should be taken with each meal. 

The benefit of digestive enzyme supplementation is certainly well studied and supported in certain conditions but is still evolving. While pancreatic enzymes may cause some dependency over time, microbial enzymes will not. For the average person who is struggling with symptoms of incomplete digestion, we suggest a trial of digestive enzymes based on the fact that they are very safe and many people have seen uncomfortable GI symptoms improve once they have added these enzymes into a gut healing protocol. For some people, digestive enzymes are only needed for a short period of time as they work on correcting underlying causes of GI distress, while others may require longer-term supplementation. Digestive enzymes and gastrointestinal pH balance may support digestion or nutrient absorption and may contribute to a variety of other health-supporting functions.

Feel free to pop into the pharmacy to get personalized product recommendations and ask any other questions!