Should you take digestive enzyme supplements?

Has someone recommended that you take digestive enzyme supplements for your gut health? Curious about what digestive enzymes are, or whether they work? Here is an evidence-based look at everything you need to know about digestive enzymes, from a registered dietitian.

Digestive enzyme supplements are super popular for bloating, gas or other tummy troubles. As a registered dietitian with over a decade of experience in gut health nutrition, I get asked about digestive enzymes all the time, so I thought it was time I wrote something to answer all of your digestive enzyme questions. So start here, and if you want to learn more about how your gut works, check out my new gut health cookbook Good For Your Gut.

What are digestive enzymes?

Digestive enzymes are special proteins made by the body that help to break down the food we eat into smaller, absorbable components. The vast majority of digestive enzymes in the body are made by the pancreas but there are also enzymes found in our saliva + stomach, as well as on the brush border, or gut-facing side, of our intestinal lining.

Types of digestive enzymes

Your pancreas releases three main types of digestive enzymes (technically, there are more but we’ll stick with the basics here):

• Amylases: amylase breaks down carbohydrates. Your saliva also contains amylase, so starch digestion actually begins in the mouth.
• Lipases: lipase breaks down fats into their smaller building blocks, a glycerol backbone and fatty acid chains.
• Proteases: proteases break down proteins. Your stomach cells also release a type of protease called pepsin, which starts breaking down proteins into peptide blocks in the acidic environment of the stomach.

You have more enzymes on the surface of your gut cells, known as brush border enzymes. This includes enzymes such as lactase, which breaks down the lactose in dairy products as well as sucrase-isomaltase, an enzyme that breaks down both sucrose (table sugar) and maltose.

Symptoms of digestive enzyme insufficiency

People with pancreatic insufficiency, such as those with cystic fibrosis, require daily intake of prescription pancreatic enzymes in order to digest and absorb food. This can also be an issue for some people with diabetes.

For the rest of us, when you consume more of a food than you have enzymes to digest, it can cause symptoms, such as consuming dairy in those with lactose intolerance, which is super common. Lactose is also a FODMAP, and is one of the components we reduce on a low FODMAP diet for IBS.

Symptoms of digestive enzyme deficiency can include:

• Gas: if maldigested food remains in the gut, it can travel to the colon to be fermented by your gut microbiome. But it is also normal to have some gas, especially if you are eating a diet rich in high fiber foods.
• Bloating: bloating is complex and there are many different causes of bloating so don’t immediately assume you have low digestive enzymes if you’re bloated, especially if you’re bloated on a plant-based diet.
• Diarrhea: diarrhea is a common symptom of both lactose and sucrose intolerance, as these sugars will draw water in them when left in the gut, loosening up stools. 
• Oily, foul smelling stool: if there is a lot of fat in the stool, it can look oily or discoloured.
• Nausea + reflux
• Loss of appetite
• Unintentional weight loss 
• Fatigue

Digestive enzyme supplements benefits

Digestive enzymes are promoted as improving digestion and absorption of nutrients as well as relieving symptoms of maldigestion such as gas, bloating and indigestion.

Your digestive tract can only absorb small building block-like components of food, such as the peptides and amino acids that make up proteins. If you are not adequately producing digestive enzymes, your body can have a hard time digesting and absorbing nutrients.

If this is you, digestive enzyme supplements may help you be better nourished and help decrease symptoms caused by poorly digested food in the gut. But… it’s a BIG “IF”.

Lactose intolerance, on the other hand, is super common. So there is a very clear case for using lactase enzyme (or just go dairy free!). For folks with celiac disease or Crohn’s disease, you may benefit from a lipase supplement as lipase deficiency may be present. However, if you’re generally healthy but just struggling with some gas or bloating? We have little human data to prove any benefits.

Do digestive enzyme supplements work?

We have clear data that the use of prescription pancreatic enzymes improves outcomes in frank pancreatic insufficiency, such as cystic fibrosis. However, for the rest of us? There is little to no research to prove they do what they say they do. But that’s not the same as saying zero research. Or, that there is a robust evidence base showing they don’t work.

However, as a dietitian it really annoys me that digestive enzyme companies make so many claims without actually backing them up. The exception? Standard lactase pills for lactose intolerance and alpha-galactoside (Beano) for helping to relieve symptoms of gas due to eating beans. We know those work so use as needed.

I was able to find 2 interesting studies about the use of digestive enzymes for functional digestive issues. If that seems good, know that I recommend probiotics only for some clients, and they have an evidence base of literally thousands of studies. Read this if you want to know how I choose a probiotic.

As an evidence-based practitioner, this is the reason why I generally do not recommend digestive enzymes to my clients. Plus, they’re quite pricey! However, after over a decade of practice, I also have seen that some people find they do relieve occasional symptoms. If this is the case for you, I suppose that I am not concerned about you using them once in a while, the same way you might take a Tums to settle your stomach every once in a while. Also, note that there can be issues if you have allergies to things like papaya and kiwi.

However, if you are taking them everyday, that means you probably have something real going on with your gut. And that’s an issue, as enzymes aren’t fixing the underlying cause of your digestive distress. If this is you, perhaps sign up for some one-on-one time with a dietitian or pick up my book Good For Your Gut to help you learn more about digestive health.

What about digestive enzyme supplements for bloating?

Bloating is super complex, and can have a number of root causes from stress and tight waistbands to irritable bowel syndrome or being new to a vegan diet. 

My clients will report that enzymes help their bloating, but we have minimal evidence in humans to show they do – and as I said above, rarely is it an actual enzyme deficiency causing the bloating which means that enzymes are a quick fix and not addressing the root cause of your issues.

Are digestive enzymes vegan?

While some enzymes come from microbial (bacterial or fungal) sources, others may be from animal sources so if you’re vegan or vegetarian, be sure to check the labels.

Which foods contain digestive enzymes?

Many foods naturally contain enzymes…but we don’t have research to prove all the claims that the internet makes about the effect these foods have on digestion. Luckily, they’re just food – and nutrient dense food at that – so feel free to give it a go as long as allergies aren’t an issue.

• Kiwi: contains actinidin to break down proteins, and it is thought that the actinidin component of kiwi may be part of the reason why kiwis help beat constipation. There is even a pilot trial of actinidin supplementation that was shown beneficial for constipation.
• Papaya: papain in papaya breaks down proteins. I couldn’t find any newer (after 2010) trials to prove its effectiveness for digestion.
• Pineapple: contains bromelain which also breaks down proteins, and is a frequent ingredient in digestive enzyme blends. Bromelain is also a component of enzymes touted for chronic inflammation based on cell culture (in vitro) studies but we don’t really have the human evidence to support that claim yet…just a couple really, really old studies.

The take home message? Digestive enzymes are very well-marketed, but poorly researched. If you’re working with a dietitian to address nutrition and underlying causes of your symptoms but still need extra help, it may be worth a trial for some…as long as they fit the budget.