Digestive enzymes are quite popular as they claim to reduce common gut symptoms. And people with IBS are often drawn to them in their search for a solution to their IBS problems. But do you really need them? Let’s talk about whether digestive enzymes can help people with IBS reduce their gut symptoms.
Do people with IBS need Digestive Enzymes?
To start with, what are digestive enzymes? These are proteins our body produces to help us digest proteins, carbohydrates, and fats from the foods we eat. For example, when we start chewing, amylase, produced by our salivary glands, starts breaking down the carbohydrates in our food. The major digestive enzymes in our body break down carbohydrates (amylase), proteins (protease), and fats (lipase). In addition, a few others break down more specific food components. For example, lactase breaks down lactose, the sugar in dairy products. The pancreas produces most of our digestive enzymes, but the small intestine, stomach, and mouth can also produce them.
Most people – even those with IBS – do not need to supplement with digestive enzymes. However, there is a deficiency that requires supplementation. Exocrine Pancreatic Insufficiency (EPI) occurs when our pancreas doesn’t produce enough enzymes to digest the carbohydrates, proteins, and fats in food and makes us less able to absorb the nutrients from the food we eat. In this case, your doctor would give you a prescription for pancreatic enzymes.
Can over-the-counter digestive enzymes help with IBS?
On the other hand, there are some over-the-counter formulations that contain a mix of the digestive enzymes mentioned. And they claim to help with IBS symptoms such as gas, bloating, diarrhea, and even acid reflux. One thing to keep in mind is that they are not regulated by the FDA and their claims don’t need to be supported by evidence. When it comes to studies in people with IBS-like symptoms, the research is far from conclusive.
There are few well-designed studies using different enzyme complexes and sometimes other substances are added. This makes it difficult to tease out which components are responsible for any treatment success. And which symptoms, or groups of symptoms, are most likely to respond to a particular enzyme combination.
One particular study drew my attention: it included people with diarrhea-predominant IBS (IBS-D). The study showed an improvement in stool frequency and consistency and a reduction of abdominal pain with pancreatic enzyme supplementation in a subset of participants who had low elastase levels (which suggests pancreatic insufficiency). These are promising results. However, in regard to the effectiveness of digestive enzymes in reducing IBS symptoms, we definitely need more research.
What about targeted enzymes?
Nonetheless, the evidence supports the use of three specific digestive enzymes to help some people with IBS. Although the cause of IBS is complex and multifactorial, we do know that some people experience symptoms after ingesting certain FODMAPs. For instance, many people don’t tolerate lactose (found in some dairy products), and/or oligosaccharides, mainly GOS (mostly found in legumes and some nuts), and fructans (found in wheat and certain vegetables and fruits).
And we do have enzymes to help with that! Some people may not be producing enough lactase, the enzyme responsible for digesting lactose in milk and its related products. Approximately 15% of white, 40% of Asian, and 85% of African-American adults in the United States don’t produce enough lactase. In this case, ingesting a lactase tablet (such as Lactaid) just before drinking milk, or eating ice cream or other high-lactose dairy products can help prevent gut symptoms. Similarly, consuming lactose-free dairy products can help as manufacturers add lactase to products such as milk, yogurt, cream cheese, and ice cream.
Another helpful enzyme is alpha-galactosidase, commonly known as Beano or BeanAssist. This enzyme breaks down the complex carbohydrates (oligosaccharides) found in beans, lentils, and nuts like cashews and pistachios. Humans don’t produce this enzyme. While most people may experience just mild gas after eating these foods, people with IBS have more severe symptoms and may benefit from this enzyme.
Finally, a novel enzyme on the market, fructan hydrolase, targets fructans, a family of complex carbohydrates found in a variety of foods such as wheat, garlic, onions, artichokes, bananas, dried fruit, and more.
In conclusion, don’t rush to buy generic digestive enzymes to help with your IBS symptoms. They can be expensive and are not without side effects. Although most people tolerate them well, some have reported increased bloating, gas, and diarrhea. Discuss all your symptoms with your doctor. He/she will know which tests to order to get to the bottom of your symptoms, including tests for EPI, if needed.
Then, work with a specialized dietitian (like me) to identify your trigger foods. Once you know which FODMAPs you have trouble tolerating, you can use the appropriate enzyme. Although targeted supplements are not a panacea for all IBS symptoms, they may help if you don’t tolerate foods that contain lactose, galactooligosaccharides, or fructans. They can help you include these foods without experiencing symptoms and avoid over-restricting your diet.
If you don’t know your trigger foods yet, I can help!
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