Digestive enzymes are substances that help you digest your food. They are secreted (released) by the salivary glands and cells lining the stomach, pancreas, and small intestine.
Digestive enzymes do this by splitting the large, complex molecules that make up proteins, carbohydrates, and fats into smaller ones. This allows the nutrients from these foods to be easily absorbed into your blood and carried through your body.
There are several digestive enzymes, including amylase, maltase, lactase, lipase, sucrase, and proteases.
Some conditions can result in digestive enzyme deficiencies, such as lactose intolerance or exocrine pancreatic insufficiency. In that case, supplementation with foods, over-the-counter supplements, or prescription digestive enzyme supplements may be necessary.
What Are Digestive Enzymes?
Digestive enzymes are released when we:
- Anticipate eating
- Smell and taste food
- Go through the digestive process
Some foods require certain digestive enzymes to break down the specific nutrients they contain.
A variety of health conditions, especially those that affect the pancreas, can lead to deficiencies in digestive enzymes. This is because the pancreas secretes several key enzymes.
Often these deficiencies can be fixed by changing your diet. You can avoid certain foods or eat foods containing naturally occurring digestive enzymes. You can also take prescription or over-the-counter (OTC) enzyme supplements.
What Are Enzymes and How Do They Work?
Most pancreatic enzyme supplements come in capsule form. Inside each capsule are many small beads that contain the digestive enzymes. Each bead is covered with a special enteric coating.
This coating allows the beads to dissolve in the small intestine. The digestive enzymes are then released in the small intestine to help digest food. Enzymes work for about 45 to 60 minutes after taking them.
Enzymes work by helping you to:
- Digest carbohydrates, proteins and fats (the three nutrients in food that supply calories).
- Gain and maintain a healthy weight.
- Absorb essential nutrients such as vitamins and minerals.
In the short term, not taking your enzymes or not taking the proper dose can lead to poorly digested fat, protein or starch. The poorly digested food sits in your intestines, which causes gas, pain and unpleasant smells. It can also cause problems ranging from constipation and DIOS to lose, floating, greasy, frequent stools.
In the long term, compromised is associated with higher body weight, so it is very important to take enzymes with all meals and snacks.
Cystic Fibrosis & Enzymes
Most people with Cystic Fibrosis – CF need to take pancreatic enzyme capsules before every meal and snack so their bodies can digest the nutrients. People with CF should take enzymes with any food, unless it is pure sugar such as a clear Popsicle, hard candy or fruit juice.
Older children and adults should take the capsules with liquid and swallow them whole. If you or your child are not able to swallow the capsules, open them and sprinkle the beads on a small amount of an acidic food, such as applesauce, that you can swallow. Don’t crush or chew the enzyme beads. They won’t work as well.
If meals are longer than 30 minutes, some people split their enzyme dose, taking half at the start of the meal and the other half partway through the meal.
The side of your enzyme bottle lists the amount of lipase (to digest fat), protease (to digest protein) and amylase (to digest starch) in the enzyme. The number that comes after the name of your enzyme capsule is the amount of lipase units per capsule. Because fat is the hardest thing for the body to digest, dosing guidelines primarily take into account the amount of lipase in the enzyme.
Many people have a fixed dose for example, a certain number of capsules with each meal and a smaller number with a snack. Others increase their dose if they eat a meal that has lots of fat in it, such as a pepperoni pizza or chicken wings in blue cheese sauce. Tell your CF dietitian or care provider if high-fat foods cause problems.
As you get older or start to eat more, you will have to increase the amount of enzymes. If you have any questions about how many enzymes to take, talk to the dietitian, doctor or nurse on your care team.
Taking too many enzyme supplements can actually damage your intestines, but taking too few can keep you from absorbing the nutrients you need. Do not change the dose without talking with your CF care team.
- Enzyme brands are not interchangeable. The products vary slightly in the amounts of enzymes and the way the coating on the enzyme beads dissolves.
- Avoid skipping enzymes. Keep a supply of enzymes with you in case you want to eat meals or snacks while away from home.
- If you’re supplementing your diet with tube feedings, talk to your health care team about the best way to incorporate enzymes into your tube feeding plan, as there are many different approaches to take.
Types of Digestive Enzymes
Each of the many different digestive enzymes targets a specific nutrient and splits it up into a form that can eventually be absorbed.
The most important digestive enzymes are:
Amylase is important for digesting carbohydrates. It breaks down starches into sugars.
Amylase is secreted by both the salivary glands and the pancreas. The measurement of amylase levels in the blood is sometimes used as an aid in diagnosing various pancreas or other digestive tract diseases.
High levels of amylase in the blood may mean you have:
- A blocked or injured duct of the pancreas
- Pancreatic cancer
- Acute pancreatitis, which is a sudden inflammation of the pancreas
Low levels of amylase may mean you have chronic pancreatitis (ongoing inflammation of the pancreas) or liver disease.
The small intestine releases maltase, which is responsible for breaking down maltose (malt sugar) into glucose (simple sugar). The body uses glucose for energy.
During digestion, starch is partially transformed into maltose by amylases. The maltase enzyme then changes maltose into glucose. This sugar is then either used immediately by the body or stored in the liver as glycogen for future use.
Lactase (also called lactase-phlorizin hydrolase) is an enzyme that breaks down lactose, a sugar found in dairy products. It turns lactose into the simple sugars glucose and galactose.
Lactase is produced by cells known as enterocytes that line the intestinal tract. Lactose that is not absorbed is fermented by bacteria in the gut. This can cause you to have gas and an upset stomach.
Lipase is responsible for the breakdown of fats into fatty acids and glycerol (simple sugar alcohol). It’s produced in small amounts by your mouth and stomach, and in larger amounts by your pancreas.
Also called peptidases, proteolytic enzymes, or proteinases, these digestive enzymes break down proteins into amino acids. They also play a role in numerous body processes, including:
- Cell division
- Blood clotting
- Immune function
Proteases are produced in the stomach and pancreas. The main ones are:
- Pepsin: Pepsin is secreted by the stomach to break down proteins into peptides, or smaller groupings of amino acids. Those amino acids are then either absorbed or broken down further in the small intestine.
- Trypsin: Trypsin forms when an enzyme secreted by the pancreas is activated by an enzyme in the small intestine. Trypsin then activates additional pancreatic enzymes, such as carboxypeptidase and chymotrypsin, to help break down peptides.
- Chymotrypsin: This enzyme breaks down peptides into free amino acids that can be absorbed by the intestinal wall.
- Carboxypeptidase A: Secreted by the pancreas, it splits peptides into individual amino acids.
- Carboxypeptidase B: Secreted by the pancreas, it breaks down basic amino acids.
Sucrase is secreted by the small intestine, where it breaks down sucrose (the sugar in table sugar) into fructose and glucose. These are simpler sugars that the body can absorb.
Sucrase is found along the intestinal villi. These are tiny hair-like structures that line the intestine and absorb nutrients into the bloodstream.
Digestive Enzyme Deficiencies
There are a variety of health conditions that can interfere with the secretion of enough digestive enzymes to fully digest foods. Some are inherited genetic conditions while others develop over time.
Lactose intolerance occurs when you aren’t able to digest lactose because of insufficient production of lactase by the small intestine. When you consume dairy products, you may experience:
- Abdominal pain
There are several forms of lactose intolerance.
Congenital Lactase Deficiency
Congenital lactase deficiency (also called congenital alactasia) is a rare inherited form of lactose intolerance. It happens when newborns are unable to break down lactose in breast milk or formula. They get severe diarrhea if they aren’t given a lactose-free alternative.
Congenital lactase deficiency is caused by mutations in the LCT gene that provides instructions for making the lactase enzyme.
Lactase non-persistence is a common type of lactose intolerance that some people develop as adults. It affects around 65% of people, and it’s caused by decreased expression (activity) of the LCT gene. Symptoms typically begin 30 minutes to two hours after eating or drinking dairy.
Most people with lactase non-persistence keep some level of lactase activity and can continue to include a small amount of lactose in their diets. This may be in the form of cheese or yogurt since both tend to be tolerated better than fresh milk.
Secondary Lactose Intolerance
Secondary lactose intolerance develops when lactase production is reduced because of diseases that can damage the small intestine. These diseases include celiac disease or Crohn’s disease as well as other illnesses or injuries that affect the intestinal wall.
Exocrine Pancreatic Insufficiency
The pancreas produces the key digestive enzymes amylase, protease, and lipase. People with exocrine pancreatic insufficiency (EPI) have a deficiency of these enzymes. As a result, they are unable to digest food properly, especially fats.
The health conditions that affect the pancreas and are associated with EPI are:
- Chronic pancreatitis: An inflammation of the pancreas that can permanently damage the organ over time
- Cystic fibrosis: An inherited genetic condition that causes severe damage to the lungs and digestive system, including the pancreas
- Pancreatic cancer
Foods High in Digestive Enzymes
A variety of foods, especially tropical fruits and fermented vegetables, are naturally high in digestive enzymes that might speed up the digestion of certain nutrients.
It’s best to eat them raw since heat can lessen or destroy these plant enzymes.
Proteases (bromelain) – Helps digest proteins and has additional anti-inflammatory effects.
Proteases (papain) – Papain is used to improve digestion as it contains an enzyme that helps break down proteins.Papaya is rich in dietary fiber, which is beneficial for our digestive system. This fruit also has papain, a digestive enzyme that helps with digestion and stomach discomfort.
Proteases (actinidain) – In addition to its digestive enzymes, the fruit is high in fiber to support digestive tract function
Amylases – Helps break down carbohydrates from starches into simple sugars and increases as the fruit ripens
Amylases, glucosidases – Like amylases, glucosidases also break down complex carbohydrates
Digestive Enzyme Supplements
People who don’t have sufficient amounts of digestive enzymes or who are looking to support healthy digestion should consider supplementing their diet with digestive enzymes.
They can do this by eating healthy foods that contain naturally occurring digestive enzymes. But they can also take nutritional supplements under a healthcare provider’s guidance.
Digestive enzyme supplements can come in:
- Liquids sourced from animals, plants, or microbes
There are prescription supplements regulated by the FDA as well as over-the-counter supplements.
Prescription enzyme supplements are recommended for conditions that affect the functioning of the pancreas, such as chronic pancreatitis or pancreatic cancer.
Brands of prescription pancreatic enzyme supplements (pancrelipase) include:
Over-the-counter enzyme supplements are not regulated by the FDA. There haven’t been enough high-quality studies on them, so it’s hard to know how effective they are.
The following are some of the supplemental enzymes that don’t require a prescription:
- Lactase supplements may help people who are lactose intolerant to digest dairy products and are available as tablets or drops.
- Bromelain is a powerful protease from the fruit or stem of pineapples that comes in capsule, tablet, or powder form and may help with the digestion of protein.
- Papain from papaya may help with digesting proteins, and the powder form can be used as a meat tenderizer.
As with any supplement, check with your healthcare provider before taking an over-the-counter digestive enzyme to make sure it’s safe for you.
Digestive enzymes are substances that help you digest your food. They’re secreted by the salivary glands and cells lining the stomach, pancreas, and small intestine.
Sometimes people have a digestive enzyme deficiency. These deficiencies are connected to various health conditions. Many of these health conditions are related to the pancreas.
You can treat a digestive enzyme deficiency by changing your diet and/or taking a prescription or over-the-counter enzyme supplement. Before you decide to take an enzyme supplement, get your healthcare provider’s advice. They can help you determine if it’s safe for you.