Surely these digestive enzymes I’ve found can help – or are they money down the toilet?

You may be aware of ‘digestive’ enzymes and if you are currently in ‘gut hell’ you might have considered these of use. This post will give you the facts about digestive enzymes and whether they are of real benefit to everyone – or just those with a real clinical need!

I apologise now, but we have to discuss the business of stools (poo,) so if you are not happy with this I suggest you choose some of my other posts to read! Our bodies are generally very effective at producing enzymes, substances in our gut, which help break down the food we eat and allow it to pass into our bodies. Sometimes these do not work as effectively, or our bodies start to produce less, or we may have a genetic (family) link, which means our bodies don’t produce the enzyme at all (as with some Lactose Intolerance.)

You may have noticed that food passes right through your digestive tract and looks very similar when it comes out – to when it went in, this can be a bit shocking! Typical examples are sweetcorn. You may feel that digestive enzymes are therefore needed to help to break down the food you have eaten so you can utilize the nutrition it contains. Recognizable food in stools can suggest that you are not chewing your food well enough – your digestive tract mixes food, but past your mouth it does not have teeth!! So ensure you chew each mouthful well, this may reduce symptoms of bloating & pain and helps your body to get all the nutrients from the food you eat.

The picture ‘The Bristol Stool Chart‘ helps you identify the types of stool your body produces to help you to modify your diet to keep your gut healthy. 6927778-3x4-700x933Now ☺️ do you look in the toilet pan? Or are you a bit squeamish about matters below 😲 ? Not looking is NOT an option, how do you know that you are leaving the lav in a clean condition for the next user, if you flush and run? Going to the loo is a natural part of life, and for your health, you need to look – so get over it! The chart is about consistency, type 1-3 and you are constipated, check out post on fibre, type 4 is normal and type 5-7 means you have diarrhoea. This chart will be discussed in more detail in future posts.

So, have you heard also that digestive enzymes can help reduce the dreaded bloating that sometimes occurs? Who have you heard that from, producers of digestive enzyme ‘health’ supplements? Have you asked them how they know that the supplements they make are effective? – Do they put them through rigorous randomised controlled trials? Probably not.

We need to discuss digestive enzymes in two distinct areas – lactose and fructose intolerance and FODMAPs are a specific case and will be dealt with separately. But, how effective are ‘mixed’ digestive enzymes? Well, medications recommended by doctors are very effective, and if you doctor has prescribed pancreatic enzymes (containing lipase, amylase, proteases) to help with a medical condition, then you need to take them. If your body is producing ‘floaty’ greasy stools and you need to flush the loo more than once and they don’t go away, or your stools are very pale, like the colour of clay, then I would advise a trip to the doctors to get this investigated further. However mid brown stools are normal and should not require any ‘over the counter’ digestive enzymes to help your digestion. Diarrhoea means that your food is moving too quickly through your body, this may mean that you don’t get the full benefit of food, however this needs treating by a doctor, to resolve the situation – they may advise you see a dietitian. Any blood in stools, or black coloured stools (when not taking iron supplements) needs a trip to the doctors, with some urgency! Health food supplements containing mixed ‘digestive enzymes’ are generally not that effective, as the doses they contain are not adequate to be of any real use, and some ‘health food’ brands do not even state how much enzymes are in their product – positive obfuscation! How unhelpful :-(. I wouldn’t waste your money on these supplements, all they are good for is reducing your bank balance. Your doctor will prescribe you pancreatic enzymes should they be necessary.

Some food we eat never gets digested and these are generally starches that form part of the fibre in our diet. Our bodies do not produce the type of enzymes to help their digestion, examples are Fructo-oligosaccharides, sugar alcohols, Galacto-oligosaccharides. Sometimes they can be problematic if you are prone to bloating (See FODMAPs link below.) Since writing this post links to a website producing Fructosin a supplement that is suggested to help with fructose malabsorption has been removed and the company website has no reference to this supplement, so I can only assume they no longer supply this product. I will keep looking for this and post again if their is an update.

For galacto-oligosaccharides a product called Beano has been available for some time, but not widely in the UK, this may be worth considering but again efficacy may not be guaranteed for all. You need to check the labels of these products for other FODMAPs, such as polyols (sorbitol, mannitol, xylitol) – no enzyme helps with polyol digestion unfortunately.

Lactose intolerance is a condition where the body does not produce enough of the enzyme lactase to digest lactose (a sugar found in milk,) it can be as a result of a genetic family link and sometimes can occur after gut infections or as a result of coeliac disease (this usually resolves on following a strict gluten-free diet.) Lactose then ferments in the gut leading to lots of bloating and diarrhoea. The amount of lactose that is tolerated varies and lactase supplements are suggested to be helpful. The reference below is a very good piece of work on the effectiveness of lactase supplements, they need to be taken with the food and the study suggests that they are not that effective in manufacturers recommended doses, enteric coated* tablets are better. This is only true for the supplements that were tested, but it is worth a read. Other recent studies suggest that they might be of benefit, again we have an example of medical dichotomy so how do we resolve it? Looking at the harm of products might help, do lactase supplements cause harm? Probably not in doses advised for most people, therefore if you wish to try them as long as you are happy to buy them with the possibility that they may not work, I don’t have a problem with it! However if you suffer from galactosaemia you should avoid using enzymes to help milk digestion see the link below for more information. We are always questioning the efficacy of treatments by undertaking studies and new advice is always welcome, it is not that the medical community are always changing their minds without good cause.

* allows supplement to pass through your stomach unchanged to where it’s needed, – your small intestine.

O’Connell, S., Walsh, G., (2005) Physicochemical Characteristics of Commercial Lactases Relevant to Their Application in the Alleviation of Lactose Intolerance Applied Biochemistry and Biotechnology Vol. 134, 2006 (revised)

Post updated May 2016

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I am a state registered dietitian. My speciality is dietary treatment of gut disorders such as irritable bowel syndrome, crohns disease, ulcerative colitis, coeliac disease, lactose & fructose malabsorption and multiple food intolerances. I have had lots of experience in other areas of dietetics and I wished to start this blog to spread the word about evidence based dietary treatments and dispel much of the quackery that is common with these diseases. All information on this site is of a general nature and is based on UK based treatments and guidelines. Please see your healthcare practitioner should you need more country specific information.

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