What Are Digestive Enzymes?

BY AMY CAMPBELL, MS, RD, LDN, CDCES | JANUARY 3, 2023

We all need enzymes to help digest the food that we eat. Enzymes in the digestive tract help to break foods down so that the body can use the nutrients they contain. Without these enzymes, the body can become deficient in nutrients, and that can lead to certain health problems. Sometimes people have trouble making enough of these enzymes or can’t use them properly. If this happens, digestive enzyme supplements are needed.

What do enzymes do?

Enzymes are found in all forms of life, including humans, plants, and microorganisms such as bacteria. Enzymes are proteins that catalyze (cause or accelerate) chemical reactions; in humans, enzymes are needed for numerous reasons, including growth, blood clotting, breathing, digestion, reproduction, and healing.

Our bodies make enzymes, and they’re also found in some foods, such as:

• Papaya
• Pineapple
• Honey
• Mangoes
• Bananas
• Avocados
• Sauerkraut

In addition, enzymes are available in supplement form.

How do digestive enzymes work?

Digestion begins in the mouth once you start eating. Saliva contains an enzyme called amylase that begins to break down carbohydrate. Once you swallow the food, enzymes in the stomach and intestines further break down carbohydrate, protein, and fat. This process allows the body to use nutrients in food for growth and repair.

Digestive enzymes are made by the salivary glands, stomach, pancreas, and small intestines. There are many types of digestive enzymes, and each enzyme has a very specific job:

• Amylase: breaks down starches in grains, beans, and starchy vegetables into sugars
• Lactase: breaks down lactose found in dairy foods, such as milk and yogurt, into sugars
• Maltase: breaks down maltose, found in grains, into sugars
• Sucrase: breaks down sucrose into sugars
• Lipase: breaks down fat into fatty acids

Enzymes that break down proteins into amino acids include:

• Chymotrypsin
• Pepsin
• Peptidase
• Protease
• Trypsin

What happens when there is a lack of digestive enzymes?

Certain health conditions can affect the amount and effectiveness of digestive enzymes. Here are some examples:

• Exocrine pancreatic insufficiency (EPI): This occurs when the pancreas stops making digestive enzymes as a result of diseases that impact the pancreas, such as chronic pancreatitis, pancreatic cancer, cystic fibrosis, and type 1 diabetes.
• Achlorhydria: This means that there is a lack of stomach acid, caused by hypothyroidism, H. pylori infection, certain autoimmune disorders, stomach cancer, or long-term use of some medicines that reduce stomach acid production.
• Lactose intolerance: This happens when the body doesn’t have enough lactase, the enzyme needed to breakdown lactase found in milk and other dairy foods.
• Genetic disorders: Certain genetic disorders, including maple syrup urine disease, prevent the body from making specific types of digestive enzymes.

What are symptoms of a digestive enzyme deficiency?

Symptoms that may suggest a lack of digestive enzymes are:

• Gas
• Bloating
• Stomach pain
• Heartburn
• Nausea
• Diarrhea
• Oily stools
• Weight loss

A lack of digestive enzymes can interfere with nutrient absorption from foods. This may lead to serious health conditions, such as osteoporosis, anemia, or peripheral neuropathy.

How is a digestive enzyme deficiency treated?

If you are lacking in digestive enzymes, you will need to take them as a supplement in order to properly digest food and absorb nutrients.

But before you reach for an enzyme replacement supplement from the drug store, you should have a visit with your health care provider for a proper diagnosis. Your provider may first need to rule other possible causes of your symptoms, such as Crohn’s disease or chronic gastritis. You will likely need to provide a stool sample, as well. If EPI is suspected, your stool will be checked for its fat content. You might also have a secretin stimulation test. A suspected lactose intolerance is done with a breath test or a blood test.

If an enzyme deficiency is diagnosed, you will likely be treated with a prescription medicine called pancreatic enzyme replacement therapy, or PERT. Examples of PERT include:

• Creon
• Pancreaze
• Zenpep
• Ultresa
• Viokace

Are over-the-counter digestive enzymes safe to take?

Stop in at your local drugstore or health food store or do a quick search online and you’ll find a number of digestive enzyme supplements. It may be tempting for you to try one of these, especially if you are experiencing any type of digestive symptoms. However, unlike medications, supplements are not regulated by the Food and Drug Administration (FDA), so there is no guarantee that they’ll be effective or even safe to take.

Many over-the-counter digestive enzymes are targeted to people who have conditions such as irritable bowel syndrome, celiac disease, gluten sensitivity, digestive distress, or autism. At this time, there isn’t enough evidence to support the use of enzyme supplements for these conditions. There is also a risk of side effects; most side effects are mild (nausea, diarrhea, stomach upset), but serious side effects could be an allergic reaction, interactions with medicines, skin irritation or, rarely, a perforated esophagus.

There are two over-the-counter enzyme supplements that are safe to take, however:

• Lactase supplements for lactose intolerance. An example is Lactaid.
• Galactose supplements for an intolerance to beans and cruciferous vegetables. An example is Beano.

In general, it’s best to talk with your health care provider before taking any over-the-counter digestive enzyme supplement.

Is it safe to eat foods that contain enzymes?

Certain foods, when eaten raw, naturally contain enzymes. For example, pineapples contain bromelain, papaya contains papain, and kiwi contains actinidin. However, it’s not clear if you will get any benefit from the enzymes in these foods (however, it’s still fine to enjoy them for their nutrient benefits).

Milk that has been treated with the lactase enzyme is an option for people who have lactose intolerance.

Should people with type 1 diabetes take digestive enzymes?

Unless you have a pancreatic insufficiency, there is no evidence that taking a digestive enzyme supplement will help manage blood sugar levels.