Should you take digestive enzymes with IBS

Hello and welcome to episode 67 of the Inside Knowledge podcast. I’m Anna Mapson. The reason I’m talking about digestive enzymes today is that they are one of the main parts of our chemical digestion. So we have a mechanical digestion process by using our teeth to crunch up the food and using our stomach, which is a muscle, to mash up the food and mix it all together with juices.

We also have chemical digestion, which starts with our stomach acid. Enzymes are compounds that help us break down food so that we can absorb it better, get the nutrients into our cells, and use them effectively.

In this session, I’m going to cover different types of enzymes and where they are produced. I’ll also discuss why you might have issues creating digestive enzymes and touch on supplements—which types might help, when you should take them, and when you definitely shouldn’t.

Where digestive enzymes are produced

Digestive enzymes are produced throughout the digestive process, starting in the mouth. For instance, we have salivary amylase, which begins to break down carbohydrates. There is some fat breakdown in the mouth as well. Then, in the stomach, we have gastric enzymes. The pancreas produces pancreatic enzymes, and finally, the small intestine produces brush border enzymes as food is further broken down.

Starting with salivary amylase, this is why chewing your food thoroughly is important. The first stage of digestion happens in the mouth, both mechanically through chewing and chemically through saliva. You might notice this if you chew something like white bread or rice for a long time—it starts to taste sweet because saliva breaks down the glucose in the grains.

In the stomach, we have gastric enzymes like pepsin, which starts breaking down protein. Your stomach cells release pepsinogen, and when it mixes with stomach acid (hydrochloric acid), it activates into pepsin, which is the active enzyme breaking down proteins. Later in this episode, I’ll talk about whether you should take digestive enzymes containing pepsin or hydrochloric acid.

The role of pancreatic and brush border enzymes

Moving into the small intestine, pancreatic enzymes such as amylase (for carbohydrates), lipase (for fats), and proteolytic enzymes (for proteins) are delivered here. The small intestine is more alkaline compared to the stomach. Lipase, for example, can be denatured by stomach acid, but our body delivers it to the small intestine, where it can function effectively.

The small intestine also produces brush border enzymes, which are found on tiny villi lining the intestine. These include lactase, maltase, and sucrase, which break down specific sugars. For example, lactase breaks down lactose. This process ensures that food is broken into single molecules, such as glucose, for absorption.

Why you might lack digestive enzymes

If you have issues breaking down carbohydrates, it could be due to insufficient salivary amylase or pancreatic amylase production. For fats, it could be related to enzymes from the pancreas or small intestine. Protein digestion depends on having enough stomach acid to activate pepsinogen into pepsin.

One major reason for insufficient enzyme production is poor pancreatic function. This could result from conditions like pancreatitis or pancreatic cancer, which is often a concern for people. If you’re worried, it’s crucial to speak to your doctor and get it checked. Another reason could be microbial interference in the small intestine, such as from small intestinal bacterial overgrowth (SIBO). This can disrupt enzyme production, leading to issues like lactose intolerance or difficulty breaking down other sugars.

Symptoms of enzyme insufficiency

Common symptoms of pancreatic enzyme insufficiency include weight loss, greasy stools (steatorrhea), and diarrhoea with a yellow or green colour. Greasy stools may appear frothy or have oil floating in the toilet. These symptoms indicate insufficient breakdown of fats.

If you suspect enzyme insufficiency, a stool test can measure pancreatic elastase levels. Anything below 200 micrograms per gram indicates an insufficiency. Your GP or a private provider can arrange this test. If diagnosed, you might be prescribed a medication like Creon, which contains enzymes for digesting fats, proteins, and carbohydrates.

Should you take digestive enzyme supplements?

Supplements can help if you know which enzyme you’re lacking. For example, alpha-galactosidase targets galacto-oligosaccharides found in beans and pulses. Lactase supplements are useful for dairy digestion. A general digestive enzyme supplement typically covers proteins, fats, and starches, which is a good starting point if you’re unsure about your triggers.

There is also a product called Fodzyme, which targets FODMAP foods like GOS, lactose, and fructans. However, it doesn’t cover polyols or fats, and it’s more expensive than other options. Fodzyme works quickly as it’s mixed with food and starts acting in the stomach. Most supplements, however, can’t be sprinkled on food and must be taken with meals to avoid irritating the stomach lining.

Timing and precautions for taking digestive enzymes

Take digestive enzymes at the beginning of your meal. Have one bite of food, take the supplement, and continue eating. This helps activate digestion effectively. Taking them after a meal is still better than not at all, but starting with the supplement is ideal.

Avoid taking digestive enzymes during elimination diets like the low FODMAP diet. During food reintroductions, you need to observe your natural reaction to foods without interference from supplements.

Finally, be cautious with supplements containing pepsin, as they can aggravate conditions like gastritis or ulcers. It’s better to work on improving your body’s natural enzyme production than rely on supplements containing pepsin or hydrochloric acid.

Closing thoughts

I’ve tried to keep this session concise while packing in as much information as possible. If you have questions, feel free to email me at info@goodnessmenutrition.com or send me a DM on Instagram at @goodnessme_nutrition. If you have suggestions for future episodes, I’d love to hear them.

Thanks for listening to this episode. Better digestion for everyone!