Do digestive enzyme supplements really work? Experts respond

When people eat foods they love, sometimes that love isn't reciprocated by those treats, causing digestive discomfort that leads them to look for a remedy.

Sometimes this comes in the form of digestive enzyme supplements — but whether people should take them and how well they work depends on how you're sourcing the products, your health status, and more.

Digestive enzymes that occur naturally in the body “break down our food so that we can absorb the nutrients needed for our bodily functions,” says Caroline Tuck, a nutritionist and senior lecturer in dietetics at Swinburne University of Technology in Melbourne, Australia, via e- mail.

Digestive enzymes are produced in the pancreas, small intestine and stomach, according to Johns Hopkins Medicine. The main enzymes produced by the pancreas are amylase, which breaks down complex carbohydrates; lipase, which digests fats; and proteases, which break down fats. The enzymes lactase and sucrase, produced in the small intestine, break down milk sugar and sugar, respectively. Pepsin, produced in the stomach, is the main enzyme involved in the digestion of proteins.

Most manufactured digestive enzymes, on the other hand, are derived from pig pancreas, said Deborah Cohen, associate professor in the department of clinical and preventive nutritional sciences at Rutgers University in New Jersey, in an email.

But there are some plant-based alternatives, such as bromelain from pineapple or papain from papaya, and enzymes extracted from various microbes or yeasts, Cohen added.

Despite the body's ability to produce digestive enzymes, research has shown that the market for these products is growing, estimated at almost US$700 million (about R$3.4 billion) in 2021 and expected to reach US$1.6 billion (around R$7.95 billion) by 2031, said Akash Goel, clinical assistant professor of medicine at Weill Cornell Medicinein New York.

Here's what you should know to determine if these supplements are worth it.

Prescription versus Over-the-Counter Digestive Enzymes

A key difference between prescription and over-the-counter digestive enzymes is that the FDA (Food and Drug Administration) of the United States regulates the former as medicines, “so that they go through a rigorous approval process, including extensive testing with safety and efficacy data,” Goel said in an email.

This rigorous process ensures that products are of pharmaceutical or prescriptive quality, Cohen said, and that the dose of active ingredient is therapeutic enough to treat the patient's symptoms.

Studies have demonstrated the effectiveness of prescribed pancreatic enzyme supplementation, Goel said.

But over-the-counter supplements are regulated like foods, so “there is a lot less standardization and quality control in terms of ingredients,” Goel said.

As a result, the source and dose of an active ingredient — or whether the product actually contains the active ingredient — are at stake, Cohen said. Supplements also tend to have less active ingredient than prescriptions.

“That’s the problem with supplements and digestive enzymes,” she added. “[As marcas] they can say whatever they want in TV ads, in magazines or in [redes sociais]…And that’s perfectly legal. But whether that’s true or not is a totally different story.”

Because supplements don't undergo FDA approval, those that have been third-party tested are safer bets, experts say. These could include the NSF certification – which claims to have the only national standard that establishes requirements for ingredients in dietary and nutritional supplements – the U.S. Pharmacopeia or ConsumerLab.com.

It is also important that over-the-counter enzymes have what is called an enteric coating.

“The enteric coating protects the enzymes, which are proteins, from being digested by the acid contained in and secreted by the stomach,” Cohen said, so that “the enzyme can safely reach the small intestine, where it does its main work.”

Some commonly used over-the-counter enzymes have long been known to work. These include Lactaid It is Beano, used by people who are lactose intolerant or who experience gas or bloating after eating vegetables, respectively. “Beano contains alpha galactosidase, an enzyme that our bodies do not produce,” Tuck said.

Regardless of whether you are taking prescription or over-the-counter digestive enzymes, guidance from a professional on the best time to take and dosage is key, Cohen said.

When is it good to take digestive enzymes?

By itself, the body must produce sufficient levels of digestive enzymes to assimilate nutrients, Goel said. But when this does not happen, due to deficiencies evidenced by a stool test performed by a doctor, prescribed digestive enzymes are the main treatment.

“Prescription enzymes are primarily used by individuals diagnosed with cystic fibrosis and exocrine pancreatic insufficiency,” Cohen said. Cystic fibrosis is a disease that damages the lungs, digestive tract and other organs, while exocrine pancreatic insufficiency is a condition in which the small intestine cannot completely digest food due to problems with pancreatic enzymes.

Signs of digestive enzyme deficiency include diarrhea, stomach pain, bloating, unexplained weight loss and greasy, oily poop that floats, experts said.

People with these diagnoses are really the only ones with a clinical or legitimate need for digestive enzyme products, Cohen said — especially prescription ones, as, again, they are more likely to receive the precise dose needed.

“If there are no medical problems or established food intolerances, digestive enzyme supplements are not necessary,” Tuck said.

Some healthy people take digestive enzyme supplements after a heavy meal, thinking they will have difficulty digesting the food. But the body can digest a heavy meal just fine, Cohen said. It turns out that food can slow the process and cause bloating or gas, she added — so not overdoing it is a better choice than taking a supplement.

If you accept them anyway, she added, most of the danger lies in the possible waste of your money.

But if you consume them for digestive problems you face regularly, you should consult a gastroenterologist or your doctor as you may be masking symptoms and delaying diagnosis and needing supervised treatment, experts said.

Can digestive enzyme levels be improved naturally?

If you have enzyme deficiencies, nothing can be done to improve levels naturally, Cohen said. Consequently, the only options are to take prescribed digestive enzymes or avoid foods that you cannot digest due to their deficiencies.

But if you're a healthy person, you can improve your overall digestive health, including not eating meals that are so taxing on your system.

“Something we as registered dietitians hear a lot is 'I have trouble digesting food' or 'I have slow digestion' when what they actually have is constipation,” Cohen said. “Digestive enzymes do not help with constipation.”

What can help is avoiding processed and highly refined foods and consuming a diet rich in whole, plant-based foods, with fish and lean meats in moderation, Goel said.

Goel also recommended complying with the United States exercise guidelines and North American guidelines for fiber intakeas well as regular sleep and rest, being exposed to nature and spending time with loved ones.

“Managing stress through various practices that can include meditation but also recreational activities that bring joy,” he added, “is key.”