Enzymes

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Table of Contents
Are Enzyme Supplements Needed?
Enzyme Supplement Potential Side Effects
Enzymes You Produce & Bodily Sources
Food Sources of Enzymes
Enzymes For FODMAPs
– Galacto-oligosaccharides (GOS)
– Fructose
– Polyols
– Fructans/FOS
– Lactose
Enzymes For Gluten
Protein Digestion
Enzyme Dosage
Further Reading And References

Are Enzyme Supplements Needed?

True enzyme deficiency is rare with the exception of lactase which digests lactose found in dairy products including milk. Even if true deficiency happens, those affected are more likely to be malnourished and ill, rather than those with digestive complaints, but otherwise well. Gastroenterologists suggest that over-the-counter enzymes are no more than a placebo at best, tend to lack enteric costing to deliver them to the intestines and will be digested by the body before they can aid digestion of foods. They are quite different to FDA-regulated prescription enzymes. (1)

It is normal for stool to contain intact food particles, particularly fibrous foods such as corn kernels, tomato skins, quinoa grains, whole flaxseeds, raw leafy greens, or fruit seeds. Presence of these does not mean that you are not digesting food. These particles help to bulk out stool and provide feed for beneficial bacteria in the colon. (2)

Poorly formed stools that might resemble shredded wheat suggests food is passing through your system too quickly, meaning there is not enough time for excess water to be drawn from the stool. Reducing raw vegetables and increasing soluble fibres like oats, oat bran, rice, barley, root vegetables (including carrots and potatoes), apple sauce or peeled apples, banana and papaya may help slow down transit. In some cases it is worth discussing with your doctor soluble fibre supplements such as Benefiber, Citrucel or psyllium husk to help to create soft, bulky stools that are easy to pass. (2) However, foods containing soluble fibre should be considered first.

Enzyme Supplement Potential Side Effects

Apart from allergic reaction, there are a number of potential side effects from taking enzyme supplements including stomach pain, headache, gas, constipation, cough, sore throat, diarrhoea, upset stomach, nausea or vomiting, neck pain, stuffy nose, heartburn, ear pain, dizziness and nosebleed (3).

I found that enzyme supplements triggered my IBS pain even in tiny amounts. I wouldn’t necessarily advocate enzyme supplements unless your doctor or consultant has told you that you need them for a specific condition such as pancreatic exocrine insufficiency. A doctor will be able to tell you if you are getting at least enough of the specific nutrients that they look for in blood tests, which may go some way to indicate whether you are breaking down foods correctly. However, I did a great deal of research and my own trials prior to coming to this conclusion, so I have included this research below for completeness. This includes discussion around enzymes for FODMAPs, which some may wish to trial, where available for specific FODMAPs.

Enzymes You Produce & Bodily Sources

By the mouth
- Ptyalin- Converts starch to simple soluble sugars
- Amylase- Converts starch to soluble sugars
- Betaine- Maintains cell fluid balance as osmolytes
- Bromelain- Anti-inflammatory agent, tenderizes meat
By the stomach
- Pepsin- Breaks protein into small peptides
- Gastric amylase- Degradation of starch
- Gelatinase- Degradation of gelatin and collagen
- Rennin- Conversion of liquid milk to solid particles
- Gastric lipase- Degradation of butter fat
By the pancreas
- Pancreatic lipase- Degrades triglycerides into fatty acids and glycerol (fats)
- Phospholipase- Hydrolyzes phospholipids into fatty acids (fats)
- Trypsin- Converts proteins to basic amino acids
- Steapsin- Breakdown of triglycerides to glycerol and fatty acids (fats)
- Chymotrypsin- Converts proteins to aromatic amino acids
- Carboxypeptidase- Degradation of proteins to amino acids
- Pancreatic amylase- Degradation of carbohydrates to simple sugars
- Elastases- Degrade the protein elastin
- Nucleases- Conversion of nucleic acids to nucleotides and nucleosides (mainly found in meats)
By the small intestine
- Sucrase- Converts sucrose to disaccharides and monosaccharides
- Maltase- Converts maltose to glucose (contained in starch is fermented by yeast or enzymes, such as in bread. Some breakfast cereals contain maltose, cooked sweet potatoes, honey).
- Lactase- Converts lactose to glucose and galactose
- Isomaltase- Converts maltose to isomaltose

(4)

Food Sources of Enzymes

Some foods contain enzymes that can help digest meal components including:

Food	Contains Enzyme	Enzyme Function
Pineapple	Bromelain	A type of protease enzyme which breaks down proteins
Papaya (raw)	Papain	A type of protease enzyme which down proteins
Mango	Amylases	Break down carbs from starch (a complex carb) into sugars like glucose and maltose
Honey	Diastases	Break down starch into maltose
Honey	Amylases	Break down starch into sugars like glucose and maltose
Honey	Invertases	Break down sucrose, a type of sugar, into glucose and fructose
Honey	Proteases	Break down proteins into amino acids
Bananas	Amylases and glucosidases	Break down complex carbs like starch into smaller and more easily absorbed sugars
Avocados	Lipase	Helps digest fat molecules into smaller molecules, such as fatty acids and glycerol, which are easier for the body to absorb
Kefir	Lipase	Helps digest fat molecules into smaller molecules, such as fatty acids and glycerol, which are easier for the body to absorb
Kefir	Proteases	Break down proteins into amino acids
Kefir	Lactase	Aids digestion of lactose
Sauerkraut	Various	Various
Kimchi	Proteases	Digest proteins
Kimchi	Lipases	Digest fats
Kimchi	Amylases	Digest carbohydrates
Miso	Lactases	Break down lactose
Miso	Lipases	Break down fats
Miso	Proteases	Break down proteins
Miso	Amylases	Breaks down carbohydrates
Kiwifruit	Actinidain	A protease which helps digest proteins
Ginger	Zingibain	Digests proteins into their building blocks

Source: Adapted from Ryan Raman MS RD (2023) (29)

(29)

Enzymes For FODMAPs

Galacto-oligosaccharides (GOS)

GOS can be found in foods such as beans, pulses and some nuts (5)

Oligosaccharides remain undigested by the body, since the body does not produce the necessary enzyme, α-galactosidase (Alpha-galactosidase), to digest them. They also have a high molecular weight which means they can’t be resorbed by the intestinal wall. Instead they are consumed by bacteria in the lower parts of the intestine producing gas as a by-product and promote the growth of Bifidobacterium. Another side effect is that they can cause diarrhoea if consumed in excess of a particular quantity (6)

Raffinose, a type of GOS, can be found in beans, which contain large amounts with smaller amounts found in cabbage, Brussel sprouts, broccoli, asparagus, other vegetables, and whole grains. (7) Some people may find taking a alpha-galactosidase enzyme found in the product Beano helpful in dealing with GOS such as raffinose found in these foods. Note that Beano contains Mannitol which is also a FODMAP. There is another product called BeanAssist. A study found that alpha-galactosidase reduced gas production from these foods and may be helpful in patients with gas-related symptoms. (23)

Alpha-glucosidase should be be safe for healthy adults. However, it should be avoided if you have diabetes, or a genetic condition called galactosemia, which affects how your body processes sugar. Alpha-glucosidase may raise your blood sugar as it enhances carbohydrate absorption. A class of diabetes drugs called alpha-glucosidase inhibitors blocks the alpha-glucosidase enzyme. Taking alpha-glucosidase supplements may reduce the effectiveness of this class of medications. (24)

Some people find that experimenting with very small amounts of raffinose containing foods such as broccoli every day and gradually increasing intake to see if it is possible to build up tolerance to it (8) (25).

Fructose

In order to utilise fructose, the GLUT-5 transporter must be available in sufficient quantities to carry fructose across the small intestine into the bloodstream. This transporter can only carry so much, so if there is excess fructose, it will end up in the colon where it is fermented by bacteria which can produce symptoms. (19)

Interestingly, in a medical study using MRI imaging, scientists were able to show that while fructose alone was poorly absorbed and distended the small bowel of some IBS patients, when it was combined with glucose, the poor absorption was prevented. (20) This means that fructose is better digested when there is more glucose than fructose. Foods with excess fructose include mango, honey, agave syrup, watermelon, apples, and pears. (19)

The fructose load of a high-fructose food or meal can be lowered by the enzyme xylose isomerase by converting excess fructose into glucose. (14) Xylose isomerase is not produced by the body. (19)

Polyols

There are no enzyme supplements for polyols (sorbitol, mannitol, xylitol etc), since they are not broken down by enzymes before they are absorbed. (9)

Polyols are only partially digested and absorbed in the small intestine. They travel to the large intestine where they may be fermented by bacteria. Water follows the undigested and unabsorbed polyols into the large intestine which can softens stool (10).

Depending on the amount, polyols may cause flatulence, abdominal discomfort and laxative effects when consumed by both IBS patients and healthy subjects (11).

Symptoms from sorbitol and mannitol can relate to their osmotic (ability to attract water) properties. Healthy volunteers and IBS patients can experience worsened symptoms when sorbitol and mannitol are consumed alongside fructose. (12) Polyols are absorbed by diffusion (spreading of particles from one substance to another), which varies across the intestine and by individual. If the polyol is too large for diffusion, malabsorption may occur resulting in fermentation by bacteria or increased osmotic load leading to small intestine fluid retention. (15)

Interestingly, IBS patients seem to absorb twice the amount of polyols, than healthy people and absorption occurs more quickly for mannitol than for sorbitol. However, healthy individuals do not show any difference in their rates of absorption between mannitol and sorbitol. (13)

Erythritol does not normally lead to gastrointestinal changes, whereas mannitol may cause changes at 10g to 20g daily for adults. Xylitol may be better tolerated but safer doses vary widely for each individual between 20g to 70g per day. Lactitol and isomalt may also lead to similar gastrointestinal issues. (16)

The frequent consumption of foods containing polyols may increase tolerance and decrease negative effects, by the rise in bacteria capable of metabolising the polyol over time. Many people may adapt to polyols after a few days as is the case with increasing other high fibre foods. (10)

Fructans/FOS

Fructans consist of chains of fructose sugars joined together with a glucose molecule at the end. They must be broken down into these simple sugars in order to be fully digested. Humans do not possess the enzyme necessary to break the bonds between these simple sugars, so they end up in the colon where they undergo fermentation by gut bacteria (Bifidobacterium and Lactobacillus). These bacteria produce the 2,1-β-d-fructan-fructanohydrolase enzyme which helps to break the fructans apart. (19).

The fructan hydolase enzyme, produced by bacteria and which breaks down fructans is available in the product FODZYME.

A “Journal of the American Dietetic Association” study from June 2010 found that fructans were better tolerated at daily consumption amounts of under 10 milligrams per day of inulin and less than 5 grams per day of oligofructose. (17)

Fructanase enzymes from good gut bacteria break down fructans into fructose. It is to be noted that fructose generated by bacteria and directly from the diet can increase intestinal permeability, induce metabolic syndrome (a cluster of risk factors for cardiovascular disease) and encourage the development of insulin resistance (18). This is more related to high fructose intake. Fructans should not be avoided just for this reason since they are highly beneficial to health, as they stimulate of beneficial bacteria (e.g. Lactobacilli and Bifidobacterium), provide relief from constipation, lower of blood glucose levels, improve mineral uptake, reduce blood serum triacylglycerol levels, reduce colon pH, increase production of SCFAs, reduce risk of colon cancer, stimulate the immune system and inhibit growth of pathogenic microorganisms. (28)

Lactose

Lactose found in dairy products consists of the sugars glucose and galactose. Lactase enzyme helps to digest lactose. If the body produces insufficient lactase enzyme, lactose passes unabsorbed into the colon where is is fermented by bacteria, which can lead to gas and bloating. Once in the colon, lactose can be osmotic (drawing fluid into the colon), which can cause diarrhoea in some people. (19)

Lactase (B-galactosidase) enzyme supplements can be used to help digest lactose, breaking it down into its component sugars, glucose and galactose. (19)

Enzymes For Gluten

Enzymes to digest gluten are still under research. There is an interesting article discussing this here.

Protein Digestion

Some people feel they have a problem digesting meat, but it could be their portion sizes are much too large. A portion of meat should be around 3oz or the size of your palm. (26)

This article discusses protein digestion: (27).

Enzyme Dosage

The information below is from a website that is no longer available: (21), (22). However, the information seemed useful so I have included some the points below:

When taking enzymes start with a partial dose and work up to a full dose.
Capsules are preferable since they can dissolve in the stomach releasing enzymes to help break down food in the stomach before the food passes to the small intestine. Alternatively the capsule can be opened and mixed with any food or drink. They need to be in contact with food to work.
Take enzymes during the start of a meal.
Enteric coated tablets won’t start working until they reach the intestines and the coating has dissolved.
Capsules are either vegetable-based (veggie) or gelatine-based. Some find it better to wait 20-30 minutes to allow time for veggie capsules to dissolve. Gelatine-based dissolve straight away.
Some find it better to mix the enzyme with food. It is a case of experimenting.
If your gut is compromised you may need a product that is low in proteases, since proteases can be irritating. Proteases can also produce die off reactions from bad bacteria, yeast, parasites, and viruses. They also heal tissue and clean out wounds, which is beneficial but may cause issues which might take 1 day to over 4 weeks to resolve. Some people get reactions, but others may not.
A low protease broad-spectrum product could be commenced with and introduce the stronger protease product at a later date, once the body is more acclimatised to the enzymes.
Try the broad spectrum product as 1/2 capsule at two meals on day 1, then all meals on day 2, then one full capsule at each meal on days 3 and 4.
It is possible to go even slower starting with 1/4 capsule per day, with increments of 1/4 capsule every 3 days, until an entire capsule is reached by day 10, then increased by approximately 1/2 capsule every 4 days until reaching the therapeutic dose of 1 capsule with each meal by day 25.
Allow 1-3 weeks for preliminary gut healing to occur before adding strong proteases, which can be introduced in the same manner.

(21)

Based on the above advice I tried Digest Basic since it has a lower amount of proteases. I started with 1/4 capsule as suggested. Even at this level it triggered my IBS pain.

There is a suggestion to try enzymes for two to three months. Since I couldn’t get this far I couldn’t back this up with my own experience and as previously mentioned pancreatic exocrine insufficiency, where the body does not produce enough enzymes, is a rare condition.