While the body produces digestive enzymes on its own, poor nutrition and other lifestyle factors can impede the production of these essential digestive components.  

THE MAIN TYPES OF DIGESTIVE ENZYMES 

While digestive enzymes are made in the mouth, stomach, and small intestine, they are predominantly produced by the pancreas. There are three major types of digestive enzymes: 

• Amylase: Enzymes that digest starches. Insufficient amylase can lead to diarrhoea. 
• Protease: Enzymes that digest proteins. Patients with an insufficient amount of lipase will be lacking in fat-soluble vitamins such as A, D, E, and K. 
• Lipase: Enzymes that digest fats. A shortage of protease can lead to allergies or toxicity in the intestines. 

“These enzymes are responsible for breaking down the three major dietary components of the foods that we eat so obviously, they are vital to life,” said Dr Bruce Weiner (Cleveland Clinic nutrition director). A lack of digestive enzymes can lead to a variety of gastrointestinal symptoms such as bloating, cramping, gassiness, irritable bowel type symptoms, diarrhoea, constipation, gut microbiota dysbiosis, food allergies and intolerances, feeling full after only a few mouthfuls, and can even lead to malnutrition.  

“Often these deficiencies can be addressed with dietary changes, such as restricting certain foods or adding those with naturally occurring digestive enzymes, or by taking prescription or OTC enzyme supplements,” Dr Barbara Bolen said in Types and Functions of Digestive Enzymes (published on Verywell Health).  

“In some, the lack of enzymes can become a chronic insufficiency,” Dr Michael Ash cautioned in Digestive enzymes (published on ClinicalEducation.org). “The wider impact of digestive enzyme deficiency on health includes obesity, allergies and poor immune function, depression and anxiety, premenstrual syndrome, fatigue, autoimmune conditions such as coeliac disease, and ulcerative colitis and Crohn’s disease.  

“It’s important to bear in mind that as we age, or indeed experience chronic sub-optimal health, our digestive function deteriorates. The appropriate use of enzymes in the ageing population may well help prevent nutrient deficiencies and even inflammatory conditions,” he said.  

SUPPLEMENTATION 

“Digestive enzyme supplements can come in pills, powders, or liquids sourced from animals, plants, or microbes,” Dr Bolen explained. There are also prescription and OTC supplements. “Medicinal enzymes are combinations of amylase, protease, and lipase that can help people with enzyme deficiencies to digest food. Typically, we can adjust the doses for each patient’s clinical needs,” said Dr Weiner.   

OTC ENZYMES: If your patient’s main symptoms are gas or bloating, they probably don’t need a prescriptive fix and can use OTC remedies. According to dietician Eliza Savage: “OTC digestive enzymes supplements can be an effective and reliable treatment for various gastrointestinal concerns, like IBS, low stomach acid, or age-related enzyme insufficiency,” (The 7 Best Digestive Enzymes of 2021, published by Verywell Health).   

PRESCRIPTION ENZYMES: Prescription enzyme supplements are indicated for conditions that affect the functioning of the pancreas, such as chronic pancreatitis or pancreatic cancer.  

Scientific research supports the role of digestive enzyme therapy in health maintenance, with particular benefits for digestive and joint disorders. “Through a comprehensive approach to treating gastrointestinal distress should involve more than just enzymes, you should always include a good-quality digestive enzyme in your repertoire of treatment options,” Dr Todd Singleton advised in Digestive enzymes primer: patient benefits for pain and healing (published in Chiropractic Economics). A patient’s age, weight, and other things determine the right dose.  

Certain medications can interfere with digestive enzymes. For example, the effectiveness of oral digestive enzymes may decrease when they are given calcium or magnesium-containing antacids. As such, it’s important to check what other medications and supplements a patient is taking before making any recommendations.