Irritable Bowel Syndrome (IBS) affects around 10-20% of people in North America and Europe. If you have IBS, chances are that your medications aren’t working very well. This is something common in IBS patients, which is why many turn to alternative treatment methods like digestive enzymes.
In this article, we’ll take a look at whether digestive enzymes really work (in the light of science!).
What are digestive enzymes?
Digestive enzymes are proteins that break down large molecules in your diet to aid digestion. They were initially designed for people with pancreatic insufficiency because the pancreas produces most digestive enzymes in the body (although smaller amounts are produced by the salivary glands, stomach, and the small intestine too).
Types of digestive enzymes include:
- Amylase — breaks starch into maltose
- Protease — breaks protein into amino acids
- Lipase — breaks down fat into its constituent fatty acids and glycerols
- Pepsin — breaks down protein and activates other protein-breaking enzymes
- Lactase — breaks down the milk sugar lactose into glucose and galactose
All of these enzymes break down a larger molecule which is difficult to digest (like lactose) into smaller molecules that can easily diffuse through your gut lining (like glucose and galactose).
People with pancreatic insufficiency lack these enzymes and can face uncomfortable abdominal symptoms and malnutrition. This is why digestive enzyme supplements were made — supplementing the body with the enzymes it lacks in the form of a pill or droplet can alleviate the symptoms of pancreatic insufficiency. But how do these help IBS patients if at all? Let’s find out.
Do enzymes help with IBS?
Digestive enzymes do help in patients with IBS. IBS patients are often sensitive to a class of food molecules called FODMAP. Other patients lack the enzyme lactase and can’t digest dairy products including milk, cheese, cream, and yogurt.
As undigested FODMAPs and lactose make their way to the large intestine, they are fermented by bacteria and cause gas accumulation. These substances are also osmotic, which means they increase the water content of the gut. Since IBS patients have heightened gut sensitivity, increased amounts of gas and water lead to uncomfortable symptoms like bloating, pain, and nausea.
Since digestive enzymes can break down FODMAPs and lactose and reduce their delivery to the large intestine, they can potentially reduce the symptoms of IBS.
Let’s take a look at what research says about digestive enzymes and IBS.
Which digestive enzymes work for IBS?
There are many digestive enzymes available in the market, but only two have been studied closely by scientists. These are lactase and alpha-galactosidase, which break lactose and galactooligosaccharide (GOS) respectively.
Lactose deficiency is relatively common in IBS patients, and in these patients, symptoms of lactose intolerance (diarrhea, bloating, and flatulence) are indeed improved by lactase supplements. However, lactase supplements are not effective at treating IBS alone. And this is very important to realize. IBS treatment is holistic and involves medication to treat diarrhea/constipation as well as lifestyle changes like regular exercise and a low-FODMAP diet.
Lactase supplements can serve as an adjunct to these treatments but not a replacement.
The case is similar for alpha-galactosidase. Interestingly, all humans naturally lack alpha-galactosidase. In healthy individuals, GOS (which are found in cashews, beans, soy milk (produced from soybeans), pistachios, and green peas) is fermented by bacteria in the large intestine. This leads to the production of gas and short-chain fatty acids, which are believed to benefit health.
However, since the digestive tract of IBS patients is in sort of an overdrive, excess gas from GOS fermentation leads to uncomfortable symptoms in these patients.
In this study conducted by Monash University, 31 IBS patients on a low-FODMAP diet (except for GOS) were studied. Some patients were given full-dose alpha-galactosidase supplementation, others half-dose, and still others placebo. Patients given full-dose supplementation showed reduced IBS symptoms.
Interestingly, half-dose supplementation did not improve IBS symptoms, emphasizing the need for sufficient enzyme doses for effectiveness.
So how can I use enzymes for IBS?
Before you decide to try a supplement, here are some principles to bear in mind. First, it’s always a good idea to consult a doctor or a dietitian before investing in a product. It’s especially important to review the dosage and ingredients of a supplement with an expert because as we’ve seen, insufficient doses make supplements ineffective. Plus, some supplements contain FODMAPs like polyols, which can make your IBS worse instead of better. These can be identified by an expert.
Second, digestive enzymes are not stand-alone treatments for IBS. They are best used as an adjunct to a low-FODMAP diet, after you’ve identified your sensitivities to lactose or GOS. The goal of digestive enzymes is to allow you to follow a relatively less strict low-FODMAP diet. This will help you consume dairy, which is essential for bone health.
Third, digestive enzymes don’t work for everyone. All IBS patients respond differently to enzyme supplements. It may be a good idea to try them but there’s no guarantee they will work.
Finally, digestive enzyme supplements are not controlled by the FDA. This means it’s important to do extensive research about the quality and efficacy of a supplement before investing in it. Our FODMAP Digestive Enzymes is a good choice because in addition to being high-quality, it breaks down all FODMAPs (instead of just one or two some other supplements target), reducing your chances of IBS symptoms significantly.
Medically Reviewed by Onikepe Adegbola, MD PhD