If you have Irritable Bowel Syndrome (IBS) and are looking to tolerate FODMAPs better, this article will walk you through some of the enzyme supplements you can take, how to use them, and their side effects.
IBS is a common gut condition characterized by long-term abdominal pain. While there is no “structural” abnormality at play in IBS, the pain of IBS is considered real. Doctors use the Rome criteria to diagnose the condition and several medical treatments exist to control it.
Sometimes, medical treatment doesn’t work as expected. At other times, patients might want a little bit of dietary freedom. In both these cases, digestive enzyme supplements may be helpful.
What are FODMAPs?
FODMAP is an abbreviation for fermentable oligo-, di-, mono-saccharides and polyols.
They are basically sugars that are resistant to digestion. Most of the food you eat is broken down into smaller molecules and absorbed in the small intestine. Some foods, like fiber and FODMAPs, cannot be broken down by the body.
As a result, most FODMAPs pass unchanged to the large intestine, where they are digested by colonic bacteria. These bacteria produce hydrogen gas during this process, which leads to bloating, gas, cramping, and constipation.
While this effect is seen in healthy individuals too, it becomes exaggerated in IBS patients because of heightened gut sensitivity.
Also, many FODMAPs are osmotic, which means they pull water into the large intestine. This can lead to diarrhea.
If you have IBS and experience symptoms after eating the following high-FODMAP foods, you will benefit from a low-FODMAP diet and FODMAP Digestive Enzymes:
- Grains like rye and barley
- Fruits — apples, cherries, pears, watermelon, peaches, and many more
- Dairy products (contain lactose)
- Vegetables — broccoli, beetroot, cabbage, garlic, onions, and many more
- Legumes
- Beer, high-fructose corn syrup, soy milk, and fruit juices
So let’s take a look at some of the available digestive enzyme supplement options.
What enzymes break down FODMAPs?
Common types of FODMAPs include fructose, lactose, polyols, fructans, and galactans. And theoretically, there could be an enzyme for each of these. However, only a few options exist commercially. One popular enzyme is alpha-galactosidase, which is commercially available as Beano (other brands exist too). This enzyme breaks down galacto-oligosaccharides (GOS), which are sugars that make up the ‘O’ of FODMAP. GOS are found in foods like nuts, beans, soy milk, cashews, and pistachios, so if you experience abdominal discomfort after eating these, an alpha-galactosidase supplement may be helpful.
Note that Beano contains polyols, the ‘P’ in FODMAP, and can make your symptoms worse if you’re intolerant to polyols. In this case, switch to another alpha-galactosidase supplement or choose a general supplement that works on all FODMAPs.
Xylose isomerase is another supplement available commercially and breaks down fructose. Fructose makes the ‘M’ of FODMAP, and is found in most fruits and honey. If you feel sick after eating fruits or honey, you may have fructose intolerance, and a xylose isomerase supplement like Fructaid may be helpful. One cause of fructose intolerance is an enzyme deficiency. This is called hereditary fructose intolerance and while it’s rare, enzyme supplements are not suitable if you have it.
Finally, lactase is another enzyme commercially available. Lactase breaks down lactose, which is found in dairy products. Many IBS patients are also lactose-intolerant, which means they naturally lack lactase and experience abdominal discomfort after consuming dairy. In these patients, a lactase supplement can help reduce IBS symptoms and allow greater freedom when it comes to enjoying dairy foods.
These enzymes work only on one component of FODMAPs. If you feel you’re intolerant to multiple FODMAPs, you can try a combination supplement that contains a mixture of these enzymes.
What enzymes break down fructans?
Currently, there are no commercial supplements available to break down fructans. Fructans are long chains of fructose with a glucose molecule at the end. They make up the ‘O’ of FODMAP, and are found in foods like garlic, onion, bananas, wheat, asparagus, and processed foods. Many IBS patients are intolerant to fructans and if you feel abdominal discomfort after eating these foods, you may have it too. Since there are no enzyme supplements that break down fructans, the best way to deal with fructan-intolerance is a low-fructan diet. This is where you identify specific foods that trigger your symptoms and eliminate them from your diet.
You shouldn’t eliminate all fructans from your diet since they increase the number of healthy bacteria in the gut and have been linked to a number of health benefits such as an improved lipid profile.
What is the enzyme that breaks down protein?
Protein is broken down by the enzyme protease. Protease enzymes may not help IBS patients because proteins are not a component of FODMAP. However, those with food allergies may find protease enzymes very useful. Food allergy is the body's reaction to a protein in the diet, which the body considers foreign. Larger proteins are more likely to trigger this reaction. A protease supplement will break down dietary proteins into smaller fragments, which are more likely to slip under the immune system’s radar.
Do digestive enzyme supplements have side effects?
While enzyme supplements are generally considered safe, they can sometimes cause:
- Nausea
- Constipation
- Headache
- Vertigo
- Weight loss
- Diarrhea
Rarely, an enzyme supplement may trigger serious side effects like:
- Severe abdominal pain
- Allergic reaction, characterized by facial swelling and difficulty breathing
Both of these require urgent medical attention.
Things to keep in mind when using digestive enzyme supplements
Digestive enzyme supplements don’t work for everyone. It’s a good idea to begin a 2-week trial with your desired product and see if your symptoms improve. If they don’t, consider talking to your doctor and changing your supplement. It’s also very important to review a product and its dosage with an expert (doctor or dietitian) before investing in it. Research shows that inadequate doses of enzyme supplements make them ineffective.
Finally, digestive enzyme supplements work best with a low-FODMAP diet. They are meant to help you tolerate the “hidden” FODMAPs that you may consume unknowingly. Supplements are not a replacement for a low-FODMAP diet and medical treatment for IBS, which is something useful to keep in mind!
