Regulation
In the UK, digestive enzyme supplements are regulated as food supplements by the Food Standards Agency (FSA). However, food supplements are not subject to the same high level of regulation as prescription medications.
Any claims made about the health benefits of food supplements must be supported by scientific evidence. They cannot be misleading or false. For this reason, it may be useful to read carefully through the manufacturer’s information on the product on their website or on the supplement packet.
Read closely and you will find that many companies only explain how digestive enzymes work in the body, but not whether their product can actually do this!
Dose
Measuring the dosage or amount of active ingredients in digestive supplements is also very confusing.
FCC stands for Food Chemicals Codex which is a standardised measurement system used for enzymes found in food products. It measures the amount of enzyme activity needed to achieve a specific chemical reaction under specific condition.
However, different enzymes have different FCC unit measurements. For example, lactase (the enzyme that break down lactose) may be measured in FCC Acid Lactase Units, which is then sometimes shortened to just ALU.
Whether the enzyme was extracted from plants or animals also affects the units used. There are also United States Pharmacopeia (USP) units and European Pharmacopoeia (PhEur) units.
As you can imagine, with all of these different units and labels, figuring out the amount of different enzymes in different products is confusing.
Our experts at TummyMOT are here to help. So, when reviewing digestive enzymes, we will try to compare it to the amounts that were used in scientific studies. However, for the enzymes with less evidence it may be difficult to know what amount is likely to have a beneficial effect.
The evidence
Plant enzymes
Many supplements include enzymes that are not produced naturally by the human body. Mostly, they will come from plants (you can usually tell if the product says ‘suitable for vegans’).
For example, bromelain is an enzyme extracted from pineapple and papain is from papaya. Both of these are protease enzymes, which break down protein. There are some studies in mice and in test tubes to show that bromelain and papain break down protein, but there is no clear evidence that these enzymes can help digestive symptoms.
Betaine Hydrochloride (HCL)
Betaine HCL is not an enzyme, but when mixed with water, it will make the same type of acid that is produced by the stomach. It is commonly added in digestive enzyme products or recommended to take alongside enzymes.
This is because some enzymes work better in an acidic environment. However, this is only true for pepsin, a protease that the stomach produces. Other enzymes, such as amylase and lipase, are denatured by acid meaning they no longer work. This is why enzymes have to be taken quickly with food. Food buffers stomach acid, giving you a window of around 30-minutes where the stomach environment is no longer acidic, and enzyme supplements work.
Some people do have low stomach acid, which can cause digestive issues. However, this is rare, and we have a blog [insert link to blog here] where you can read more about low stomach acid.
Ultimately, our Tummy MOT experts urge you to be cautious of betaine HCL supplements. Without dosing evidence, someone could take too much and potentially damage their stomach or oesophagus lining. However, the opposite is also true, smaller doses may have little effect and merely be a waste of money.
Pancreatic Insufficiency
The pancreas creates many of the digestive enzymes used by the body. If the pancreas does not produce enough enzymes, this can lead to a condition known as exocrine pancreatic insufficiency (EPI). It can be a common complication of some diseases, such as cystic fibrosis or diabetes. Also, around 5% of people with diarrhoea-predominant IBS are thought to have EPI.
Treatment for those diagnosed with pancreatic insufficiency includes enzyme replacement therapy. In the UK, all recognised forms of enzyme therapy are derived from pigs due to the enzyme’s high activity level. For example, the ingredients of a starting dose in pancreatic replacement therapy such as Creon includes lipase 10,000 PhEur units, Amylase 8,000 PhEur units and Protease 600 PhEur units.
Lactase Deficiency
Lactase helps to breakdown lactose, which is the main sugar found in dairy. It’s produced by humans in the small bowel. Lactase activity peaks at birth and usually decreases through adulthood. Although, lactase deficiencyis more common in people from African, Asian and Middle Eastern populations.
Lactase deficiency leads to lactose malabsorption and lactose intolerance. Since lactose is no longer being absorbed properly by your body, it remains in the bowel until it eventually reaches the colon. Here, billions upon billions of microbes (the gut microbiota) ferment the lactose. They produce gas, which can cause symptoms of bloating, wind, and diarrhoea.
Treatment for lactase deficiency is usually centred on avoiding dairy and lactose products. However, lactase deficiency doesn’t mean complete loss of lactase, and many people with lactose intolerance can tolerate around 6-12g in one sitting without symptoms. For example, one serving of Greek yogurt is around 5g of lactose. In fact, people with lactose malabsorption who consume more yogurts regularly can build up their ability to digest lactose easily, probably by introducing more bacteria into the gut that help break down lactose!
Supplementing lactase has been shown to help reduce symptoms. However, the dosage varies across studies. Typically, a dose between 4500-9000 FCC (or ALU) appears to help. Some prebiotics, such as short-chain galacto-oligosaccharides (GOS), as well as probiotics have been shown to potentially help with lactose malabsorption too.
Overall, while digestive enzymes can be beneficial for people with certain digestive disorders, the evidence for their benefits in otherwise healthy individuals is limited. It is recommended that people consult with a healthcare professional before taking digestive enzyme supplements and use caution when selecting and using these products.
