Bowl of yogurt, cooked beans and bread on a table

Digestive Enzymes: What You Need to Know

ByCraig Brockie Last updated

What digestive enzymes are

Digestive enzymes are proteins your body makes to cut food into pieces small enough to absorb. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), proteins are broken into amino acids, fats into fatty acids and glycerol, and carbohydrates into simple sugars. Without that step, most of what you eat would pass through unused.

The work starts in the mouth and runs through the stomach and small intestine. Johns Hopkins Medicine calls the pancreas the enzyme “powerhouse” of digestion, because it makes the three main groups: amylase for starches, lipase for fats and protease for proteins. The lining of the small intestine adds enzymes such as lactase, which splits milk sugar, and sucrase, which splits table sugar.

WhereMain enzymes or juicesWhat they break down
MouthSaliva (amylase)Starches
StomachStomach acid and digestive enzymesProteins
PancreasPancreatic juice (amylase, lipase, protease)Carbohydrates, fats and proteins
LiverBile (not an enzyme, but it helps)Fats
Small intestineIntestinal juice (lactase, sucrase and others)Sugars, starches and proteins
Large intestineGut bacteriaSome food not digested earlier

The table follows the NIDDK digestive process chart, with enzyme names from Johns Hopkins. Food is pushed along this route by muscle contractions, covered in our article on gut motility.

Why they matter for gut health

When enzymes are missing, undigested food moves on to the large intestine, where bacteria ferment it. That fermentation makes gas and can pull water into the bowel, which is why enzyme shortfalls tend to show up as bloating, gas, cramps or loose stools.

Lactose intolerance

The most common example is low lactase. NIDDK explains that if your lactose intolerance comes from lactase nonpersistence, the normal drop in lactase after childhood, no treatment can raise the amount your small intestine makes, so management means adjusting your diet (NIDDK). Lactase tablets or drops can help some people, and NIDDK suggests checking with a doctor first, since some groups, including young children and people who are pregnant or breastfeeding, may not be able to use them.

Yogurt is a useful middle ground. The bacteria in yogurt carry their own lactase, which survives the stomach and keeps working in the small intestine, so lactose in yogurt is digested better than lactose in milk (Savaiano, 2014). Longer fermentation leaves less lactose behind; see lactose remaining after 8 to 36 hours and whether Greek yogurt is lactose free.

Pancreatic problems

When the pancreas cannot make enough enzymes, called exocrine pancreatic insufficiency, fat is poorly absorbed. Johns Hopkins lists chronic pancreatitis, cystic fibrosis, some gastrointestinal surgeries and pancreatic cancer among the causes (Johns Hopkins Medicine). NIDDK notes that people with chronic pancreatitis may have greasy, foul-smelling stools and weight loss (NIDDK).

This is treated with prescription enzymes, not store supplements. Pancrelipase, a prescription mix of pancreatic enzymes, is used to improve digestion in people with pancreatic insufficiency (MedlinePlus), and NIDDK lists enzyme pills among the treatments for chronic pancreatitis (NIDDK).

Rare inherited shortfalls

Some people are born without a working enzyme. In congenital sucrase-isomaltase deficiency, a rare genetic disorder, the body cannot break down sucrose and maltose, and symptoms usually appear once an infant starts eating fruit, juice and grains (MedlinePlus Genetics).

Over-the-counter enzyme supplements

Store shelves carry many enzyme blends sold for gas, bloating and “better digestion.” Johns Hopkins says a healthy person really does not need them, and that claims such as weight loss or a flatter stomach lack supporting evidence (Johns Hopkins Medicine). Unlike prescription pancrelipase, supplements are not approved by the FDA for safety or effectiveness before they are sold (FDA), so the amount of enzyme in a capsule is the maker’s claim.

Two single-enzyme products have targeted evidence:

  • Lactase: in a randomized trial of 60 people with lactose intolerance, tilactase (a lactase enzyme) taken before a lactose test cut breath hydrogen and symptoms compared with placebo. A group given the probiotic Lactobacillus reuteri for 10 days also improved, though less (Ojetti and colleagues, 2010).
  • Alpha-galactosidase: this enzyme breaks down the gas-forming sugars in beans. In a small placebo-controlled study of 8 healthy volunteers who ate a large serving of cooked beans, the higher dose lowered breath hydrogen and flatulence (Di Stefano and colleagues, 2007).

Broader blends are less studied. A 2016 review found that animal-derived pancreatic enzymes are the established standard of care, while plant- and microbe-derived enzymes look promising but need more research (Ianiro and colleagues, 2016). Johns Hopkins adds that there is no definitive evidence yet for enzymes in irritable bowel syndrome, and no real evidence that “enzyme-rich” foods such as pineapple or avocado aid digestion (Johns Hopkins Medicine).

How to choose and use them

Plain white capsules in a small dish beside a glass of water
  • Match the enzyme to the food: lactase for dairy, alpha-galactosidase for beans and some vegetables. A blend with a dozen enzymes is not more useful if one food is the problem.
  • Take it with the food: enzymes work on what is in your gut at that moment, so follow the label on timing.
  • Try food changes first: smaller meals, cooked vegetables and easy-to-digest foods often help, and our list of foods that are hard to digest shows common triggers.
  • Know the difference from probiotics: probiotics are live bacteria; enzymes are proteins that break down food. They are not interchangeable, though yogurt cultures do bring lactase with them.
  • Ask first if you are pregnant, breastfeeding, buying for a child or taking medicines, and do not swap prescription enzymes for store products.

When to see a doctor

Johns Hopkins advises talking to a doctor if belly pain, bloating, diarrhea, gas, oily stools or unexplained weight loss keep coming back (Johns Hopkins Medicine). NIDDK says to seek care right away for severe or worsening abdominal pain, nausea and vomiting, fever or chills, a fast heartbeat, shortness of breath, or yellowing of the skin or eyes (NIDDK). Self-treating with supplements can delay finding the cause. This article is general information, not medical advice.

Related topics

Sources

Craig Brockie is the founder of Ultimate Health Solutions, the company behind Ultimate Gut, and the author of Ultimate Health, The Ultimate Gut Health Guide and The Unlimited Probiotics Guide. After injuries and chronic health problems in his twenties that conventional care didn’t resolve, he began researching health on his own and has studied natural health for 30 years. He is not a medical professional, and his articles are general information, not medical advice.

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