Do digestive enzyme supplements really work? Experts weigh in

By Kristen Rogers, CNN

(CNN) — When people eat foods they love, sometimes those treats don’t love them back, causing digestive discomfort that has them reaching for a remedy.

At times, that’s in the form of digestive enzyme supplements — but whether people should take them and how well they work depends on how you’re getting the products, your health status and more.

The digestive enzymes naturally occurring in the body “break down our food so that we can absorb the nutrients required for our bodily functions,” said Dr. Caroline Tuck, a dietitian and senior lecturer in dietetics at Swinburne University of Technology in Melbourne, Australia, via email.

Digestive enzymes are made in the pancreas, small intestine and stomach, according to Johns Hopkins Medicine. The main enzymes produced by the pancreas are amylase, which breaks down complex carbohydrates; lipase, which digests fats; and proteases, which break down fats. The enzymes lactase and sucrase, made in the small intestine, break down dairy sugar and sugar, respectively. Pepsin, made in the stomach, is the main enzyme involved in the digestion of protein.

Most manufactured digestive enzymes, on the other hand, are derived from hog pancreas, Dr. Deborah Cohen, an associate professor in the department of clinical and preventive nutrition sciences at Rutgers University in New Jersey, said via email.

But there are some plant-based alternatives, such as bromelain from pineapple or papain from papaya, and enzymes extracted from various microbes or yeast, Cohen added.

Despite the body’s ability to produce digestive enzymes, research has shown the market for these products is booming, estimated at nearly $700 million in 2021 and expected to hit $1.6 billion by 2031, said Dr. Akash Goel, a clinical assistant professor of medicine at Weill Cornell Medicine in New York City.

Here’s what you should know to determine whether these supplements are worth it.

Prescription vs. over-the-counter digestive enzymes

A key difference between prescription and over-the-counter digestive enzymes is that the US Food and Drug Administration regulates the former as drugs, “so they undergo a rigorous approval process including extensive testing with safety and efficacy data,” Goel said via email.

This strict process ensures the products are pharmaceutical or prescriptive grade, Cohen said, and that the dose of the active ingredient is therapeutic enough to treat a patient’s symptoms.

Studies have shown the effectiveness of prescribed pancreatic enzyme supplementation, Goel said.

But over-the-counter supplements are regulated as food, so “there is much less standardization and quality control in terms of ingredients,” Goel said.

As a result, the source and dose of an active ingredient — or whether the product even actually contains the active ingredient in the first place — are up for grabs, Cohen said. The supplements also tend to have less of the active ingredient than prescriptions do.

“That’s the issue with supplements and digestive enzymes,” she added. “(Brands) can say whatever they want on TV ads, on magazine ads or on (social media) … and it’s perfectly legal. But whether or not it’s true is a whole different story.”

Because supplements don’t undergo FDA approval, those that have been tested by a third party are safer bets, experts said. These could include the NSF — which says it holds the only national standard that establishes requirements for the ingredients in dietary and nutritional supplements — the US Pharmacopeia or ConsumerLab.com.

Whether over-the-counter enzymes have what’s called an enteric coating also matters.

“Enteric coating protects the enzymes, which are proteins, from being digested by the acid contained in, and secreted by, the stomach,” Cohen said, so “the enzyme can safely get to the small intestine where it does its main work.”

A couple of commonly used over-the-counter enzymes have long been known to work. These include Lactaid and Beano, used by people who are lactose intolerant or who have gas or bloating after eating legumes, respectively. “Beano contains alpha galactosidase, an enzyme that our body does not produce,” Tuck said.

Regardless of whether you’re taking a prescription or over-the-counter digestive enzyme, a professional’s counseling on the timing and dosage is critical, Cohen said.

When is it OK to take digestive enzymes?

On its own, the body should produce levels of digestive enzymes sufficient for assimilation of nutrients, Goel said. But when it doesn’t, due to deficiencies evidenced by a stool test a doctor performs, prescription digestive enzymes are the primary treatment.

“Prescription enzymes are used primarily by individuals diagnosed with cystic fibrosis and exocrine pancreatic insufficiency,” Cohen said. Cystic fibrosis is a disease that damages the lungs, digestive tract and other organs, while exocrine pancreatic insufficiency is a condition in which the small intestine can’t thoroughly digest food due to problems with pancreatic enzymes.

Signs of digestive enzyme deficiencies include diarrhea, stomach pain, bloating, inexplicable weight loss and fatty, oily poop that floats, experts said.

People with those diagnoses are really the only people with a clinical or legitimate need for digestive enzyme products, Cohen said — particularly prescribed ones as, again, those are more likely to have the precise dose needed.

“If there are no medical issues or established food intolerances, then digestive enzyme supplements are not required,” Tuck said.

Some healthy people take digestive enzyme supplements after eating a heavy meal, thinking they’ll have trouble digesting the food. But the body can digest a heavy meal perfectly fine, Cohen said. It’s just that the contents may slow the process and cause bloating or gas, she added — so not overdoing it is a better choice than taking a supplement.

If you take them anyway, she added, most of the danger lies in the possible waste of your money.

But if you’re consuming them for digestive issues you’re experiencing on a regular basis, you should see a gastroenterologist or your doctor since you may be masking symptoms and delaying a diagnosis in need of supervised treatment, experts said.

Can digestive enzyme levels be improved naturally?

If you have enzyme deficiencies, nothing can be done to improve levels naturally, Cohen said. Consequently, the only options are to take prescription digestive enzymes or avoid the foods you can’t digest because of your deficiencies.

But if you’re a healthy person, you can improve your digestive health overall, including by not eating meals that are so taxing on your system.

“Something we registered dietitian nutritionists hear a lot is ‘I have trouble digesting food’ or ‘I have slow digestion’ when what they actually have is constipation,” Cohen said. “Digestive enzymes will not help with constipation.”

What can help is avoiding processed and heavily refined foods and consuming a diet rich in whole plant-based foods, with fish and lean meats in moderation, Goel said.

Goel also recommended meeting the national exercise guidelines and the guidelines for fiber intake as well as regularly getting restful sleep, being exposed to nature and spending time with loved ones.

“Stress management through various practices that could include meditation, but also recreational activities that bring one joy,” he added, “is key.”

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