Digestive enzymes are natural substances produced by the body to help break down and digest food. They are primarily produced in the pancreas and small intestine, but they are also made in the saliva glands and stomach.

Insufficient amounts of digestive enzymes can interfere with the breakdown and absorption of food and nutrients.

Classes of digestive enzymes

Digestive enzymes can be divided into four classes: protease, lipase, amylase and gelatinase.

Proteases: Proteases break down proteins. This includes proteins in meat, dairy and plant sources.

Proteases produced in the pancreas are trypsin and chymotrypsin. Both enzymes are released into the small intestines during digestion to break down proteins into single amino acids.

Proteases are also found in pineapple (bromelain) and papaya (papain).

Lipases: Lipases break down triglycerides (fats) into fatty acids and glycerol. Once broken down, fatty acids can be absorbed by the body and used for energy. Lipase is produced in the pancreas and liver, but also in the mouth and stomach.

Lipase supplements are recommended for individuals with Crohn's disease, celiac disease and cystic fibrosis.

Amylases: Amylases break down carbohydrates into a simple carbohydrate, maltose. Amylases are found in the saliva and are also produced in the pancreas and secreted into the small intestine to continue the breakdown of carbohydrates into glucose.

Gelatinases: Gelatinases are proteolytic enzymes that hydrolyse gelatin into its sub-compounds: polypeptides, peptides, and amino acids.

What Interferes With Proper Digestive Enzyme Activity?

Diseases may prevent proper digestive enzyme production

• Pancreatic diseases: cystic fibrosis, pancreatic cancer, and acute or chronic pancreatitis.
• Brush border dysfunction: long-standing celiac disease: a digestive disorder, which damages the small intestine and interferes with absorption of nutrients, and Crohn's disease: which causes inflammation and erosion of the intestinal walls.
• Low stomach acid (e.g., hypothyroidism, autoimmune disease,  Helicobacter pylori infection, stomach cancer, use of antacids).

Other conditions that can lead to deficiencies in digestive enzymes

• Low-grade inflammation in the digestive tract (e.g., “food allergies") can lead to deficiencies in digestive enzymes.
• Aging has been associated with decreased digestive function.
• Chronic stress. This is thought to contribute to digestive enzyme problems. Stress activates the: sympathetic “fight or flight” response. In this mode, the body reduces digestive activity (including digestive enzyme output).

Even healthy individuals can experience greater digestive comfort with the aid of digestive enzyme supplements. A double-blind, crossover study confirms the efficacy of digestive enzyme supplements in optimising digestion. Healthy volunteers consumed a high-calorie, high-fat meal, either with pancreatic enzyme capsules or with placebo. Gastrointestinal symptoms were recorded for the next 17 hours. Pancreatic enzyme supplements significantly reduced bloating, gas, and the feeling of fullness.

Are Digestive Enzymes Safe?

Digestive enzymes act locally in the gastrointestinal tract and are not absorbed. Occasional adverse effects from supplemental digestive enzymes include nausea, diarrhea and abdominal cramping. Contraindications to their use include hypersensitivity to any component, acute pancreatitis or acute exacerbation of chronic pancreatitis.

What Are the Differences Between over-the-counter and Prescription Digestive Enzymes?

Prescription enzymes are recommended since they are better regulated than over the counter products. The FDA ensures that the manufacturing process of prescription enzymes is consistent and that products are safe and effective.

Non-prescription enzymes, on the other hand, are labeled as dietary supplements by the FDA, and follow a different set of regulations. Contamination is a cause for concern with over the counter enzymes due to inconsistencies in the manufacturing process.

Selecting a trusted brand is important for over-the-counter digestive enzymes.

www.superpharmacy.com.au  Australia's best online pharmacy

References

Ekue A. Four Classes of Digestive Enzymes.  www.SFGate.com. http://healthyeating.sfgate.com/four-classes-digestive-enzymes-9941.html

El-Omar EM, Oien K, El-Nujumi A, et al. Helicobacter pylori infection and chronic gastric acid hyposecretion. Gastroenterology 113(1): 15-24.

Laugier R, Bernard JP, et al. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly. Digestion. 1991;50(3-4):202-11.

Tiscornia OM, Cresta MA, de Lehmann ES, Celener D, Dreiling DA. Effects of sex and age on pancreatic secretion. Int J Pancreatol. 1986 Jul;1(2):95-118.

Vellas B, Balas D, Moreau J, et al. Exocrine pancreatic secretion in the elderly. Int J Pancreatol. 1988 Dec;3(6):497-502.

Ishibashi T, Matsumoto S, Harada H, et al. Aging and exocrine pancreatic function evaluated by the recently standardized secretin test. Nippon Ronen Igakkai Zasshi. 1991 Sep;28(5):599-605.

Gerstmar T. Everything You Ever Wanted to Know about Digestive Enzymes. Whole9Life.com.  http://whole9life.com/2012/09/digestive-enzymes-101/

Suarez F, Levitt MD, Adshead J, Barkin JS. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Dig Dis Sci. 1999 Jul;44(7):1317-21.

Barclay L, Hitt E. FDA Approvals: Two New Pancreatic Enzymes to Aid Food Digestion. Medscape.http://www.medscape.org/viewarticle/760273.  Published 15 March 2012. Accessed 5 June 2014.