Digestive enzymes are tools produced by our bodies to break food down into smaller parts that can be absorbed into our bodies through our gastrointestinal tracts.
What are some of the key enzymes involved in digestion (amylase, lipase, protease, lactase, etc.)? What does each do?
The most well-known digestive enzymes are amylase, protease and lipase because these are responsible for the bulk of carbohydrate, protein and fat digestion, respectively.
Amylase, produced by the salivary glands and pancreas, is responsible for breaking down starch into sugars. These sugars plus other sugars, such as sucrose (table sugar) and lactose (milk sugar) require further digestion by our intestinal lining’s brush border enzymes before they can be absorbed into the body.
Brush border enzymes include lactase (breaks down lactose), sucrase (breaks down sucrose), and maltase (breaks down maltose, a byproduct of starch digestion).
Pepsin begins protein digestion in the stomach, but most protein digestion happens in the small intestine thanks to proteases secreted by the pancreas.
Like protein, fat (aka lipid) digestion begins in the stomach by gastric lipase before it enters the small intestine where it is further broken down by a variety of pancreatic lipases before it undergoes a complicated absorption process.
What happens if you lack an enzyme or enzymes?
Without the necessary enzymes to break down food, food goes maldigested, which can lead to nutrient deficiencies, weight loss, malnutrition, diarrhea, abdominal pain, bloating and gas.
Not all enzyme deficiencies are serious. Many people are familiar with lactose intolerance. Lactose intolerance happens when people lack lactase, the enzyme that breaks down lactose. As a result, lactose travels to the large intestine where it is fermented by bacteria and causes gas, bloating and diarrhea.
Are there tests that can tell you if you are deficient in the various types of enzymes?
Your doctor can order blood, urine, stool and/or breath tests to identify various enzyme deficiencies. Clinical presentation, past medical history and food challenges can also help health care providers determine if you’re deficient in certain enzymes.
Where do you stand on taking digestive enzyme supplements?
I frequently recommend over-the-counter comprehensive digestive enzymes for my patients with small intestinal bacterial overgrowth, Crohn’s of the small intestine, irritable bowel syndrome, and complaints of abdominal bloating or gas. Not only do these enzymes provide more of our bodies’ own enzymes, but they also give us enzymes that as humans we do not produce.
Any suggestions on supplements, such as how to select the "best" products given that there is no FDA oversight?
As a healthcare professional, most of my brand recommendations come from clinical experience. In addition to speaking with your health care provider, you can look for products that have been certified by third-party certification organizations.