For IBS Treatment
Since IBS is my speciality, I am starting this series of articles about enzymes talking about the impact of them for IBS patients.
We all know that we sometimes lack the enzymes required to digest specific foods and this can cause a range of digestive issues including gas, bloating, and diarrhea. Digestive enzyme supplements may remedy this, but it depends on what food intolerance is the problem.
This article is a sales-free look at the effectiveness of digestive enzyme supplements, based on the latest scientific evidence.
What are Digestive Enzymes?
Digestive enzymes are chemicals produced in our body. All animals have them as they are necessary to break down food into individual nutrients for absorption. Hence the name digestive enzymes.
Not all digestive enzymes are created equal. There are specific groups of enzymes needed for fats, proteins and carbohydrates (1).
Carbohydrase – for digestion of carbohydrates (and sugars)
Protease – for digestion of proteins
Lipase – for digestion of fats.
You should also be familiar with ‘Brush-Border’ enzymes that are produced in the small intestine, such as lactase, maltase and sucrase.
If the body fails to produce enough digestive enzymes, certain foods are not digested properly. This leads to digestive stress that is often classified as a food intolerance or Irritable Bowel Syndrome.
Unfortunately some are genetically predisposed to low levels of a certain enzyme, which leads to an intolerance. The most well-known is lactose intolerance (more on that on part 2 - keep following my blog).
Replacing enzymes with supplemental enzymes has emerged as useful way to overcome certain issues.
Summary: Digestive enzymes break down food into individual nutrients. Some people have low levels of certain enzymes, which leads to food intolerance and digestive stress. Supplementing digestive enzymes has emerged as a useful alternative.
How Do Digestive Enzymes Work?
Here below you have an image which illustrates how digestive enzymes work on a cellular level. It shows the 3 main groups of enzymes, and how they work, from left to right. Once molecules are broken down into individual parts, the body can use them.
Digestive Enzymes for IBS Treatment
Those diagnosed with IBS typically have trouble digesting foods high in FODMAP carbohydrates.
Digestive enzyme supplements containing alpha-galactosidase (a type of carbohydrase enzyme) may help with the starchy carbs, at least in theory.
Alpha-galactosidase helps break down larger complex carbohydrates (oligosaccharides) into smaller easier to digest particles (monosaccharides). However both of these are still FODMAPs, and the scientific evidence for its use in IBS is minimal.
The Research
One study of 19 participants found that alpha-galactosidase reduced gas after eating a high fibre (high FODMAP) meal. But there was only a small number of participants and it was not specific to IBS patients (3).
A more recent study of 101 IBS patients found those supplementing with alpha-galactosidase experienced a greater reduction in IBS symptoms compared to placebo (fake pill), but the difference was not statistically significant. That means the benefit observed might be due to factors other than the enzyme supplement (4).
Another study of 90 IBS patients looked at the effects of a supplement called Biointol, which is a combination of some soluble fibers (beta-glucan and inositol) and digestive enzymes. I could not find the exact blend of enzymes used, but most supplements are typically a combination of carbohydrases, lipases and proteases (5).
Biointol use was shown to help improve abdominal pain, bloating and flatulence compared to placebo. However, because it was a blend of ingredients it’s not possible to say how effective the digestive enzymes were.
The effect of Biointol on bloating in control (placebo) group vs Biointol group. A decrease was observed in the IBS patients over the 4 weeks.
A review paper of 5 individual studies supports the use of alpha-galactosidase to reduce digestive discomfort after eating. However, the authors were affiliated with an enzyme supplement manufacturer, and the studies looked at a small number of participants (2).
Lastly, a recent study has just been released looking at the effectiveness of alpha-galactosidase on IBS symptoms. This study was specifically measuring the effect of alpha-galactosidase when taken with foods high in galacto-oligosaccharides (GOS) a specific FODMAP carbohydrate.
Thirty-one participants with IBS were recruited and they went through 3 stages, placebo, half dose of enzyme and full dose of enzyme. At each stage they consumed a diet high in GOS but low in other FODMAPs.
The full dose enzyme but not the half dose saw a reduction in IBS symptoms compared to the placebo. However, no change in breath hydrogen production was seen with treatment (breath hydrogen is used to measure sensitivity to a particular FODMAP). The significance of this is not yet fully understood.
Because this study was specific to high GOS foods the effectives in people who are not sensitive to GOS is still unknown. The researchers recommend the use of alpha-galactosidase enzymes for IBS patients who have specifically identified a GOS sensitivity and not as a blanket recommendation for all IBS patients (6).
Summary: Digestive enzymes containing alpha-galactosidase may help alleviate gas and other IBS symptoms in some people. However, there’s still a lack of consistent scientific evidence and it is more likely effective in those with a galacto-oligosaccharide sensitivity.
References
1- https://www.ncbi.nlm.nih.gov/pubmed/27522847
2- https://www.ncbi.nlm.nih.gov/pubmed/15481741
3- https://www.ncbi.nlm.nih.gov/pubmed/7964541
4- https://www.ncbi.nlm.nih.gov/pubmed/26133538
5- https://en.wikipedia.org/wiki/Lactose_intolerance
6- https://www.ncbi.nlm.nih.gov/pubmed/28809383