Almost one in every four adult American suffers is known to experience discomfort immediately after a meal. Digestive ailments result in the production of less digestive enzymes, which in turn result in the accumulation of undigested compounds in the large intestine. Consequently, individuals experience bloating, flatulence, in addition to depriving the body of essential nutrients. Digestive ailments also end up impacting the energy levels of the individual. Among the various cures and options available for these conditions, digestive enzymes are emerging as a strong contender with claims of cures. Here is an in depth look to understand if the claims are true or hype, in addition to learning all about digestive enzymes side effects.
Overview of digestive enzymes
The body produces proteins that break down the food into nutrients, energy. Different types of enzymes target different type of food – proteins, fat and carbohydrates. The enzymes produced in the body mix with the food and are effectively a part of the entire digestive cycle. The enzymes are released in the mouth, in the stomach, pancreas, small intestines and the liver. As outlined above, when there is insufficient release or production of these enzymes, individuals end up with digestive ailments. Supplements contain various digestive enzymes including proteases, lipases and amylases.
Three broad categories of digestive enzymes
The supplements can be broadly classified into three different categories – prescription, OTC and combination enzymes. The first category, as the name suggests is prescription only enzymes that are typically recommended for patients with certain medial conditions. For instance, individuals with cystic fibrosis, or pancreatitis may require digestive enzymes as part of treatment regimen. These formulations are typically orally administered, with FDA approval for specific use cases in recommended dosages. This effectively also means that the outcomes and the undesirable digestive enzymes side effects have been documented prior to regulatory approval.
The second category of digestive enzymes, OTC products are typically procured when individuals experience gas or bloating without any other medical conditions. For instance, the carbohydrates in beans may trigger flatulence and OTC products such as alpha-galactosidase can help improve the digestion by breaking down the carbs. Similarly, lactase digestive enzymes are also available as OTC products and are meant for breaking down sugar in milk. Undigested lactose triggers unpleasant conditions, including gas and possible diarrhea. This is because of the movement of the lactose to the colon, with large amount of water for dilution. This combination creates symptoms, including lactose intolerance.
The third category of digestive enzymes are the latest products available as OTC formulations that are essentially enzyme combinations. These products differ from regular OTC digestive enzymes, and comprise enzymes from plants and animals. The unregulated use of these supplements can trigger unwanted side effects or interactions. For instance, one popular combination comprises bromelain, from pineapples, which may have an impact on medications prescribed as blood thinners.
Types of formulations
Digestive enzymes are available in three different oral formulations – capsules that are not coated, delayed release capsules that come with a coating and mini-microsphere delayed release formulations. The delayed release capsules come with enteric coating and are designed to ensure that the capsules do not dissolve quickly in the stomach. The coating prevents the enzymes from being released until the capsules reach the lower portion of the gastrointestinal tract where the mechanism of action offers the desired outcomes. This delayed release offers targeted outcomes and is effective.
The second type of formulation are the capsules that are not coated, which need to be taken alongside another medication – proton pump inhibitor. The proton pump inhibitor reduces the amount of stomach acid, and this in turn helps prevent the destruction of the enzymes in the stomach by the acid. The purpose of taking the medication along with proton pump inhibitors is to ensure that the desired outcomes are not affected by the natural process of stomach acid release.
In addition to the above two categories, newer formulations of digestive enzymes also include min-microsphere delayed release formulations that are available in various oral presentations. This includes tablets, powder form and capsules. Determination of the actual form that is most suitable to individuals with specific conditions will be as per the evaluation of the treating specialist.
Conditions that can be treated or managed with oral digestive enzymes
The complex proteins that are responsible for breaking down food are secreted from the pancreas. When the ability of the pancreas to function effectively is affected, digestive enzymes are not produced as required. This includes proteases that are essential for digesting proteins, lipases that are required for digesting fat, and amylases that are required for digesting carbohydrates. Oral digestive enzymes available as supplements are called PEPs (pancreatic enzyme products), and are used for treating or managing a variety of conditions. For instance, individuals who have had a part of their pancreas removed, or patients with pancreatic diseases, cystic fibrosis, cancer of pancreas, or tumors, and Shwachman-Diamond syndrome can be administered the supplements. Digestive enzymes can also be used by patients diagnosed with gastrointestinal conditions including Crohn’s disease, poor digestive health and celiac disease.
Documented drug interactions of digestive enzymes
Without exception all medications are known to trigger drug interactions when taken along with other medications or OTC products, supplements. This could impact the efficacy of either of the medications, by amplifying the effect of the medications or by reducing the outcome of the medication. Similarly, drug interactions could also aggravate the potential side effects of either of the medications. The effectiveness of oral digestive enzymes may reduce when taken along with antacids or calcium. Similarly, specific types of digestive enzymes may interact with certain alpha-glucosidase inhibitors and diabetic medications that are administered orally. It is important to seek medical advice before taking oral digestive enzymes when on other medications or OTC products. Additionally, individuals are also advised to check for possible interactions when the digestive enzymes are taken alongside herbal remedies and natural supplements.
Commonly reported digestive enzymes side effects
All medications and most supplements come with the possibility of undesirable effects. The effects may be either mild, moderate in nature or could also be strong and intense. The duration of the effects could vary from short term effects to possible long-term conditions. It is necessary to understand that unwanted effects of medications are a possibility, but this is not to be interpreted as conditions that will affect all users of the medications. Certain patients may not experience any effects whatsoever, while other may experience one set of effects. Digestive enzymes are no exception, and there is the possibility of undesirable effects from its use.
Rare, serious effects and possible symptoms
This also includes the possibility of rarely occurring allergies that can be serious in nature, warranting medical intervention and triaging at a healthcare facility. Individuals who experience certain symptoms are advised to stop the supplements immediately and seek medical intervention at the earliest. Symptoms include any abnormal tightening of the chest, wheezing or difficulty while breathing. Similarly, swelling in the face, especially, the mouth, tongue, lips and throat that is not linked to any other condition is also indicative of possible allergic reaction. The outbreak of rashes or hives are also symptomatic of allergies. Patients who experience itching sensations, or observe any reddish appearance on the skin, are to seek medical attention. This also includes skin that is either peeling or blistered.
Relatively mild undesirable effects of digestive enzymes
In addition to the above, there is also the possibility of mild and moderate undesirable effects. These effects may resolve naturally in a few days or may require some attention if persistent or intense. This includes possible pain in the stomach that is not attributed to any other condition, and the formation of gas. Users may also end up with throbbing headache, while others may experience pain in the neck. Users may also experience possible constipation, and contrastingly, a different set of users may experience diarrhea. Feelings of nausea, vomiting and an upset stomach are common conditions that may be felt during initially.
In addition to the above, users may end up with cough and a sore throat, while others may experience a stuffy nose and pain in the ear. Heartburn is another condition that may be experienced by users, that may require to be treated symptomatically. Side effects of digestive enzymes also include the possibility of fibrosing colonopathy, a serious bowel condition that is rare in occurrence. Individuals who are afflicted with his condition end up with inflammation in the colon, that may also be scarred in the process. Symptoms that are indicative of this condition include pain in the stomach, vomiting, diarrhea and constipation. Finally, individuals who are either allergic to pork products, or abstain from pork due to dietary preferences are advised to look at the ingredients of digestive enzymes, as certain enzymes are derived from pork.
Precautions to be taken by pregnant women or nursing mothers
The efficacy of the medication and the potential undesirable outcomes on pregnant women or nursing mothers have not been studied in depth. It is therefore necessary to either avoid the supplements during pregnancy, or seek medical advice regarding use. The use of supplements or other OTC formulations during pregnancy is always to be decided after a proper assessment where the benefits are viewed against the probable risks. Potential risks to the health of the fetus apart from that of the mother need to be ascertained clearly. Similarly, there is insufficient evidence to ascertain if digestive enzymes may end up in breast milk, and affect the suckling infant. Here again, it is necessary to weigh the benefits and take a decision with medical advice.
Education: Master’s in Nursing (MSN) from Johns Hopkins University. Experience: 7 years writing for online health portals and nursing journals, specializing in patient education and chronic illness management.
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