Digestive enzymes break down fats, proteins, and carbs so your body can absorb the nutrients. The majority of them are produced by the pancreas, followed by the small intestine, stomach, and mouth. Read on to learn how different enzymes work, genetic factors behind their levels and digestive disorders & ways to naturally boost digestion.
What Are Digestive Enzymes?
Digestive enzymes are a broad group of enzymes that break down large nutrients such as fats, proteins, and carbs into smaller ones your body can absorb easier. The body naturally produces most of these enzymes in the pancreas, while smaller amounts are made in the stomach, small intestine, and mouth [1, 2, 3, 4].
The following enzymes help you soak up nutrients from specific foods [1, 2, 3, 4]:
- Proteases break down proteins into amino acids
- Lipases break down fats into fatty acids
- Amylases break down carbs into simple sugars, such as glucose
Their main role is to aid your digestion, and the amount and activity of these enzymes in your body depends on a complex set of factors. Digestive enzyme supplements may seem like an easy and effective option to compensate for the low levels and improve digestion.
Preliminary research suggests that digestive enzymes may help with various digestive disorders, inflammation, gut infections, and more [4, 5, 6, 7].
Still, digestive enzymes are no magic pills, and they may help only in certain situations.
To Supplement or Not to Supplement
If you have low enzyme levels and suffer from indigestion, you are usually presented with two basic options: to take enzyme supplements or to work to change your diet and lifestyle to increase your enzyme production.
That said, it’s not that you have to strictly choose one or the other. Digestive enzyme supplements may feel like a short-term life-saver for some, and oftentimes, they help lower indigestion symptoms. But they are usually no long-term solution [8].
Digestive enzymes do offer relief to people who chronically suffer from specific issues such as chronic pancreatitis (inflammation of the pancreas) and cystic fibrosis. In those cases, doctors prescribe potent FDA-approved digestive enzymes (pancrelipase) [9].
Another group of digestive enzymes are the more popular and diverse over-the-counter supplements. However, there’s limited evidence that their use for some common gut problems will be beneficial.
What’s more, they come with a major drawback: they won’t do anything to restore your natural enzyme production. If you don’t have a serious problem with your pancreas, the chances are you probably don’t need them.
Ideally, you should work with a practitioner to uncover the underlying cause of your gut issues. This will help you create and follow a holistic program to get you back on track.
For this reason, we included a brief section about ways to naturally support digestion with diet and lifestyle.
What Causes Low Digestive Enzymes?
Low levels of digestive enzymes show that the pancreas is not working properly and is struggling to produce important digestive compounds. In severe form, this condition is called exocrine pancreatic insufficiency (EPI). In this condition, cells of the pancreas that make digestive enzymes are destroyed over time [10, 11, 12].
EPI is not the only cause, although it’s the most serious one. Various conditions can decrease the production of digestive enzymes (to a smaller or greater extent):
- Cystic fibrosis [13, 14]
- Chronic pancreatitis (pancreas inflammation) [15, 16, 17, 10]
- Pancreatic cancer and Zollinger-Ellison syndrome [18]
- Diabetes [19, 20, 14, 21, 22]
- Obesity [23, 16]
- High triglycerides [14]
- Insulin resistance [24]
- Metabolic syndrome [25, 16, 26]
- Autism [27, 28]
- Nonalcoholic fatty liver disease (NAFLD) [29].
- Cancer radiotherapy and/or chemotherapy [30].
- “Leaky gut” [31].
- Celiac disease [11, 12].
- Short bowel syndrome [32, 11].
- Stomach ulcers [32, 11].
- Autoimmune diseases (Crohn’s disease, multiple sclerosis, lupus) [11, 12, 33].
- Genetic disorders [34, 35, 36, 37, 38, 11]
Digestive enzyme production also gradually declines with aging [39].
Types of Digestive Enzymes & How They Work
Fats: Lipases
Lipases are enzymes that break down fats. They are produced in the pancreas but can also be extracted from plants, animals, and fungi [40, 41, 42]:
Sugars: Amylases
Amylases or amylolytic enzymes break down complex carbs into glucose and other simple sugars [43, 44].
These enzymes broadly include amylases, as well as maltase-glucoamylase, sucrase-isomaltase, and lactase [45, 46, 47].
Amylases
The body produces two types of amylase: the salivary and pancreatic. Salivary amylase is produced by salivary glands and it starts digesting food as you chew it. Pancreatic amylase is produced by the pancreas and helps digest complex sugars in your gut [2].
Amylases can be found in and extracted from various sources, such as plants, bacteria, fungi, and dairy products [48, 49, 50, 44, 51].
There are three main types of amylases: alpha-amylases, beta-amylases, and glucoamylases [46].
Maltase
Maltase (alpha-glucosidase family) is an enzyme produced in the small intestine to break down maltose into glucose. Various malted products contain this sugar, while the enzyme that breaks it down is also found in plants, bacteria, and yeast [52, 53].
Sucrase-Isomaltase
Sucrase-isomaltase (alpha-glucosidase family) breaks down table sugar (sucrose) into fructose and glucose. It can also improve immune function, help with bone and stomach cancer and reduce oxidative stress [54, 53].
Lactase
Lactase (beta-galactosidase family) breaks down lactose, a sugar found in milk products, into glucose and galactose. People lacking this enzyme have lactose intolerance. The lactose added to supplements is produced by fungi, such as Aspergillus niger or yeast, such as Kluyveromyces lactis [53, 36, 55].
Proteins: Proteases
Proteases or proteolytic enzymes are produced in the stomach and the pancreas to break down proteins into amino acids [56, 57].
Some proteases are essential to the human body and allow cells to properly divide and be eliminated once they are no longer needed. Proteases also support immune function, wound healing, blood clotting, and many other vital functions. For this reason, they play a crucial role in fighting infections, inflammation, cancer, heart diseases and other conditions [4, 58, 57].
Among different proteases, some are widely used in the pharmaceutical industry as drugs, while others can be monitored as diagnostic markers [59, 60].
Other proteases are available as dietary supplements and are extracted from various sources, including plants, animals, and fungi [61, 5, 62, 63, 64, 65, 66]:
Trypsin and Chymotrypsin
Trypsin and chymotrypsin are protease enzymes you make to break down proteins in the small intestine. Aside from pepsin secreted in the stomach, these two are the main protein-degrading enzymes you produce. In supplements, they are usually made from ox, pig or cow pancreas. Alternatively, they can also be extracted from fungi, plants, and bacteria [67, 68, 69].
Trypsin can fight bacteria by preventing the formation of biofilms. It also helps lower inflammation and reduce pain and swelling from joint and muscle injuries [70, 71, 72].
Chymotrypsin and trypsin supplements have been on the market since the 1960s and have been tested in many clinical trials for combating inflammation and helping heal wounds [73, 74].
Aside from these proteases, which are naturally produced in your digestive system, many specific proteases are found in foods and can be formulated into more potent supplements.
Bromelain
Bromelain is extracted from the fruit or stem of pineapples (Ananas comosus). It is a mix of proteases that break down proteins into amino acids and other enzymes [5, 4].
The other enzymes in bromelain include phosphatase, glucosidase, peroxidase, cellulase. Interestingly, bromelain is also made up of some protease inhibitors that stop specific protein-digesting enzymes outside the gut from breaking down proteins you need. As a result, blocking them may help fight off infections and inflammation [75, 76, 77].
Stem bromelain has a higher protease content compared to fruit bromelain [78].
Thanks to its wide-spectrum enzymes, bromelain may help with digestion, reduce pain, and provides benefits to the skin. It has also strong inflammation- and immune-boosting properties [5, 79, 80, 81].
Papain
Papain is a protease extracted from papaya (Carica papaya). If you like papayas, you can get enough of this enzyme by eating them raw. Alternatively, papain supplements are available as chewable tablets or as regular capsules [63, 82, 83, 84].
Papain has been used traditionally to decrease pain, inflammation, and swelling. Studies show that it can improve digestion, reduce bloating, gas, diarrhea, and it might also help fight cancer and infections [85, 86, 87].
Serrapeptase & Nattokinase
Serrapeptase and nattokinase are not digestive enzymes, but they are proteases that affect inflammation and blood clotting. And although they don’t influence digestion, some supplement formulations combine them with typical digestive enzymes to achieve a wider spectrum of benefits.
Serrapeptase is extracted from the bacteria Serratia e15, found in silkworms. It acts to degrade harmful inflammatory proteins. For this reason, many people who struggle with chronic pain and inflammation take this enzyme [88, 89].
Nattokinase is an enzyme found in nattō, a fermented soybean product. This protease breaks proteins that cause excessive blood clotting, making it a potential natural remedy for heart and circulatory issues. It is produced when the soybeans are cooked and later fermented by adding the bacteria Bacillus subtilis natto. To get its benefits, you can eat nattō or take it as a dietary supplement [64, 90, 91].
Combination Enzymes (PEPs & Dietary Supplements)
Digestive enzymes are often combined, both in clinical practice and in scientific research.
In fact, your body will always make and use various enzymes at the same time. It only makes sense to mimic an ideal natural balance with supplements rather than to use any enzyme in isolation. The only exceptions are specific genetic defects (e.g. lactose intolerance) or disorders (pancreatic insufficiency) [69].
One such combination is a prescription-grade pancrelipase. It contains lipase, amylase, and trypsin (protease). Another, called pancreatin, contains the same enzymes and both are extracted from the pancreas of animals (pigs or cows) [92, 93, 94, 69].
The only FDA-approved Pancreatic Enzyme Products (PEPs) marketed in the US are:
- Creon
- Zenpep
- Pancreaze
- Ultresa
- Viokace
- Pertzye
Some have enteric coating that helps enzymes survive the acidic environment of the stomach and delays their release until they reach the intestines. They are prescribed in cases of pancreatic insufficiency [92, 93, 94, 69].
Although these enzymes are typically extracted from animals, many other over-the-counter (OTC) digestive enzymes can be isolated from plants, bacteria (lipase) or fungi (protease and amylase) [95, 62].
OTC digestive enzymes are used as dietary supplements to support digestion, not to cure or treat any health problems. They are also not regulated by the FDA and their contents and ingredients can greatly vary. Numerous combinations exist, sometimes with added nutrients or probiotics.
Digestive Enzymes vs. Probiotics
As diverse a group as digestive enzymes are, perhaps only one other category is even larger and more diversified: probiotics. The “good enzymes” and the “good bacteria” get along very well in your gut. They have a very tight relationship.
Although one needs the other, each has a distinctive role. How exactly are digestive enzymes different from probiotic bacteria?
The most obvious difference is that digestive enzymes are proteins produced by your digestive organs that mostly act in the intestines, whereas probiotics are bacteria that tend to live in your colon.
Digestive enzymes break down fats, proteins, and carbs into smaller nutrients you can absorb. Probiotics, in a nutshell, maintain your immune function, digest fibers, and also influence your mood through the gut-brain axis. [2, 96, 68, 97, 98, 99].
Now, here’s where the line gets blurry: various bacteria in your gut may produce proteases, lipases, and amylases. On the other hand, digestive enzymes may enhance the activity of good bacteria. For this reason, probiotics and digestive enzymes may be a great match [100, 101].
Probiotics Increase Digestive Enzyme Activity and Vice Versa
Preliminary studies support the theory that digestive enzymes and probiotics act closely together as part of your gut’s “mega-network”.
In a 2-month study on 34 women, banana amylase reduced bloating and increased the good gut bacteria (bifidobacteria) [102].
In chickens, a probiotic increased the activity of proteases and amylases while enzymes (proteases or amylases and glucoamylases) increased the gut bacteria [103, 104].
In piglets, another probiotic (Bacillus amyloliquefaciens) enhanced the activity of chymotrypsin and amylases. In mice, pancrelipase supplementation increased the good gut bacteria, such as Lactobacillus reuteri [105, 106].
In a cell study, probiotics and digestive enzymes increased the good gut bacteria and prevented gut bacteria disturbances from antibiotics and chemotherapy [107].
Additional Synergies
Aside from the already mentioned synergies, the combination of digestive enzymes with probiotics may improve blood lipids. In mice, a diverse combination of both lowered LDL-cholesterol, and increased HDL-cholesterol [108].
Gastric Acid Support
Some digestive enzyme supplements also contain betaine hydrochloric acid or betaine HCl, which is used to increase gastric acid (HCl). Note that betaine (TMG) alone will not increase your stomach acid, as it does not contain HCl [109].
Clinical studies confirmed that betaine HCl can lower stomach pH levels, which may additionally support digestion and help soak up more nutrients. However, you shouldn’t use Betaine HCl if you have normal gastric acid levels, as too much acid can damage the stomach lining and cause ulcers [109].
If you’re not sure whether your gastric levels are low, some practitioners recommend doing an “HCl challenge” by taking 1 capsule before a large meal. If a person feels burning or warmth in the stomach, indigestion, or an “acidic” sensation, they are probably producing enough gastric acid already.
In that case, they shouldn’t take betaine HCl. The lack of unpleasant effects may indicate a deficiency. Practitioners recommend slowly increasing the dosage until you feel stomach warmth (but not to an unpleasant extent).
One study suggests that the betaine HCl challenge is tolerated well, but this approach lacks solid research and mostly relies on clinical experience. If you’re not sure whether your stomach acid levels are low, it’s best to consult a practitioner [110].
Genetic Predispositions
It’s important to note that just because certain genotypes are associated with a condition or irregular lab marker, it doesn’t necessarily mean that everyone with that genotype will actually develop the condition. Many different factors, including other genetic and environmental factors, can influence digestive enzyme levels and gut health.
Amylase & Carbs
Salivary amylase is produced by the AMY1A, while pancreatic amylase is produced by the AMY2A and AMY2B genes. People with a low number of AMY1A copies are less able to digest and use complex carbs (glucose malabsorption) and more likely to have a higher body mass index (BMI) and obesity [43, 111, 112, 113, 114, 115, 116, 113, 117].
On the contrary, people with a high number of AMY1A copies, can better digest starch (glucose tolerance), have more good gut bacteria, can lose weight easier and are less likely to develop diabetes type 2, metabolic syndrome, and insulin resistance [118, 119, 120, 121, 122].
Pancreas Insufficiency
Exocrine pancreatic insufficiency (EPI), a condition which causes low production of digestive enzymes, can also be caused by rare, genetic disorders. These include Shwachman–Diamond syndrome (mutations in the SBDS gene) and Johanson-Blizzard syndrome (mutations in the UBR1 gene) [123, 38]
Lactose Intolerance
Lactase is an enzyme that breaks down lactose, a sugar found in milk products, into glucose and galactose and is coded in the LCT gene. Mutations in the LCT gene, such as LCT- 13910CC can lead to lactase deficiency and lactose intolerance. People with lactose intolerance who consume lactose-dairy products may experience stomach pain, bloating, gas, nausea, and diarrhea [34, 35].
Sucrose and Maltose Intolerance
Sucrase-isomaltase is coded in the SI gene, and variations in the SI gene, such as V577G and C1531W mutations lead to congenital sucrase-isomaltase deficiency. People with this rare disorder cannot break down the sugars sucrose and maltose. After consumption of sucrose and maltose, people will experience stomach cramps, bloating, excess gas, and diarrhea [37, 124].
Pompe Disease
Alpha-glucosidase is an enzyme encoded in the GAA gene. Mutations in the GAA gene can lead to a serious disorder called Pompe disease, or glycogen storage disease type 2. Pompe disease is caused by the buildup of a complex sugar (glycogen) in the body’s cells, which impairs the muscles and organs. People with Pompe disease suffer from respiratory failure, heart damage, and severe muscle weakness [125, 52].
Low Digestive Enzymes? Ways to Naturally Boost Digestion
Digestive enzyme levels are a marker of gut health. Low or high levels don’t necessarily indicate a problem if there are no symptoms or if your doctor tells you not to worry about it. Improving your digestive enzyme levels won’t necessarily cause improvement in digestion.
The following is a list of complementary approaches to stimulate digestion that may also increase enzyme levels. Despite the promising preliminary research, additional large-scale studies are needed. Remember to talk to your doctor before making any major changes to your day-to-day routine.
Herbal Bitters
Many bitter herbs can increase your production of digestive enzymes and help you overcome gut problems [126, 127, 128, 129].
Extracts of bitter herbs can be used in various ways: added to food, poured into drinks such as tea, or taken alone in their pure form. Several herbs are traditionally combined into digestive elixirs, the most well-known ones being Swedish bitters and Iberogast. Bitters are typically used before a meal to stimulate digestive juices.
Enzyme-Rich Foods
Another option is to increase the consumption of food naturally rich in digestive enzymes such as [5, 4, 130, 48, 49, 50, 63, 40, 131, 132, 133]:
- Pineapple (bromelain)
- Kiwis (actinidin)
- Papaya (papain)
- Banana (amylases)
- Mango (amylases)
- Honey (amylases, proteases)
- Avocado (lipase)
- Walnuts (lipase)
- Pinenuts (lipase)
- Coconut (lipase)
- Lentils (lipase)
- Chickpeas (lipase)
- Mungbean (lipase)
- Oats (lipase)
- Castor beans (lipase)
- Eggplant (lipase)
- Ginger (protease)
- Kefir (lipase, protease, lactase)
Probiotics
A healthy gut microbiome is essential for proper digestive enzymes function. To increase your good gut bacteria, include more fermented and fiber-rich foods in your diet. Alternatively, you can search for specific probiotic strains or their combination in supplement form.
Exercise
In a study with over 400 people, moderately intense exercise increased amylase levels [134].
Weight Loss
In a study with 160 people, obese and overweight people had lower amylase, which increased with weight loss [23].
Stop Smoking
In 70 people, smokers had lower amylase levels compared to nonsmokers [135, 16].
Avoid Late-Night Meals/Snacks
In 2,500 people, eating late in the evening was linked with low amylase levels [136].
