Irritable bowel syndrome, or IBS, can result in uncomfortable and distressing symptoms that impact your quality of life. The FODMAP diet is one method used to manage IBS symptoms. FODMAPs are a group of sugars that are poorly digested and cause an increase in water and gas in the digestive tract resulting in constipation, diarrhoea, bloating and more.
Digestive enzymes are being promoted as a way to improve digestion and manage symptoms of IBS. They can be purchased as supplements and often come with a promise to improve digestion. But, is there any evidence that they work and should you be taking them?
Our body makes digestive enzymes everyday to help us break down and absorb the fat, protein, and carbohydrates in food. The most common digestive enzymes are:
Without digestive enzymes, we would be unable to absorb the nutrients in food.
Most of our digestive enzymes are made in our pancreas. When we eat food, our pancreas releases these enzymes into our small intestine where they break down carbohydrates, fat, and protein. Some people do not produce enough digestive enzymes due to damage or disease in their pancreas. These people must take high doses of digestive enzymes when they eat, this is called pancreatic enzyme replacement therapy, or PERT. These medications require a script from the doctor and are for people with medically diagnosed enzyme deficiency
The digestive enzymes promoted to help with IBS are a much lower dose than PERT and can be purchased online or over-the-counter. They either come as a single enzyme or as a blend of multiple digestive enzymes. But do they work for IBS?
There is evidence to support the use of two specific digestive enzymes for some people with IBS. Those enzymes are lactase and alpha-galactosidase. Let’s look at these enzymes in more detail and find out who should use them.
We produce the enzyme lactase in our small intestine. It is required for the digestion of lactose – a FODMAP sugar found in many dairy products. Foods such as milk, cream, and yoghurt are higher in lactose, while hard cheese and butter have very little lactose. People who are lactose intolerant can only manage small amounts of lactose due to having inadequate amounts of the lactase enzyme.
When these people consume high lactose foods, symptoms such as flatulence, bloating, and diarrhoea can occur. These symptoms are caused by the undigested lactose sugars travelling through the digestive tract. People with a lactose intolerance manage these symptoms by avoiding high lactose foods.
Lactase supplements allow lactose intolerant people to enjoy certain dairy foods without uncomfortable symptoms. The lactase enzyme is taken directly before enjoying the high-lactose food and enables to person to digest the lactose sugars. It is important to note that lactase enzymes do not cure IBS or lactose intolerance. They are a management strategy.
If you are unsure if you have a lactose intolerance, or if you want support while you try lactase enzymes, you can see a dietitian.
Galacto-oligosaccharides, or GOS, is another type of FODMAP sugar that can trigger IBS symptoms. Foods high in GOS include nuts, lentils and soy beans. Alpha-galactosidase is the enzyme that breaks down the GOS sugars. Our human body does not make this enzyme. The GOS sugars travels through our intestine where it becomes food for our gut microbiome – also called a prebiotic. The gut microbes ferment the GOS which creates gas and short-chain fatty acids which are beneficial to our health.
Some people with IBS are sensitive to GOS sugars and develop uncomfortable symptoms when they eat foods high in GOS. A study by Monash University showed that people with IBS, who are sensitive to GOS, can take alpha-galactosidase enzymes to reduce these symptoms. This enzyme is only beneficial when taken by people with a GOS intolerance. Similar to lactase, the alpha-galactosidase enzyme should be taken when consuming a meal high in GOS.
To find out if you are intolerant to GOS sugars, you can complete the FODMAP diet with a dietitian. Get in touch here to find out more.
When it comes to managing IBS, digestive enzymes are not the magic bullet we are promised by supplement companies.
There is evidence to support the use of digestive enzymes in people who have a lactose intolerance and those who are sensitive to GOS. There is insufficient evidence to support the use of any other enzyme in the management of IBS.
If you choose to try digestive enzymes, you must take them at the right dose and at the correct time for them to work. A dietitian can support you to use digestive enzymes effectively. There is a lot of misinformation out there when it comes to gut health and IBS. If you would like support and strategies that actually work get in touch here.