This blog post is written by Kathleen Morgan and edited by Lauren Renlund. Please talk to your health care provider before taking any new digestive enzyme supplements. This blog post is not sponsored by any company. IBS stands for Irritable Bowel Syndrome. Click here for a general introduction to IBS.
DIGESTIVE ENZYMES! LACTAID®! BEANO®! Do you often see these supplements advertised, claiming to decrease side effects of eating your favourite foods? Ever wonder how they work, and if you should give them a go? Hopefully, this post will clear things up for you.
First of all…
What’s a Digestive Enzyme?
Enzymes are special proteins the body produces to digest different components of food, and each one will end in -ase. There are three major types of enzymes produced by the body and each one is important for digestion. The first, amylase, breaks down starch into simple carbohydrates for our bodies to absorb and use. Another called protease breaks down proteins into amino acids, which are known as “building blocks” to proteins. They can be put together in various patterns to create any protein. The last major enzyme is lipase, which breaks down fats into glycerol and fatty acids so that they can be absorbed and enter the blood to go where they are needed1.
General Digestive Enzymes
There are many different general digestive enzyme supplements on the market that contain various combinations of digestive enzymes. Many of these supplements claim to improve digestion and reduce symptoms… but do they actually help with IBS? There is no high-quality research to show that there is any benefit of general digestive enzyme supplements on IBS symptoms. There are many other ways to manage IBS symptoms that are evidence-based. Click here for a list of simple changes to try!
There are two specific enzymes that research has found can help break down certain types of FODMAPs: alpha-galactosidase and lactase. Keep reading to learn more about these two enzymes.
Beans & More
If you have IBS and are following a low FODMAP diet, you may be avoiding beans, lentils, soy, nuts and other foods containing the complex carbohydrates galacto-oligosaccharides (GOS)2. Humans do not have the enzyme to break down GOS (called alpha-galactosidase), so the GOS ends up fermenting in the gut, producing gas. For most people, eating GOS may only cause minor discomfort, but for others the symptoms could be painful. The best way to know if GOS triggers your IBS symptoms is to work with a dietitian to follow the low FODMAP diet and then systematically test high GOS foods.
Supplements that contain the enzyme alpha-galactosidase are commonly sold in Canada. This enzyme can break down GOSs before they enter the large intestine, and therefore avoids or reduces the gas-producing fermentation process.
Research Shows…
A study at Monash University studied GOS-sensitive IBS patients. Alpha-galactosidase was shown to reduce IBS symptoms when taken at a dose of 300 GALU, the same amount found in 1 regular Beano® tablet. The authors concluded that use of this enzyme can increase tolerance of high GOS foods4.
Before trying an alpha-galactosidase supplement, Lauren recommends completing all FODMAP testing. If you find that you are sensitive to GOS, your dietitian may recommend trying an alpha-galactosidase supplement. If you find that GOS containing foods do not trigger IBS symptoms, then there would be no benefit to taking alpha-galactosidase.
How can I get it?
A popular brand of alpha-galactosidase supplement in Canada is Beano®. However, it also contains the FODMAP mannitol (a polyol). If you are sensitive to mannitol, Beano® may actually trigger IBS symptoms. Talk to your dietitian to discuss the best option for you.
There are other alpha-galactosidase supplements, although they are not as easily found in Canada. Bean-Zyme is mannitol-free and available in the USA if you’re visiting, but unfortunately does not currently ship to Canada3.
Dairy
Lactase is the enzyme required to break down lactose, which is a sugar found in dairy products. Unlike alpha-galactosidase, humans do make lactase. However, about 65% of people in the world have a reduction or loss of lactase production after the first 1-2 years of life5. We call this lactose intolerance.
Lactose is one of the five types of FODMAPs. Similar to GOS, if you have completed FODMAP testing and found you are sensitive to lactose, a lactase supplement may help you better tolerate high lactose foods6. If you find that lactose does not trigger symptoms, then lactase will not impact your IBS symptoms.
How to choose a lactase digestive enzyme
When selecting a lactase supplement, make sure to choose one that does not contain any FODMAPs such as mannitol. For example, the brand Lactaid® sells a “fast act caplet” that is low FODMAP (as of June 2018), but their chewable supplement contains mannitol. Lactaid® also offers drops, which can be added to liquid dairy products to break down lactose7.
What about lactose-free dairy products?
If you read the ingredients lists of lactose-free milks and yogurts, you will see that they contain added lactase. Lactose-free milks and yogurts are low FODMAP and acceptable for the elimination phase.
It’s important to note that not all dairy products contain high amounts of lactose. Click here to read a blog post on why butter is low in lactose.
Digestive Enzyme Conclusion…
There is no high-quality research showing benefits of general digestive enzyme supplements for IBS. Two specific enzymes can help with digestion of certain FODMAPs. An alpha-galactosidase supplement may be helpful for someone who cannot tolerate GOS, and a lactase supplement may be helpful for someone who cannot tolerate lactose. It is recommended to work with a dietitian to complete the low FODMAP diet before trying digestive enzyme supplements. Always make sure to talk to your dietitian and/or doctor before trying a new supplement!
REFERENCES
- Byju’s. (2017, October). Digestive Enzymes. Retrieved from https://byjus.com/biology/digestive-enzymes/
- Catsos, P. (2017, July). After The Fodmap Elimination Diet: Should I Try Enzyme Supplements? Retrieved from https://www.ibsfree.net/news/enzyme-supplements
- Bean-Zyme. (n.d.). Price/Shipping. Retrieved from http://www.bean-zyme.com/Bean-zyme%20same%20as%20Beano%20info.htm#Pricing
- Tuck CJ, Taylor KM, Gibson PR, Barrett JB, Muir JG. (2017, August). Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by [alpha]-Galactosidase Treatment, Am J Gastroenterol, 113:124–134. Retrieved from https://www.nature.com/articles/ajg2017245.epdf?author_access_token=aYFoW5_5fbfDyij45l9bk9RgN0jAjWel9jnR3ZoTv0OxgTKDT5fLsM9VLnm5Hp35jHct7Fxt_9slUcSRzOFn1sHv_2ubcj3zOoLTKgHIiGHf63sc2TeVHoKpoCzArc9Z
- S. National Library of Medicine. (2018, March). Retrieved from https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics
- Dietitians of Canada. (2013, February). Healthy Eating Guidelines for Managing Lactose Intolerance. Retrieved from https://www.dietitians.ca/Your-Health/Nutrition-A-Z/Lactose/Managing-Lactose-Intolerance.aspx
- Lactaid®. (2014, October). What Is Lactaid? Retrieved from http://www.lactaid.ca/whats-lactaid-drops.html
ABOUT THE GUEST AUTHOR
Kathleen is a third-year Applied Human Nutrition major at the University of Guelph. She is passionate about plant-based nutrition as well as ethics and sustainability surrounding food. She hopes to become a Registered Dietitian so she can help others live a healthy happy life!
Thanks for this really helpful post, Kathleen!
Do you know anything about the enzyme used to break down fructose? I read about it once and was really interested, but I haven’t been able to find it since.
Right now there isn’t enough research to determine if xylose isomerase is effective in reducing digestive symptoms. Diet vs disease has written a blog post with more information on that topic https://www.dietvsdisease.org/fructose-malabsorption/
There is now a third enzyme which can help low FODMAP patients. It is usually called xylose isomerase, but other names may be used in different brands.
The product Fructaid can be useful it converse the surplus fructose amount in food to glucose.
Hi Bente! Thanks for commenting. Xylose isomerase wasn’t included because there is currently very limited research on this enzyme and the effect on IBS symptoms. If someone is sensitive to fructose they could try it out. As always, read ingredients lists carefully to look for other high fodmap ingredients.