What Are Digestive Enzymes?

The impact on digestion and inflammation.

Digestive Enzyme capsules and tablets

Verywell / Anastasia Tretiak

Food fuels your body. Digestive enzymes (proteins in the body) help break down your food into smaller parts so your body can use it more easily. Usually, digestive enzymes are produced in different parts of the body, like the mouth (where digestion begins), stomach, pancreas, and small intestine. These digestive enzymes are "endogenous" (made in the body). Sometimes the body doesn't make enough of these endogenous enzymes or can't use them properly, so people take digestive enzymes to replace them. The following are examples of digestive enzymes.

Digestive enzymes that break down carbohydrates (and where they're found):  

  • Amylase (found in saliva and the pancreas) breaks down complex carbohydrates and starches in grains, beans, and starchy vegetables. 
  • Lactase (small intestine) breaks down the sugar called lactose in dairy products.
  • Maltase (saliva, pancreas) breaks down the sugar called maltose in grains.
  • Sucrase (small intestine) digests sucrose, a sugar found in fruit, nuts (in pretty small amounts), and veggies.

A digestive enzyme that breaks down fat: Lipase (pancreas).

Digestive enzymes that break down proteins:  

  • Chymotrypsin (pancreas)
  • Pepsin (stomach)
  • Peptidase (stomach, pancreas, small intestine)
  • Protease (pancreas)
  • Trypsin (small intestine

A digestive enzyme that breaks down multiple nutrients: Elastase (pancreas) helps digest carbohydrates, fats, and proteins.

Oral digestive enzyme supplements made from plants:

  • Bromelain (from pineapple) digests proteins
  • Papain (from papaya) also digests proteins

This is not an exhaustive list of endogenous digestive enzymes and/or available over-the-counter (OTC) products.

Some people can't produce or use digestive enzymes effectively. A healthcare provider will likely prescribe prescription enzyme replacement therapy (ERT) for these conditions. However, this article will focus on major OTC digestive enzyme supplements, not prescription enzyme placement therapy products (ex., pancreatic enzyme replacement therapy (PERT)).

OTC enzymes have been studied in people with autism, arthritis pain, celiac disease, Crohn's disease, irritable bowel syndrome, muscle soreness, and more. It's important to discuss any digestive symptoms with your healthcare provider. OTC digestive enzymes are not meant to treat life-threatening medical conditions. 

Dietary supplements are not regulated in the United States, meaning the FDA does not approve them for safety and effectiveness before products are marketed. When possible, choose a supplement that has been tested by a trusted third party, such as USP, ConsurerLabs, NSF. However, even if supplements are third-party tested, that doesn't mean that they are necessarily safe for all or effective in general. It is important to talk to your healthcare provider about any supplements you plan to take and to check in about any potential interactions with other supplements or medications.

Supplement Facts

  • Active Ingredient(s): Alpha-d-galactosidase (Beano), amylase, bromelain*, chymotrypsin, elastase, lactase, lipase, maltase, papain*, pepsin, peptidase, protease, sucrase, trypsin
  • Alternate Names(s): Amylolytic enzymes, lipolytic enzymes, proteolytic enzymes
  • Legal Status: Over-the-counter (OTC) supplements (United States), food additives (select enzymes), GRAS (select enzymes).
  • Suggested Dose: Dosage depends on the condition.
  • Safety Considerations: Prescription blood thinners, children (people under 18), pregnancy, and breastfeeding.

Uses of Digestive Enzymes

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian, pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.

Digestive enzymes help break down the food you eat so your body can get the most nutrients. When this process is disrupted, you may experience discomfort (ex., bloating, gas). In more severe conditions where digestive enzymes aren’t produced or used efficiently, your body could become malnourished as it can’t use nutrients from your food as well. Over time, this can cause issues like osteoporosis. People with more severe conditions (ex., exocrine pancreatic insufficiency (EPI), pancreatitis, surgical removal of the pancreas, cystic fibrosis) will likely need prescription enzyme replacement therapy (ERT).

Over-the-counter supplements may be used in other conditions (lactose intolerance, trouble breaking down carbohydrates in beans). Digestive enzyme supplements available over the counter have been studied for their use in inflammatory bowel disease (Crohn’s, ulcerative colitis), irritable bowel syndrome (with FODMAP intolerance), lactose intolerance (due to aging, premature digestive systems in babies, injury, or disease like celiac), trouble digesting carbohydrates, and more. This article covers these conditions.

Be sure to discuss your symptoms and use of digestive enzymes with your healthcare provider.

Digestive Symptoms in Autism

Eating a balanced diet is a part of an overall approach to health. However, eating a wide variety of foods can be challenging for some people with autism spectrum disorder (ASD). People with ASD may have special dietary needs, including help slowly introducing foods that otherwise may cause them to experience sensory overwhelm or even digestive upset, which may cause rejection of certain foods. If you or a loved one is having issues or concerns in the area of eating and ASD, or find yourself needing support, consider speaking with your or your child's healthcare provider about working with a food therapy specialist (ex., an occupational therapist or a registered dietitian nutritionist with food therapy training). Note: digestive enzymes are not a cure for autism. Please discuss digestive enzymes with your child's health provider before using them.

Reports suggest anywhere from nine to 70% of people with autism spectrum disorders (ASD) experience gastrointestinal problems. That's an extensive range. Abdominal discomfort, gassiness, loose stools, or constipation (which may contribute to limiting food variety) have been reported. Some studies have suggested enzyme deficiencies - in lactase, maltase, sucrase, alatinase, and glucoamylase - may contribute to digestive discomfort, which may, in turn, contribute to different emotions and behaviors.

One study of 199 adults and children (ages 33 months to 28 years) with ASD looked at digestive enzyme activity, specifically lactase, maltase, and sucrase. The researchers suggested that boys under five years with ASD were more likely to have lactase deficiency than girls with ASD. Other digestive enzyme deficiencies that they noted were sucrase and maltase. Only 6% of the participants had small intestine (duodenum) inflammation.

An investigation of different ways to support digestive health in children with ASD has been suggested. However, research on using digestive enzymes (or any supplements) for gut issues in children with ASD is mixed.

In one placebo-controlled study with 92 children (three to nine years) with ASD, 47 were given digestive enzymes (Neo-Digestin; papain 0.08 grams and pepsin 0.04 grams per 5 milliliters solution) three times daily (for a total of papain 0.24 grams and pepsin 0.12 grams per 15 milliliters solution per day) before meals for three months. The children who took enzymes had improvements in emotional response and general behavior. They also had improvements in the following:

  • Abdominal pain
  • Food variety (selective eating may be seen in children with ASD)
  • Quality of stools
  • Vomiting

In a study of 29 children with ASD, a combination supplement with caso-glutenase 10,000 AU; bromelain 230 BTU; acid-fast protease 100 SAPU; lactase 330 LacU; phytase 125 U; and galactose 100 milligrams was taken with each meal for twelve weeks. Guardians, parents, teachers, or therapists evaluated thirteen health and behavior parameters. Socialization and hyperactivity improved by 90% and 80%, respectively. Stimming and speech improved the least.

However, several other studies using a different enzyme combination have not found similar effects.

More research is needed. Talk to your child's healthcare provider (ex., pediatrician) before giving them digestive enzymes.

Cancer Treatment Complications

A review showed mixed results for using digestive enzymes to treat complications from cancer or cancer treatment.

While some studies suggested OTC enzymes improved the quality of life for people with colorectal cancer or increased survival in people with multiple myeloma also receiving standard treatment, other studies reported conflicting results.

More research is needed. Talk to your healthcare provider before taking any supplements or over-the-counter medications due to possible interactions, especially during cancer treatment.

Celiac Disease

Enzymes have been studied for celiac disease (an autoimmune disease). A review highlighted studies using gluten-degrading enzymes like cysteine proteases, prolyl endopeptidases, and subtilisin. Some of these enzymes are being studied for drug development. However, the review suggests gluten-degrading enzymes could potentially increase or decrease the body’s immune response to gluten, potentially making symptoms worse. Other studies using other enzymes for celiac were inconclusive.

Enzymes alone should not be used to manage or treat celiac disease. Follow the guidance of your healthcare provider (ex., registered dietitian nutritionist, gastroenterologist) and your body.

Fermentable Carbohydrate Digestion

Some people have trouble digesting specific carbohydrates in beans. Studies have suggested an alpha-galactosidase supplement (ex., Beano) reduced gastrointestinal symptoms (ex., abdominal discomfort, bloating).

Functional Dyspepsia

Researchers conducted a randomized, double-blind, placebo-controlled study of 40 individuals (32 people assigned female at birth, eight assigned male at birth) with symptoms of functional dyspepsia (including indigestion). Fifty milligrams of a combination enzyme product (α-amylase, protease, cellulase, lactase, and lipase) were used twice daily for 60 days. The researchers reported that the treatment reduced indigestion symptoms compared to the placebo.

Of note, the study's authors were founders or employees of the company that manufactured and marketed the enzyme product used in this study. This could introduce bias in study results and needs to be considered when interpreting the findings. Further study is required to confirm any of these results.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) includes ulcerative colitis (bowel disease) and Crohn’s disease (inflammation anywhere in the digestive tract, even the mouth). The use of digestive enzymes has been suggested as a potential treatment option for IBD, although conflicting evidence exists. It’s also been suggested that people with IBD may not make enough lactase, leading to dairy intolerance.

A few case studies in humans suggested bromelain may help symptoms in people with colitis.

Digestive enzymes have also been studied for IBD-IBS syndrome. IBD-IBS syndrome is an inflammatory bowel disease (IBD) with irritable bowel syndrome (IBS) symptoms, such as abdominal pain and diarrhea. In a study, people with IBD-IBS (including those with Crohn’s disease or ulcerative colitis) were given Asacol (an anti-inflammatory drug) with Biointol (a combination product with digestive enzymes, inositol, and beta-glucan) for four weeks. The control group received Asacol only. After four weeks, those who received Asacol and Biointol said they had less abdominal pain. They also said they had less bloating and flatulence. Those who took only Asacol slightly improved fecal urgency (sudden need to have a bowel movement). 

While these effects are promising, more studies are needed to confirm the results.

Irritable Bowel Syndrome (IBS)

Digestive enzymes have been studied in people with irritable bowel syndrome (IBS). One study discussed in a review used Essential Enzymes 500 (Source Naturals, Scotts Valley, CA, USA), a combination product containing protease (4375 USP units), lipase (375 USP units), a-amylase (2614 USP units), as well as amyloglucosidase, cellulase, hemicellulase, and lactase in people with diarrhea associated with IBS. Of the 86 people in follow-up, 71 (82.5%) experienced improved or eliminated IBS-D symptoms. 

It’s important to note that this study used a combination product. It would be challenging to understand which ingredients were most effective over time. Further studies are needed to confirm these results.

Lactose Malabsorption and Intolerance

People who have trouble digesting dairy (ex., lactose malabsorption, lactose intolerance) may take OTC digestive enzymes like lactase. Lactase digests lactose. Lactose is the primary sugar in milk and other dairy products (ex., buttermilk, condensed and evaporated milk, yogurt, ice cream, and cheese). Lactase supplements can help prevent indigestion in people who have trouble digesting lactose. Secondary lactose intolerance can arise in people with IBD (Crohn’s, ulcerative colitis) and other diseases like celiac. This is due to potential intestinal damage and, thus, decreased lactase production in the body.

Lactase malabsorption and intolerance must be addressed to prevent diseases like osteoporosis.

Muscle Soreness

Studies have also looked into OTC enzymes as a treatment for sore muscles. In a placebo-controlled study, 20 men were given protease (breaks down proteins) supplements containing 325 milligrams of pancreatic enzymes, 75 milligrams of trypsin, 50 milligrams of papain, 50 milligrams of bromelain, 10 milligrams of amylase, 10 milligrams of lipase, 10 milligrams of lysozyme, and two milligrams of chymotrypsin. The supplement reduced pain in men after intense downhill running.

A study using a different product (300 milligrams of bromelain, twice daily) on another area of the body showed no difference in elbow pain soreness after exercise between the bromelain group, 400 milligrams of Advil (ibuprofen) twice daily, placebo, and control groups.

Further study is needed.

Osteoarthritis

Researchers have studied the effects of bromelain on osteoarthritis (OA) pain. It's been suggested that bromelain works by reducing inflammation.

A review of studies on supplements in OA found evidence that bromelain may ease OA pain. The authors noted, however, that many of the studies had a suboptimal design.

Another study of 150 people with moderate-to-severe knee OA compared Voltaren (diclofenac) with Wobenzym. Voltaren is a prescription non-steroidal anti-inflammatory (NSAID) pain reliever. In the suggested daily dose, Wobenzym contains milligrams of trypsin (an enzyme derived from pig or cow pancreas that breaks down proteins), 540 milligrams of bromelain (from pineapple), and 600 milligrams of rutoside trihydrate (rutin, an antioxidant derived from the Japanese pagoda tree, Sophora japonica). After 12 weeks, people taking Wobenzym had less joint pain and improved knee function (walking ability and knee flexibility) compared to the NSAID group. The effects of the individual enzymes on arthritis are unclear. A study with a similar supplement suggested only minor improvements in pain.

Based on the current research, it's challenging to know how effectively individual enzymes may improve OA symptoms, mainly when using combination products that contain more than just enzymes. Larger, high-quality studies are needed before these results can be confirmed.

Digestive Enzyme Deficiency

In the body, most digestive enzymes are made by the pancreas, small intestine, and mouth (saliva). These are called endogenous digestive enzymes. These enzymes help your body break down fats, proteins, and carbohydrates from food.

When your body doesn't make enough enzymes, it can't break down foods as easily. That means it cannot absorb the nutrients from those foods easily. This can cause malabsorption.

Malabsorption can lead to nutritional deficiencies and uncomfortable symptoms, like:

What Causes a Digestive Enzyme Deficiency?

Diseases that cause digestive enzyme insufficiency include but are not limited to:

These conditions may require prescription enzyme replacement therapy (ERT). Prescription products are different from over-the-counter products. 

Other conditions that may cause inefficient production or use of digestive enzymes include:

How Do I Know If I Have a Digestive Enzyme Deficiency?

Your healthcare provider will diagnose a digestive enzyme deficiency and can determine whether you need a prescription product or if an over-the-counter product will suffice. 

Symptoms of enzyme deficiency may include:

Keep track of when you experience these symptoms and the foods you consume before experiencing symptoms. Consult your healthcare provider if you experience any of these symptoms.

What Are the Side Effects of Digestive Enzymes?

Most digestive enzyme supplements are safe at doses recommended by the manufacturer. Side effects are generally mild. However, the risk of severe side effects does exist.

Common Side Effects

Common side effects of digestive enzyme oral supplementation are primarily gastrointestinal upset, such as:

  • Allergic reactions
  • Diarrhea
  • Loose stools
  • Nausea
  • Stomach pain
  • Vomiting

Side effects, when applied to the skin, include:

  • Redness and swelling

Severe Side Effects

Severe side effects of digestive enzymes are rare. Each supplement can have different effects. The risk of an allergic reaction is present for all digestive enzyme supplements, particularly if you have a known allergy to them or the products from which they are derived (for example, an allergy to papaya or pineapple).

  • Anaphylaxis (chymotrypsin)--this is rare.
  • Pain and burning when applied to the skin (trypsin)
  • Perforated esophagus (papain in high amounts)--this is rare.
  • Severe irritation (papain latex)

Precautions

Some digestive enzyme products are derived from animals (ex., cattle, pigs). If you’re following a specific diet that avoids animal products, please be aware of the origin of your enzymes. 

Avoid use if allergic to the ingredient (ex., ingredients in fruit latex). Ask your pharmacist or review the product label for a complete list of ingredients. 

Use caution when using bromelain if you take blood thinners. If you take blood thinners or have low platelets, using bromelain may increase your risk of bleeding.

If pregnant or breastfeeding,  consult a healthcare provider before taking digestive enzymes.

Digestive enzyme capsules
Verywell / Anastasia Tretiak

Dosage: How Much Digestive Enzymes Should I Take?

Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage are appropriate for your individual needs.

Dosing for digestive enzyme supplements differs for each enzyme and different conditions. The following has been suggested:

  • Bromelain: up to 400 milligrams (mg) per day by mouth
  • Chymotrypsin: up to 100,000U USP four times daily by mouth
  • Papain: up to 1500 milligrams per day by mouth
  • Trypsin: up to 50 milligrams; combined with bromelain

Digestive enzymes are usually taken before meals.

As a general rule, never take more than the recommended dose. Follow instructions on product labels and include your healthcare provider and pharmacist in your decisions. Look for supplements certified by a third party if purchasing in a store.

What Happens If I Take Too Much Digestive Enzymes?

A standard dose for over-the-counter digestive enzyme supplements is lacking. Follow the instructions on your supplement package. Consult with your healthcare provider for further guidance.

In rare cases, an excess amount of digestive enzyme supplement has resulted in esophageal perforation (torn esophagus).

Interactions

Digestive enzyme supplements may interact with blood-thinning medicines like:

Digestive enzymes, specifically bromelain, may interact with other supplements with blood-thinning effects. These include:

  • Garlic (high amounts)
  • Ginger
  • Gingko biloba
  • Ginseng
  • Fish oil
  • Vitamin E
  • Willow

Bromelain may impact absorption and the body's use of medications such as:

  • Antibiotics (ex., amoxicillin, tetracycline)
  • Blood pressure medication/ACE inhibitors (ex., Capoten (captopril), Zestril (lisinopril))
  • Chemotherapy drugs (ex., 5-fluorouracil, vincristine)

Papain may impact how the body absorbs amiodarone, levothyroxine, antidiabetes medications, and warfarin.

It is essential to carefully read a supplement's ingredient list and nutrition facts panel to know which ingredients and how much of each ingredient is included. Please review this supplement label with your healthcare provider to discuss potential interactions with foods, other supplements, and medications.

How to Store Digestive Enzymes

Store digestive enzymes in a cool, dry place. Keep digestive enzymes away from direct sunlight. Follow the manufacturer’s guidance on your digestive enzyme packaging.

Similar Supplements

Select foods contain digestive enzymes, like pineapple and papaya. Pineapple contains bromelain, and papaya contains papain.

Papain is a proteolytic enzyme found in papaya and is believed to aid digestive issues. However, eating papaya has the same benefits as taking papain as an oral supplement.

While probiotics and prebiotics are used for digestion, they have different mechanisms of action (they work differently) than digestive enzymes.

Frequently Asked Questions

  • What’s prescription enzyme replacement therapy?

    People with conditions like cystic fibrosis, pancreatitis, and pancreatic cancer are prescribed prescription enzyme replacement therapy, usually in the form of pancreatic enzyme replacement therapy (PERT). Prescription PERT products include Creon, Pancreaze, Ultresa, Viokace, and Zenpep. Prescription PERT is different from over-the-counter products.

  • Should you take digestive enzymes before or after you eat?

    While digestive enzymes are typically taken before meals, read the manufacturer’s suggestions. Ask a healthcare provider if you have any questions.

  • Is Lactaid a digestive enzyme?

    Lactaid is an over-the-counter product that contains the digestive enzyme lactase. Lactase breaks down lactose (a sugar) in dairy products. It helps people with lactose intolerance.

Sources of Digestive Enzymes & What To Look For

Digestive enzymes are typically found naturally in the body. They are also sold as supplements and are found in foods like pineapple and papaya.

Food Sources

The digestive enzyme bromelain can be found in the core and stem of the pineapple. Papain can be found in papaya. While digestive enzymes exist in these plants, it’s unclear whether you’ll get extra digestive enzymes by eating the fruit of these plants.

Some food products also contain enzymes, like Lactaid milk which contains lactase.

Supplements

Digestive enzymes are widely available online and in stores. They typically come in capsule form. They may have different amounts of enzymes and sometimes may contain other ingredients like prebiotics or probiotics. Speak with your healthcare provider before using digestive enzymes, particularly if you’re having trouble with digestion.

Summary

Digestive enzymes have been studied for several health conditions, like IBS, IBD, autism, and more. The evidence is mixed regarding whether or not they’re useful for some of these conditions. Digestive enzymes are readily available over the counter for issues like lactose intolerance and for help with digesting other carbohydrates. Some digestive enzymes may have mild side effects. Since digestive symptoms can also be connected with more serious conditions, be sure to discuss your symptoms and concerns with your healthcare provider.

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Additional Reading

By Regina C. Windsor, MPH, RDN
Listen to yourself. Connect the dots. Find your people. Go have fun.

Originally written by
Cathy Wong
Cathy Wong

Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health.

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