We naturally make enzymes as part of digestion to break down fats, carbohydrates and protein. If you’re not producing enough of certain enzymes then it could be contributing to bloating and gas build up.

In this episode of the Inside Knowledge podcast I’ll talk through

• the different types of digestive enzymes we make,
• why you might be low in them,
• options are for improving the way you break down your food. 

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The information in this podcast is not medical advice and is not designed to treat, diagnose or provide personalised health advice. This podcast content is information only and any changes you make are at the user's own risk. Please consult with your doctor or healthcare provider before implementing any new treatment.

Have you tried taking digestive

enzymes to help your IBS?

2

We naturally make enzymes as part

of our digestive process which

3

breaks down fats and carbohydrates

and protein from our food.

4

If you're not producing enough of these

certain enzymes, it could be contributing

5

to your bloating and gas build up.

6

And the issue is that sometimes when we

take supplements, they also contain things

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that might make your symptoms worse.

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So it's not always a

good idea to supplement.

9

In this episode of the Inside Knowledge

podcast, I'll talk through the different

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types of digestive enzymes we make,

why you might be low in them, and

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what the options are for improving

the way you break down your food.

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Hello

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and welcome to episode 67 of

the Inside Knowledge podcast.

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I'm Anna Mappson.

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The reason I'm talking about digestive

enzymes today is that they are one of

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the main parts of our chemical digestion.

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So we have like a mechanical

digestion process by using our

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teeth to crunch up the food.

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Using our stomach, which is a

muscle, which is also mashing up

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the food and mixing it all together,

mixing it with all the juices.

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We also have chemical digestion, started

by our stomach acid and then enzymes are

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compounds that help us break down our food

so that we can better absorb them, get

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them into our cells, and actually start

to use the key nutrients from our food.

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In this session, I'm going to talk

about the different types of enzymes,

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like where they're produced, I'll

talk a bit about why you might have

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issues creating digestive enzymes and

then also a little bit about specific

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supplements that you can take looking at

different types that might be helpful.

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when you should take digestive enzymes and

when you definitely should not take them.

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So, to get into the first section,

digestive enzymes are made up of

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All along the digestive process

really, even starting in the mouth.

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We have something called salivary

amylase which starts to break down

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carbohydrates and there is some

breakdown of fats as well in the mouth.

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Then we also have digestive breakdown in

the stomach, so we have gastric enzymes.

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Then we also have some coming from

the pancreas, pancreatic enzymes.

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And then, finally, into the small

intestine, we've got brush border

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enzymes that are produced as

the food is getting broken down.

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It's already been mashed up.

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So, starting with the salivary amylase,

or the saliva enzymes, this is partly why

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it's so important to chew your food up.

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The first stage of digestion is really

happening when you're crunching up the

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food with your teeth, but also there's

a chemical breakdown with the saliva.

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You might even try this, like if

you have a mouthful of rice or white

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bread, and you chew it up and chew

it up and chew it up, what you will

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find is it can actually end up tasting

quite sweet, and that is because your

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saliva is starting to break down the

glucose and extract it from the grains.

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In your stomach we also have some gastric

enzymes and one of the key important

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ones I want to mention is pepsin

which starts to break down protein.

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So this is where our

protein digestion begins.

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When the food gets into the stomach, your

stomach cells release something called

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pepsinogen and then when that mixes with

stomach acid, the hydrochloric acid, it

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activates pepsin pepsinogen into pepsin,

which is the active component that starts

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to break down proteins from your food.

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Now, remember this because I'm going

to come back to it a little bit at

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the end when I talk about whether we

should be taking digestive enzymes

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that include pepsin or that include

hydrochloric acid because it is important.

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But just for now, I want to

explain all the little bits.

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Then moving into the small intestine.

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Then we also have pancreatic

enzymes, which are delivered to

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the small intestine, and these

are a range of different enzymes.

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So they're proteolytic ones, which

which start to digest proteins we

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also have amylase, breaking down

carbs, and lipase, breaking down fats.

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So these come into the small intestine,

where the environment is more

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alkaline than in the stomach acid.

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Sometimes when you take lipase, it

is actually denatured by stomach

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acid, and so it's, this, our body

has a way of delivering it to the

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small intestine, but where it's

not so acidic, it's more alkaline.

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And then, also in the small intestine,

you have these little villi that stick

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out into the tube of your small intestine.

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Brush border enzymes are

produced right at the coal face

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where the stuff is happening.

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And these break down lactase

and also maltase and sucrase

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which are other types of sugars.

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So that's a very high level

little overview of your

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chemical digestion process.

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The reasons why you might not

have enough of specific enzymes.

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depend a little bit on what

type of enzymes you don't have.

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It's unlikely to be all of them.

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So for example, if you're not breaking

down carbohydrates very well, it could

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be down to the production in the mouth.

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Like, are you actually chewing food?

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Is it staying in your mouth long enough

to get broken down by the saliva?

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And then also the pancreas,

pancreatic enzymes, the

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amylase that's produced there.

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With fats, again, it can be down

to your saliva, it could be down to

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the small intestine in the pancreas.

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And then with protein, it's more about

whether your stomach acid is high

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enough, because that is really key

to breaking down proteins, because

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if you don't have high enough stomach

acid, it's not going to activate

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the pepsinogen into pepsin.

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So those are kind of reasons why you

might not be producing the enzymes.

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One of the main reasons would be your

pancreas isn't functioning properly.

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Now that could be down

to all number of things.

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It could be down to an inflamed pancreas,

that's pancreatitis, could even be

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pancreatic cancer and a lot of people

I work with this is their ultimate fear

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because that is one of the cancers that

unfortunately It's often discovered quite

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late and there's very little that can be

done, so people do tend to panic about it.

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However, these things can

definitely be shown up in scans.

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And so if you've got a concern about

this, it's really important to go speak

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to your doctor, get it checked out.

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Other reasons why you might not be

producing enough of these enzymes is

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that you've actually got microbes in the

small intestine that are interfering with

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the brush border production of enzymes.

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This can happen if you've had a

stomach bug or some kind of gastric

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bug, because things like lactase

deficiency, so lactase is the sugar

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that's breaking down your lactose, and

lactose intolerance can actually be

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worsened after you've had a stomach bug.

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It can come and go and you can

actually get over that kind of lactose

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intolerance in time rather than it

being a genetic, thing that you don't

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have enough of this lactase production.

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There are some cases where people will

have SIBO, which is small intestine

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bacterial overgrowth, and it can

interfere with the production of these

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brush border enzymes, making them more

susceptible to things like lactose

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intolerance, to what's sometimes

called sucrose isomaltase deficiency.

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So that is your inability to break down

sucrose and maltase, which are these

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two sugars that That are disaccharides

and they're broken apart at the brush

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border if you don't have the enzyme

To do that then you can start to get

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bloating gas Diarrhea a lot of cramping

and pain because your guts don't know

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what to do with this disaccharide.

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Disaccharide is kind of two bundles of

sugar linked together and your body cannot

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absorb those in the same way that it can

with one molecule of glucose, for example.

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So what our body likes to do is

to get them into single molecules

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that can be easily absorbed.

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Sometimes what we don't know is whether

there is an issue with the pancreas that

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then leads to less enzymes being produced

that then leads to this overgrowth of

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the bacteria, or is it the other way

around that the bacteria are there or

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the microbes are there in your small

intestine and then They're stopping

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the production of the brush border

enzymes, like it, it's hard to know.

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But, there's a bit of research where

they basically took out the pancreas or

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they kind of adjusted the power of the

pancreas in, I think it was in pigs.

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It was definitely an animal study.

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Anyway, it wasn't people.

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And they found that that increased

the amount of bacteria that grew

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in the small intestine of the pig.

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So we don't have many human trials.

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But we do know that About six or seven

percent of people who have IBS diarrhea

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predominant symptoms potentially

have some kind of impairment to

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their pancreatic enzyme production.

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I guess what I'm trying to say with

all of this big long introduction is

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that it could be quite a common thing

that you Have got some impairment to

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the production of enzymes or your way

that you're able to break down the food

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that you're getting that then leads you

to have undigestible products in your

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small intestine that then are fermented

by bacteria causing more bloating,

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causing diarrhea, causing faster transit

time and potentially cramps as well.

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So these things are very

common in people who have IBS.

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Some of the symptoms of having pancreatic

enzyme insufficiency, which means your

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pancreas isn't producing enough of these

enzymes, might be that you're losing

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weight, that you have a lot of fat in

your stool, so your poo is very greasy,

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and you can see, uh, oil floating on the

top of the toilet bowl, and you might

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have steatorrhea, which is like kind of

frothy, greasy diarrhoea, often yellowy,

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greeny even in colour, um, and that can be

a very common sign of having insufficient

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breakdown of fats in your poo.

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Listen to episode 23 if you

want more on dietary fats and

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fat breakdown and IBS because I

recorded a whole episode on that.

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There is a way to test for pancreatic

enzyme production by a stool test.

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They look for the amount of what's

called pancreatic elastase in your stool.

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This can be done by your doctor.

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So the NHS do run these as

well as on private stool tests.

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You, if you're getting a private

stool test, you should make sure

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that this is going to be tested

because it's a good marker to see.

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And what they're looking for is anything

less than 200 milligrams per gram.

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And that would indicate that

yes, you have, an insufficiency

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of enzymes being produced.

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If your doctor does this test

and then you are offered some

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medication to support this.

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Um, the most common one given

in the UK is called Creon.

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And it is just, enzymes for breaking

down fats, proteins, and carbs.

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I once worked with a client who had been

prescribed this by her doctor, but then

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told me, I don't want to take medication.

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I want to do it naturally.

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I think what people don't always realize

is that the, Supplements that you

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can get, are also digestive enzymes,

pretty much the same as this medication.

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They might be in different

quantities and, , the amount of

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enzyme per product is important.

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But this is a medication that

you can get on the NHS, which

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helps you break down your food.

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But, if you are looking for a

supplement that contains digestive

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enzymes because you think this could be

something that you want to look into.

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And you know you've got IBS, so as

I always say, like, if you haven't

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had a diagnosis of IBS, it's really

important that you do go to your doctor.

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Don't just start making changes to your

diet and start taking supplements if you

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don't really know what the problem is.

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But if you are looking for something,

it's really helpful to know what

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your particular food triggers are.

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If you don't have any sense of

what your food triggers are, then

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I do suggest following something

like the low FODMAP diet process.

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in order to identify your triggers.

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So one way of doing that would be to

cut out all the FODMAP foods that are

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highly fermentable, then you slowly

reintroduce them to see if there's

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a particular type of carbohydrate

that is causing your problems.

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Once you know this, you can be a lot

more targeted with your digestive enzymes

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and actually, you don't need to take

them all if there's only one particular

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one that you're struggling with.

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Now, obviously this won't test you

for fat malabsorption, for example,

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because the low FODMAP diet shouldn't

really be altering the amount of fats

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that you're eating and it wouldn't

necessarily look at protein digestion.

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So this is why some people just say, I'm

just going to try a digestive enzyme.

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But what I'm saying is you can be

a bit more targeted if you know the

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particular types of carbohydrates

that might be an issue for you.

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For example, there is, a particular enzyme

that breaks down galacto oligosaccharide,

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so that's in the FODMAP groupings.

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These are found in beans and

pulses, um, and some nuts as well.

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If you know that that kind of food

is your problem, there is an enzyme

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that you can take just when you're

having like a big lentil dal, or

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just when you're having a vegetarian

chilli with loads of kidney beans,

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this might be really helpful for you.

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And the enzyme is called

alpha galactosidase.

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If you don't know, and you're looking for

a generic brand of digestive enzymes, I

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suggest you get one that includes alpha

galactosidase because it does cover you

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off for the galacto oligosaccharides.

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Then, for example, if you know you just

have a problem with lactose, you can

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also get digestive enzymes that just

contained lactase are going to break

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down the sugars in your dairy products.

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Most digestive enzymes contain a range

of different enzymes, so they'll have

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something that covers proteins, fats

and starches, and that's probably

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a good place to start if you don't

know what your particular issues are.

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There is, uh, a new ish digestive

enzyme that's been around for about

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a year called Fodzyme, that is

particularly specific to FODMAP groups.

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So it covers off GOS, lactase,

and fructans, which tend to be the

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things that people react to the most.

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So this would include wheat,

onions, garlic, beans, and dairy.

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And if you think about those

food groups, that's quite a

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lot of the common IBS triggers.

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What it doesn't do is it doesn't contain

any polyols, so these are foods like,

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um, avocado, sweet corn, cauliflower,

mushrooms, blackberries, stone fruit.

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They are not necessarily covered

by this enzyme, so it's not

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really for all the FODMAP groups.

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They also don't have any fat breakdown

in there, so there's no lipase, and it's

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a powder that you sprinkle on your food.

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Now, the benefit to this is that

it tends to work within 30 minutes

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so it's very quickly absorbed.

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So you're eating the digestive enzyme

with your food and so it starts that

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breakdown in your stomach and as soon

as it hits the small intestine it's

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breaking down those key FODMAP foods.

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Then the theory is that they are

already broken down when they hit the

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small intestine so they shouldn't cause

you too many problems as these larger

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molecules will not be getting to the

large intestine causing you excessive

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gas and bloating, that is really common

with other FODMAPs that go undigested.

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The other thing is that it doesn't

include any fat breakdown, any

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protein digestion, and it's incredibly

expensive compared to other products.

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So, I'm just specifically calling

them out just because I know that

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a lot of people ask about them.

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Is it worth it?

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So those are my thoughts on that

particular product But there are lots

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of other digestive enzyme products out

there that do contain the full spectrum

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But won't necessarily be so fast acting.

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The one thing that um is really important

though is that you cannot open other

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digestive enzymes and put them on your

food and start eating them with your meal.

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These ones are different, the, the

Fodzyme ones, because they don't

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contain any proteolytic enzymes,

that's any pepsin or anything

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that's going to break down protein.

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The reason that your stomach acid

has to activate pepsinogen into

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pepsin is to protect your stomach.

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Your stomach only activates that when

you've got food on the go, because what

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you don't want to happen is that these

protein degrading enzymes are hitting

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your stomach if you don't have enough

mucus lining there and if you haven't got

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a good healthy of digestion if there's

not food there already being broken down.

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The reason it's important is because if

you've got gastritis or if you've got a

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very sore stomach and you don't know why

you might have gastritis and you don't

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know that could be that you haven't got

a sufficient mucous layer lining your

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stomach bag and these proteolytic enzymes

break down protein so they can actually

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aggravate your stomach lining and make

your symptoms much worse and over time

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could lead to you getting a stomach ulcer.

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This is one of the reasons why I really

do not suggest taking things that have

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got pepsin in them, because you don't

know that Whether you're going to have

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a problem with your stomach lining.

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The only thing that happens when

people do take them and they do

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find out that they've got an issue

is that they get in a lot of pain

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and I'd rather people avoid that.

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I don't think it's necessary

to take additional pepsin.

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What we want to do is to try and get

your own body producing that properly.

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Now in terms of when you should

take digestive enzymes, ideally you

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take them at the start of your meal.

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So take one bite of your food,

take the digestive enzyme.

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You can wash it down with some

liquid, some water, don't worry

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about drinking, it's not going

to invalidate your stomach acid.

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Then eat the rest of your meal.

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The benefit of that is that

it gets churned up with all

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your food in your stomach.

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So, you're starting to activate that

digestive process as quickly as possible.

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I know some people are told that

they should have it after their meal.

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There's no harm in doing that, and

it's better than not doing it at all,

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but it might be more effective if you

take it at the beginning of a meal.

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The only other time I don't suggest

taking a digestive enzyme is whilst you're

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doing any food reintroduction process.

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So if you've been on an elimination

diet, like the low FODMAP diet,

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then whilst you're doing the careful

reintroductions, ideally, you don't

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want to be taking a digestive aid

that is helping you with this process.

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If it is the only thing keeping

you going and you're really

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struggling, then yes, keep it in.

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However, ideally, you want to try and stop

the digestive enzyme to enable you to see

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what your own reaction is to these foods.

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Is it, do you have an actual

imbalance that's stopping

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you break down these foods.

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If you're looking at your long

term digestive capability, you want

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to know without the supplements

what it's like when you have that

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food in your small intestine.

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As always, I have tried to keep it short.

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I try and keep these sessions to about

20 minutes, so I have rushed through

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quite a lot of information here.

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But I want to keep these Inside

Knowledge podcast episodes succinct

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and full of information, which is

why I don't have too much chat.

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But if you do have questions

from about anything I've said,

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then feel free to drop me a line.

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It is [email protected]

and I will get back to you or you can

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follow me and send me a DM on Instagram.

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I am, goodnessme_nutritionthere.

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Also if you have any

suggestions for future episodes.

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I've had a few requests recently and I

will be getting round to going through

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all of those once I get through the

plan for the next couple of months.

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But thank you very much for

listening to this episode.

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Better digestion for everyone.