Digestive enzymes. We’re betting you’ve heard of them, have a vague idea that they’re good, and wonder if you should be taking them. But this is one area where we also see a lot of confusion. Supplementation of any sort without knowing what or why you’re doing what you’re doing can be just as detrimental to your health as doing nothing at all. So before you stock up on papain and bromelaine, let’s get the complete low-down on all things digestive enzymes from today’s guest expert, Dr. Tim Gerstmar of Aspire Natural Health.
What are digestive enzymes, and why are they so important?
We eat food, but our digestive system doesn’t absorb food, it absorbs nutrients. Food has to be broken down from things like steak and broccoli into its nutrient pieces: amino acids (from proteins), fatty acids and cholesterol (from fats), and simple sugars (from carbohydrates), as well as vitamins, minerals, and a variety of other plant and animal compounds. Digestive enzymes, primarily produced* in the pancreas and small intestine, break down our food into nutrients so that our bodies can absorb them.
*They’re also made in saliva glands and stomach, but we’re not going to focus on those here.
If we don’t have enough digestive enzymes, we can’t break down our food—which means even though we’re eating well, we aren’t absorbing all that good nutrition.
What would cause digestive enzymes to stop working correctly in the body?
First, diseases may prevent proper digestive enzyme production.
- Pancreatic problems, including cystic fibrosis, pancreatic cancer, and acute or chronic pancreatitis.
- Brush border dysfunction, the most severe is long standing Celiac disease, where the brush border is flattened or destroyed. Other diseases like Crohn’s can also cause severe problems.
But even in the absence of any obvious disease, things still may not be working properly.
- Low-grade inflammation in the digestive tract (such as that caused by “food allergies,” intestinal permeability, dysbiosis, parasitic infection, etc.) can lead to deficiencies in digestive enzymes.
- Aging has been associated with decreased digestive function, though I personally wonder if this is a result of aging, or aging badly.
- Low stomach acid—we’ll talk about this more in a future article, but if you have low stomach acid, it’s likely that you won’t have adequate digestive enzymes either.
- Chronic stress. This is the most common reason for digestive enzyme problems. Our body has two modes: sympathetic “fight or flight,” and parasympathetic “rest and digest.” When we’re in “fight or flight” mode, digestive is given a very low priority, which means digestive function (including digestive enzyme output) is dialed down. Chronic stress= constant “fight of flight” mode = impaired digestive enzyme output.
How do we correct a digestive enzyme deficiency?
First, a Whole30 or a Paleo-style diet can help to restore normal digestive function, including digestive enzymes. Dietary interventions work by reducing inflammation in the body and the digestive tract, improving nutrient deficiencies, removing enzyme inhibitors by taking out things like grains and legumes, and fixing gut bacteria.
However, just because you eat Good Food doesn’t automatically mean your digestion will be healthy. In my previous article, I talked about gut bacteria, which may not be in perfect balance with a Paleo diet alone. Improper digestion is another issue that diet alone may not solve.
Managing chronic stress is vitally important to restoring healthy digestive function. Most of us are cramming food in our faces at our desks or while we’re on the go, then we’re off to do the next thing on our list. We live most of our lives in sympathetic mode—and aren’t giving a high priority to properly digesting our food. When we sit down to eat food, we should switch into a parasympathetic mode, and ideally stay in parasympathetic mode for a while afterwards. Think long European meals, followed by a siesta. (Refer to pages 182-185 in It Starts With Food for more specifics.)
Finally, after implementing these healthy dietary and lifestyle practices, digestive enzyme supplementation may be necessary to help your body properly break down your food.
How do I know if I should be taking digestive enzyme supplements?
The best way to know is by stool testing, to measure how well you’re digesting and how well your pancreas is producing digestive enzymes. Many traditional medical doctors are unlikely to run these tests, and they may not be covered by insurance. If you’d like to run one of these tests, seek out a qualified alternative provider who you trust.
Other symptoms that suggest you might have problems with digestive enzymes are:
- Gas and bloating after meals
- The sensation that you have food sitting in your stomach (a rock in your gut)
- Feeling full after eating a few bites of food
- Undigested food in your stool*
- Floating stools (an occasional floating piece is fine, but if all your poop consistently floats, that might be a sign something is wrong)
- An “oil slick” in the toilet bowl (undigested fat)
The good news is that since digestive enzymes are very safe and reasonably cheap, you can always try them and see if you notice any difference in your digestion.
*If you’re serious about your health, I encourage you to periodically look at your poop—it’s one of the simplest ways you can gain insight into your health. Take a glance a few times a week. If there’s a significant change, have a talk with your doctor; it could be a sign of something going on.
What kinds of digestive enzyme should I take?
There are a variety of digestive enzymes on the market, including single enzyme and multiple enzyme. Without testing, I typically recommend a mixed enzyme to cover your bases.
As with all supplements, you’re looking for brands that meet the following criteria:
- Quality/Price: Buying cheap supplements is almost always a waste of money—you’re almost never going to get the benefit you’re looking for. When buying enzymes, don’t look for the cheapest brand on the shelf, and steer clear of conventional grocery stores and drug stores, as they carry poor quality product.
- Reputation: There are about a zillion companies selling supplements right now, and I don’t pretend to know all of them. Two over-the-shelf companies are Jarrow and NOW Foods. A couple of ‘doctor’ grade companies that you can get over the Internet are Thorne and Klaire labs. These companies have good reputations, and I’ve seen patients have good luck with their products.
- Source: There are three major sourcing for digestive enzymes. Fruit sourced (isolated from papaya or pineapple) work well for some people, but tend to be the weakest digestive enzyme supplement, and aren’t sufficient for people who need more support. Animal sourced (typically listed as pancreatin) are not for vegetarians or vegans, and can have issues with stability. They work really well for some people, but typically are not the forms I’m using. “Plant” sourced (from fungus) are the most stable of all the enzymes, survive digestion well, and have a broad spectrum of action. These are the ones I most commonly use.
- Multiple enzymes: Most people are going to benefit from a multi-enzyme product, so you’ll want to see a number of enzymes listed, including proteases (which break down proteins), lipases (which break down fats), and carbohydrases (such as amylase, which break down carbohydrates). Look at the labels of the products linked above for specifics—there are a ton of enzymes, but your product should include at least some from these labels.
- Strength/potency listed: Enzymes are rated on various scales (which are too complicated to go into here), but you want to see numbers beside each enzyme showing their strength. If it’s just a proprietary formula without strengths listed, be cautious—it usually means a weak product.
- Ingredients: As with all supplements, you want to see all the ingredients listed. And you especially want to see what ingredients are not in the product like gluten, dairy, etc. If it doesn’t say “contains no: sugar, salt, wheat, gluten, soy, milk, egg, shellfish or preservatives,” you need to assume that it does. (The above-referenced NOW Foods enzyme is a good example.)
When should I take digestive enzyme supplements, and how much should I take?
Take your digestive enzymes with food. Some people make a big deal of timing, but my bottom line is just to get them in around the time you’re eating. Most people find it easiest to pop them just before they sit down to eat, but anytime within about 30 minutes of your meal is going to be beneficial.
If you have a high quality product, most people need 1-2 capsules with their major meals. (Most people don’t need to take any with light meals or snacks unless their digestion is very messed up.) The most I’ve ever had to use with a person was 4 capsules with each meal.
When you’ve found a dose that works well for you, your symptoms should go away—that gas or bloating after meals, the feeling of a stone in the guts, or your messed up poop should get better. If not, try increasing your dose slowly, by one pill per meal, giving it at least a 3 days (and up to a week) to evaluate how things are working.
Dr. Tim Gerstmar is a Seattle-based Naturopath who specializes in treating complex chronic diseases – those issues that leave most other doctors stumped. His area of expertise is in digestive health. He uses clinical nutrition (primarily Paleo, Weston A. Price and GAPS) and lifestyle counseling, botanical medicine (herbs), functional medicine, homeopathy in his practice. You can learn more about Dr. Gerstmar and Aspire Natural Health at http://aspirenaturalhealth.com, or contact him via Facebook (http://facebook.com/AspireNaturalHealth) or Twitter, @DrTimGerstmarND.
Hi,
My family takes digestive enzymes with HCL. I am wondering when it is recommended to take digestive enzymes with HCL (such as Zypan or NOW Super Enzymes as we take) vs. without. None of us have heartburn, GERD, etc., but have been told we have symptoms of digestive issues (such as coating on tongue, son has sore throat upon waking, kids (9 and 12) and husband have allergies, husband and I tested low for some of the comment micronutrients (for example, B12) and I have constipation and am still not eliminating daily despite taking about 12-20 Zypan daily ), and my husband and I both have autoimmune thyroid ds Graves’/Hashimoto’s).
I’d like to know a little more about the floating stools. The only reputable websites I can find that describe this are very brief articles on pubmed health and NIH websites. When they describe floating stools, when it’s not linked to excess gas, they suggest that these stools are generally pale and very foul smelling. I ALWAYS have floating stool, however there is no strong odor and the color is a very normal brown, and I quite often experience an oil slick. I had some blood work done from my doctor (I can’t remember what tests) and everything was within normal limits (I even made sure to check the numbers to see if they were close to the limit). The bottom line is, do you know where I can find more sources that explain this in more detail? Especially peer reviewed primary or review articles.
Thanks for the great article! This had a lot of useful info. One thing that would be very helpful to know more about is the length of time one should take digestive enzymes. Is taking digestive enzymes just a stop-gap measure until things are better with your digestion or are digestive enzymes something most of us should be taking on a regular basis? If they are just a stop-gap measure, could you talk a bit about when you should be able to stop taking them? Should you be able to stop taking them when your symptoms first stop or should you take them for a few more weeks (months?) after that to make sure that everything is ok? Thanks again for all the great info.
This article is very timely for me as I feel like I’m really in need of something like this. I was just wondering what the reputable brands out there are? Are there any specific brands that anyone would recommend?
Thanks!
The floating/sinking stool comment is always confusing. It seems there are two very different viewpoints on this topic. Two weeks ago my coach wrote an article saying they should float based on the information from Paul Chek’s book.
I’m confused. We should only eat real food–nothing we cannot pronounce or recognize as food. But we might need to take this capsule which has a whole list of things I don’t recognize?
HI AMM,
Thanks for the question. I’m sure a lot of other people are wondering this too. The short answer is that you should take a combined product or both enzymes and additional HCL when you need the additional HCL. Many people need both, but not everyone. Some people need just enzymes, others just need HCL.
The only real way to know for sure is to do some testing. Short of that, you can do some experimentation with HCL and enzymes to see what works best for you. HCL can cause irritation and discomfort if the guts are inflamed, but is otherwise quite safe.
I hope that helps. Best of luck with your family’s health concerns
Best,
Dr Tim Gerstmar
Hi CG,
I’m afraid I don’t have any sources to point you to at the moment, but I can say if you are experiencing an oil slick than you are having fat malabsorption. I would consider adding some lipase to your diet/regimen and/or some ox bile and see what difference it makes.
There is some debate about floating stool, which I’ll talk about in a later comment, but oil slicks are signs of fat malabsorption. Often with fat malabsorption there is deficient bile which causes stools to be light colored or even white, it sounds like that may not be an issue for you.
Hope that helps
Best,
Dr Tim Gerstmar
Hi Robby,
Thanks for the questions. Ideally we should not need to take supplemental enzymes as our bodies should produce all the enzymes that we need. However, many of us run into problems for a variety of reasons from diet & lifestyle related functional issues to more serious disease states. Depending on what’s going on for you digestive enzymes may be a temporary measure while you ‘fix your guts’ and get things working properly or it may need to be a lifetime thing to compensate for issues.
As for how long to take them, assuming your situation requires temporary supplementation, testing ideally tells us if they’re not necessary anymore, but generally I would take them for at least 3 months, and yes ideally continue to take for “a while” after symptoms disappear, phasing down supplementation and monitoring how you’re doing.
Hope that answered your questions.
Best,
Dr Tim Gerstmar
Hi Naz,
The article has links to 4 different reputable brands. Two over the counter and two ‘doctor’ brands.
Hope that helps.
Best,
Dr Tim Gerstmar
Kim,
Yes I’ve seen Paul’s recommendations before, and as far as I’m aware he’s the only one/the source of the recommendation for floating stool. I can’t speak for him, but I believe the reason he recommends floating stool is he wants to see robust fatty acid production by gut bacteria (a sign of healthy gut flora) leading to higher levels of fat in the stool leading to floating stool.
While I’m always open to reinterpreting my views, I have seen floating stools to far more often be a sign of dysfunction rather than optimal health, and so will continue to hold the view that major floating stools, especially in conjunction with oil slicks are signs of a problem.
At the end of the day, recognize that none of us ‘experts’ are always right or always know what is going on. Take everyone’s information with a grain of salt, see what sounds reasonable to you, and try it. If you look, feel, and perform well and your blood work and/or other tests are good, then keep doing it, if not, do something else.
Hope that helps.
Best,
Dr Tim Gerstmar
Hi Linda,
I can understand your confusion. To be healthy we must eat real food, and a shortcut to ensuring that we do so is to look at labels and avoid things we don’t understand. But just eating healthy food isn’t enough for everyone to recover their health (sure wish it was). So for those people they need to do more. And sometimes that includes taking supplements (vitamins, minerals, herbs, etc) and prescription drugs (everything has a time and a place).
I hope that helps.
Best,
Dr Tim Gerstmar
Ahhh ok I see it now thanks! Had to read over it again to see the brands that were featured.
Thank you Dr. Gerstmar. I have a follow up question if I may. What are the symptoms of HCL irritation? I know that my 12 year old complains of an “ache” (says its not a burning) in his chest when he takes them. He says it feels like the pills accumulate in his chest and sit there and lasts about 30 minutes and says it doesn’t matter if he takes 2 or 4. My husband and kids are taking them to help treat seasonal allergies and their eliminations seem fine. The dr. said that if they have more symptoms, to take more enzymes. I am the only one with obvious digestion / elimination issues. If we were to try them both (with HCL vs. without) and see which we get the best results from, what would we be looking for?
I’ve had my gallbladder removed and have read on several occasions that digestive enzymes are a must after that has been done, however I don’t see it mentioned in your article. Is this the case? I’m currently taking the Now Foods enzymes, but I’m not actually sure I’ve noticed much difference between now and prior to taking them.
Naz,
Glad you found it!
AMM,
HCL irritation is usually a burning, uncomfortable sensation in the chest or throat. Can include heartburn or sour tastes in the mouth but is less common. For your son, I would find out if he has problems with other pills or if it’s just the HCL in particular.
I personally don’t use digest enzymes as a standalone treatment for seasonal allergies. It can be part of a treatment plan to reduce the systemic load on the immune system, but personally I don’t think I would say more enzymes for more symptoms. But if it works for you… I have rarely found kids to need HCL unless they have pretty profoundly messed up guts. In adults, and especially older people it is much more common.
Hope that helps.
Best,
Dr Tim Gerstmar
Michael,
Thanks for the question. That’s not quite right. The gallbladder is involved in the absorption of fat. Some people who have their gallbladders removed are able to do okay without it. For many others they have issues dealing with fat. If you are unable to tolerate a higher fat meal and/or have significant floating stools or see oil slicks in your toilet bowl then you are not absorbing your fats well and need some help.
Enzyme wise you are looking for lipase specifically for this issue as opposed to a broad spectrum enzyme. Things like ox bile and/or herbs for the liver are often helpful as well.
Hope that helps.
Best,
Dr Tim Gerstmar
Hi,
These are the enzymes I personally take, do they look alright to you?
http://www.windhawk.com/index.php/products/enzyme-probiotic-formula
Thanks.
Sami,
It looks reasonable, though it’s kind of a kitchen sink product. Unless the pills are big giant horse pills I’m skeptical that you’re going to get a strong therapeutic product in just a 2 pill dose. Having said that if it works for you, go for it. I probably wouldn’t choose it for my patients.
Best,
Dr Tim Gerstmar
Is it common for some people to have weird “reactions” or issues with animal-sourced digestive enzymes?
I took the Jarro-Zymes (which I think are plant-based) for the last month or so, and didn’t seem to have any problems. Started taking NOW’s Super Enzymes this week, and I keep getting a kind of burning in my throat all day long, and a weird taste in my mouth, after taking them. At first, I thought it was maybe my actual breakfast, but then I realized I’ve pretty much been eating the same breakfast for the last month or two. And last night, I took a super enzyme about 30 minutes before dinner, and within maybe 5 minutes of taking it, started to feel that burning and unpleasant taste again. I looked at the ingredient labels for each (just now), and they’re obviously completely different.
Just wondering if this is somewhat common…
Hi Krista,
No, not common. It is most likely the HCL (acid) that is in the Now Super Enzymes that is causing the problem. It sounds like, for one of a variety of reasons, that that is not working well for you. I would generally recommend you switch back to an enzyme only product.
Hope that helps.
Best,
Dr Tim Gerstmar
Dr. Gerstmar,
Thanks for the quick reply! It does sound like the HCl irritation you described in other comments above…(burning in throat, sour taste, etc.)
Thanks again!
Dr. Tim,
Thanks for the response.
If you had to choose one product to give to someone, which one is the best option, in your opinion?
Sami
Thanks for the information. Can you site some disadvantages of taking digestive enzyme supplements ?
I drink Kombucha a couple of times a week. I also eat a little fermented saurkraut a few times a week. Also drink a tiny bit of kefir. I don’t have any issues normally. I limit wheat and corn and am trying to eliminate sugar. oops FAIL! The label on the Kombucha reads Klamath mountain blue green algae, spirulina, chlorella. Are those the enzyme sources?
Mdingo98, don’t worry – those are all plant-based ingredients (various forms of algae) to provide color (and a marketing boost, as some circles consider them to have health benefits!) to your drinks. There is nothing unhealthy or off-limits for your Whole30 there.
Melissa
I began eating the paleo way and I have to say that I am surely enjoy what I am eating. I am also feeling major changes in my health.
I had almost all symptoms of enzyme deficient . 10 days ago started with multi enzyme formula. It helps with gas , etc but now I feel burning in the stomach almost all the time. There is no Betaine in the formula, just enzymes.It seems to be different from heartburn and I don’t feel bad or acidity taste in my mouth. What could be the reason? Please, help me. I spent a lot of time trying to find an answer in internet but I couldn’t. I feel much better with the enzymes BUT this burning kills me.
Thank you.
Elena,
I’m not sure Dr. Gerstmar himself could tell you what’s going on, but a burning in your stomach isn’t a good sign. I’d recommend getting with a doctor or naturopath right away to do some testing – and consider immediately switching the brand or type of digestive enzyme, to see if you can get the benefits without the burning.
Best,
Melissa
Hi guys,
Planning to trek Kilimanjaro in October. Digestive ability decreases at altitude. Would you suggest we take enzymes during the trek?
Otherwise healthy, no conditions, have been living a Paleo/whole food lifestyle for almost 4 years now.
Thanks,
Matt.
Matt,
No experience with this, but it would seem reasonable that improved digestion = improved nutrition = improved performance.
Don’t forget probiotics!
Best,
Dr Tim Gerstmar
What your take on using psylium fiber along with digestive enzymes? I take 3 things,a pro-biotic-digestive enzyme and psyilium fiber drink?
HI Mary,
Should be okay. Psyllium works well for many, not so well for others. If the combo works well for you, I’d keep doing it.
Best,
Dr Tim Gerstmar
hi i am a recently diagnosed celiac..Nov,2012…i have been eating gluten free and did better for just a little bit, then it seems as if im on the same road again with the fatigue,weight loss,nausea,going to bathroom frequently. i am at my witts end, mother passed away suddenly on 12-12-12 right after my dx, i had been sick for quite some time before i was biopsied and blood tested positive….in the last couple of months that i havent gotten better they have added buspar 5 mg, vistaril 25 mg, because my heart has been racing which they think is due to recent stress(mother passing) i think that the fact i dont seem to be getting better is more stress than anything in my life !!!! i dont feel im getting any nutrition from my food, sometimes i feel dehydrated,this is enough to make you crazy after so long…… i am a mother with very active children, and i cant tell you from day to day if im gonna be able to run them as needed, i just pray for the help/strength. Is there any advice you can give me on what to do what type of doctor to see, something? I have also had trouble sleeping for a very long time i have to take someting to sleep or i just dont. Thanks
My Grandson suffers for weeks at a time from whats been diagnosed as Chronic Vomiting Syndrome. Drs. don’t seem to know how to treat this. They just give him drugs that don’t seem help. Recently I have seen your article on enzymes, but none of the symptoms for low enzymes seem to be vomiting. Can you maybe give me some information on this condition and if enzymes would help. Thank you
I’ve been taking a mass gainer to help me gain some weight before wrestling season and I’ve been having really bad pain in My abdomen , and my stomach gurgles a lot , also my poop floats , so I was wondering what I should do , because I really don’t want to have to stop taking it, I’ve gained a lot of strength and size , what do you think I should do ?
And I’m 14 years old.
Hi Christie,
I’m sorry to hear about all your troubles. Stress could certainly be playing a major part in what’s going on for you. Also long-term celiac causes a lot of damage to the intestines that can take quite a long time to heal.
Here are a couple ideas/points for you
1. You may be cross reacting to other foods you are eating. Some people react to dairy, corn, and oats among a possibility of others. You may have to look at your diet and see what might be contributing to the problem
2. Long-standing damage to the intestines often causes digestive enzyme deficiencies. I would consider supplementing with a good digestive enzyme and/or hcl and see if it helps you
3. Probiotics
4. Consider adaptogens – herbs that help normalize the stress response – siberian ginseng is very well tolerated by most
5. Electrolytes with your fluids can assist in absorption
Obviously I’m biased to Naturopathic doctors (being one) and think we could help you. Other options include doctors of “functional medicine” or “integrative” of “holistic” doctors (MD, ND, DO, well-trained DC). Make sure they offer you a free phone consult to speak with them and find out if you feel they’ll work for you and make sure you’re comfortable with them and their education, they give you a clear treatment goals, general time frames, explanations for what you’re doing & taking, etc.
I do offer phone & skype consults if that’s something that might work for you. There are a lot of options out there for you, and please don’t think there’s no help for you, there is
Best,
Dr Tim Gerstmar
Hi Rose,
Chronic (or cyclic) vomiting syndrome can be very challenging to treat. Often, I find there are some underlying “food allergies” present. Stress often plays a big part as well. Enzymes will be unlikely to directly treat the problem but may be part of a generalized treatment plan to rehabilitate the gut. Both his gut and nervous system need support.
I would consider a comprehensive stool test (offered by companies like Doctor’s Data and Metametrix, among others) and possibly and IgA/E/G “food allergy” test to see if you can locate some/all of the underlying issues.
I hope that was helpful.
Best,
Dr Tim Gerstmar
Hi Adam,
I can’t tell you what to do, but clearly it doesn’t sound like the mass gainer is agreeing with you if it gives you all those symptoms. You’re probably either reacting to one of the main ingredients or to an additive/filler in the product. At the least I’d switch to another product and/or focus on packing in “real” food instead.
Best,
Dr Tim Gerstmar
Hi
I am taking Enzymedica Digest Gold tablets and getting the burning throat sensation but there is no HCL in there – is there anything else that could be in there that I am responding to?
The ingredients are: Amylase, Protease, Glucoamylase, Alpha Galactosidase, Cellulase, Lipase, Lactase, Beta Glucanase, Maltase, Xylanase, Invertase, Pectinase (with Phytase) and Hemicellulase.
Thanks
Sharis
I also get a lot of protein and carbs from real food , do you think it’s because I’m eating too much protein and not enough of other nutrients ?
Hi Adam,
I’m sorry, I honestly can’t say, since I don’t know what you’re eating. I know this isn’t much help, but there are a lot of people out there who are qualified to do an examination of your diet and see if it’s appropriate for you and your goals. Unfortunately an MD is probably not going to be one of them.
Best,
Dr Tim Gerstmar
Hi Sharis,
I’m sorry, I missed your comment. It’s possible you could be responding to something else in the product – binder, filler, coloring, etc. Or it’s possible, though very uncommon that you could be responding to the protease. Protease is a protein digesting enzyme, and rarely, when someone has a very inflamed gut, I can see proteases contributing to that irritation.
I would try a different product and see if the irritation continues.
Best,
Dr Tim Gerstmar
its good that modern medicine is slowly acknowledging the findings of ayurveda and yoga which go back 5,000 years,they have still so much to learn,taking artificial enzymes is not a solution,take a supplement that boosts production of all types digestive enzymes,for that ayurveda helps,and there are yoga practices that can easily be learned and done by even small children which will cure this problem from root.
Hi Siddharth,
Yoga is great, and for those who are willing, interested and able can be a very helpful tool. It, of course, isn’t the right tool or sufficient for everyone. No system of medicine has all the answers, each has strengths and weaknesses. Our goal has to be to stay open-minded and learn everything we can from anywhere (conventional medicine, “alternative” medicine, any other field of learning) that provides comfort and healing to people.
Best,
Dr Tim Gerstmar
I am wondering if you can tell me if about the safety of digestive enzymes during pregnancy & breastfeeding. I understand they naturally occur in raw foods, are made by our bodies, and thus I hadn’t really thought of them being harmful, until I started thinking about trying to conceive. It seems that there is controversy over the safety of animal-derived enzymes without real explanation. Yet, it also seems that most cheeses are made with animal enzymes (rennet, etc) so I wondered why the enzymes in a supplement would be different. I have taken a few different broad spectrum enzyme supplements – Kirkman, Now, Enzymedica, Klaire Labs – to name a few. They have helped me significantly but contain some animal based proteins. My Betaine HCL also includes pepsin. Of course I can buy only plant based varieties next time I order more, but I wonder if it is necessary. I know you said plants sourced were more stable, but are animal sources harmful? Why? Is there a resource for determining safety of supplements in pregnancy & breastfeeding? I take several supplements and am having hard time finding any data other than the standard “we don’t really know anything, so no!” kind of advice. I’m talking about L-Glutamine, d-Limonene, Iberogast, Serrapeptase, 5Htp, enteric coated peppermint oil capsules, etc. I would appreciate any advice or resource information you feel comfortable providing. Thanks!
Hi DeterminedHealth,
Here’s the reality. Most supplements have not been tested for safety in pregnancy. So we can’t say with certainty that they are either safe or unsafe. Therefore all supplement manufacturers are going to label “not to be taken in pregnancy or breastfeeding” not because they are necessarily unsafe but because we don’t know and they are all about CYA, understandably.
As doctors, the general principle is to use as little as necessary during pregnancy (and just in general) but to use things when necessary. So, just because a woman is pregnant, doesn’t mean we let her suffer.
So, all that being said, I can’t tell you with absolute certainty that enzymes are safe in pregnancy, and ultimately you have to make the decision as to whether you feel comfortable taking them or not. Having said that, I cannot think of any physiology or biochemisty which would suggest that enzymes are in any way unsafe to take.
I don’t, per se, have any issue with animal based enzymes. As you and I both mentioned, I’ve found plant (really fungal) based enzymes to be more stable and have yielded my consistently good results. I do have some patients who choose to use animal based enzymes and they seem to do fine with them. The only harm I can think of with animal based enzymes might lie in contamination of the product with either something bad (perhaps a virus or something similar) or if you have an immune reaction – for example someone who is “allergic” to pork might react badly to a pork based enzyme.
I hope that answers your question for you.
Unfortunately I haven’t found any good resources to direct you to re: supplementation and pregnancy. Most are ridiculously overcautious. The best we can do is look at the real evidence that exists (also folklore and lay use – if an herb has been in use for thousands of years, there is reason to believe that it is safe) and understand as much of the physiology and biochemistry we can. Then determine if it’s really needed for the case and determine the woman’s acceptable level of risk. It’s silly we have to go to all this trouble.
Best,
Dr Tim Gerstmar
Dr. Gerstmar,
Thank you so much for your reply. I understand the CYA mentality completely & erring on the side of caution. They do have to protect themselves & their patients. I have several physicians in my family and many that I see unfortunately none of them are very open to thinking about “alternative” therapy or medicine and consider natural supplements very alternative.
I just wish I could find a doctor who would sit down with me & talk through each supplement. I do have real reasons to take them. I have gastroparesis and am healing from SIBO. I need help digesting food & keeping things moving to avoid SIBO coming back. I do my part – I follow the Specific Carbohydrate Diet – which takes a lot of dedication. It is amazing though & has enabled me to avoid all side-effect laden medications my doctors think are the answer. It has literally given me my life back and enabled me to consider pregnancy. I just wish doctor would dedicate just a little time to look at me as an individual & not just give a blanket response of we don’t know so it’s not safe; instead of saying well you can take this medication that we KNOW isn’t safe, but it’s not too horrible, at least we have data. Most of the doctors I see don’t even believe that my drastic improvement and healing is related to my diet changes. They go back to it’s not proven, there is no research, & we just don’t have the data to recommend it (a healthy, no sugar, low carb, low starch, diet full of variety). Yikes!
Do you have any suggestions on how to find a physician who is open minded, supportive, and willing to help manage my care and coordinate with an OBGYN/Midwife?
Thank you again for sharing your insight and taking the time to reply.
I can’t even find a doctor who admits going gluten free makes sense, much less one who supports the fact that I am grain free! And instead of supporting eating lactose free, they say I should take lactase! Apparently they don’t realize that is a digestive enzyme! I’m pretty sure no one tells pregnant women not to take lactase. Our country’s healthcare system needs help – I know I work in it!
hi tim,you are right no system has all the answers,but yoga and ayurveda have the most,ayurvedic practitioners can identify the root cause of health problems,inability of the body to produce digestive enzymes has a specific name in ayurveda,the medicines they give are very helpful,yoga is not just aasanas(postures) thats a very small part of it,it has exercises specifically designed to make digestive system work efficiently,one such exercise is called “kapalabhati pranayama” ,youll be able to find on youtube and google,it must always be learned from an expert and not done directly from watching videos,another exercise is called “agnisar kriya” this must also be learned from a teacher,there are many such exercises that one can follow that specifically target the problem area and these are not strenuous on the body and anybody can do them including children,hope this helps,best of luck.
Dr. G.
My brother had a Whipple procedure in July of last year, due to bile duct cancer, and he is really struggling to regain back any of the 70 lbs he lost. He is cancer free so far, but suffering from food aversion, bloating, diarrhea, general anorexia. He lost his gall bladder, duodenum, and 2/3rds of his pancreas. No digestive enzymes were prescribed by his Dr. but I’m thinking he probably needs them. What would you suggest?
This was by far the most informative and useful page on Digestive Enzymes I’ve read so far. I have RA so autoimmune response is already in my history. I’ve had about 3 or 4 months of significant digestive difficulty, primary tremendous bloating after eating, and a constant feeling like my food is sitting in my stomach for many hours, if not a full day after eating. Finally, our of pure desperation, I very reluctantly tried digestive enzymes. I went to the Vitamin Shoppe down the street and bought the Vitamin Shoppe brand in a hard capsule form. (which I’ve now read are the worst) From the very first dose, I had an immediate response and nearly 100% resolution of all my problems. I take 1 with every snack, and 2 with every meal. I’ve notice if I have an alcoholic drink or 2 and don’t take an enzyme tablet I immediately get bloated. This has been nothing short of a miracle for me as I was in constant pain and many days couldn’t tolerate wearing anything around my waist and it even hurt to sit, as I felt like my stomach was pushing up under my rib cage and it was difficult to breath. Thank you sooooo much for this information ! It has brought me my life back! I do have one question though. Why out of the clear blue, do my digestive enzymes suddenly quit working? I’m glad there is a simple cheap solution, but I wish I didn’t have to carry digestive enzymes around with me for the rest of my life !
So as not to write a book, I’ll say that I have had severe bathroom issues, including both problems and colon cancer being the #1 killer in my family, my mom battling it now, Myself being tested at the same Cancer Center. But feeling as if I had been told that I have erosion of the esophagus, in my stomach, etc. At times not having a bowel movement for WEEKS, feeling as if I were a number not an individual. No one explaining how to prevent the same issues over. I was a Statistic. I felt as though my own body was poisoning itself so I decided to try cleansing and afterwards I was thrilled to have had bowel movements without the use of Assistanc so I read by researching myself about digestive enzymes. I decided to try because I can’t cleanse forever. I am taking Chlorella as well as spirulina and vegetarian enzymes made by Basic Vitamins. I am still researching which is how I came across this article, but I had a scare after I don’t always eat on a regular basis and I was still taking the enzymes, woke up one night, barley making it to the bathroom before, well you can emagine. I was horrified. I recently started taking the enzymes WHEN I eat. I was told by an M. D that a lot of information and Very Little Experience was DANGEROUS? These Dr’s don’t want to teach me themselves though and I obviously have inherited Slow Digestion and other medical issues so I am trying to Help Myself, before I am a Statistic. Please I am now on Disability with little money, trying to live alone and I am getting so discouraged.
I am sorry I ment to say, Please I am so discouraged so any advice or even a small amount of knowledge based on experiences can go Along Way and would be Greatly appreciated. Thanks sincerely, Lorechelle
Hi Determined Health,
Sorry for the delay in responding. I’m sorry to hear your all too common story. There are a variety of resources you can use to find a doctor who meets your needs. You need to be aware your ob/gyn or midwife may or may not be open to your use of supplements, no matter what other medical professionals say or what evidence you are able to provide. There are plenty of open-minded medical professionals out there, and (like in life) plenty who are close-minded and aren’t willing to change their minds. You may need to take matters in your own hands and “defy” your other providers if you feel that it’s in your and your baby’s best interests.
If you’re looking for an “alternative” MD or DO, one of your best resources is going to be ACAM (acam.org). If you’re open to ND’s, you can look at naturopathic.org or for your state organization by Googling [state] association of Naturopathic doctors. You can also google your area alternative/holistic/natural doctor and see who comes up.
Lastly, I do do phone/Skype consults and would be happy to talk things through with you if you’d like.
Regardless of who you see, I commend you for taking your health into your own hands, and for the massive improvement you’ve made in your health. A healthier mom = a healthier baby.
I hope that helps, and if I can help further, just let me know.
Best,
Dr Tim Gerstmar
Hi Siddharth,
Thanks for sharing your knowledge!
Best,
Dr Tim Gerstmar
Hi Kate,
Sorry for taking so long to reply. I would strongly recommend digestive supplements for your brother. To me, it is a TRAVESTY that his doctors did not recommend any digestive support given how much of his digestive system has been removed.
I would consider: a strong multi-enzyme formula as described in the article above (probably 2-3 with meals as a starting place), and an ox bile formula (probably 2 with meals) to help with fat digestion. He may or may not need supplemental stomach acid (HCL) as well (1-4 with meals). Given how much of his digestion was taken out I would also recommend a strong multi-vitamin, and supplemental B12. And lastly probiotics (see my other article on this site).
I hope that helps.
Best,
Dr Tim Gerstmar
Hi Loriry,
Thanks for sharing your experiences, and I’m glad something as simple as digestive enzymes has made such a big impact for you. In answer to your question, I’ll be honest and say I’m not sure. We know many things affect a persons digestive capacity including: stress, inflammation, gut bacterial imbalances, and autoimmunity.
The underlying question, which a lot of people have is: do I need to take enzymes for life? The answer, I don’t know. Some people do, other do not. First, make sure your diet & lifestyle are in order. Are you stressed around eating, or relaxed? Stress shuts down digestion. Is your stomach acid working properly? If not, the rest of your system does not get the proper signal to digest. Are your intestines inflamed? Has your pancreas been damaged? Depending on what is happening, correcting these problems corrects the need to take digestive enzymes. If these issues have gone on too long, you may need to supplement from here on. Luckily, like you said, digestive enzymes are reasonably cheap and very safe.
All the best,
Dr Tim Gerstmar
Hi Lorechelle,
I’m very sorry to hear how difficult things have been for you. I can’t offer you treatment advice, but let me help as much as I can.
1. Digestive enzymes are very safe. I have had a few people with very inflamed guts react badly to digestive enzymes, usually with sensations of burning, irritation or discomfort. Aside from that or a reaction to something in the capsule, I have never seen nor heard of any “danger” from digestive enzymes. As they seem to be helping you, I feel comfortable in saying, you can disregard the advice you were given by that doctor.
2. Enzymes are best taken with meals, though for most, are not a big deal if taken between meals (obviously not very helpful in helping you digest your food) and there are some indications for taking them that way.
3. If you have not added any probiotics to your regimen, I strongly regimen slowly adding in probiotics. Please see the probiotic article written by me on this site to help you get started.
4. You may consider adding the Ayurvedic (traditional Indian medicine) Trifala to your regimen. It is a mild bowel balancer that can be helpful with diarrhea and constipation. Don’t expect miracles, but I have seen it be very helpful in the longer run.
5. Please remember you can get better and can feel better. You haven’t to this point because you haven’t had the right guidance and support to do so. The tests that your conventional providers have done haven’t been appropriate to find out what your problem(s) is, and therefore they haven’t had the right tools to help you. The human body is amazing and can heal from a great deal. The human body wants to feel good and if you remove the things that are “blocking” it from feeling better it will heal.
I wish you all the best.
Regards,
Dr Tim Gerstmar
Thank you Dr.Gerstmar for the quick reply. I will most definitely listen, try, read anything that in the long run helps me, as you are most definitely correct, that the body does want to feel good. I have seen so many Dr’s with the approach medicate instead of educate and I knew once I found this site and read what others were saying and you response to them, I had found a Gold Mine, so to speak, as far as learning to live in a healthier way! I don’t know if you could ever know what a long, lonely road this has been for me, as I have seen so much suffering and suffered myself, and there are so many Dr’s believing that I am a quack, even telling my family that I have had no schooling and not to listen to me. I DO want to feel better and I will continue to follow any source that leads me in that direction. What you are doing here is a Marvelous Wonder for people and I commend you, Thank you kindly, Lorechelle
So now that my tummy troubles have all but vanished, how do I proceed on easing off of these enzymes? All at once? Take 1 with each meal instead of 2? Only take them with 1 meal? Anyone had any experience?
Good Morning Dr.Gerstmar,
I appreciate reading the comments above as they – along side of the article iteself, have answered many of my qyestions. I was as “thrown off” as “DeterminedHealth” was by not being able to find information about taking Digestive Enzymes while pregnant – good, bad or otherwise. Below is the enzyme blend (Udo’s Choice, made by FLORA) which I usually take in order to aid digestion of certain foods.
http://www.naturalexpress.com/en/products/enzymes/digestive-enzymes/udo-s-choice-enzymes-digestives-supreme-1.html?id=27887&category=547&x=46&y=8&cat=547&viewMoreCategory=1&viewMoreHealthConcerns=1&___from_store=fr&health_concerns=226
In the past, I would usually only take them when I knew I was going to eat a meal that would upset the natural digestion (basically because my will power to avoid certain foods, is nil) in my body. Food’s such as dairy products typically make me bloat with trapped gas and stool instead of the usual affect most claim of – diahrrea. Until now, I took the digestive enzymes only when I knew that there would be a problem, and it was enough. However, I just recently found out that I am in my first trimester of pregnancy and, boy do I notice a big difference already in how my body reacts to food. ANY food – makes me bloat with air that gets trapped under my ribs – I can’t seem to pass it. I have also become more likely to be constipated on a more frequent basis. I would really like to be able to take the enzymes (along with some wonderful Mint Tea’s) on a regular basis in order to avoid discomfort throughout my pregnancy. Given that most conventional GP’s do not “agree” with homeopatic regimens, can you offer some advice as to whether you think this enzyme is one that should be safe? I realize you are not “supposed” to say yay/nay about anything that isn’t tested – however, if you were in my shoes (and female of course), would you feel safe taking this one for youself while pregnant? So far, since finding out I was pregnant, I have taken it on two occasions, though I took one capsule, as opposed to the two I would have taken in the past. It has seemed to help on those occasions, though I know a more regimented, daily practice would be more beneficial.
I apprecaite any feedback you can offer. The above artice truly is the most informative I have been able to find so far. Thank you!
Thanks for your time
Pregnant’n'Pondering
Loriry,
If you want to try weaning off I would start backing off how many you are taking at each meal. After a few days or a week if everything is feeling and moving well you can continue backing down until you are either not taking any enzymes or you have symptoms which tell you to increase the dose.
Hope that helps!
Best,
Dr Tim Gerstmar
I had a Dr recommend taking sorbitol as a natural laxative,I took 2 teaspoons I did and researche d myself later what exactly it was. I was up sick All Night, SEVERELY ILL. I feel like I am still recuperating from the ordeal. Maybe it was too high pf adosage for me, but now I am afraid to put Anything in my mouth! It sounded like a gift and ended very traumatizing, Is this normal? Should I have not tried it along with digestive enzymes, etc? I want so badly to feel, act and be healthy and I don’t know where to go
Hi Pregnant’n’Pondering,
If I was pregnant I would have no problems taking a full dose of digestive enzymes with my meals if I felt they were helpful. I personally wouldn’t have any concern it would affect my pregnancy.
The Udo’s product seems fine, though it has buckwheat powder in it which might be a problem for some and no big problems for others.
Hope that helps!
Best,
Dr Tim Gerstmar
Lorechelle,
Sorbitol is a sugar alcohol that is very poorly absorbed by the human body and feeds the gut bacteria. It can cause diarrhea if taken in “excessive” dosages. There is no reason I know of it would cause problems or interact with digestive enzymes.
Best,
Dr Tim Gerstmar
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