Enzymes facilitate the many daily reactions in the body to keep us alive. They play a vital role in our digestive systems’ ability to help us break down proteins, fats, and carbohydrates for proper digestion and absorption of nutrients. Naturally, digestive enzymes and mucus are secreted in response to the presence of food at mealtimes. Mechanical and enzymatic break down of food begins in the mouth. The anticipation of food triggers the release of salivary amylase to begin the process of breaking down the carbohydrates as we chew. The stomach is then filled with hydrochloric acid to denature dietary proteins in order to give proteases more surface area to work upon. The intestines are supplied with bile and pancreatic enzymes to further break down the remaining carbohydrates, fats, and proteins. When functioning properly, the GI tract works in harmony, like a beautiful symphony, in order to properly digest and assimilate the food we eat.

In the realm of functional medicine and nutrition, the gut is the center of health. As Hippocrates stated, “All disease begins in the gut.” Was he correct? An article published in the journal Brain believes so explaining the connection between the gut and the brain, and how our friendly (and not-so-friendly) microbiota communicates with the brain and vice versa. The enteric nervous system which lines our entire GI tract plays a huge role in our ability to digest foods. With that being said, the environment within the gut is highly influenced by external factors and dietary inputs, and exceptionally susceptible to radical changes in its composition, pH, solubility, and reactivity.

Inflammatory lifestyle and dietary habits - which are unfortunately on the rise in fast-paced westernized countries that no longer take the time to cook homemade meals - are the primary culprits for malabsorption and digestive dysfunction. Factors such as surgery (e.g. bariatric, cholecystectomy), general aging, medications (e.g. PPIs, NSAIDs), environmental chemicals and toxins, excessive alcohol use, chronic stress, and processed foods all greatly influence the health of the GI tract.  

Depending on preference and where along the GI tract patients’ digestive issues lie, finding the appropriate enzyme combination and formula is important for restoring proper GI function.

Mentioned in an earlier post, the efficacy of supplements are affected by changes in pH, motility, enzymes, and mucus levels within the GI tract and may need to be strategically taken to maximize their potential. Digestive enzymes, along with betaine hydrochloride (HCl), are best taken just before meals as they function to break down food.

Originally discovered in beets, betaine, or trimethylglycine (TMG), is a naturally occurring nonessential amino acid compound found in numerous food sources including quinoa, brown rice, sweet potato, spinach, turkey, and beef. Betaine is rich in methyl groups and is known as a methyl donor and has numerous health benefits. When taken as a digestive supplement, betaine HCl aids digestion by promoting the production of hydrochloric acid in the stomach.

Considering normal gastric acid levels are required to enhance vitamin and mineral absorption and prevent nutritional deficiencies, as well as helping prevent infections in the gut, supplementing with betaine HCl may be an appropriate treatment to support your patient’s digestive system, especially those currently prescribed antacid medication. Betaine HCl supplementation, along with other herbs and nutraceuticals, may help reduce the need for antacids which are often a major cause of poor GI function due to insufficient stomach HCl levels. Without stomach acid, digestion is slowed and protein-rich meals sit in the stomach, putrefy, and may actually be causing symptoms associated with gastroesophageal reflux disease (GERD), as symptoms of hypochlorhydria often mirror those of hyperchlorhydria.  

Proteolytic enzymes (proteinases, proteases, and peptidases) are most commonly known for their role in aiding in the digestion and absorption of proteins into smaller amino acids, but also play an essential role in various other processes, such as regulating intestinal barrier function and mucosal homeostasis. Pepsin, trypsin, and chymotrypsin are the three main enzymes produced by the pancreas and stomach but are also found naturally in certain foods; particularly high amounts of papain and bromelain are found in papaya and pineapple. Proteolytic enzyme supplements may contain both plant and animal-derived enzymes. Patients who do not secrete sufficient protease enzymes may suffer from multiple food allergies, sensitivities, or intolerances.

Tough proteins found in certain foods, for example, glutenin and gliadin found in gluten-containing grains like wheat, barley, and rye, are resistant to digestion. Gluten and gliadin are proline-rich proteins that require protease enzymes to break the proline bonds; however, the human GI tract produces very few of these necessary proteases, which may often lead to gluten sensitivities and intolerances. Lactose is another enzyme that nearly 65% of the world’s population is unable to break down due to lactase deficiency or some other inflammatory condition such as celiac disease or inflammatory bowel diseases. “Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by intestinal [e.g. irritable bowel syndrome] and extra-intestinal [e.g. brain fog, dermatitis, headache] symptoms, related to the ingestion of gluten in subjects who are not affected by celiac disease or wheat allergy” affecting between 0.6-10.6% of the general population.

According to the National Institutes for Health, celiac disease afflicts approximately one in 141 Americans, and many people don’t even know it. Celiac disease is an autoimmune digestive disorder that damages the microvilli of the small intestine often causing nutrient malabsorption, which can lead to more serious diseased states such as malnutrition and osteoporosis. Those on specialized diets (e.g., gluten-free, dairy-free) are still frequently exposed to gluten and casein proteins making enzyme supplementation from exogenous sources especially essential. Dipeptidyl peptidase IV (DPP IV) is a special protease shown to aid in the breakdown of gluteomorphin (derived from gluten-containing grains) and casomorphin (from casein proteins found in dairy). 

In addition to enzyme supplementation, integrating dietary and lifestyle changes is a vital piece in restoring a happy, healthy gut. Look for formulas that combine amylases, pepsin, lipase, proteases, glucoamylase, invertase; and also contain peptidase DPP IV and lactase for patients who have gluten and dairy allergies.