Being tired of being constipated might send you searching the aisles of a drugstore for relief. Digestive enzymes seem like a logical approach to resolving constipation by helping the body process food, right? Unfortunately, digestive enzymes won't fix constipation and could mask a bigger problem.
The Lowdown on Enzymes and Constipation
Instead of ending constipation, digestive enzymes will do the opposite, says Amanda Pressman, MD, FACG, gastroenterologist with the Lifespan Physician Group. "They're absolutely not for constipation."
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There are several types of enzymes your body makes to digest food. The three main groups are amylases, which break down complex starches into simpler sugars; lipases, which convert fats into fatty acids; and proteases, which break down proteins, according to Beth Israel Lahey Health.
Most digestive enzymes are made by the pancreas, and they do their work in the small intestine. A lack of one or more of these enzymes can cause undigested food particles to travel down to the large intestine where they will pull in water and cause diarrhea, says Dr. Pressman, also the codirector of the Program for Pelvic Floor Disorders at the Women's Medicine Collaborative and associate professor at Warren Alpert Medical School at Brown University in Providence, Rhode Island. Taking digestive enzymes might prevent watery stools, but not constipation.
How These Over-the-Counter Supplements Work
Most people make enough digestive enzymes to process their food. The major exception is lactase insufficiency, a shortage of the enzyme that breaks down lactose, the sugar found in milk.
"About 70 percent of adults globally have lactose intolerance," Dr. Pressman says. For them, she recommends buying dairy products sold as lactose-free because the needed enzyme has been added. This may work better than trying to take a lactase pill, such as Lactaid.
For that medication to be effective, it must be present in the small intestine at the same time as the food, she says. Simply taking a pill while eating dairy may fall short, as milk may pass into the small intestine while the pill is still in the stomach, even if you consume them together.
Another common enzyme, alpha galactosidase, sold as Beano, breaks down carbohydrates found in beans. While Beano and Lactaid are over-the-counter supplements sold for aiding digestion of a specific food group, Dr. Pressman says, other digestive supplements may include a single enzyme or a combination.
And not all do what they claim. For instance, bromelain, or pineapple extract, is marketed to help digest proteins, but Dr. Pressman says there are no studies supporting this use. (Plus, it can interfere with some medications.)
Supplements that claim to help digest gluten, a protein found in wheat, also lack scientific proof that they work, and may pose a hazard to people with celiac disease, according to an April 2017 study in Therapeutic Advances in Gastroenterology.
Supplements are not regulated by the U.S. Food and Drug Administration as medicines and may vary in contents and dosage from pill to pill. "We really don't know what's in there," Dr. Pressman says.
When to Talk to a Doctor
People with pancreatitis, pancreatic cancer, celiac disease, diabetes or cystic fibrosis or who have had bariatric surgery may lack adequate amounts of digestive enzymes and need enzymes prescribed by a doctor, Dr. Pressman says. These conditions can be diagnosed via tests.
If you regularly have problems with constipation, diarrhea, bloating and/or gas, or if you notice a new or significant change in your digestion and bowel habits, contact your doctor, especially if you also experience bleeding, weight loss, night sweats or loss of appetite, Dr. Pressman says.
Trying to treat these symptoms with digestive enzyme supplements without consulting a physician and without the proper diagnostic tests to identify the true problem could be dangerous. "It could be celiac disease, a gastric ulcer or an H. pylori infection," Dr. Pressman says, all of which need specific care.
- Amanda Pressman, MD, FACG, gastroenterologist, Lifespan Physician Group; codirector, Program for Pelvic Floor Disorders, Women’s Medicine Collaborative; associate professor, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Beth Israel Lahey Health: “Digestive Enzymes, Key Points”
- Therapeutic Advances in Gastroenterology: “Commercially Available Glutenases: A Potential Hazard in Coeliac Disease”
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.