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Apr 14th, 2006 - 15:01:32 |
Poor digestion can lead to gas, bloating, and heartburn. Our experts weigh in on whether supplemental enzymes help.
THERE'S NO QUESTION that digestive enzymes are helpful for people with conditions like cystic fibrosis, chronic pancreatitis, and lactose intolerance, but what about those of us with simple, occasional indigestion - or those who simply want to digest food better? The answer to that really depends on who you ask. While most healthcare practitioners agree that supplemental enzymes aren't harmful to a healthy person, whether or not they're needed is open to debate.
Digestive enzymes are protein catalysts that help break down food, so the body can absorb nutrients. Saliva contains salivary amylase, which begins to break down carbohydrates as we chew our food. Lipases. amylases, and proteases, which break down fats, carbohydrates, and proteins, are secreted from the pancreas into the small intestine, where most digestion takes place.
Proponents argue that enzyme supplementation is necessary for optimal digestion, particularly because so many foods are heavily processed. Others contend that a healthy person manufactures all of the enzymes needed, and that supplements are a waste of money.
However, many naturopaths, holistic physicians, and even some mainstream gastroenterologists take a more middle-road approach: that enzymes can be helpful for some people, especially when used in conjunction with dietary changes.
Petra Eichelsdoerfer, ND., R.Ph., an adjunct faculty member at Bastyr University in Seattle, points out that the primary reason to supplement with enzymes is when a
person is not manufacturing sufficient amounts of them.
"If a person is having digestive problems, and they aren't making enough enzymes, then yes, supplements can help," she says. "If they have a malabsorption syndrome,
then enzymes would help."
But patients with digestive issues need to be evaluated, to find out the cause of the problem. Enzymes may be only one part of the problem, says Eichelsdoerfer. For example, in some patients, digestive problems may be due to a lack of stomach acid rather than enzymes. This is especially
common in older adults.
But do supplemental digestive
enzymes help the average person digest their food better? Probably not, according to Eichelsdoerfer. "If they're healthy, then they're making enough of their own enzymes."
An alternative approach to supplements, explains Eichelsdoerfer, is to use bitter herbs, which help improve digestion by increasing the secretion and production of all digestive juices, including enzymes.
David J. Getoff, ND., a naturopath in private practice in southern California, takes a less conservative approach. "I use digestive enzymes in people over the age of 20 years, because by that time, digestion is often poor enough that enzymes will be helpful."
"I don't use them on everyone, but do prescribe them to a fairly large number of people who have problems with gas, bloating, and gastrointestinal reflux," says Getoff, who is also vice president of the Price-Pottenger Nutrition Foundation. "These problems are due to incomplete digestion, no matter how frequently or infrequently they occur."
However, adds Getoff, with all of these problems, enzymes may not be the only component that's missing. If stomach acid is low, for example, that needs to be supplemented. Another common problem is that people are often in a hurry and don't chew their food properly.
Chewing is an extremely important, yet often overlooked, part of healthy digestion. If food is not well
Chewing is an extremely important, yet often overlooked, part of healthy digestion. If food is not well chewed and the food fragments are too big to be properly broken down, incomplete digestion occurs.
"I don't want to use a supplement to undo a problem that is not a deficiency to begin with," says Getoff, "So very often I begin with the basics, like having my patients chew their food more thoroughly and for a longer period of time. And many people are astounded at how much their gastric bloating has improved, simply by chewing their food."
Eileen Wright, M.D., a holistic physician practicing at the Great Smokies Medical Center in Asheville, North Carolina, also uses digestive enzymes in her practice.
"If stomach acid isn't the problem, then symptoms like gas or bloating right after eating may be due to low enzyme processing," she says. "We may try enzymes empirically to see if
they will get relief, as there's very little chance of a negative reaction."
Sometimes what appears to be a food sensitivity is really an enzyme deficiency, she says. "And some patients may have a problem with one type of food but not another."
As an example, Wright points out that some individuals may have a history of digestion problems associated with protein or fat, but not carbohydrates, so enzyme therapy should be tailored to that need.
One thing that all three practitioners agree on is that digestive enzymes are generally not used as a sole therapy, and that the most important first step in solving any digestive issue is to improve one's diet.
Unless they're prescribed for an acute condition, most of my patients will continue to need enzymes long term, says Wright. "But sometimes if they just change their eating habits and move to a healthy diet, they may
not need them anymore, or at least, lessen the need."
Getoff agrees. "Some of my patients find that changing their diet may allow them to get off of enzymes, while others may need lifelong therapy."
But while digestive enzymes are generally safe, people with certain medical conditions or who are using certain drugs, need to tread carefully. They should not pick up a bottle of enzymes over the counter and begin taking them without conferring with their healtheare practitioner.
"This would include patients with a history of ulcers, especially a recent ulcer, or patients who are on medication that might make them likely to get an ulcer," says Eichelsdoerfer. "Enzymes can also interfere with some of the drugs used to treat diabetes, as well as anticoagulants that thin the blood and prevent clotting." --TH&W
P.18 • TODAY'S HEALTH & WELLNESS March/April 2006
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