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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

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This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

The Truth About Digestive Enzymes for IBS

Written by Dr. Ruscio on December 3, 2020

Written by Dr. Ruscio on December 3, 2020 — Reviewed by Aimee Gallo

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

How Digestive Enzymes Improve IBS Symptoms, and How to Use Them

• What Is IBS?|
• What Are Digestive Enzymes?|
• Research|
• General Enzymes|
• FODMAP & Lactose Intolerance|
• Exocrine Pancreatic Insufficiency|
• Probiotics & Enzymes|
• Choosing & Using Enzymes|
• Side Effects|
• Bottom Line|

Are you thinking of taking digestive enzymes for your digestive symptoms? Digestive enzymes are one of the most frequently recommended supplements in the wellness industry for digestive health, but does research support their use for IBS?

There isn’t a lot of research to go by, but what’s there does suggest that enzymes improve IBS symptoms like bloating and abdominal pain. Let’s explore what digestive enzymes are, what research actually shows about their effectiveness for IBS symptoms, and how to choose and use them.

What Is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome is a gastrointestinal disorder characterized by digestive tract symptoms that have lasted longer than six months [1]. Symptoms include:

• Bloating, abdominal pain, stomach pain, or cramping
• Changes in bowel movements, including constipation, diarrhea, or loose stools
• Flatulence or gas

IBS symptoms may also include general indigestion, discomfort in the small intestine, fatigue [2, 3], mood symptoms [4, 5, 6, 7], and migraine headaches [8].

What Are Digestive Enzymes?

Digestive enzymes are natural substances your body makes to help your body digest food.

Your pancreas produces the enzymes amylase, protease, and lipase to prepare your food to be absorbed by your small intestine. Your stomach acid helps stimulate your pancreas to release enzymes. Other enzymes, such as lactase, are produced by your small intestine or gut bacteria [9].

Different types of digestive enzymes help break down different types of foods. For example, amylase breaks down carbohydrates, protease breaks proteins down into amino acids or peptides, and lipase breaks dietary fats down into fatty acids so they can be absorbed by the small intestine.

Other enzymes help digest more specialized nutrients. For example, lactase is responsible for breaking down lactose, the natural sugar in dairy products. If you don’t make enough lactase enzyme, you may become lactose intolerant, and experience bloating, abdominal pain, or cramping when you consume dairy products like cheese or milk.

Additional digestive enzymes include:

• Alpha-galactosidase, an enzyme that helps break down legumes.
• Beta-glucanase, which is thought to help break down beta-glucan in the biofilm of fungi and yeasts like candida [10].
• Cellulase, an enzyme that breaks down cellulose, the material plant cells walls are made of, into a digestible form
• DPP-IV (dipeptidyl peptidase IV) helps break down gluten proteins.
• Bromelain and papain are naturally occurring proteases found in pineapple and papaya [11, 12].

Insufficiency of particular enzymes can lead to malabsorption of particular nutrients, or cause symptoms, which can have consequences for your health.

Because IBS has multiple causes, digestive enzymes alone are unlikely to resolve your IBS. But in some IBS cases, a lack or deficiency of particular digestive enzymes may contribute to your symptoms. For example, symptoms of lactose intolerance —which includes bloating, cramping, and diarrhea — mimic symptoms of IBS. So the question is, can digestive enzymes relieve IBS symptoms?

Research About Digestive Enzymes for IBS

Surprisingly, there isn’t yet research that shows common, over-the-counter digestive enzymes help IBS. But there are a few studies that have looked at particular enzymes and their role in improving IBS symptoms and quality of life. Let’s review.

General Digestive Enzymes and IBS

Only a handful of studies have been done to evaluate the use of supplemental enzymes for IBS.

In a pilot study, patients who had recognized food-induced IBS symptoms were randomized to receive a digestive enzyme called pancrelipase or a placebo after six meals. Those given pancrelipase had less cramping, bloating, abdominal pain, digestive noises, and less stool frequency [13].

Two clinical trials tested a combination of digestive enzymes with the soluble fibers beta-glucan and inositol on IBS patients.

Patients who used this combination — called by the trade name Biointol — improved bloating, abdominal pain, and gas compared to controls [14, 15]. It’s not clear whether these results were from the digestive enzymes or the additional supplements, but they are promising nonetheless.

A plant-based protease enzyme called Zyactinase was given to IBS patients in another clinical trial. It was shown to improve participants’ stool consistency and abdominal discomfort without side effects [16].

In another clinical trial, IBS patients who were given alpha-galactosidase saw some improvements compared to the placebo group, but the difference between the two groups was not statistically significant [17].

With this limited data, which studied different types of enzymes, it’s difficult to make broad assumptions about their usefulness. However, these data suggest that several digestive enzymes can help reduce IBS symptoms. The specifics still require more research to understand which combinations or specific enzymes are best. However, there are a few clues that may help you narrow down the enzymes that might work best for you.

FODMAP and Lactose Intolerance

Many IBS patients are sensitive to high FODMAP foods, which contain fermentable carbs and prebiotic fiber that feed bacteria. These foods and fiber can contribute to IBS symptoms [18, 19, 20].

Lactose is the natural sugar in dairy products like milk and cheese and is a high FODMAP food. A meta-analysis and another study found that lactose intolerance is more common in IBS patients than in healthy controls [21, 22].

If digesting certain types of fermentable carbohydrates is as difficult for IBS patients as low FODMAP diet studies suggest, enzymes that help digest these specific foods could help reduce IBS symptoms. Research supports this theory, though not in a general sense.

Lactase — actually termed “Beta-galactosidase” — is produced by the villi in the small intestine [23], and a variant of this enzyme can be produced by bacterial fermentation and has shown a promising — but not proven — ability to reduce the symptoms of lactose intolerance [24].

Similarly, in a small study, women who were sensitive to galacto-oligosaccharides, a type of FODMAP, found that six days of oral alpha-galactosidase supplementation reduced general IBS symptoms and bloating [25].

Though more research is needed, these small studies suggest that digestive enzymes may be helpful for FODMAP and lactose intolerance.

Exocrine Pancreatic Insufficiency (EPI) and Enzymes

Chronic diarrhea, loose stools, and bloating may be caused by exocrine pancreatic insufficiency (EPI). EPI occurs when your pancreas no longer produces enough enzymes to maintain normal digestion.

EPI is more common with age and is thought to affect between 5% and 30% of people over 70 [26], but it can affect anyone. EPI is also common for people who have cystic fibrosis, pancreatic cancer, and chronic pancreatitis.

Symptoms of EPI may include bloating, abdominal pain, fatty stools, diarrhea, excessive gas, and weight loss, all of which are common symptoms in IBS, celiac disease, IBD, and SIBO [27]. An observational study found that 6.1% of IBS patients had EPI [28]. Therefore, EPI should be considered as a possible diagnosis in patients with IBS-D.

Prescription pancreatic enzyme replacement therapy (PERT) is the main treatment for EPI. A systematic review found that PERT improves EPI-related symptoms and quality of life in patients with EPI [29]. If you think you may have EPI, reach out to the clinic or your healthcare provider for help.

Probiotics and Digestive Enzymes

There is some interesting research about the interrelationship between the gut microbiome and digestive enzymes. A clinical trial determined that patients with post-infectious IBS had changes in their small intestinal microbiome that left them susceptible to lactase deficiency. After 14 days of probiotic treatment containing Bifidobacterium longum and Enterococcus faecium, 70.8% of patients had resolved their dysbiosis and received normal scores on the lactase test, as determined by biopsy of the duodenum [30].

This result aligns with a recent systematic review that concluded that probiotics can improve lactose intolerance [31]. Bifidobacterium animalis was the most well-studied and effective microorganism in the review, perhaps because of its ability to express the enzyme β-galactosidase, and positively affect intestinal functioning and large intestinal microbiota.

This is an interesting line of research that suggests that probiotics may play an important role in the manufacture of digestive enzymes that can improve food intolerance and IBS symptoms.

How To Choose and Use Digestive Enzyme Supplements

There are many different digestive enzyme products, and choosing the right specific digestive enzymes for you may require some trial and error. This may also depend on what kind of digestive trouble you are experiencing.

If you are lactose intolerant, a lactase enzyme like Lactaid may be all you need. If you generally only react to high FODMAP beans and legumes, using a product like Beano may be sufficient.

If you have more generalized digestive symptoms, a good place to start is with a general pancreatic enzyme formula, usually called pancreatin. You may also opt for a formula that contains ox bile, especially if you have had your gallbladder removed. If you are vegetarian or vegan, plant-based options are available as well.

To see if digestive enzymes are helpful for you, take digestive enzyme capsules with each meal for 2 to 3 few weeks. If you notice improvement, you can continue. If you haven’t noticed any benefit, you can stop your trial knowing that you gave them a reasonable try.

Digestive Enzyme Side Effects

Digestive enzymes generally cause minimal, if any, side effects. However, protease supplements can irritate some people’s digestive tracts, especially if they already have some irritation or gastritis. Signs that may indicate that the digestive enzyme you’re using isn’t working for your body include:

• Increased bloating or gas
• Burning or irritation in your stomach or intestines
• Increased diarrhea

If any of these symptoms happen soon after introducing a digestive enzyme, it’s a sign that you should stop and maybe try a different formula.

The Bottom Line

Research on digestive enzymes for IBS is still in its infancy, but early results indicate that various enzymes can help reduce bloating, abdominal pain, gas, and stool irregularities. Enzymes seem especially useful for specific deficiencies, like lactose intolerance or pancreatic insufficiency. Try including a basic digestive enzyme formula to see if it helps your symptoms, or reach out to our clinic for medical or health coach support with your IBS.