Digestive Enzymes

Is an enzyme the right answer, or is the real issue acid, bile, dairy or something that needs testing? These are the questions our naturopaths ask in store every day.

A good fit if

• You're an adult, and heavy, overfull feelings follow bigger meals rather than every meal
• You'll take it with the meal, not hours later
• You're happy that this is based on how enzymes work and on permitted wording, not on a trial of a blend
• You want a vegan option and you're checking the label says it's from fungi or plants

Check with us first if

• You're pregnant or breastfeeding. Australia sets no pregnancy warning for these enzymes, but there are no pregnancy trials either, and no warning isn't the same as proven safe.
• It's for a child, or you're considering lactase drops for a baby with colic. The colic trials are mixed, so have your GP or child health nurse check first.
• You take a reflux or acid-reducing medicine and you're looking at betaine HCl. It does the opposite of that medicine, and it can change how other medicines dissolve.
• You think you have histamine intolerance and you're considering DAO. In a placebo-controlled challenge, most people who suspected it didn't have it.
• You react to pineapple or papaya. Check the label for bromelain or papain before you buy, and ask us if you're unsure.

• Plant-based (fungal) blend: protease, amylase, lipase, cellulase, lactase. Best known for: Covers a mixed meal in one capsule, and it's vegan. Absorption: Not absorbed as such. It works on the food in your gut, and fungal enzymes stay active in stomach acid. Typical use: One capsule with each main meal. It's the only multi-enzyme option in Australia that can be fully listed as a medicine.
• Lactase (tilactase). Best known for: Splitting lactose, the sugar in milk, into glucose and galactose. Absorption: Works in the gut, so take it with the dairy. Typical use: Taken with the dairy serve, and labelled in FCC units. Trials are mixed on whether it helps symptoms.
• Bromelain (pineapple stem or fruit). Best known for: A protein-digesting enzyme used with food, and between meals for other reasons. Absorption: Labelled in GDU or FIP units, which don't convert to the milligrams trials report. Typical use: With meals for digestion. Its between-meal use has its own page.
• Papain (papaya latex). Best known for: A protein-only enzyme with no specific requirements on the Australian list. Absorption: There's no trial of papain taken on its own for digestion. Typical use: Usually one ingredient in a blend or chewable.
• Pancreatin and prescription pancreatic enzymes. Best known for: Diagnosed pancreatic enzyme failure, on prescription. Absorption: Needs enteric-coated microspheres to get past stomach acid. Typical use: A prescription-only (Schedule 4) medicine dosed by your prescriber. Not available over the counter, and not interchangeable with a blend.
• Betaine hydrochloride. Best known for: Not an enzyme. It supplies stomach acid. Absorption: Lowered stomach pH sharply for about 75 minutes in one six-person study. Typical use: Allowed here only as an inactive ingredient, not as the active. One for your practitioner.
• Ox bile. Best known for: Not an enzyme. Bile salts help break up fat so lipase can reach it. Absorption: Only one study, in a single patient with severe bowel disease. Typical use: Not an allowed ingredient in Australian listed medicines.
• DAO (diamine oxidase). Best known for: Breaks down histamine from food, rather than digesting a nutrient. Absorption: Worked in two small trials, only in people with measured low DAO. Typical use: Not on the Australian permitted list under that name. Get checked before buying.

Reference values. There's no recommended intake or upper limit for any digestive enzyme, because they aren't nutrients.

Typical supplemental range. Most blends are one capsule with each main meal. Enzymes are labelled by activity, not weight: lactase in FCC units, bromelain in GDU or FIP units, and lipase in USP or BP units. The milligrams of powder tell you nothing about how much work an enzyme can do.

Upper level. Australia sets no daily cap on any permitted enzyme. The one number that applies is for lipase: 20,000 lipase units or less per dose unit.

Worth knowing. For comparison, prescription pancreatic enzymes for diagnosed pancreatic failure are dosed at 25,000 to 40,000 lipase units per meal, which is why an over-the-counter blend can't replace them. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Pineapple, stem and fruit: bromelain, from both parts, at no measured activity
• Papaya: papain, a protease from the latex
• Koji foods (miso, soy sauce, sake lees): fermented with Aspergillus oryzae, the named source for amylase, protease and lactase
• Kiwifruit: actinidin, a protease that isn't a permitted enzyme ingredient in its own name
• Yoghurt and aged cheese: live bacteria have already broken down some of the lactose
• Lactose-free milk: lactose already split commercially before it reaches you

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• You have ongoing or unexplained digestive symptoms. Genuine pancreatic enzyme failure needs testing, usually a faecal elastase-1 test, and prescription treatment. Treating yourself delays that.
• You take prescribed pancreatic enzymes. These are Schedule 4 medicines dosed per meal by lipase units, and an over-the-counter blend isn't a substitute or a top-up.
• You take betaine HCl with a PPI or H2 blocker. It works directly against the medicine and changes how some other medicines dissolve. Only use it with practitioner advice.
• You think you have histamine intolerance. It was ruled out in 84.7% of suspected cases when tested, so get checked before buying DAO.
• Babies. Lactase drops for colic need a clinician's assessment first, and the evidence is split.
• You're pregnant or breastfeeding. There's no Schedule 1 warning and no trial, so safety is unknown rather than reassuring.
• Children in general. There's no age restriction and no data in children beyond infant colic.
• You're sensitive to pineapple or papaya. We have no allergy study for bromelain or papain, so check the label as a precaution.