Digestive enzymes
Also called: lactase, alpha-galactosidase, amylase, protease, lipase, bromelain, papain.
Two targeted enzymes have data, lactase and alpha-galactosidase; the blends sold to "digest everything" have almost none.
What it is
Digestive enzymes break food down into absorbable fragments: amylases for carbohydrates, proteases for proteins, lipases for fats, lactase for lactose. The pancreas and the intestinal lining normally produce enough. As a supplement, people buy them for bloating, lactose intolerance, legumes and heavy meals.
What the label does not say
- The quantity that counts is activity, not weight. Health Canada requires the quantity per dosage unit to be the enzymatic activity (ALU for lactase, GalU for alpha-galactosidase, DU, HUT, LU or PU for the others), with milligrams remaining optional. A "proprietary blend" in milligrams compares to nothing.
- Lactase does what it says, but the symptom data are meagre: a 2010 systematic review (Annals of Internal Medicine) judged them insufficient, and a single crossover trial (47 adults, 2021) reports fewer symptoms and 55% less breath hydrogen. The same review concludes that most intolerant people already tolerate 12 to 15 g of lactose.
- Alpha-galactosidase works at the right dose: in the only controlled trial found (8 volunteers, 420 g of cooked beans), 1,200 GalU reduced breath hydrogen and flatulence, 300 GalU only the overall score. A tablet that shows its GalU can be placed against those doses; a blend that does not show them cannot.
- For the blends sold to "digest everything" in someone without a diagnosed deficit, no systematic review or authoritative fact sheet documenting a benefit was found; the Canadian monograph grants them only a generic claim.
The forms on the shelf
- Lactase (beta-galactosidase): dosed in FCC ALU units. The Health Canada monograph ties it to the claims "helps digest foods containing lactose" and "helps prevent symptoms of lactose intolerance", at 3,000 to 54,000 ALU per day, without exceeding 18,000 ALU per dose.
- Alpha-galactosidase: dosed in FCC GalU, 260 to 3,000 GalU per day according to Health Canada, to reduce gas after a meal rich in fermentable oligosaccharides (legumes, vegetables, whole grains).
- Broad-spectrum blends (amylase, fungal proteases, lipase, cellulase, bromelain, papain): the accepted claim is limited to "digestive enzyme" or "digestive aid", plus "helps digest proteins" for proteases.
- Over-the-counter pancreatic enzymes (porcine pancreatin): the claim targets bloating after a fat-rich meal; pancreatitis, pancreatic insufficiency and cystic fibrosis call for a consultation according to the monograph.
Published reference values
- No recommended intake or upper limit: they are not nutrients.
- Lactase: 3,000 to 54,000 FCC ALU per day, maximum 18,000 ALU per dose (Health Canada).
- Alpha-galactosidase: 260 to 3,000 FCC GalU per day (Health Canada).
- The NIDDK puts 12 g of lactose at about one cup of milk, often taken without symptoms, places lactase tablets before the dairy product, and considers lactose-free milk as nutritious as regular milk.
When
With the meal or immediately before, according to the Health Canada monograph. A lactase has no purpose unless lactose is present.
To mention to a professional
- Diabetes (carbohydrases and lactase release sugars), ulcers or digestive lesions and planned surgery for proteases, use of anticoagulants or anti-inflammatories with bromelain or papain, allergy to latex or to certain fruits for papain, sensitivity to pork proteins for pancreatin, pancreatitis or cystic fibrosis, pregnancy and breastfeeding: check with a health care professional.
What it is sold for, and what the data show
Enzyme blends are sold to digest any meal and make bloating disappear. The data found target two specific enzymes for two specific foods, lactose and the oligosaccharides in legumes, and even there, the trials are small. For a person whose pancreas is working, no controlled trial found shows that an over-the-counter blend improves the digestion of an ordinary meal.
Sources
- Health Canada, natural health product monograph, Digestive Enzymes
- Shaukat et al., Systematic review: effective management strategies for lactose intolerance, Annals of Internal Medicine (DARE abstract, NCBI Bookshelf)
- NIDDK, Lactose Intolerance, Treatment
- NIDDK, Lactose Intolerance, Eating, Diet and Nutrition
- Baijal and Tandon, Effect of lactase on symptoms and hydrogen breath levels in lactose intolerance: a crossover placebo-controlled study, JGH Open (single trial)
- Di Stefano et al., The effect of oral alpha-galactosidase on intestinal gas production and gas-related symptoms, Digestive Diseases and Sciences (single trial)
Educational information, drawn from the sources above. It does not replace the advice of a health professional, who remains the reference for your situation, your medications, pregnancy or breastfeeding.