Digestive Enzymes – Informed Opinion

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By Gene Bruno, MS, MHS – Dean of Academics, Huntington College of Health Sciences. Adequate digestive enzymes and hydrochloric acid can alleviate and prevent many gastrointestinal symptoms and chronic disorders.

Smart Supplementation™ is a free series of educational literature created by Huntington College of Health Sciences (HCHS) as a public service. Although copyrighted, it may be freely photocopied and distributed, but may not be altered in any way. Smart Supplementation™ is not intended as medical advice. For diagnosis and treatment of any medical condition, consult your physician.

Do you have indigestion, heartburn, bloating or gassiness? If so, rather than blocking the digestive process with antacids, you may wish to try the natural approach which focuses on aiding digestion. Digestive enzymes and hydrochloric acid supplements are often recommended by practitioners of natural medicine to help improve digestion and prevent reflux.[i]

Low digestive enzyme and hydrochloric acid secretion

The rationale for this approach is that a more likely cause of indigestion is a lack of digestive enzyme secretion as well as a lack of hydrochloric acid secretion, or hypochlorhydria, rather than hyperacidity.[ii] In fact, both human and animal research has demonstrated that digestive enzymes produced by the pancreas reduce with age.[iii] [iv]  In addition, suboptimal pancreatic function may occur for other reasons, including pancreatic and non-pancreatic disorders—both of which may cause an impaired production of pancreatic digestive enzymes, resulting in poor digestion. At least in part, this is there is also an age-related decline in bile acid synthesis by the liver[v]—bile acids help digest fats. Furthermore, insufficient amounts of digestive enzymes can cause or exacerbate abnormal digestive conditions, such as maldigestion, food allergies or sensitivities, intestinal fermentation, putrefaction and peroxidation, and the phenomenon known as intestinal hyperpermiability, or “leaky gut.”[vi]

Likewise, several studies have shown that the ability to secrete hydrochloric acid decreases with age[vii] [viii] [ix], with low stomach acidity in more than half of the subjects older than 60 years in some cases.  In addition some research suggests that people with a wide variety of chronic disorders do not produce adequate amounts of stomach acid. These disorders include allergies[x] [xi] [xii],asthma[xiii] [xiv], gallstones[xv] [xvi], rosacea[xvii], dermatitis herpetiformis[xviii], rheumatoid arthritis[xix], and vitiligo.[xx]

Inadequate secretion of digestive enzymes and hydrochloric acid can be addressed through the use of a multi-digestive enzyme (MDE) supplement. Such supplements may contain pancreatin or pancrealipase, pancreas extracts from pork (porcine) or beef (bovine) sources that contain lipase, protease, and amylase.[xxi] The may also contain microbial/fungal sources of enzymes, as well as betaine hydrochloride as a source of hydrochloric acid, and ox bile as a source of bile.

Posted May 2, 2011.

References:

[i] Golan R. Optimal Wellness. New York: Ballantine Books; 1995:373–4.

[ii] Pizzorno JE, Murray MT. Textbook of Natural Medicine, 3rd ed. Edinburgh: Churchill Livingstone; 2006.

[iii] Laugier R, et al. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly Digestion 1991;50(3‑4):202‑11.

[iv] Wang CS, Floyd RA, Kloer HU. Effect of aging on pancreatic lipolytic enzymes. Pancreas 1986;1(5):438‑42.

[v] Einarsson K, Nilsell K, Leijd B, Angelin B. Influence of age on secretion of cholesterol and synthesis of bile acids by the liver. NEJM 1985; 313(5):277-282.

[vi] Rachman B. Unique features and application of non-animal derived enzymes. Clinical Nutrition Insights 1997; 5(10):1-4.

[vii] Rafsky HA, Weingarten M. A study of the gastric secretory response in the aged. Gastroenterology 1947;May:348-352.

[viii] Davies D, James TG. An investigation into the gastric secretion of a hundred normal persons over the age of sixty. Br J Med 1930;i:1-14.

[ix] Baron JH. Studies of basal and peak acid output with an augmented histamine test. Gut 1963;4:136-144.

[x] Kokkonen J, Simila S, Herva R. Impaired gastric function in children with cow’s milk intolerance. Eur J Pediatr 1979;132:1–6.

[xi] Kokkonen J, Simila S, Herva R. Gastrointestinal findings in atopic children. Eur J Pediatr 1980;134:249–54.

[xii] Gonzalez H, Ahmed T. Suppression of gastric H2-receptor mediated function in patients with bronchial asthma and ragweed allergy. Chest 1986;89:491–6.

[xiii] Gillespie M. Hypochlorhydria in asthma with specific reference to the age incidence. Q J Med 1935;4:397–405.

[xiv] Bray GW. The hypochlorhydria of asthma in childhood. Q J Med 1931;24:181–97.

[xv] Fravel RC. The occurrence of hypochlorhydria in gall-bladder disease. Am J Med Sci 1920;159:512–7.

[xvi] Capper WM, Butler TJ, Kilby JO, Gibson MJ. Gallstones, gastric secretion and flatulent dyspepsia. Lancet 1967;i:413–5.

[xvii] Johnson L, Eckardt R. Rosacea keratitis and conditions with vascularization of the cornea treated with riboflavin. Arch Ophthamol 1940;23:899–907.

[xviii] Yancy KB, Lawley TJ. “Immunologically Mediated Skin Diseases.”Harrison’s Online. 1999. http://www.harrisonsonline.com/hill-bin/Chapters.cgi (Jan 10, 2000).

[xix] Hartung EF, Steinbroker O. Gastric acidity in chronic arthritis. Ann Intern Med 1935;9:252.

[xx] Francis HW. Achlorhydria as an etiological factor in vitiligo, with report of four cases. Nebraska State Med J 1931;16(1):25–6.

[xxi] McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.