Reprinted with the kind permission of Life Extension.
By Alicia Nadil
Do you remember how easy it was in youth to consume a high-calorie meal and suffer no unpleasant aftereffects?
One reason we internally managed foods so easily back in those days were the massive amounts of digestive juices we produced that efficiently broke down foods for healthy absorption.
Contrast this to what many adults take after meals, such as over-the-counter drugs like Alka-Seltzer® and Pepto-Bismol® to relieve gas, bloating, cramping, and other digestive problems. These drugs can provide temporary relief, but they don’t treat the underlying cause of the problem.
Over-the-counter drugs are a huge business.1,2 In the United States alone, people with digestive discomfort spend $9.5 billion on over-the-counter stomach remedies, and studies show that people taking such medications commonly report not thinking that their problem was serious enough to seek medical attention.2-4
A national survey in 2013 demonstrated that 72% of respondents experienced one or more symptoms such as diarrhea, gas, bloating, stomach pain, frequent bowel movements, unexplained weight loss, or nonspecific abdominal discomfort and 74% of those surveyed reported living with their symptoms for more than six months.4
Unfortunately, over-the-counter drugs could be masking a more serious issue.
After-meal abdominal symptoms often represent poor digestion of complex foods, causing one to be unable to fully absorb nutrients needed for optimal health. This can lead to chronic low-level malnutrition and/or stomach distress after most meals.5,6
A common cause of these widespread digestive problems is the age-related decline of active enzymes that help break down foods into absorbable nutrients.7-9
A second major cause of abdominal symptoms in older adults is the chronic imbalance of the trillions of beneficial organisms that populate our gastrointestinal (GI) tract. Such disturbances contribute to nutrient malabsorption, while also producing inflammation that can weaken the intestinal barrier and allow bacteria and toxins into the circulation where they may aggravate food allergies and sensitivities.10-13
Fortunately, studies show that it is possible to address both of these underlying causes of gastro-intestinal distresses. By properly supplementing with digestive enzymes and probiotics, healthy older adults can take meaningful steps to maintain good digestive health. The result can be better digestion, less abdominal stress, and greater retention of nutrients.
Why Digestive Enzymes Are so Important
In order for the food we eat to be absorbed into our bloodstream, the actions of powerful enzymes are required to break down the food in order to extract vital nutrients. Each of the three major food groups—carbohydrates, proteins, and fats—must be broken down by specific enzymes before being absorbed by cells in the digestive tract.
When the digestive tract is in good working order, food is almost completely broken down by the time it reaches the end of our small intestine, leaving few undigested food molecules to pass into the colon. The result is a well-nourished body that continuously renews itself, and a comfortable sensation following a meal.
With age, the production of normal digestive enzymes begins to fall off, leaving significant amounts of all three major food groups (fats, proteins, and carbohydrates) to pass undigested into the large intestine, or colon.8,9,14
This can lead to bloating, gas, diarrhea, and cramping—and even worse, can contribute to the malnutrition that threatens older people as a result of lost appetite and changes in muscle and fat stores.15,16 That’s why the proper complement of healthy enzymes is crucial not just for healthy digestion—but for good health in general.
WHAT YOU NEED TO KNOW
Enzymes and Probiotics for Healthy Digestion
- Research indicates over 70% of Americans report feeling discomfort, bloating, gas, cramps, or urgency to defecate following a meal.
- This problem is especially prevalent in older adults, whose natural production of digestive enzymes dwindles with age.
- Loss of normal balance of beneficial gastrointestinal microbes further exacerbates symptoms.
- Supplementation with digestive enzymes that break down starches, protein, fats, and fiber is a proven method to reduce symptoms and improve nutritional status.
- Supplementation with B. coagulans, a beneficial probiotic microbe, can further improve comfort and reduce symptoms by balancing your population of intestinal organisms.
- If you suffer from any degree of discomfort following what should be a pleasant and fulfilling meal, it’s time to add digestive enzymes and sustainable probiotic bacteria to your regimen.
Improving Digestive Comfort and Function
A natural solution to declining levels of digestive enzymes is to supplement with digestive enzymes that cover the major needs of the body to break down all classes of food, including starch, proteins, fats, cellulose, and milk.
For optimal digestion, it is important to include these major digestive enzymes:
- Amylase to break down starch and short sugar chains called oligosaccharides,
- Protease to help break down proteins,
- Lipase to break down fats,
- Cellulase to break down the indigestible polysaccharide in dietary cellulose, and
- Lactase to break down lactose (milk sugar).
People suffering from pancreatic insufficiency as a result of cystic fibrosis, pancreatic surgery, or trauma have long used supplemental digestive enzymes.17But researchers have recognized that the addition of digestive enzymes is beneficial to healthy individuals as well.
In various studies, each of these major enzymes has shown specific benefits in digesting food.
Animal studies have repeatedly demonstrated that when supplemental digestive enzymes are added to the normal food supply, they can significantly improve digestibility of dietary foods, improve nutrient absorption, reduce gas production, and, in at least one case, reduce food intake, as a result of improved nutritional status.5,18,19 Furthermore, in stressed or aged animals, a mix of pancreatic digestive enzymes improved muscle wasting in addition to the other benefits.5
Human studies are now revealing similarly impressive results for supplemental digestive enzymes. In a study of adults with chronic pancreatic insufficiency, in which the subjects were unable to fully digest and absorb fats and proteins, researchers tested two pancreatic enzyme replacement products. A supplement with bromelain proved significantly more effective at improving both protein and fat digestion and absorption.20
Pancreatic lipase (the fat-digesting enzyme) has been routinely used for years in people with pancreatic insufficiency to assist with digestion.21 A study in healthy volunteers demonstrated that the use of this enzyme could be beneficial in others as well.
For the study, subjects ate 185 grams (about 6 ounces) of cookies containing 1,196 calories and 72 grams(about 2.5 ounces) of fat, along with capsules of lipase or a placebo.22 They were then followed for up to 17 hours. Compared to placebo patients, patients supplemented with lipase showed significant reductions in bloating over the entire period, with significant reductions in bloating, gas, and fullness later in the day.
Lactase , the enzyme that breaks down lactose, or “milk sugar,” is sharply reduced in adults from everywhere except Northern Europe, and both human and animal studies demonstrate that this lactase deficiency increases with advancing age.8,23 Deficiency of lactase produces a condition known as lactose intolerance, characterized by cramps, bloating, gas, and often diarrhea following consumption of milk products. Lactose intolerance is known to be a significant problem in the elderly, and can lead to insufficient calcium intake, resulting in greater risks of osteoporosis and subsequent fractures.9,24,25 Thus, it is especially important in older adults to be capable of comfortably consuming milk products to help avoid osteoporosis.
Studies show that supplementation with lactase produces a significant reduction in excretion of hydrogen in the breath (a marker of improved lactose digestion), while also significantly reducing symptoms of abdominal cramping, belching, flatulence, bloating, and diarrhea.26
Consuming these specific digestive enzymes would provide comprehensive assistance to one’s ability to digest foods in a more youthful and tolerant fashion—and would also help relieve discomforts after eating, as well as improve your overall nutritional status.
THE FIVE MOST PREVALENT DIGESTIVE ENZYMES
Each major food group has a specific type of enzyme responsible for its breakdown. Deficiency in any of these enzymes can lead to a wide range of common intestinal troubles. There are five major digestive enzymes that need to be at healthy levels for the digestion of food without painful or embarrassing side effects. These include amylase, protease, lipase, cellulose, and lactase.
Carbohydrates and starches are digested by the enzyme amylase. A deficiency in amylases causes undigested carbohydrate molecules to pass on to the colon, where gut organisms break them down, literally fermenting them to produce carbon dioxide and water that lead to cramping, flatulence, and diarrhea.41,42,43
Proteins are digested by the protease enzymes. A deficiency in proteases leaves protein molecules or fragments undigested. Again, these pass on to the colon, in this case giving rise to a host of unpleasant-smelling and potentially toxic molecules.44-47 Undigested protein in the colon has also been associated with colon cancer initiation, though the exact mechanisms are still under investigation.48
Fats are digested by the lipase enzymes. A deficiency in lipases leaves long-chain fats undigested. Undigested fats cannot be absorbed anywhere in the body and are typically passed on through the GI tract to produce greasy, fatty stools, cramping, and even malnutrition when fat-soluble vitamins are lost.17
Though several different digestive system organs produce some digestive enzymes, the pancreas makes all three of these essential digestive enzymes.49 Loss of pancreatic function is therefore a common cause of after-meal indigestion and other symptoms. Pancreatic insufficiency was long thought to be found only in patients with disorders of the pancreas itself, such as cystic fibrosis, pancreatitis, or pancreatic tumors. However, it is now recognized as being associated with aging.9,17,50,51 One recent study found pancreatic insufficiency in more than 7% of a large group of patients with general abdominal pain and discomfort.32
Cellulase is the enzyme that breaks down cellulose, the indigestible polysaccharide in dietary fiber.52 Fiber is increasingly recognized as vital for healthy digestion because, though humans cannot break it down, it feeds the beneficial organisms in our colons, which use it to produce beneficial short-chain fatty acids that nourish our colonic cells and help to prevent cancer.53 But, precisely because we cannot digest fiber ourselves, it can produce symptoms of bloating, flatulence, diarrhea, and constipation when broken down by our intestinal tenants.54
Lastly, lactase is the enzyme that breaks down milk sugar (lactose).55 A deficiency in lactase can prevent the body from breaking down lactose, leading to lactose intolerance, which can lead to abdominal cramping, belching, flatulence, diarrhea, and bloating.56
In addition to having reduced levels of digestive enzymes, another cause of digestive malfunction and after-meal discomfort occurs when the normal microbial populations become imbalanced.27
The body relies heavily on the teeming communities of bacteria that live in the large intestine, or colon. Like any community, this group of microbes, collectively known as the intestinal microbiome, functions best when its occupants are richly diverse and respect one another’s boundaries. If those properties are not present, symptoms of indigestion may arise.28,29
When colonic bacteria move out of the colon and into the small intestine, a condition called small intestinal bacterial overgrowth, develops.30 Small intestinal bacterial overgrowth is associated with carbohydrate malabsorption and may also result in intestinal inflammation. This inflammatory response can then cause the normally tight intestinal barrier to leak, permitting bacteria and toxins to enter the bloodstream, where they may contribute to symptoms of food allergy and food sensitivity.10-12
A related condition is intestinal dysbiosis, in which the natural balance of beneficial bacteria living in the gut becomes disturbed.31 This is a huge and growing area of medical research, as researchers learn that it does not take a true pathogen (disease-causing organism) to produce abdominal symptoms and increase the risk for a host of life-shortening disorders.
In fact, simply having the wrong mix of bacteria in your intestines can set the stage for obesity, cardiovascular disease, and many other chronic, age-associated conditions.32,33 Studies show that as many as 73% of people with abdominal complaints have some form of dysbiosis.32
In addition to causing GI discomfort and related symptoms, all of these problems can contribute to malnutrition, a serious and growing problem in older adults—one that exacerbates their frailty and vulnerability to falls, fractures, and infections.34
Fortunately, supplementing with probiotic bacteria can help alleviate the digestive issues that can occur as a result of microbial imbalance.
Easing Abdominal Symptoms with Probiotic Bacteria
Beneficial bacteria are essential for maintaining proper balance among the trillions of organisms living in the intestines. Low growth of the “good guys” can lead to overgrowth and imbalance of organisms less directly beneficial (and some directly harmful) to the body’s health.
Studies show that probiotic organisms (which are cultures of living beneficial bacteria) can help reduce abdominal symptoms and promote healthy intestinal function by promoting their own and other beneficial organisms’ growth and suppressing that of less useful bacteria.35,36
The MTCC 5856 strain of Bacillus coagulans (formerly known as Lactobacillus sporogenes) is especially beneficial because it is coated in a tough outer layer that resists digestion in the stomach and small intestine.35,37 This allows it to be delivered intact to the large intestine, where it can then “hatch” out to set up new colonies in a sustainable fashion.35,37,38
It takes an estimated four hours from ingestion to germination in the intestine. However, over time, it is gradually excreted and needs to be replenished with fresh supplementation.36,37
Once established, B. coagulans produces lactic acid, which is a useful chemical that helps suppress the growth of disease-causing bacteria and promotes its own growth.35,37,38 Lactic acid bacteria are commonly used as “starter cultures,” in fermented foods such as yogurt, kimchi, sauerkraut, kefir, sourdough bread, pickles, and many other healthful foods.35 Furthermore, production of lactic acid is the result of the presence of lactase, the digestive enzyme that breaks down lactose, and is missing in so many adults.37,39
B. coagulans also produces bacteriocins, which are compounds that help maintain a healthy balance of bacteria by limiting the growth of less desirable bacteria.35,37
The value of this resilient B. coagulans strain of bacteria has been shown in studies of people with gastrointestinal issues, such as chronic constipation, chronic diarrhea, and irritable bowel syndrome.
A study of people with chronic constipation showed that 70% of subjects had improvement in abdominal distension and normalization of stools following supplementation with 300 to 750 million spores of B. coagulans per day for up to 10 days.37
A study of patients with acute or chronic diarrhea demonstrated, in a randomized fashion, that probiotic supplementation with either B. coagulans or another commonly used organism calledBifidobacterium longum produced good relief from symptoms.
Irritable bowel syndrome (IBS) is a common and difficult-to-treat condition that can cause diarrhea and constipation, along with significant abdominal discomfort, gas, and bloating. In a multi-center, randomized, double-blind controlled study of IBS patients, daily supplementation with tablets containing 2 billion spores of B. coagulans was found to significantly reduce symptom scores, abdominal discomfort scores, stool quality, and physicians’ overall assessment scores.40 Additionally, the patients receiving the probiotic bacteria showed improvement in bloating, vomiting, diarrhea, abdominal pain, and stool frequency, compared with control subjects.
The digestive tract changes with age. The amounts of digestive enzymes the body produces decline over time, leaving undigested food molecules free to pass into the colon where they ferment and produce noxious gas, bloating, cramping, and diarrhea.
Adding to this challenge, the body’s normally helpful tenants, the microbes living in the colon, become disruptive and imbalanced, potentially invading the small intestine where they can produce inflammation and poor digestion.
In human studies, supplemental digestive enzymes have provided increased digestive comfort and reduction in common symptoms of indigestion. And supplementation with probiotic B. coagulans bacteria not only boosts the population of good bacteria, but also results in production of natural bacterial compounds that suppress less beneficial, or even overtly harmful, bacteria. These changes have been demonstrated to improve after-meal comfort while restoring the natural balance of organisms in the intestinal tract.
For those troubled by bloating, cramps, gas, loose stools, or other digestive symptoms following a normal meal, restoring normal enzymes and intestinal microbial population could help alleviate after-meal distress.
If you have any questions on the scientific content of this article, please call a Life Extension® Health Advisor at 1-866-864-3027.
1. Taylor J, Landry E, Lalonde L, Tsuyuki RT. Results of a national survey on over-the-counter medicines, Part 1: Pharmacist opinion on current scheduling status. Can Pharm J (Ott). 2012; 145(1):40-4.
2. Sheen CL, Colin-Jones DG. Review article: over-the-counter drugs and the gastrointestinal tract. Alimen Pharmacol Ther. 2001;15(9):1263-70.
3. Van Vliet EP, Kuipers EJ, Steyerberg EW, Siersema PD. Users and utilization patterns of over-the-counter acid inhibitors and antacids in The Netherlands. Scand J Gastroenterol. 2008;43(6):662-8.
4. Available at: http://goo.gl/kyZrkD. Accessed August 6, 2013.
5. Farges MC, Vasson MP, Davot P, et al. Supplementation of oral nutrition with pancreatic enzymes improves the nutritional status of aged endotoxemic rats. Nutrition. 1996;12(3):189-94.
6. Available at: http://goo.gl/JttyqX. 2008. Accessed August 6, 2013.
7. Di Stefano M, Veneto G, Malservisi S, Strocchi A, Corazza GR. Lactose malabsorption and intolerance in the elderly. Scand J Gastroenterol. 2001;36(12):1274-8.
8. Baum BJ, Levine RL, Kuyatt BL, Sogin DB. Rat parotid gland amylase: evidence for alterations in an exocrine protein with increased age. Mech Aging Dev. 1982;19(1):27-35.
9. Laugier R, Bernard JP, Berthezene P, Dupuy P. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly. Digestion. 1991;50(3-4):202-11.
10. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978-90.
11. Kirsch M. Bacterial overgrowth. Am J Gastroenterol. 1990;85(3):231-7.
12. Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome.JAMA. 2004;292(7):852-8.
13. Vitetta L, Manuel R, Zhou JY, Linnane AW, Hall S, Coulson S. The overarching influence of the gut microbiome on end-organ function: the role of live probiotic cultures. Pharmaceuticals (Basel).2014;7(9):954-89.
14. Vellas B, Balas D, Moreau J, et al. Exocrine pancreatic secretion in the elderly. Int J Pancreatol.1988;3(6):497-502.
15. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73.
16. Friess H, Michalski CW. Diagnosing exocrine pancreatic insufficiency after surgery: when and which patients to treat. HPB (Oxford). 2009;11 Suppl 3:7-10.
17. Dominguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Gastroenterol Hepatol. 2011;7(6):401-3.
18. Eun JS, Beauchemin KA. Effects of a proteolytic feed enzyme on intake, digestion, ruminal fermentation, and milk production. J Dairy Sci. 2005;88(6):2140-53.
19. Omogbenigun FO, Nyachoti CM, Slominski BA. Dietary supplementation with multienzyme preparations improves nutrient utilization and growth performance in weaned pigs. J Anim Sci. 2004;82(4):1053-61.
20. Knill-Jones RP, Pearce H, Batten J, Williams R. Comparative trial of Nutrizym in chronic pancreatic insufficiency. BMJ. 1970;4(5726):21-4.
21. Griffin SM, Alderson D, Farndon JR. Acid resistant lipase as replacement therapy in chronic pancreatic exocrine insufficiency: a study in dogs. Gut. 1989;30(7):1012-5.
22. Suarez F, Levitt MD, Adshead J, Barkin JS. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Dig Dis Sci. 1999;44(7):1317-21.
23. Misselwitz B, Pohl D, Fruhauf H, Fried M, Vavricka SR, Fox M. Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment. United European Gastroenterol J. 2013;1(3):151-9.
24. Kuhn RJ, Gelrud A, Munck A, Caras S. CREON (Pancrelipase Delayed-Release Capsules) for the treatment of exocrine pancreatic insufficiency. Adv Ther. 2010;27(12):895-916.
25. Park S, Johnson MA. What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status? Nutr Rev. 2006;64(8):373-8.
26. Sanders SW, Tolman KG, Reitberg DP. Effect of a single dose of lactase on symptoms and expired hydrogen after lactose challenge in lactose-intolerant subjects. Clin Pharm. 1992;11(6):533-8.
27. Brown K, DeCoffe D, Molcan E, Gibson DL. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 2012;4(8):1095-1119.
28. De Vos WM, de Vos EA. Role of the intestinal microbiome in health and disease: from correlation to causation. Nutr Rev. 2012;70 Suppl 1:S45-56.
29. Semova I, Carten JD, Stombaugh J, et al. Microbiota regulate intestinal absorption and metabolism of fatty acids in the zebrafish. Cell Host Microbe. 2012;12(3):277-88.
30. Rana SV, Malik A. Hydrogen breath tests in gastrointestinal diseases. Indian J Clin Biochem.2014;29(4):398-405.
31. Hawrelak JA, Myers SP. The causes of intestinal dysbiosis: a review. Alt Med J. 2004;9(2):180-97.
32. Goepp J, Fowler E, McBride T, Landis D. Frequency of abnormal fecal biomarkers in irritable bowel syndrome. Glob Adv Health Med. 2014;3(3):9-15.
33. Zhang YJ, Li S, Gan RY, Zhou T, Xu DP, Li HB. Impacts of gut bacteria on human health and diseases. Int J Mol Sci. 2015;16(4):7493-519.
34. Saffrey MJ. Aging of the mammalian gastrointestinal tract: a complex organ system. Age. 2014;36(3):9603.
35. Available at: http://goo.gl/uAE8Lw. Accessed August 6, 2013.
36. Majeed M, Prakash L. Majeed M, Prakash, L. Probiotics for health and wellbeing: Sabinsa Corporation;2007.
37. AMR. Lactobacillus sporogenes. Alt Med Rev. 2002;7(4):340-2.
38. Sabinsa. LactoSpore: Frequently Asked Questions. 2012.
39. Available at: http://www.ncbi.nlm.nih.gov/books/NBK44619/. Accessed August 6, 2015.
40. Sivakumar A. A randomized, double blind, parallel group, placebo controlled study to evaluate the safety and efficacy of Lactospore(Bacillus coagulans MTCC 5856) in patients with diarrhea predominant irritable bowel syndrome: Sami Labs Limited; 2014. 2014.
41. Barrett JS. Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract. 2013;28(3):300-6.
42. Sjolund K, Haggmark A, Ihse I, Skude G, Karnstrom U, Wikander M. Selective deficiency of pancreatic amylase. Gut. 1991;32(5):546-8.
43. Gudmand-Hoyer E. The clinical significance of disaccharide maldigestion. Am J Clin Nutr. 1994;59(3 Suppl):735S-41S.
44. Available at: http://goo.gl/XYnsXm. ND. Accessed August 6, 2013.
45. Larque E, Sabater-Molina M, Zamora S. Biological significance of dietary polyamines. Nutrition.2007;23(1):87-95.
46. Prester L. Biogenic amines in fish, fish products and shellfish: a review. Food Addit Contam.2011;28(11):1547-60.
47. Macfarlane GT, Cummings JH, Allison C. Protein degradation by human intestinal bacteria. J Gen Microbiol.1986;132(6):1647-56.
48. Kim E, Coelho D, Blachier F. Review of the association between meat consumption and risk of colorectal cancer. Nutr Res. 2013;33(12):983-94.
49. Iovanna J, Giorgi D, Dagorn JC. Newly synthesized amylase, lipase and serine proteases are transported at different rates in rat pancreas. Digestion. 1986;34(3):178-84.
50. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. WJG. 2013;19(42):7258-66.
51. Pongprasobchai S. Maldigestion from pancreatic exocrine insufficiency. J Gastroenterol Hepatol. 2013;28 Suppl 4:99-102.
52. Carle-Urioste JC, Escobar-Vera J, El-Gogary S, et al. Cellulase induction in Trichoderma reesei by cellulose requires its own basal expression. J Bio Chem. 1997;272(15):10169-74.
53. Goncalves P, Martel F. Butyrate and colorectal cancer: the role of butyrate transport. Curr Drub Metab.2013;14(9):994-1008.
54. Eswaran S, Muir J, Chey WD. Fiber and functional gastrointestinal disorders. Am J Gastroenterol.2013;108(5):718-27.
55. Fraissl L, Leitner R, Missbichler A. Novel formulation of neutral lactase improves digestion of dairy products in case of lactose intolerance. Clin Transl Allergy. 2011;1(Suppl 1):P104.
56. Swagerty DL, Jr., Walling AD, Klein RM. Lactose intolerance. Am Fam Physician 2002;65(9):1845-50.