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Digestive enzymes are a blend of proteases, amylases and lipases which may be used to help improve digestion and absorption of nutrients within in the digestive tract. According to studies, there are a number of health conditions that may benefit from enzyme supplementation including chronic pancreatitis, cystic fibrosis, celiac disease, autism spectrum disorders and diabetes, all of which contribute to pancreatic insufficiency. When there is an enzymatic imbalance that goes untreated, malnutrition may eventually develop due to malabsorption of nutrients. One study has identified that pancreatic insufficiency is prevalent 30-40% of chronic pancreatitis and 80-90% of cystic fibrosis cases. (Fieker, Philpott, & Armand, 2011), thereby necessitating the use of oral pancreatic enzyme therapy, a treatment that has been successfully used for decades. More recently, there have been a number of products marketed to help break down the gliaden protein for those with Celiac and other gluten sensitivities. A 2015 study tested the efficacy of this enzyme therapy for breaking down gluten molecules. Results indicated that current products on the market were not effective in degrading gliaden and would not be an efficacious treatment for celiac disease. (Janssen et al., 2015) In 2015, Clinical Psychopharmacology and Neuroscience published a study showing possible benefit for children with autism spectrum disorder in managing symptoms of the disorder. Gastrointestinal conditions such as diarrhea, gas, bloating, dysbiosis, etc. have all been identified as common imbalances in children with ASD, and while no studies have been able to confirm or directly correlate digestive disorders to the onset of autism, there is growing evidence that there is a strong gut-brain connection. In this study, digestive enzymes were given to children for 3 months with significant improvement in behavior and GI symptoms. (Saad et al., 2015) Digestive enzymes are gaining more recognition for their role in managing several conditions. Animal derived enzymes have been the predominant form, however there is growing research offering evidence that newer plant-derived blends may provide equal benefit. (Ianiro, Pecere, Giorgio, Gasbarrini, & Cammarota, 2016) Digestive enzymes aren't for everyone, but they can be an easy starting point for those who experience symptoms of gas, bloating, nausea or diarrhea after eating. If the enzymes aren't doing the trick, the problem may be more complex than insufficient production of enzymes in your gut and it may be time to consult your healthcare practitioner for additional guidance. References: Fieker, A., Philpott, J., & Armand, M. (2011). Enzyme replacement therapy for pancreatic insufficiency: present and future. Clinical and Experimental Gastroenterology, 4, 55–73. https://doi.org/10.2147/CEG.S17634 Ianiro, G., Pecere, S., Giorgio, V., Gasbarrini, A., & Cammarota, G. (2016). Digestive Enzyme Supplementation in Gastrointestinal Diseases. Current Drug Metabolism, 17(2), 187–193. https://doi.org/10.2174/138920021702160114150137 Ianiro, G., Pecere, S., Giorgio, V., Gasbarrini, A., & Cammarota, G. (2016). Digestive Enzyme Supplementation in Gastrointestinal Diseases. Current Drug Metabolism, 17(2), 187–193. https://doi.org/10.2174/138920021702160114150137 Janssen, G., Christis, C., Kooy-Winkelaar, Y., Edens, L., Smith, D., van Veelen, P., & Koning, F. (2015). Ineffective Degradation of Immunogenic Gluten Epitopes by Currently Available Digestive Enzyme Supplements. PLoS ONE, 10(6). https://doi.org/10.1371/journal.pone.0128065 Saad, K., Eltayeb, A. A., Mohamad, I. L., Al-Atram, A. A., Elserogy, Y., Bjørklund, G., … Nicholson, B. (2015). A Randomized, Placebo-controlled Trial of Digestive Enzymes in Children with Autism Spectrum Disorders. Clinical Psychopharmacology and Neuroscience, 13(2), 188–193. https://doi.org/10.9758/cpn.2015.13.2.188
How are stress and your gut linked? Many connections are being made to the health of our microbiome (the colonies of microbes in our gut) and our overall health and wellbeing. One area that has emerged in studies is the effects of stress on the microbiome, and vice versa. The HPA axis, which is the hypothalamus, pituitary, adrenal axis, is deeply involved in our stress responses in the body and recent research has uncovered some interesting relationships with our gut. According to studies, Lactobacillus and Bifidobacterium, two bacterial strains often found in probiotic supplements, improve the function of proteins which connect the cells of the intestinal wall resulting in reduced intestinal permeability (leaky gut). The effect on the HPA axis is a reduction in the release of cortisol and other stress hormones into the blood (Carabotti, Scirocco, Maselli, & Severi, 2015). Another study suggests that Lactobacillus and Bifidobacterium can also mitigate the effects of stress on the HPA axis. And for infants that experienced early separation from their mother, their Lactobacillus levels were significantly lower due to the stress response (Kelly et al., 2015). In “germ-free rodents” supplementation with probiotics reduced the serum levels of cortisol (Schmidt et al., 2015). Studies are also showing a link between prebiotics and stress responses in the body. A double blind randomized control trial of 45 healthy adults were supplemented with prebiotics FOS or B-GOS for 3 weeks and then measured for salivary cortisol levels, emotional response, and other cognitive functions. Results of the study showed lowered cortisol levels in those supplementing the prebiotics versus placebo. It’s important to note however that this study was partially funded by the prebiotics supplement company (Schmidt et al., 2015). A human trial in France studied the effects of Lactobacillus and Bifidobacterium supplementation on stress and mood. Results of this 30-day double blind randomized control trial showed a significant reduction in perceived stress, anxiety, depression and urinary free cortisol levels (Galland, 2014). A similar study published in 2009 showed improved symptoms of chronic fatigue syndrome including decreased anxiety and stress responses with supplementation of Lactobacillus and Bifidobacterium strains of probiotics (Rao et al., 2009). There is further evidence pointing toward the effects of the microbiome on sleep and cortisol levels due to shifts in cytokines and their effects REM and nREM sleep states. According to Galland (2014) “the gut microbiome stimulates a chronic state of low-level activation of the innate immune system in humans, which is influenced by the circadian pattern of adrenal cortical function.” So what does all of this research mean to the average person? Essentially, a healthy diet that includes traditionally fermented foods like kimchi, miso, saur kraut and yogurt, and prebiotic foods like beans, grains, greens, apples, flaxseeds, asparagus, etc. will help to balance the gut and also reduce the effects of stress on the body. References: Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology, 28(2), 203–209. Galland, L. (2014). The Gut Microbiome and the Brain. Journal of Medicinal Food, 17(12), 1261–1272. https://doi.org/10.1089/jmf.2014.7000 Kelly, J. R., Kennedy, P. J., Cryan, J. F., Dinan, T. G., Clarke, G., & Hyland, N. P. (2015). Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders. Frontiers in Cellular Neuroscience, 9. https://doi.org/10.3389/fncel.2015.00392 Rao, A. V., Bested, A. C., Beaulne, T. M., Katzman, M. A., Iorio, C., Berardi, J. M., & Logan, A. C. (2009). A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathogens, 1, 6. https://doi.org/10.1186/1757-4749-1-6 Schmidt, K., Cowen, P. J., Harmer, C. J., Tzortzis, G., Errington, S., & Burnet, P. W. J. (2015). Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology, 232(10), 1793–1801. https://doi.org/10.1007/s00213-014-3810-0
