07 – Best Digestive Enzymes2018-12-17T18:57:57+00:00

Digestive Enzymes

January 2019

hands on stomach
the Bottom LineDigestive and pancreatic enzymes help us efficiently digest food and correctly absorb the nutrients within. Healthy levels decline with age and certain people are naturally short on some enzymes. This leads to very unpleasant digestive disturbances in response to eating specific foods or whole food groups. Enzyme supplements can help but not all are the same. We analyzed the widely available supplements for dosage, efficacy, and purity and here are the products that passed our very stringent standards. Read more details below.

Douglas Labs Lipanase

Lipanase™

Douglas Labs
Check Price
Pure Encapsulations Digestive Enzymes Ultra

Digestive Enzymes Ultra

Pure Encapsulations
Check Price

DigestWise

Naturenetics
Check Price
Source Naturals

Daily Essential Enzymes

Soure Naturals
Check Price

All of our recommended products pass a stringent methodology for selection. We strive to bring you the best quality and most effective supplements on the market. We are brand-agnostic in our recommendations and have no relationships with manufacturers.

Digestive Enzymes: What You Need To Know

Digestive enzymes are critical for digestion and help our bodies break down food into absorbable nutrients. Some individuals are deficient in certain digestive enzymes and have trouble digesting certain foods, which leads to common digestive disorders. Those with lactose intolerance, pancreatic disease, chronic inflammatory bowel disease, cystic fibrosis, or are particularly sensitive to beans and cruciferous vegetables could most benefit from an enzyme.

Other than lactase supplements (lactaid) intended to treat those with lactose intolerance, prescription digestive enzyme supplements intended to treat those with pancreatic insufficiency (PI) and alpha-galactosidase enzyme supplements (Beano) intended to help people digest beans and vegetables, other digestive enzyme supplements have not been well studied. There is little research to back up the benefits, as well as the potential risks, of over the counter digestive enzyme supplements.

If you experience bloating, gas, or diarrhea after consuming dairy, than you’re likely lactose intolerant and can experiment with different strength digestive enzymes depending on your given tolerance. The strength of the supplement will depend on the amount of beta-galactosidase in the capsule, which will be expressed as FFC lactase units.

If you have diarrhea, malnutrition, light-colored, foul smelling, or loose stools, then your doctor can test if you’re deficient in pancreatic digestives enzymes through a direct pancreatic function test and then prescribe a pancreatic digestive enzyme if necessary.

While over the counter digestive enzymes supplements should work in theory if you are deficient in digestive enzymes, it can be hard to know if you really do have a digestive enzyme deficiency. Common digestive issues, such as bloating, indigestion, and constipation could be caused by a host of various issues.

However, more and more research shows the benefits of taking digestive enzymes and it is possible that over the counter enzymes can help you with digestive issues. The body does produce less digestive enzymes as you age and if you notice new digestive issues as you age, you may want to experiment with an over the counter digestive enzyme supplement. While they may not help you, they are very unlikely to harm you.

If you do decide to experiment with one, make sure you find one with an enteric coating so that it is not digested in the stomach before it can help aid digestion in the intestines. Over the counter digestive enzymes can only be harmful if they cause an allergic reaction. Don’t use a particular enzyme if you know you’re allergic to its source, such as bromelain, from pineapple, papain, from papayas, ficin, from figs, or pancreatic enzymes from pigs, cows, or oxen. If you notice symptoms such as a sore throat or red eyes, stop taking the supplement as this could be a sign of an allergic reaction.

A Closer Look at Digestive Enzyme Supplements

We all naturally have digestive enzymes, which are the chemicals produced by our body to help us break down food into nutrients. Some individuals are predisposed to have low levels of certain enzymes and therefore are unable to ingest certain foods, leading to various digestive issues and food intolerances. Studies suggest that age and illness are associated with a decrease in the production of enzymes, which means that your digestive issues and need for a digestive enzyme may change as you age.[1] The people who could most benefit from enzymes are those with lactose intolerance, pancreatic disease, chronic inflammatory bowel disease, cystic fibrosis, or are particularly sensitive to beans and cruciferous vegetables.

Overall digestive enzymes seem to help people with gastrointestinal issues, but it may depend on the individual. Individuals who suffer from IBS and gluten intolerance may potentially benefit from digestive enzymes, but the evidence is not conclusive. Many enzyme suppliers boast bold claims about improvements to overall health and digestion, but if you do not have a specific enzyme deficiency, then you likely will not benefit from a digestive enzyme supplement.

Why Digestive Enzymes are Crucial for Health

When considering the benefits of digestive enzymes for health, it’s important to remember that digestive enzymes includes a broad category encompassing many different types of enzymes in the same way “vitamins” is a broad category. When considering their benefits and effectiveness, it would depend on the specific enzyme and the specific type of population.

Digestive enzymes play a critical role in digestion from the moment that food enters the mouth. Salivation and chewing cause the digestive enzymes amylase and lipase to begin to break down starches and fats.[2] Then food passes from the esophagus to stomach, where more enzymes are released, such as pepsin, and hydrochloric acid, which help break down proteins before the food is passed to the small intestine. In the small intestine, additional digestive enzymes are released by the intestinal lining and pancreas, including trypsin, lipase, and amylase, which helps break down proteins, fats and starches. The intestine also produces peptidases, sucrase, lactase, and maltase, which help break down sugar and milk sugar. Lastly, food is absorbed through the gut wall and into the bloodstream for transport to the liver, where bile salts from the liver release fat globules to help break down fat. Therefore digestive enzymes play a critical part in aiding digestion.

Digestive enzymes are crucial in helping to manage digestive disorders, such as lactose intolerance, cystic fibrosis, and IBS, as well as disorders associated with disruption of the pancreas, such as exocrine pancreatic insufficiency (EPI) in chronic pancreatitis, pancreatic cancer, cystic fibrosis (CF), or diabetes.[3] Digestive enzymes essentially replace the enzymes that the body stops making due to these disorders. By taking digestive enzymes, individuals who suffer from these disorders can be relieved of issues, such as malnutrition, gas, bloating, and diarrhea.

The malabsorption of nutrients in the elderly is correlated with a decline in digestive enzyme production. The malabsorption of nutrients in the elderly has been linked to altered cognitive functions, an acceleration of neurodegenerative diseases, and a faster deterioration of the musculoskeletal system. Ageing is associated with declines in saliva secretions, gastric secretions, and pancreatic exocrine secretions.

Three studies conducted in humans showed that, compared to young controls, subjects above 65–70 years-old had a decrease in pancreatic exocrine secretions, including lipase, chymotrypsin, amylase secretions.[4] After about age thirty, studies suggest that digestive enzymes in the body begin to decrease.[5] However, as the elderly also experience a reduction in the stability of intestinal microbiota, changes in the gut wall, changes in oral cavity and overall body composition, there is no way to know if the decline in digestive enzymes is sufficient to cause the degree of malnutrition observed in the elderly, but it could certainly play a role.[6]

Internal Processing of Enzymes

Digestive enzymes are produced and secreted by the gastrointestinal system to breakdown fats, proteins, and carbohydrates, aiding in digestion and absorption of nutrients. Each enzyme plays a specific role in digestion by breaking down and synthesizing compounds. Alpha-galactosidase help break down carbohydrates in legumes that cause flatulence, glucoamylase helps break down maltose, the sugar in grains, amylase helps break down starches, cellulase helps break down fibers in fruits and vegetables, invertase helps break down sucrose (sugar), lactase helps break down lactose, milk sugar, lipase helps break down fats, malt diastase breaks down carbohydrates, protease, a blend of alkaline, neutral, and acid proteases, breaks down proteins, peptidase breaks down casein (in milk) and gluten (in grains), xylanase helps break down plant fibers, pectinase helps break down pectin a carbohydrate in fruits, and hemicellulase helps break down plant fibers.

Lactase enzymes (Lactaid)

By far the most common digestive disorder, lactose intolerance results when individuals do not produce the lactase enzyme, which is necessary to break down and absorb milk sugar. Lactase is a type of beta-galactosidase, a sugar that differs from alpha-galactosidases, which is needed to digest starchy carbs.

Without the lactase enzyme, lactaid from milk and other dairy products will remain undigested in the intestine, which will cause bloating, gas, diarrhea for some people.[7] Over 75 percent of adults are estimated to have some sort of lactose intolerance, which can increase with age as the body produces less lactase it ages.[8]

Lactase digestive enzyme supplements can be bought over the counter and have been shown to be a very effective digestive enzyme. Their effectiveness, however, can depend on an individual’s given tolerance.[9] These digestive enzymes have been shown to be most effective when consumed before eating smaller amount of dairy, and have been found to be less effective when consuming larger amounts.[10]

Signs of lactose intolerance can include bloating, pain or cramps in the lower belly, gurgling sounds in the lower belly, gas, or diarrhea after consuming dairy. You may need to experiment to determine the strength of the lactase digestive enzyme supplement you need. You can determine the strength of the digestive enzyme by looking for the amount of beta-galactosidase in the supplement, which will be expressed as FFC lactase units. You can also add lactase drops to food or buy milk already treated with lactase.

Alpha-galactosidase enzymes (beano)

Alpha-galactosidase enzymes are the enzymes responsible for breaking down some of the complex sugars (oligosaccharides) found in foods and other complex carbohydrates, such as beans and other high fiber foods, such as cabbage, broccoli and cauliflower. Many people have trouble digesting these high carbohydrates, leading to gastrointestinal symptoms that can often be uncomfortable or embarrassing at times. The complex carbohydrates are not entirely broken down in the digestive tract and instead feed the intestinal bacteria. These bacteria produce hydrogen and carbon dioxide gas as they digest the carbohydrates, which leads to gas and bloating.

Studies have found that digestive enzymes that contain alpha-galactosidase, such as Beano are safe and effective in reducing gas after eating a high fibre diet and may benefit anyone who is sensitive to these foods or those are vegan or vegetarian and consume large quantities of these high-fiber foods regularly.[11, 12]

Those who have digestive disorders, such as Irritable bowel syndrome (IBS) may also benefit from a digestive enzyme.[13] IBS is a common disorder that affects the large intestine, leading to cramping, abdominal pain, bloating, gas, diarrhea and constipation, as well as more serious symptoms such as rectal bleeding, abdominal pain, and weight loss. Those with IBS often have trouble digesting beans and other high-fiber foods and therefore can benefit from digestive enzymes contain alpha-galactosidase.

One should take the enzyme along with the beans or other meal for better effectiveness.
It’s worth noting that alpha-galactosidase supplements may reduce the effectiveness of some diabetic medications and could be unsafe for those with diabetes. Alpha-glucosidase breaks down complex carbohydrates into easily absorbed sugars and this may raise blood sugar levels in people with diabetes. Drugs that block alpha-glucosidase (alpha-glucosidase inhibitors) have proven benefit for people with diabetes and therefore an enzyme with alpha-galactosidase may interfere with those drugs.[14]

Lipase (pancreatic enzyme replacement)

Pancreatic insufficiency (PI) prevents the pancreas from producing the normal amount of digestive enzymes, resulting in malabsorption. PI can result from a number of different diseases and disorders. Those with pancreatic cancer, insulin-dependent diabetes, lysosomal storage disease, ulcerative colitis, crohn’s disease, or have had pancreatic or gastric surgery will benefit from a pancreatic digestive enzyme.[15]

The main cause of pancreatic insufficiency in adults is chronic pancreatitis, while the main cause of pancreatic insufficiency in children is cystic fibrosis.[16] PI is treated with supplemental lipase, a prescription digestive enzyme, which is coated to resist digestion by the stomach acid in order to reach and be effective in the intestines.[17] Signs and symptoms of PI include diarrhea, malnutrition, light-colored, foul smelling, loose stools—often that float as a result of malabsorbed fat. You will most know if you should benefit from a pancreatic enzyme as these enzymes will be prescribed by your doctor. These enzymes should always be taken with meals for better absorption.

New frontier of Digestive Enzymes

There is constant new research just beginning to surface that seeks to determine which enzymes and enzyme combinations can be helpful with various digestive issues and disorders. The enzyme aspergillus niger-derived prolyl endoprotease (AN-PEP) has recently shown promising results in helping those with gluten sensitivity ingest small amounts of gluten.[18] However, one study analysed five commercially available digestive supplements and found they did not help to breakdown gluten.[19] Other studies have shown that supplements with mixture of beta-glucan, inositol and digestive enzymes reduces bloating, flatulence and abdominal pain, and overall improved the health of patients with IBS.[20]

Some researchers believe that modern diets have less enzyme activity due to cooking and heavy processing of foods and that therefore many people, not just those without a digestive disorder, could benefit from a multi-enzyme digestive supplement. Several studies suggest that multi-enzyme supplement, which could consist of a number of different type of enzymes, such as bromelain and microbial-derived protease, amylase, cellulase, lactase, can improve digestion and mitigate a variety of gastrointestinal symptoms.[21, 22] However, most of these studies were funded by companies that sell digestive enzymes and there is a lack of research about the effectiveness of multi- enzyme digestive supplements from more independent sources. While digestive enzymes should work well in theory, one issue is that many commercial enzyme products, especially those that are plant based and lack an enteric coating, is that they are unable to be absorbed by the intestines and are digested by the stomach before they can help aid in digestion.

Signs of Insufficiency in Digestive Enzymes

The signs of insufficient digestive enzymes can vary depending on the disorder. The signs of insufficient pancreatic enzymes can include weight loss, greasy and foul-smelling stools that float or are tough to flush, stomach cramps, and diarrhea. Symptoms of lactose intolerance are bloating, pain or cramps in the lower belly, gurgling or rumbling sounds in the lower belly, gas, or loose stools after consuming dairy. More generally, those who suffer from indigestion, bloating, gas, diarrhea, and chronic fatigue, may also suffer from a digestive disorder.

Those who have disorders, such as chronic pancreatitis, cystic fibrosis, crohn’s disease, IBS, celiacs, or are over the age of 65, are the most likely to be deficient in digestive enzymes.

Considerations When Choosing To Take Digestive Enzymes

Digestive enzymes are safe to consume and are most effective when taken with food and capsules should swallowed with a cold drink rather than a hot beverage as enzymes are damaged at high temperatures. Many doctors believe that unless you have an extreme digestive enzyme deficiency, you won’t benefit from a digestive enzyme. Enzymes are proteins and the stomach simply digests the proteins that it doesn’t use, which means that extra digestive enzymes won’t have an effect unless you’re deficient. This also means that it’s hard to overdose or take too many enzymes as the body will just digest the excess enzymes.

Some over the counter enzyme complexes include Betaine HCL, which is an acidic form of betaine, a vitamin-like substance found in grains and other foods. Some doctors recommend betaine hydrochloride as a supplemental source of hydrochloric acid for people who have a deficiency of stomach acid production (hypochlorhydria). In 1993, a federal law banned Betaine HCL because there wasn’t enough evidence to classify it as “generally recognized as safe and effective.” There are many claims that Betaine HCL can improve digestion by increasing stomach acid for individuals with low stomach acid, which decreases with age. There is not enough evidence that Betaine HCL alters stomach acidity or provides any benefit. However, there is also little evidence that suggests Betaine HCL is harmful and should be avoided if listed as one of the ingredients in a digestive supplement.

The three main sources of digestion enzymes are fungal, plant, and animal. While digestive enzymes that contain pancreatic enzymes are usually made from porcine (pig) or other animal sources, alpha-galactosidase and lactase enzymes are made from fungi and yeast sources and are safe for vegans and vegetarians. Prescription enzymes will have an enteric coating to help prevent the capsules from breaking down in the stomach and allows it to reach the lower gastrointestinal tract where its effective. When choosing an over the counter enzyme, try to find one that has an enteric coating.

Unless you are deficient in a specific digestive enzyme, then you may benefit from a probiotic rather than a digestive enzyme for digestive issues. While digestive enzymes are proteins found in various locations throughout the gastrointestinal tract, probiotics are living bacteria concentrated in the small and large intestines. The bacteria in probiotics play a role in supporting digestion, gut health, and immune health. Therefore individuals who are looking for a more overall digestive aid, but aren’t deficient in a specific enzyme may do better to experiment with probiotics than digestive enzymes. Probiotics have been shown to help people with IBS and other digestive issues.[23]

It may be possible to consume more digestive enzymes and probiotics from food naturally. Many proponents of raw food diets claim that sustained heat of approximately 118-129 degrees F (48-54 C) destroys virtually all enzymes, which means that eating raw organic food would be one way to incorporate more digestive enzymes into your diet.[24] Probiotics can be found in yogurt, kefir, sauerkraut, kimchi, and kombucha.

Contraindications

Prescription digestive enzymes almost always refer to pancreatic enzyme products that are prescribed by a doctor and used to treat patients who have Pancreatic Insufficiency (PI), which means their bodies are deficient in pancreatic enzymes. PI can be hard to diagnose because the symptoms can mirror the symptoms of other digestive diseases. To diagnose PI, your doctor will use a fecal elastase test check to see if your pancreas is producing enough of the enzyme elastase, a fecal fat test, to see how much fat your body is absorbing, and a direct pancreatic function test, which is the most effective at measuring pancreatic secretion.[25]

One of the main differences between prescription digestive enzymes and over the counter enzymes is that all prescription enzymes are FDA approved. Over the counter products are not FDA approved and considered to be digestive supplements rather than medical treatments. FDA approved supplements will all contain standard dosages and concentrations, while the concentrations of over the counter products can vary. The FDA found that unapproved pancreatic enzyme products can contain impurities and variable amounts of lipase, amylase, and protease enzymes, which can negatively affect patients ability to digest food due to underdosing or overdosing.[26] As the over the counter supplements aren’t FDA approved, they don’t need to be proved safe or effective before they’re marketed to the public.

While it’s hard to overdose or take too many digestive enzymes, some individuals can have allergic reactions to them, which can be life-threatening. You should stop taking a supplements if a rash, sore throat, or red eyes develop as these could be signs of an allergic reaction. Don’t use a particular enzyme if you know you’re allergic to its source, such as bromelain, from pineapple, papain, from papayas, ficin, from figs, or pancreatic enzymes from pigs, cows, or oxen.

Digestive enzymes may be less effective when taken with calcium or magnesium containing antacids. If you have diabetes and take medication that has alpha-glucosidase inhibitors, digestive enzymes may reduce the effectiveness of the medication. Additionally, if you’re taking a blood thinner, you may want to avoid an enzyme with bromelain, the enzyme from the pineapple, which may have anti-platelet activity.

Recommended Products and Methodology

All digestive enzyme supplements on the market are not created equal. The ones we recommend on this page passed our stringent methodology for choosing a digestive enzyme supplements.

Douglas Labs Lipanase

Lipanase™

Douglas Labs
Check Price
Pure Encapsulations Digestive Enzymes Ultra

Digestive Enzymes Ultra

Pure Encapsulations
Check Price

DigestWise

Naturenetics
Check Price
Source Naturals

Daily Essential Enzymes

Soure Naturals
Check Price
References:
1 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. PubMed PMID: 1812045. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/1812045
2 Rémond D, Shahar DR, Gille D, et al. “Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition.” Oncotarget. 2015;6(16):13858-13898. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546438/
3 Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. “Digestive Enzyme Supplementation in Gastrointestinal Diseases.” Current Drug Metabolism. 2016;17(2):187-193. doi:10.2174/138920021702160114150137. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923703/
4 Rémond D, Shahar DR, Gille D, et al. “Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition.” Oncotarget. 2015;6(16):13858-13898. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546438/
5 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. PubMed PMID: 1812045. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/1812045
6 Biagi E, Candela M, Turroni S, Garagnani P, Franceschi C, Brigidi P. Ageing and gut microbes: perspectives for health maintenance and longevity. Pharmacol Res. 2013;69:11–20. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/23079287
7 Felicilda-Reynaldo RF, Kenneally M. “Digestive Enzyme Replacement Therapy: Pancreatic Enzymes and Lactase.” Medsurg Nurs. 2016 May-Jun;25(3):182-5. PubMed PMID: 27522847. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/27522847
8 Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. “Digestive Enzyme Supplementation in Gastrointestinal Diseases.” Current Drug Metabolism. 2016;17(2):187-193. doi:10.2174/138920021702160114150137. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923703/
9 L. S. Stephenson and M. C. Latham, “Lactose intolerance and milk consumption: the relation of tolerance to symptoms.” The American Journal of Clinical Nutrition, vol. 27, no. 3, pp. 296–303, 1974. Accessed through: http://ajcn.nutrition.org/content/27/3/296.short
10 Ibba I, Gilli A, Boi MF, Usai P. Effects of exogenous lactase administration on hydrogen breath excretion and intestinal symptoms in patients presenting lactose malabsorption and intolerance. Biomed Res Int. 2014;2014:680196. doi:10.1155/2014/680196. 2014. PubMed PMID: 24967391; PubMed Central PMCID: PMC4055537. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/24967391
11 Di Nardo G, Oliva S, Ferrari F, et al. “Efficacy and tolerability of α-galactosidase in treating gas-related symptoms in children: a randomized, double-blind, placebo controlled trial.” BMC Gastroenterology. 2013;13:142. doi:10.1186/1471-230X-13-142. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849317/
12 Di Stefano M, Miceli E, Gotti S, Missanelli A, Mazzocchi S, Corazza GR. “The effect of oral alpha-galactosidase on intestinal gas production and gas-related symptoms.” Dig Dis Sci. 2007 Jan;52(1):78-83. Epub 2006. PubMed PMID: 17151807. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/17151807
13 Ganiats TG, Norcross WA, Halverson AL, Burford PA, Palinkas LA. “Does Beano prevent gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance.” J Fam Pract. 1994 Nov;39(5):441-5. PubMed PMID: 7964541. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/7964541
14 Lettieri JT, Dain B. “Effects of beano on the tolerability and pharmacodynamics of acarbose.” Clin Ther. 1998 May-Jun;20(3):497-504. PubMed PMID: 9663365. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/9663365
15 Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. “Digestive Enzyme Supplementation in Gastrointestinal Diseases.” Current Drug Metabolism. 2016;17(2):187-193. doi:10.2174/138920021702160114150137. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923703/
16 Yamada T, editor. Textbook of Gastroenterology. Fourth ed. Lippincott Williams & Wilkins; 2003.
17 Fieker A, Philpott J, Armand M. “Enzyme replacement therapy for pancreatic insufficiency: present and future.” Clinical and Experimental Gastroenterology. 2011;4:55-73. doi:10.2147/CEG.S17634. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132852/
18 Digestive Disease Week. “A unique enzyme could be a game-changer for gluten-sensitive patients: Study finds enzyme breaks down small amounts of gluten within the digestive system.” ScienceDaily. May 2017. Accessed through: https://www.sciencedaily.com/releases/2017/05/170508083210.htm
19 Janssen G, Christis C, Kooy-Winkelaar Y, Edens L, Smith D, van Veelen P, Koning F. “Ineffective degradation of immunogenic gluten epitopes by currently available digestive enzyme supplements.” PLoS One. 2015 Jun 1;10(6):e0128065. doi:10.1371/journal.pone.0128065. eCollection 2015. PubMed PMID: 26030273; PubMed Central PMCID: PMC4452362. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/26030273
20 Spagnuolo R, Cosco C, Mancina RM, Ruggiero G, Garieri P, Cosco V, Doldo P. “Beta-glucan, inositol and digestive enzymes improve quality of life of patients with inflammatory bowel disease and irritable bowel syndrome.” Eur Rev Med Pharmacol Sci. 2017 Jun;21(2 Suppl):102-107. PubMed PMID: 28724171. Accessed through: https://www.ncbi.nlm.nih.gov/pubmed/28724171
21 Karani S, Kataria MS, Barber AE. “A double-blind clinical trial with a digestive enzyme product.” Br J Clin Pract. 1971 Aug;25(8):375-7. PubMed PMID: 4935696.
22 “The First Quantitative Evidence Proving The Efficacy Of Supplemental Enzymes.” National Enzyme Company & TNO Nutrition and Food Research. 2004. Accessed through: http://www.enzymeessentials.com/TNO_Research_Web.pdf
23 Dai C, Zheng C-Q, Jiang M, Ma X-Y, Jiang L-J. “Probiotics and irritable bowel syndrome.” World Journal of Gastroenterology : WJG. 2013;19(36):5973-5980. doi:10.3748/wjg.v19.i36.5973. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785618/
24 Accessed through: https://jonbarron.org/article/food-raw-versus-cooked
25 Forsmark C, Adams PC. “Pancreatic function testing – valuable but underused.” Canadian Journal of Gastroenterology. 2009;23(8):529-530. Accessed through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732171/
26 “Updated Questions and Answers for Healthcare Professionals and the Public: Use an Approved Pancreatic Enzyme Product (PEP)” US Food & Drug Administration. 2012. Accessed through: https://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm204745.htm