Be wary of newer, unregulated digestive enzyme supplements

Does your digestion leave something to be desired? If you often experience discomfort after eating, you're not alone. According to the National Institutes of Health, 60 to 70 million Americans are affected by digestive diseases. Many are trying a fairly new but growing category of supplements called digestive enzymes, which may help the body break down compounds in food. These supplements typically contain a variety of digestive enzymes such as amylases, lipases and proteases. A report by Transparency Market Research estimates that the global market for digestive enzyme supplements, worth $358 million in 2016, is expected to grow to more than $1 billion by 2025.

Morning or night? With food or without? Answers to your questions about taking supplements.

Promotions for some of these supplements do more than promise they will cure digestive ailments. They also claim the supplements will help people lose weight, think more clearly and even give people the ability to eat foods they're allergic to. But before I explain why these supplements aren't all they're cracked up to be, and could even be dangerous, here's a quick lesson on how enzymes fit into the digestive process.

Digestive enzymes are proteins your body produces and uses to break down your food into energy and nutrients. They differ from probiotics, which are bacteria or yeasts that offer health benefits, and prebiotics, which are fibers and other non-digestible compounds that promote the growth of healthy gut bacteria. Specific types of enzymes break down carbohydrates, proteins or fats. Digestive enzymes are released and mix with your food throughout digestion, starting in the mouth and continuing in the stomach, pancreas, liver and small intestine.

When your body doesn't produce enough of certain digestive enzymes, undigested compounds can make their way into your large intestine and cause unpleasant symptoms - such as the gas some experience after eating beans - or rob your body of essential energy and nutrients.

In the latter instance, it's likely you have a more serious medical issue affecting the pancreas, such as pancreatitis, pancreatic cancer or cystic fibrosis. If so, taking enzymes orally is essential, because your body doesn't produce enough of them to break food down into energy and nutrients. You will likely need prescription-strength digestive enzymes that go by trade names such as Creon or Pancreaze. These medications, called pancreatic enzyme products, have been well-studied and are regulated by the Food and Drug Administration. Your physician will be able to determine the right dose for you.

If your main symptoms are gas or bloating, you likely don't need a prescriptive fix and can turn to over-the-counter remedies.

Alpha-galactosidase is a digestive enzyme that breaks down the carbohydrates in beans into simpler sugars to make them easier to digest. The most commonly known alpha-galactosidase supplement is known by the trade name Beano. It's been around since the early 1990s, long before digestive enzymes started trending.

Another common digestive enzyme you've probably heard of is lactase, which breaks down lactose, the natural sugar in milk. Without enough lactase, the lactose travels undigested into the colon, followed by lots of water to dilute it. This leads to the cramping, gas and diarrhea that are hallmarks of lactose intolerance. Lactase pills - or lactose-free milk, which has the enzyme already added to it - can prevent the symptoms of lactose intolerance.

Of course, you can choose to avoid foods that give you trouble. But taking alpha-galactosidase or lactase supplements to help with digestive issues is safe and evidence-based.

Lately, consumers have been purchasing over-the-counter digestive enzyme supplements that contain combinations of many different enzymes. These formulations haven't been regulated or scientifically evaluated for effectiveness, and people are taking them without a doctor's recommendation. There are several problems with this approach.

These supplements contain enzymes produced from plants or animals, such as the protein-digesting enzyme bromelain, which is found in pineapple. While they may carry labels promising they're natural and safe, they could come with potential side effects and medication interactions. For example, bromelain could interact with blood thinning medications.

Digestive enzyme supplements also could interact with antacids and certain diabetes medications. They may cause side effects including abdominal pain, gas and diarrhea.

"These over-the-counter supplements aren't regulated by the FDA and we don't know whether they're safe or effective," says Akash Goel, a gastroenterologist at Weill Cornell Medicine and New York-Presbyterian. "We don't have good data on dosing and there's always a chance that there are impurities."

There also isn't evidence to back up claims that these over-the-counter enzyme supplements can promote weight loss, improve digestion or help with food allergies. Promises of the latter are particularly concerning because taking the supplements could be dangerous. You should avoid foods you're allergic to or that your body cannot tolerate rather than relying on an untested supplement to undo any harm.

If digestive enzyme supplements aren't the panacea we were hoping for, what's a person with digestive issues to do? Goel says, "I typically tell my patients to avoid [digestive enzyme supplements] and take a safer approach." He prefers to address the root cause of diet-related digestive ailments by changing what patients eat, rather than prescribing supplements.

The Low FODMAP Diet is one possible solution to address irritable bowel syndrome symptoms. FODMAPs are short-chain carbohydrates that can cause digestive ailments. Just like in our lactose example (which is one type of FODMAP), when these carbohydrates aren't broken down properly, they can travel into the large intestine, where they can lead to symptoms such as bloating, pain, and diarrhea and/or constipation.

"By following the diet for two to six weeks, about 75 percent of people with IBS symptoms can get some relief," says Jane Muir, an associate professor in the gastroenterology department at Monash University in Melbourne, Australia, where the diet was developed. "If you think you have IBS, see a health-care professional and a dietitian to help guide you through the Low FODMAP Diet."

Beyond making dietary changes, I recommend probiotic supplements, which have been shown in research to help with digestive issues. Goel says that if his patients really want to take a supplement, he will suggest tried-and-true home remedies to add digestion. "Fennel tea and ginger are low-risk and not expensive, and have been used for centuries," he says.

• Brissette is a registered dietitian, nutrition writer, TV contributor and president of 80TwentyNutrition.com.