Do Digestive Enzymes Prevent Deficiencies and Improve Gut Health?

Digestive enzymes - what are they?
The popular expression “you are what you eat” really does carry a certain amount of wisdom. But it would be more accurate to say “you are what you digest.” And this is where digestive enzymes, or enzymes, help us, the key to good digestion, a healthy gut and getting all the nutrients you need.

Oddly enough, until relatively recently, little was known about the mechanism of the digestive system. Today, the number of diseases associated with malabsorption of nutrients due to a lack of digestive enzymes is increasing.

Why are these enzymes so important? The role of digestive enzymes is primarily to act as catalysts to speed up specific, vital chemical reactions in the body.

They help break down large molecules into particles that are easier to digest. These particles are used by the body to maintain optimal performance and health.

Types

All major digestive enzymes can be divided into three classes:

1. proteolytic enzymes necessary for protein metabolism.
2. lipases, which are necessary for the digestion of fats.
3. amylase, necessary for the breakdown of carbohydrates.

There are several types of enzymes found in the human body, including:

• Amylase. It is found in saliva and pancreatic juice and converts large starch molecules into maltose. Amylase is necessary for the metabolism of carbohydrates, starch and sugars, which predominate mainly in plant foods (potatoes, fruits, vegetables, cereals, etc.).
• Pepsin. It is found in gastric juice. Pepsin helps break down proteins into smaller polypeptide units.
• Lipase. It is produced by the pancreas and secreted in the small intestine. After combining with bile, lipase converts fats and triglycerides into fatty acids. It is necessary for the proper digestion of foods such as nuts, oils, eggs, meat and dairy products.
• Trypsin and chymotrypsin. These endopeptidases continue to break down the polypeptids into even smaller particles.
• Cellulase. It helps digest high fiber foods such as broccoli, asparagus, and beans, which can cause gas.
• Exopeptidase, carboxypeptidase and aminopeptidase. They help release individual amino acids.
• Lactase. It converts lactose into glucose and galactose.
• Saharaza. Breaks down sucrose into glucose and fructose.
• Maltase. Converts the sugar maltose into smaller glucose molecules.
• Other enzymes that help digest sugar/carbohydrates include invertase, glucoamylase, and alpha-galactosidase.

Application

Malt sugar has a less pronounced taste and sugariness than beet or cane sugar. Due to this, it is added to dietary products, muesli, baby food (milk formula, fruit purees), as a sweetener. Maltose is used in baking and confectionery production in the production of sweet syrups.

In China, malt sugar is used to prepare barley molasses; it is necessary in brewing and distilling. In addition, it is added to baked goods (cookies, bread, crackers), as it loosens the dough and makes the baked goods fluffy and airy. The resulting syrup saturates the taste of juices, ice cream, porridges, and pancakes. This is a harmless natural food coloring.

How do digestive enzymes work?

Digestion is a complex process that begins with chewing food, when enzymes are released into saliva. Most of the work is done by the gastrointestinal fluids, which contain digestive enzymes that affect certain nutrients (fats, carbohydrates and proteins).

By producing specific enzymes, we help absorb various types of food. In other words, our body produces enzymes specific for carbohydrates, proteins and fats.

Digestive enzymes are not just useful, they are vital. They convert complex foods into easily digestible compounds, including amino acids, fatty acids, cholesterol, simple sugars and nucleic acids (which help build DNA).

Enzymes are synthesized and secreted in various parts of the digestive tract, including the mouth, stomach and pancreas.

Below we have described in a little more detail the 6 main stages of the digestion process, which begins with chewing, which triggers the secretion of digestive enzymes in the gastrointestinal tract:

1. Salivary amylase, produced in the mouth, is the first digestive enzyme involved in the absorption of molecules. And this process continues after the food enters the stomach.
2. The parietal cells of the stomach then begin to release acids, pepsin and other enzymes, including pancreatic amylase. The process of breaking down partially digested food into chyme (a semi-liquid mass of partially digested food) begins.
3. Gastric juice neutralizes the action of salivary amylase, promoting the work of pancreatic amylase.
4. After about an hour, the chyme moves into the duodenum, where acidity causes the release of the hormone secretin.
5. This in turn causes the pancreas to produce hormones, bicarbonate, bile and various digestive enzymes, the most important of which are lipase, trypsin, amylase and nuclease.
6. Bicarbonate changes the environment of the chyme from acidic to alkaline, which not only allows enzymes to break down food, but also kills bacteria that cannot survive in such conditions.

At this stage, most of the work is done. However, people suffering from digestive enzyme deficiencies need support in the form of nutritional supplements.

There are even digestive enzymes for sale for cats and dogs, because animals can also suffer from this disease.

Who needs enzymes? (Signs of Deficiency)

The answer to this question may involve many more people than you might suspect.

Symptoms such as bloating, gas, abdominal pain and fatigue may be due to an inability to fully digest food. In this case, these people may benefit from taking additional digestive enzymes. Other signs indicating an enzyme deficiency may include:

• Acid reflux
• Dyspepsia (pain or discomfort in the upper stomach area)
• Cravings for certain foods
• Thyroid problems
• Heartburn, indigestion, belching
• Thinning and hair loss
• Dry or dull skin
• Concentration problems or brain fog
• Fatigue in the morning
• Sleep problems
• Arthritis or joint pain
• Muscle weakness, fatigue before exercise
• Mood swings, depression and irritability
• Headaches and migraines
• Worsening PMS symptoms

People with the following conditions may feel better with supplemental digestive enzymes:

Digestive diseases

If you suffer from any gastrointestinal condition such as acid reflux, gas, bloating, leaky gut, irritable bowel syndrome (IBS), Crohn's disease, ulcerative colitis, diverticulitis, malabsorption, diarrhea or constipation, then digestive enzymes can help you.

They can “calm” the digestive organs, reduce abdominal pain and bloating, which are associated with intestinal diseases.

Age-related enzyme deficiency

As we age, the environment in the stomach becomes more alkaline, which prevents the pancreas from producing enough enzymes.

In addition to concomitant diseases, the risk of developing digestive problems associated with a lack of gastric juice or digestive enzymes increases with age. Quite often this leads to acid reflux.

Hypochlorhydria

Hypochlorhydria (insufficient stomach acid) makes it difficult to absorb minerals, vitamins and other elements from food, resulting in nutritional deficiencies.

Liver diseases and other enzyme-related diseases

Liver diseases often result in a concomitant deficiency of digestive enzymes. The most common is alpha-1 antitrypsin deficiency, a genetic disorder that affects one in 1,500 people.

Symptoms may include unintentional weight loss, recurring respiratory infections, fatigue and rapid heartbeat.

Diseases whose diagnosis may not be associated with reduced production of digestive enzymes include:

• Crohn's disease
• Iron or vitamin B12 deficiency
• Vitamin D deficiency

Symptoms of enzyme deficiency may also include:

• Changes in stool. The stool may become paler, greasy, or float.
• Complaints related to the gastrointestinal tract. Bloating, diarrhea, especially within an hour after eating, flatulence and indigestion may be signs of enzyme deficiency.

Pancreatic insufficiency

Pancreatic insufficiency is the inability of the pancreas to secrete enzymes needed for digestion. This is a common problem among people with pancreatic cancer.

Taking medications containing pancreatic enzymes (replacement therapy) may be useful for patients with pancreatic cancer, chronic pancreatitis, cystic fibrosis, and patients who have had bowel surgery to speed up healing.

Natural springs

Many raw vegetables and fruits contain enzymes that improve digestion.

Raw fruits and vegetables grown in good, nutritious soil are the best natural sources of digestive enzymes. Try to include foods such as:

• a pineapple
• papaya
• kiwi
• kefir
• yogurt
• bananas
• mango
• miso, soy sauce and tempeh (fermented soy products)
• sauerkraut
• kimchi
• avocado
• Apple vinegar
• raw honey
• bee pollen

Digestive enzyme products are primarily manufactured using the following sources:

• Fruits are mainly pineapple and papaya. Bromelain, an enzyme derived from pineapple, breaks down a wide range of proteins, has anti-inflammatory properties and can withstand a wide range of pH (acid-base). Papain, an enzyme obtained from fresh papaya, is effective in breaking down both small and large proteins.
• Animals. These drugs include pancreatin, obtained from bovine or pig sources.
• Plants. These drugs are derived from probiotics, yeast and fungi.

The use of enzyme preparations for digestive disorders in children

Digestion is a single, holistic process due to the close relationships between the activities of various parts of the digestive tract. Dysfunction of one part of the gastrointestinal tract, as a rule, leads to dysfunction of other organs. Different processes of absorption of nutrients occur in different parts of the digestive tract. In the stomach - protein breakdown, secretion of internal factor, oxidation of iron ions; in newborns - the breakdown of fats (formation of diglycerides under the action of gastric lipase). In the duodenum - entry of bile acids, emulsification of fat, breakdown of triglycerides, formation of mono- and diglycerides, breakdown of starch and disaccharides, breakdown of protein, absorption of monosaccharides, amino acids, iron, calcium, zinc, magnesium. In the jejunum - breakdown of disaccharides; absorption of monosaccharides, monoglycerides, bile acids, fat-soluble vitamins, folate, calcium, iron, magnesium, zinc, vitamin B12. In the ileum - absorption of bile salts, water, sodium, and the main amount of vitamin B12. In the large intestine - absorption of water, potassium, sodium, calcium, bile salts.

An important digestive organ in the body is the pancreas (PG), which performs an exocrine function. When food enters the gastrointestinal tract, the pancreas secretes into the small intestine not only pancreatic enzymes, but also bicarbonates, which neutralize hydrochloric acid and maintain an alkaline environment in the duodenum, necessary for the normal functioning of pancreatic enzymes. Under physiological conditions, the pancreas produces from 50 to 2500 ml of secretion per day, depending on the age of the person and the nature of the incoming food. Pancreatic juice is a colorless liquid with an alkaline reaction (pH 7.8–8.4). It contains organic substances (proteins) and inorganic components (bicarbonates, electrolytes, trace elements), as well as mucus of the excretory ducts. The enzymatic part of the secretion is formed in acinar cells, and the liquid (water-electrolyte) part - mucin and bicarbonates - by the ductal epithelium. With the help of pancreatic enzymes (lipase, amylase and proteases), which play a key role in the exocrine function of the pancreas, the breakdown of nutrients occurs. Most of them are in an inactive form - these are proenzymes that are activated in the duodenum by enterokinase. Lipase, amylase and ribonuclease are secreted in active form. This mechanism determines the activity of pancreatic juice in the intestinal cavity, which, in turn, protects pancreatic tissue from autolysis.

Digestive enzymes of the pancreas have their own targets: amylase - α-1,4-glycosidic bonds of starch, glycogen; lipase - triglycerides (formation of di-monoglycerides and fatty acids); phospholipase A - phosphatidylcholine (formation of lysophosphatidylcholine and fatty acids); carboxylesterase - cholesterol esters, esters of fat-soluble vitamins, tri-, di-, monoglycerides; trypsin - internal protein bonds (basic amino acids); chymotrypsin - internal protein bonds (aromatic amino acids, leucine, glutamine, methionine); elastase - internal bonds of proteins (neutral amino acids); carboxypeptidase A and B - external bonds of proteins, including aromatic and neutral aliphatic amino acids (A) and basic (B) amino acids from the carboxyl end.

The last four enzymes are secreted by the pancreas in an inactive form (proenzymes) and are activated in the duodenum.

Exocrine pancreatic dysfunction is observed in various hereditary and acquired diseases and may be caused by impaired formation of pancreatic enzymes or their activation in the small intestine. Due to pancreatic dysfunction, accompanied by enzyme deficiency, a disorder of food digestion (maldigestion) and absorption of nutrients (malabsorption) in the intestine develops.

Maldigestion in children is caused by a number of disorders.

• Decreased activity of pancreatic enzymes. It can be caused by chronic or acute pancreatitis, cystic fibrosis, congenital pathology of the pancreas - morphological anomalies of the pancreas (abberant pancreas, ring-shaped pancreas, stenosis of the papilla of Vater or sphincter of Oddi, cysts, bifurcated pancreas), hereditary syndromes accompanied by congenital pancreatic insufficiency (Shwachman syndrome). Diamond, pancreatic insufficiency syndrome with multiple anomalies, deafness and dwarfism (Iohanson-Bizzard), pancreatic insufficiency syndrome with vacuolation of bone marrow cells and sideroblastic anemia (Pearson); isolated enzymatic deficiency (lipase - Sheldon-Rey syndrome; amylase, trypsin, enterokinase) , as well as pancreatic trauma, pancreatic carcinoma, primary sclerosing cholangitis.
• Bile acid deficiency in the small intestine associated with functional disorders of the biliary tract, hepatitis, liver cirrhosis, biliary obstruction.
• Violation of cholecystokinin synthesis caused by damage to the duodenal bulb (chronic duodenitis, chronic gastroduodenitis).
• Inactivation of pancreatic enzymes in the small intestine as a result of intestinal dysbiosis or rapid passage of food.
• Impaired mixing of enzymes with food chyme associated with gastro- and duodenostasis.

The cause of malabsorption is a violation of the activity of the secretion of intestinal enzymes, caused by disaccharidase deficiency, a gastrointestinal form of food allergy, a violation of intracellular digestion (celiac disease, Crohn's disease, enteritis, etc.), a violation of the transport of absorbed substances (exudative enteropathy, lymphoma, tumors, tuberculosis).

It is known that the pancreas has great compensatory capabilities, and disorders of pancreatic secretion appear only in cases of severe damage to the gland. There is an opinion that severe steatorrhea and creatorrhea in adults develop in cases where the secretion of pancreatic lipase and trypsin decreases by more than 90%. However, such a threshold has not been established in children.

The causes and mechanisms of development of exocrine pancreatic insufficiency are varied. There are absolute pancreatic insufficiency, caused by a decrease in the volume of functioning pancreatic parenchyma, and relative, which can be associated with various diseases of the gastrointestinal tract.

If symptoms indicating exocrine pancreatic insufficiency are identified, it is necessary to begin replacement therapy with pancreatic enzymes as early as possible, before malabsorption begins to develop.

Clinical signs of exocrine pancreatic insufficiency are:

• stomach ache,
• loss of appetite,
• flatulence,
• unstable chair,
• steatorrhea,
• nausea,
• recurrent vomiting,
• general weakness,
• weight loss,
• decreased physical activity,
• growth retardation (in severe forms).

There are quite a large number of methods for assessing the digestive capacity of the gastrointestinal tract.

• Determination of the content of pancreatic enzymes in the blood and urine. In acute pancreatitis, the level of amylase in the blood and urine can increase 5-10 times; the level of amylase and lipase in the blood during exacerbation of chronic pancreatitis can be normal or increase for a short time by 1-2 times (from several hours to several days), determination of elastase-1 in the blood plasma, the level of its increase reflects the severity of pancreatitis. The development of hyperenzymemia depends on the period and severity of pancreatitis.
• Scatological research. It should be recognized that scatological research has not lost its relevance to this day and is the most accessible method. It should be carried out before prescribing pancreatic enzymes to the patient. However, the accuracy of this method is also influenced by the state of intestinal motility, the volume of bile secreted into the intestinal lumen, its qualitative composition, the presence of inflammatory processes in the intestine, etc.

In case of digestive disorders, the following symptoms are identified: steatorrhea - the presence of neutral fat in the stool (type 1 steatorrhea); fatty acids, soap (type 2 steatorrhea); both (steatorrhea type 3); creativeorrhea - may be a sign of a violation of the exocrine function of the pancreas. Normally, there are very few muscle fibers in feces; amilorrhea - the presence of a large number of starch grains in the stool - indicates a violation of the breakdown of carbohydrates; It is rarely detected in patients with pancreatic insufficiency, since starch hydrolysis is practically not impaired due to the high activity of intestinal amylase. The earliest sign of exocrine pancreatic insufficiency is steatorrhea; creatorrhoea appears somewhat later. Amilorrhea is rarely observed in exocrine pancreatic insufficiency.

• Study of the content of pancreatic enzymes in duodenal secretions. The method allows you to determine the type of secretion: normosecretory, hypersecretory, hyposecretory or obstructive. The identified types of secretion reflect different degrees of functional and morphological changes in the pancreas, which allows differentiated treatment measures.
• Quantitative determination of fat in feces (stool lipid profile). This method makes it possible to summarize the total amount of fat in feces, taking into account fat of exogenous (food) origin. Normally, the amount of fat excreted in feces should not exceed 10% of the fat introduced with food. In diseases of the pancreas, the amount of fat excreted in feces sometimes increases to 60%. The method can be used to clarify the nature of steatorrhea and assess the effectiveness of enzyme therapy.
• Determination of elastase-1 content in feces. Elastase-1 is a proteolytic enzyme of the pancreas. It is known that human pancreatic elastase does not change its structure as it passes through the gastrointestinal tract. This method has certain advantages over those used today in the diagnosis of exocrine pancreatic insufficiency (fecal lipidogram, coprogram, determination of chymotrypsin in feces) due to the high specificity of the method (93%), its non-invasiveness and the lack of influence of enzyme preparations on the results of the elastase test.

Enzyme preparations were first used in gastroenterological practice about 100 years ago. Digestive enzymes are currently widely used for various gastroenterological pathologies. Despite the variety of manifestations of enzymatic digestive disorders, the main direction of treatment for such patients is enzyme replacement therapy. Currently, a large number of enzyme preparations are used in clinical practice, characterized by different combinations of components, enzyme activity, production method and release form. When choosing an enzyme preparation in each specific case, the doctor must first of all pay attention to its composition and the activity of its components.

There are two directions of action of enzyme preparations:

• primary - hydrolysis of food substrates, which is the basis for prescribing enzymes as replacement therapy for exocrine pancreatic insufficiency;
• secondary - reduction of abdominal pain syndrome (with pancreatitis), dyspepsia (feeling of heaviness, flatulence, belching, stool disorders, etc.).

Indications for prescribing enzyme therapy are:

• impaired secretion of pancreatic enzymes;
• maldigestion and malabsorption syndrome;
• motility disorders of the gastrointestinal tract.

Classification of enzyme preparations

The following groups of enzyme preparations are distinguished.

• Preparations containing pancreatin (pancreatin, penzital, mezim forte, panzinorm forte - N, creon, pancitrate).
• Preparations containing pancreatin, bile components, hemicellulase and other components (festal, digestal, enzistal, panzinorm forte).
• Herbal preparations containing papain, rice fungus extract and other components (pepphys, oraza).
• Combined enzymes containing pancreatin in combination with plant enzymes, vitamins (wobenzym, phlogenzyme).

Despite the fact that there are currently many pancreatic enzyme preparations in the doctor’s arsenal, it is still not always possible to select adequate enzyme replacement therapy in patients with severe forms of pancreatic insufficiency. The instability of many enzymes in an acidic environment remains a serious problem.

Products containing pancreatin include lipase, amylase, proteases. The raw material for the preparation of these drugs is the pancreas of pigs and cattle. When choosing enzyme preparations, it is necessary to take into account the level of enzymes included in their composition (Table 1).

Preparations containing pancreatic enzymes can be used either continuously, as replacement therapy, or once, with a high food load. The dose is selected individually and depends on the severity of clinical and laboratory parameters of exocrine pancreatic function. The effectiveness of the dose is judged by clinical (disappearance of abdominal pain, normalization of stool frequency and character) and laboratory indicators (disappearance of steatorrhea and creatorrhoea in the coprogram, normalization of triglycerides in the stool lipidogram).

Enzyme-containing preparations, along with pancreatin, may contain bile acids, hemicellulase, plant choleretic components (turmeric), simethicone, etc. (Table 2). The main indication for the use of drugs in this group in children is dysfunction of the biliary tract (hypomotor dyskinesia). Bile acids and salts increase the contractile function of the gallbladder, normalize the biochemical properties of bile, and also regulate the motility of the large intestine in children with constipation. They should be used during or immediately after meals (without chewing) 3-4 times a day in courses of up to 2 months. Enzymes of this group are not used for pancreatitis, as they contain bile components that enhance intestinal motility.

Bile acids included in the preparations increase pancreatic secretion and choleresis; stimulate intestinal and gallbladder motility.

Under conditions of microbial contamination of the intestine, deconjugation of bile acids occurs, and cyclic adenosine monophosphate of enterocytes is activated with the development of osmotic and secretory diarrhea. Bile acids enter the enteropathic circulation and are metabolized in the liver, increasing the load on it. In addition, bile acids can have a direct damaging effect on the intestinal mucosa.

Hemicellulase ensures the breakdown of polysaccharides of plant origin (digestible fiber) and reduces gas formation.

Contraindications to the use of enzyme preparations containing bile components:

• acute pancreatitis;
• chronic pancreatitis;
• acute and chronic hepatitis;
• diarrhea;
• peptic ulcer of the stomach and duodenum;
• inflammatory bowel diseases.

Enzyme preparations of plant origin containing papain, rice fungus extract and other components can be used to correct exocrine pancreatic insufficiency. They are made from plant materials.

The group of enzyme preparations of plant origin includes:

• Nigedase - plant lipase (Nigella damascene) - 20 mg; the drug, due to the absence of proteo- and amylolytic enzymes in its composition, is prescribed in combination with pancreatin;
• orase - a complex of amylolytic and proteolytic enzymes of fungal origin - Aspergillus oryzae (lipase, amylase, maltase, protease);
• pepphys - fungal diastase - 20 mg, papain - 60 mg, simethicone - 25 mg;
• solizym - lipase produced by the fungus Penicillum solution (20,000 units);
• somilase—solizim and fungal L-amylase;
• unienzyme - fungal diastase - 20 mg, papain - 30 mg, simethicone - 50 mg, activated carbon - 75 mg, nicotinamide - 25 mg;
• Wobenzym - pancreatin - 100 mg, papain - 60 mg, bromelain - 45 mg, trypsin - 24 mg, chymotrypsin - 1 mg, rutoside - 50 mg;
• merkenzyme - pancreatin - 400 mg, bromelain - 75 units, bile - 30 mg;
• phlogenzyme - bromelain - 90 mg; trypsin - 48 mg, rutoside - 100 mg.

The preparations pepphys, unienzyme, wobenzym, merkenzyme and phlogenzyme contain bromelain - a concentrated mixture of proteolytic enzymes from the extract of fresh pineapple fruits and its branches. The effectiveness of bromelains does not depend on the amount of hydrochloric acid in the stomach (pH 3-8.0).

All of the listed enzyme preparations of plant origin are contraindicated in patients with fungal and household sensitization, and with bronchial asthma (A. A. Korsunsky, 2000). Solizim and somilase should not be prescribed if you are allergic to penicillin antibiotics.

Enzymes based on plant materials can be used to correct exocrine pancreatic insufficiency, especially in cases where the patient cannot tolerate pancreatic enzymes (allergy to pork, beef).

It should be noted that data have appeared in the literature indicating the low enzymatic activity of enzymes of plant and fungal origin (75 times less effective than drugs of animal origin), and therefore they have not found widespread use in pediatric practice.

Simple enzymes (betaine, abomin) do not belong to the group of pancreatic enzymes. The following drugs with proteolytic activity are currently registered:

• abomin (combined preparation from the gastric mucosa of calves and lambs);
• acidin - pepsin (the tablet contains 1 part pepsin and 4 parts betaine hydrochloride; when it enters the stomach, betaine hydrochloride is hydrolyzed and hydrochloric acid is released);
• pepsidil (contains pepsin and peptones);
• pepsin (a proteolytic enzyme obtained from the mucous membrane of pigs and lambs).

These drugs are obtained from the gastric mucosa of pigs, calves or lambs. The presence of pepsin, cathepsin, peptidases, and amino acids in the preparations promotes the release of gastrin, which is a regulatory polypeptide, and therefore drugs of this group can be prescribed for functional disorders of the gastrointestinal tract, for gastritis with secretory insufficiency, which is relatively rare in older children. These drugs are prescribed orally with meals.

These drugs should not be prescribed for exocrine pancreatic insufficiency.

The success of therapy for exocrine pancreatic insufficiency depends on many reasons. Recent studies have not found significant differences in effectiveness when taking enzyme preparations hourly and using them with meals. However, the most convenient and physiological for the patient is to take enzyme preparations with meals.

In the case of an adequately selected dose and form of the enzyme preparation, a significant improvement in the patient’s condition occurs. The criteria for the effectiveness of treatment are the disappearance of polyfecal matter, reduction or elimination of diarrhea, increase in body weight, disappearance of steatorrhea, amilorrhea and creatorrhoea. Creatorrhoea is usually the first to disappear during enzyme therapy. This may be due to the fact that the secretion of pancreatic protease persists slightly longer than lipase.

The dose of the enzyme preparation is selected individually during the first week of treatment, depending on the severity of exocrine pancreatic insufficiency. It is advisable to calculate the dose of the enzyme preparation based on lipase, starting with small dosages (1000 IU of lipase per kg of body weight per day). If there is no effect, the dose of the drug is gradually increased under the control of scatological studies. For severe exocrine insufficiency, 4000–5000 IU of lipase per kg of body weight per day is used in 3–4 doses. The duration of therapy is determined individually. Enzyme intake is stopped if clinical and scatological signs of maldigestion and malabsorption disappear.

Reasons for lack of effect with enzyme therapy:

• insufficient dose of the drug;
• loss of enzyme activity in the drug due to violation of shelf life;
• inactivation of the enzyme in the stomach;
• destruction of enzymes during intestinal dysbiosis with high colonization of the stomach and duodenum;
• inactivation of enzyme preparations due to high “acidification” of the duodenum (to prevent this phenomenon, antacids and H2-histamine receptor blockers are prescribed);
• incorrect diagnosis (type 2 steatorrhea; giardiasis, etc.);
• violation of the drug regimen.

Despite the fact that with the help of enzyme preparations the degree of steatorrhea can be significantly reduced, its complete and permanent disappearance cannot always be achieved.

Factors that prevent the disappearance of steatorrhea:

• malabsorption syndrome;
• low micellar concentration of bile acids due to the fact that they are deposited in the pathologically acidic contents of the duodenum;
• non-simultaneous release of enzymes from the stomach with food (microtablets or microspheres with a diameter of no more than 2.0 mm are transported from the stomach faster than tablets or dragees of large diameter);
• sensitivity of lipase to the acidic contents of the stomach (up to 92% of the lipase included in “ordinary” enzymes is easily destroyed by hydrochloric acid).

Ways to overcome enzyme inactivation by gastric juice:

• increasing the dose of the drug;
• prescribing antacids (it must be remembered that antacids containing calcium or magnesium weaken the action of enzymes);
• prescription of H2-blockers of histamine receptors.

Contraindications to the use of enzyme preparations:

• acute pancreatitis (first 7-10 days);
• exacerbation of chronic pancreatitis (during the first 3-5 days);
• allergy to pork and beef products.

Currently, thanks to a large selection of pancreatic enzyme preparations, there is a real possibility of individual correction of digestive disorders in children with exocrine pancreatic insufficiency, functional disorders of the stomach, and biliary tract. Prescribing enzyme preparations requires a differentiated approach from the doctor in each specific case - it is necessary to take into account the mechanisms of development of the disease that led to disruption of the digestive processes.

N. A. Korovina , Doctor of Medical Sciences, Professor I. N. Zakharova , Doctor of Medical Sciences, Professor of RMAPO, Moscow

Nutritional supplements

Since proteins, sugars, starches, and fats require specific types of enzymes, it is best to take a product that includes all of these types.

Many experts believe that the most effective are drugs that contain a full range of enzymes that improve digestion. Look for supplements that include the following enzymes:

• alpha-galactosidase (derived from the fungus Aspergillus nigra and is thought to aid in the digestion of carbohydrates).
• amylase (produced by the salivary glands)
• cellulase
• glucoamylase
• invertase
• lactase
• lipase
• malt-diastase
• protease (or acid protease)
• beta-glucanase
• pectinase
• phytase

When selecting enzymes, we recommend following the following guidelines based on symptoms and current health:

• If you have problems with the gallbladder and are looking for a natural remedy for its treatment, then pay attention to preparations containing lipase and bile salts.
• In preparations containing betaine hydrochloride, pepsin is certainly present.
• Some medications may contain lactase, which until recently could only be purchased as a separate medication. This enzyme helps people who have problems absorbing sugar from dairy products.
• Preparations with protease help digest protein. They will be especially useful for people with autoimmune and inflammatory diseases.
• Blends with added herbs such as peppermint and ginger also support digestion.
• Some people require more pancreatic enzymes than others. For this reason, choose a drug based on your personal needs. Most foods contain some amount of pancreatin, which is a combination of three pancreatic enzymes.

Maltose molasses

Sweet light brown syrup is obtained by saccharification of starch-containing raw materials with enzymes, filtering corn, barley malt and their subsequent boiling. Maltose syrup is prepared without the use of chemical catalysts and acids. Due to the low glucose content, the syrup does not crystallize over time, has a light malt smell, and requires less added sugar. The composition of molasses is similar to beer or kvass wort.

Low-sugar maltose syrup is used to create marmalade and frozen dairy products, and high-sugar maltose syrup is used for canning and baking, being a direct sugar substitute or raw material filler.

The presence of a large amount of fermentable sugars determines the widespread use of molasses in brewing. It imparts a characteristic viscosity and softens the taste of the intoxicating drink.

Maltose malt syrup speeds up the fermentation process of beer, reducing it by three times. Due to this property, molasses is used by brewing companies to save money and increase productivity.

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Are there food enzymes for vegetarians?

Some preparations contain only enzymes of plant origin, which are quite suitable for vegetarians and vegans. They typically contain bromelain, derived from pineapple, and papain, from papaya.

Products formulated specifically for vegans typically contain pancreatin, which is derived from the fungus Aspergillus niger. The most common source of this enzyme is bovine or pig bile.

In addition, some preparations additionally contain herbs and spices. They often contain amla extract, which is not an enzyme, but is used in Ayurvedic medicine as an herbal remedy to improve overall health. It is believed to work in synergy with other compounds.

Sources

Maltose is obtained as a result of the fermentation of malt, which is used as the following cereals: wheat, maize, rye, rice or oats.
Interestingly, molasses contains malt sugar extracted from mold fungi. Table No. 1 “Foods rich in maltose”

Maltose is concentrated in small amounts in sprouted grains, honey, tomatoes, oranges, and yeast.

When should you take digestive enzymes?

For optimal results, digestive enzymes should be taken 10 minutes before meals or with your first bite. Protease supplements can be taken between meals in combination with other enzymes.

Start with twice daily and adjust dosage as needed.

Can I take probiotics and digestive enzymes at the same time?

Yes, enzymes should be taken before meals, and probiotics after or between meals.

It is beneficial to get probiotics from fermented foods. For example, yoghurt, kefir, kimchi or sour cream. Probiotics help normalize the gut microbiome, aiding digestion and reducing symptoms such as gas and bloating.

Benefit for health

What are the benefits of digestive enzymes? Mainly because they help digest food. Enzymes should be taken for the following reasons:

• Help treat leaky gut and other conditions by relieving tension in the gastrointestinal tract.
• Maintains a healthy balance of bacteria in the intestines.
• Helps the body break down difficult-to-digest proteins and sugars, such as gluten, casein and lactose (milk sugar).
• Significantly reduces the symptoms of acid reflux and irritable bowel syndrome.
• Improves nutrient absorption, preventing the development of deficiencies.
• Naturally blocks the action of enzyme inhibitors found in foods such as nuts, wheat germ, egg whites, seeds, beans and potatoes.

If you lack digestive enzymes, you may experience constipation. In this case, taking additional enzymes may help. Digestive enzymes are not associated with weight loss and cannot be used for weight loss. However, they can help eliminate cravings for certain foods and help you feel full more quickly.

Use in Traditional Chinese Medicine and Ayurveda

Traditional medicine takes a holistic approach to treating digestive problems, which involves changes in diet and lifestyle rather than drugs. Digestive enzymes in drug form only became available 50 years ago. Previously, patients were advised to include more raw foods and foods containing probiotics in their diet.

According to the ancient medical system of Ayurveda, digestion depends on the amount of Agni, the “digestive fire.” It is believed that Agni can be increased by eliminating the causes of indigestion (for example, eating under stress or shortly before sleep), adjusting the diet and strengthening the digestive organs with the help of herbs and home remedies.

In Ayurveda, spices play an important role in supporting digestion. The following are considered especially healing:

• ginger
• turmeric
• caraway
• coriander
• fennel
• cardamom
• fenugreek
• cinnamon
• rosemary
• sage
• oregano

Beet juice removes toxins and improves performance

To increase the amount of digestive fire, you need to drink herbal tea, which promotes the functioning of enzymes. This tea can be prepared by pouring boiling water over cumin, coriander and fennel (1/3 teaspoon each). The drink must be strained before drinking. Eating papaya can also be beneficial as it contains papain, which helps relieve inflammation.

In Traditional Chinese Medicine, digestion is governed by Qi, “vital energy.” Acupuncture, herbs, movement and stress relief combined with plant-derived enzymes from foods can help improve digestion and manage ailments.

To support digestion, raw fruits and vegetables that have been slightly processed are most often recommended.

Other methods that improve the condition of the gastrointestinal tract include:

• eating local/seasonal foods
• eating organic, unprocessed, non-GMO foods
• limiting sugar intake, liquids during meals and cold foods
• chewing food thoroughly
• refusal to eat 2-3 hours before bedtime
• doing yoga, tai chi, stretching and other forms of exercise to increase appetite

Risks and side effects

Can Digestive Enzymes Be Dangerous? If you suffer from chronic diseases, we recommend that you consult a doctor who can select the most suitable enzymes for you.

Depending on your health condition, a specialist will be able to prescribe the safest medications. If you have suffered or are suffering from liver or gallbladder diseases, or ulcers, be sure to consult your doctor before taking supplements.

Despite all the benefits, digestive enzymes can cause side effects, including:

• nausea
• diarrhea
• cramps in the abdomen
• gases
• headache
• edema
• dizziness
• changes in blood sugar levels
• allergic reaction
• change in stool

If you notice these symptoms, stop taking enzymes and consult your doctor.

Most often, undesirable consequences occur when the dosage is too high or the drug is taken incorrectly. For this reason, it is important to read the instructions before use.

Benefits and harms

Maltose, contained in pureed sprouted wheat paste, is a storehouse of vitamins, minerals, fiber and amino acids.

It is a universal source of energy for body cells. Remember, long-term storage of malt sugar leads to loss of beneficial properties.

Maltose should not be taken by people with intolerance to the product, as it can cause serious harm to a person's health.

In addition, uncontrolled use of sugary substances leads to:

• increased blood glucose levels and impaired carbohydrate metabolism;
• obesity;
• development of heart diseases;
• increased cholesterol;
• the appearance of early atherosclerosis;
• a decrease in the function of the insular apparatus, the formation of a prediabetic state;
• destruction of tooth enamel;
• arterial hypertension;
• decreased immunity;
• increased fatigue;
• headaches.

To maintain good health and body health, it is recommended to consume malt sugar in moderation, not exceeding the daily allowance. Otherwise, the beneficial properties of the product are neutralized and cause harm, and the product itself rightfully begins to justify its unspoken name “sweet death”.