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Research Brief: Use and Benefits of Digestive Enzymes for FODMAP IntolerancesUpdated 9 days ago

Introduction

For 50-80% of those with Irritable Bowel Syndrome (IBS), a low fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) diet helps manage abdominal pain, bloating, and other digestive symptoms [1]. However, the low FODMAP diet is highly complex and access to dietary resources and dietitians trained in the low FODMAP diet approach can be limited. 

Excessive dietary restriction on the low FODMAP diet is common and long-term adherence poses risks for nutritional deficiencies, disordered eating, gut microbiome changes, and social and psychological consequences [2].


What are digestive enzymes?

Strategies to avoid excessive dietary restriction and its consequences include use of targeted digestive enzymes designed to break down FODMAPs. 

Broadly, enzymes are highly specialized proteins (chains of amino acids) folded in particular ways. FODMAP-targeting digestive enzymes are a specific category of enzyme designed to act on troublesome FODMAPs in foods to break them down before they can trigger symptoms.

Use of digestive enzymes is a highly effective method for those with FODMAP intolerances to ensure nutritional adequacy, dietary flexibility, symptom relief and quality of life. 


Research Overview

There is a mature body of research supporting the efficacy of dietary enzyme supplementation for FODMAP intolerance. 

Efficacy of Digestive Enzymes

Research shows that patients with carbohydrate maldigestion and malabsorption, including FODMAP sensitivities, experience symptomatic benefit from consuming otherwise triggering foods with digestive enzymes.

For several decades, lactase supplementation has been used to support digestion of lactose-containing foods. Lactose is a disaccharide carbohydrate and falls under the “D” category of in the FODMAP family. Research suggests that those with lactose intolerance can benefit from use of supplementary lactase enzymes with lactose-rich foods to manage symptoms associated with lactose maldigestion [3]. Studies conducted among both adults and children show the efficacy of exogenous lactase, also called β-D-galactosidase, in reduction of bloating, abdominal pain and gas [4-9].

The majority of findings suggest that use of alpha-galactosidase supports management of symptoms of irritable bowel syndrome (IBS) related to dietary galacto-oligosaccharides, or galactans (part of the oligosaccharide, “O” family of FODMAPs). Specifically, in those with IBS alpha-galactosidase prevents an increase in bloating and gas following ingestion of foods high in galacto-oligosaccharides/galactans, such as beans and legumes [10-12]. Supplementation with α-galactosidase also significantly reduces global distress, a measure of mental health [12].


FODZYME® is a targeted enzymatic alternative to the traditional restrictive low FODMAP approach


FODZYME’s Innovative Fructan Hydrolase

FODZYME is a blend of natural enzymes featuring fructan hydrolase, lactase and alpha-galactosidase. FODZYME’s fructan hydrolase adds to the scientific and clinical field with its novel ability to break down fructans, the most common FODMAP trigger in IBS [13, 14]. Like galacto-oligosaccharides/galactans, fructans are also part of the oligosaccharide (“O”) family of FODMAPs.

The Most Common FODMAP Triggers [14]

Peer-reviewed research demonstrates FODZYME's fructan hydrolase breaks down 90% of a 3g dose of fructan (roughly 6 garlic cloves worth of fructan) under simulated gastric conditions. This research also illustrates that FODMAP-targeting enzymes, such as FODZYME's, are resilient to stomach conditions, confirming enzymatic activity remains significant despite exposure to acidity and proteases in the stomach [15].

FODZYME's Enzymatic Digestion in Simulated Gastric Conditions

% test fructan (3g of Inulin, Jarrow® Inulin FOS) liberated as fructose at different time points in the stomach simulator


Further intestinal modeling demonstrates a significant portion of the released fructose is absorbed during simulated small intestinal transit (70%), with a corresponding decrease in microbial gas production.


FODZYME® Decreases Gas Production in Model GI Tract
▲ gas production (kPa) at different time periods

A Powder Format Increases Efficacy

FODZYME’s powder format maximizes homogenization between its digestive enzymes and FODMAP-containing food, facilitating greater contact between the enzymes and their target FODMAPs at the post-prandial gastric pH most favorable to FODMAP break down [16].

Digestive enzymes like FODZYME begin work as soon as they come into contact with the FODMAPs and are most effective when they can freely homogenize with food. Its crucial to maximize food-enzyme-homogenization, which is what FODZYME’s powder form accomplishes.

Digestive enzymes in capsules or pills are a less efficacious method for delivering carbohydrate-targeting enzymes, as they isolate enzymes from their intended target and may be deactivated in the stomach before coming in contact with FODMAPs (note: this is not the case for prescription enzymes, which are used in cases where endogenous enzyme production is insufficient. These enzymes are generally encapsulated to delay release until arrival in the small intestine).

With its specialized blend and highly-targeted mode of administration, FODZYME represents the next frontier in digestive enzyme science to support the millions with FODMAP intolerances. 

Nutritional Considerations

The low FODMAP diet is highly complex and best implemented with the support of a trained professional, such as a registered dietitian.

Nutrition Concerns with a Low FODMAP Diet

A low FODMAP diet is associated with increased risk for nutrient and energy deficiencies, with particular concern for iron, calcium and protein [17].

Furthermore, FODMAPs are present in many fiber-rich foods. A typical Western diet is already low in fiber and a low FODMAP diet may further reduce fiber intake. 

Nutritional Benefits of Enzymes

Use of digestive enzymes with FODMAP containing foods provide benefits beyond symptomatic relief by enabling a more nutrient-dense, diverse diet. 


Digestive enzymes enable a more nutrient-dense, diverse diet


Enzyme supplementation allows for increased intake of tofu, peas, legumes, nuts, soy, dairy and many other nutrient-rich plant and dairy foods to avoid nutritional deficiencies and their consequences.

With digestive enzymes, lactose foods can be enjoyed more freely, providing particular benefits to support bone health. And among vegetarians and vegans, digestive enzymes can be particularly beneficial to enable inclusion of more diverse, plant-based protein options, such as legumes and pulses [17].

Whole-food, plant-based fiber sources can also be enjoyed more liberally and with fewer digestive symptoms when using supplementary digestive enzymes.

A high-fiber diet reduces risk for many gastrointestinal diseases and intake of prebiotic fibers, such as fructans and galacto-oligosaccharides, are known to be provide particular benefits to support short-chain fatty acid production (SCFA) and digestive health [18]. 

In-vitro research on FODZYME administration with prebiotic fiber demonstrates that SCFA production is reduced but not depleted, suggesting that use of digestive enzymes with FODMAPs may be favorable to overall colonic health than avoiding FODMAPs altogether [15].

Short Chain Fatty Acids (SCFA) Production is Lower but Preserved with FODZYME
▲ total SCFA (mM) at different time periods



Restrictive diets, such as low FODMAP, must be implemented with extreme sensitivity in many groups, such as children, the elderly, those who are pregnant and other populations with additional energy and nutrient needs or challenges meeting them. Negative consequences of the low FODMAP diet are diverse and may include social isolation, increased food stress and anxiety, development of maladaptive or restrictive eating habits, nutrient deficiencies and alterations to gut microbiota [17-20]. 

Digestive enzymes support development of a tailored, nutritionally robust diet that is sustainable long-term.

Clinical Application

For those looking to expand their diet despite FODMAP sensitivities, digestive enzymes are a highly effective and safe intervention [12]. 

Guidelines published in the Journal of Neurogastroenterology and Motility on how to implement the low FODMAP diet into gastroenterological and nutrition practice recommend the use of digestive enzymes, like those in FODZYME’s formula, for symptom management and to allow for more dietary flexibility [21]. Benefits also extend well beyond symptom control and into the social and psychological realm to allow more FODMAP flexibility in uncontrolled eating environments [21].

Monash University, the leading research institution on FODMAPs and the low FODMAP diet, recommends use of digestive enzymes to enable a less restrictive diet long term while managing symptoms [22]. FODMAP targeting enzymes should be used during the third, personalization phase of the low FODMAP diet, once individual FODMAP sensitivities have been established. 

Digestive enzymes may also be used prior to or in lieu of a traditional low FODMAP diet on a case by case basis. Some may be able to identify high FODMAP foods as triggers, such as garlic, onion, wheat and beans, without needing to implement an elimination diet. In these instances, digestive enzymes can be used with known or highly suspected triggers to validate a FODMAP intolerance and learn how FODMAP-targeting digestive enzymes can provide symptomatic relief.

From the ability to enjoy a communal family meal to the confidence to enjoy a catered meal at a friend's wedding, digestive enzymes provide invaluable nutritional and psychological benefits for those to enjoy the culinary and social aspects food plays in modern culture [21].

Getting Started with Digestive Enzymes

When introducing FODMAPs with the help of digestive enzymes, start gradually and introduce one FODMAP at a time to monitor symptoms. Expect to see a benefit roughly 4-8 hours after a FODMAP-rich meal, which is when FODMAPs generally tend to reach the colon and trigger distress [23]. If symptoms improve following an otherwise triggering meal, this signals digestive enzymes can support greater FODMAP intake and a less restrictive diet. 

Digestive enzyme use will depend on personal tolerances and the frequency and quantity of FODMAPs consumed. With the exception of lactase, the body does not produce enzymes for FODMAPs. Rather, FODMAP intolerances arise from alterations in the gut microbiota (dysbiosis), increased sensitivity to digestive processeses (visceral hypersensitivity) and other miscommunications between the gut-brain-axis, though research remains ongoing [24, 25]. Digestive enzymes may be used as frequently and for as long as FODMAP intolerances persist.

Conclusion

Effective management of IBS often requires both dietary and non-dietary lifestyle strategies to manage symptoms, ensure adequate nutritional intake and enjoy the many social and cultural pleasures of food. 

Digestive enzymes allow for more dietary flexibility and greater inclusion of the many nutritious, delicious high FODMAP foods. For those with FODMAP intolerances, benefits of regular digestive enzyme use include greater nutritional intake, symptom management and reduced food fears and anxiety.

Find more information on FODZYME's research and development in the FODZYME Clinical Brief and learn about FODZYME's products on the FODZYME Store. To access more resources on FODMAPs and the low FODMAP approach visit Monash University.


References

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