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What is the difference between FODZYME and prescription pancreatic enzymes, like Creon? Does taking FODZYME with other digestive enzymes influence their efficacy?Updated 10 months ago

Pancreatic Enzyme Replacement Therapy (PERT) is used to correct maldigestion and malabsorption in the presence of pancreatic disease. Overall, PERT therapy is designed to re-establish optimal digestive conditions in the presence of deficient enzyme production by the body.

PERT enzymes are generally animal-derived and encapsulated in microspheres that withstand the acidic environment of the stomach. These enzymes are designed to remain encapsulated as they pass through the stomach and are subsequently released and activated in the duodenum of the small intestine, where they digest fat, protein, and carbohydrate. For this reason, PERT enzymes are enteric-coated so they're not degraded until they reach the more basic (higher pH) level of the duodenum, generally above 5.5 pH. PERT dosages will depend on age, symptoms, and tolerance and will be titrated with a medical provider. Proton pump inhibitors may also be prescribed to increase the pH of the duodenum.

In contrast, over-the-counter digestive enzymes like FODZYME are designed to work under quite different conditions and in a different way. Apart from lactase, the body does not produce enzymes to digest FODMAPs. FODMAP tolerances vary widely and are based on numerous factors, ranging from differences in pain-sensing to variations in microbiome composition. For some, over-the-counter digestive enzymes can help reduce gut distress associated with increased sensitivity to FODMAPs.

Digestive enzymes targeting FODMAPs, such as FODZYME, begin to break down food as soon as they come in contact with the FODMAP-containing food and continue to act for the 30 minutes following this initial contact. These enzymes favor a more acidic environment than PERT enzymes — 4.0-5.5 pH to be exact. Under normal digestive conditions, it takes over 30 minutes for a meal or snack to reach the small and then large intestines, by which time FODZYME will have broken down any FODMAPs. Therefore, FODZYME acts to break down FODMAPs prior to the action of PERT. This means concerns that PERT may deactivate FODZYME due to its protein-targeting capabilities are highly minimal, though this is not something we have researched in depth.

Of note: other over-the-counter digestive enzymes (not FODZYME) that are encapsulated generally use cellulose encapsulation. This delays and prevents homogenization between the enzymes and food. For some digestive enzyme products this delay is intentional because their optimal pH is not acidic (so the enzymes are meant to act in the small intestine). However, for many others, including those targeting FODMAPs, this encapsulation can reduce overall efficacy by preventing optimal contact between the enzymes and the food compounds they’re targeting.

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