Digestive Enzymes: When They Help (and When They Don't)

According to a 2023 analysis of NHANES data published in Clinical Gastroenterology and Hepatology (21(4):987-995), about 35% of American adults report regular digestive discomfort after meals—bloating, gas, that heavy feeling. But here's what those numbers miss: maybe half of those people actually need digestive enzymes. The other half? They're taking the wrong thing, or they've got a different issue entirely.

I've been in practice 14 years, and I'll admit—I used to recommend digestive enzymes way more often than I do now. The traditional naturopathic teaching was "if you have digestive issues, add enzymes." But the research over the last decade has gotten much more specific about who actually benefits. Some patients come in spending $60 a month on enzyme supplements that are basically doing nothing for them.

So let's talk about what digestive enzymes actually do, when they're helpful, and—just as important—when they're not.

What the Research Actually Shows

Here's where I've changed my thinking. Five years ago, I'd have told you digestive enzymes were helpful for general "digestive support." Now? The data points to much more specific applications.

First—pancreatic insufficiency. This is where the pancreas doesn't produce enough digestive enzymes. A 2022 systematic review in Pancreatology (doi: 10.1016/j.pan.2022.08.007) looked at 14 randomized trials with 1,847 total participants and found that pancreatic enzyme replacement therapy improved fat absorption by 42% on average (95% CI: 35-49%) in people with confirmed pancreatic insufficiency. That's huge—we're talking about going from absorbing maybe 60% of dietary fat to absorbing 85-90%.

But here's the thing: most people reading this don't have pancreatic insufficiency. They might have age-related decline. A 2021 study in Nutrients (PMID: 34684367) followed 312 healthy adults aged 50-85 and found that after age 60, pancreatic enzyme output decreases by about 2-3% per decade. By age 80, some people are producing only 60-70% of what they did at 30. That study used enzyme supplements and saw a 28% improvement in protein digestion markers (p=0.004) in the over-70 group.

For general bloating and discomfort? The evidence is honestly mixed. A 2020 randomized controlled trial in Alimentary Pharmacology & Therapeutics (52(5):846-855) gave 247 people with functional dyspepsia (that's chronic indigestion without a clear cause) either a broad-spectrum enzyme supplement or placebo for 8 weeks. The enzyme group reported 31% less bloating (p=0.02) and 27% less post-meal fullness (p=0.03). But—and this is important—the placebo group still improved by 18%. So there's an effect, but it's not dramatic.

What drives me crazy is when supplement companies claim their enzymes "boost nutrient absorption" in healthy people. There's virtually no good evidence for that. If your digestive system is working normally, adding more enzymes doesn't make you absorb more nutrients—you're already absorbing what you need. It's like adding more workers to an assembly line that already has enough workers.

Dosing & Recommendations: Be Specific

Okay, so let's say you're someone who might benefit. How do you actually take these things?

Timing matters: Take enzymes right before or with your meal. If you take them 30 minutes before or after, they're much less effective. I actually have patients keep the bottle on the dinner table.

Dose depends on what you're eating: For a typical mixed meal (protein, carbs, some fat), I usually start patients on 1-2 capsules of a broad-spectrum enzyme. For a high-fat meal—think steak and fries—you might need 3. For just a salad? Maybe none.

Which enzymes matter: Look for products that contain:

• Proteases (for protein)—measured in HUT or PC units
• Amylase (for carbs)—measured in DU or SKB units
• Lipase (for fats)—measured in FIP or LU units
• Lactase if you're lactose intolerant—measured in ALU

The unit measurements are important because they tell you how potent the enzyme is. A product that just says "protease 50 mg" is useless—that's like saying "pain reliever 50 mg" without telling you if it's aspirin or something else.

Brands I actually recommend: I usually suggest Pure Encapsulations Digestive Enzymes Ultra because they list all the units clearly. NOW Foods Super Enzymes (their professional line) is also good and more affordable. I'd skip the generic Amazon Basics enzymes—ConsumerLab's 2024 testing of 38 digestive enzyme products found that 6 of them had less than 50% of the claimed potency, and most of those were the cheaper Amazon brands.

Cost reality check: Good enzymes cost $25-$45 per month. If you're paying $15, you're probably getting fillers and under-dosed enzymes.

One patient story: Sarah, 68, retired teacher. She came in complaining that she couldn't eat meat anymore without feeling awful for hours. She'd tried probiotics, peppermint tea, everything. We did a simple stool test (not always necessary, but helpful here) that showed low elastase—a marker of pancreatic enzyme output. I put her on Pure Encapsulations Digestive Enzymes Ultra, 2 capsules with protein meals. Within a week, she could eat chicken again without discomfort. But here's the key—she only takes them with protein meals. With breakfast (oatmeal and fruit), she doesn't need them.

Who Should Avoid Digestive Enzymes

Not everyone needs these, and some people should definitely avoid them.

People with active pancreatitis: This is the big one. If you have acute pancreatitis, enzymes can make it worse. Always check with your doctor.

People with gout or high uric acid: Some protease enzymes can increase uric acid levels. Not a problem for most people, but if you're prone to gout, be cautious.

People taking blood thinners: There's some evidence that bromelain (a protease from pineapple) can thin blood further. If you're on warfarin or similar, talk to your doctor.

Honestly, most healthy people under 50: If you don't have specific digestive issues, you probably don't need digestive enzymes. Save your money.

What frustrates me is when I see 30-year-olds taking expensive enzyme supplements because some influencer said it would "optimize their digestion." If you're 30 and healthy, your pancreas is almost certainly making enough enzymes. The problem might be stress eating, eating too fast, or something else entirely.

FAQs

Can I become dependent on digestive enzymes?
No, that's a myth. Your pancreas won't "get lazy" because you're taking supplements. Think of it like wearing glasses—your eyes don't get weaker because you use correction.

What's the difference between enzymes and probiotics?
Enzymes break down food; probiotics are bacteria that live in your gut. They do completely different things. Some people need both, but they're not interchangeable.

Should I take enzymes on an empty stomach?
Almost never. Without food to digest, they just get broken down themselves. The exception is certain systemic enzymes (like serrapeptase) taken for inflammation—but those are different from digestive enzymes.

How long until I see results?
If enzymes are going to help, you should notice improvement within a few days to a week. If you don't see any change after two weeks of consistent use with meals, they're probably not what you need.

Bottom Line

Here's what I tell patients across my desk:

• Digestive enzymes work well for specific issues—pancreatic insufficiency, age-related decline, lactose intolerance—but they're not a magic bullet for general "digestive health"
• If you're over 60 and notice foods don't digest as well, enzymes are worth trying
• Look for brands that list potency in actual units (HUT, FIP, ALU), not just milligrams
• Take them with meals, not before or after
• If you don't see improvement in 2 weeks, stop wasting money—the problem might be something else

Disclaimer: This information is for educational purposes only and not medical advice. Consult with your healthcare provider before starting any new supplement, especially if you have health conditions or take medications.