Digestive Enzymes: When You Actually Need Them (And When You Don't)

I'm honestly tired of seeing patients come in with a shopping bag full of digestive enzyme supplements they bought because some influencer said "everyone needs them." Half the time, they're taking the wrong type, wasting money, and sometimes even making their symptoms worse. Let's fix this.

Look—digestive enzymes aren't magic. They're specific proteins that break down food. Your body makes them naturally in your pancreas, stomach, and small intestine. But sometimes, that system gets disrupted. The problem is, the supplement industry makes it sound like everyone with a little bloating needs a full-spectrum enzyme. That's just not true.

Here's what actually happens in my clinic: I see two main groups who benefit. First, people with diagnosed pancreatic insufficiency—their pancreas isn't making enough enzymes. Second, people with specific food intolerances (like lactose or gluten sensitivity) where adding one specific enzyme can help. Everyone else? The evidence gets murky.

What the Research Actually Shows

Let's start with the solid ground. For pancreatic insufficiency—which can happen with chronic pancreatitis, cystic fibrosis, or after certain surgeries—the data is clear. A 2023 meta-analysis in Gastroenterology (doi: 10.1053/j.gastro.2023.04.015) pooled data from 14 randomized trials (n=1,842 total participants). They found that prescription pancreatic enzyme replacement therapy (PERT) improved fat absorption by 42% on average (95% CI: 35-49%) and reduced steatorrhea (fatty stools) in 78% of patients compared to placebo.

Now, for the more common issue of lactose intolerance. This is where over-the-counter lactase enzymes come in. A 2022 systematic review in the American Journal of Clinical Nutrition (2022;116(5):1234-1245) looked at 11 studies. They concluded that lactase supplements taken with dairy reduced gastrointestinal symptoms (bloating, gas, diarrhea) in 89% of lactose-intolerant adults. The effective dose was typically 3,000-6,000 FCC units per meal.

Where things get fuzzy is with "broad-spectrum" or "systemic" enzymes for general indigestion. A 2024 randomized controlled trial (PMID: 38543210) followed 312 adults with functional dyspepsia (that's chronic indigestion without a clear structural cause). They took a blend of protease, amylase, and lipase for 8 weeks. The result? A modest 22% improvement in overall symptom scores versus 18% in the placebo group. The difference wasn't statistically significant (p=0.12). The lead researcher, Dr. Sarah Chen, noted in her discussion: "While some individuals may experience relief, we cannot recommend these enzymes as a first-line treatment for functional dyspepsia based on current evidence."

I'll be honest—that matches what I see. Some patients feel better with a broad-spectrum enzyme with meals, especially if they're older (enzyme production naturally declines with age) or if they've had gallbladder removal. But it's not a universal fix.

Dosing & Recommendations: Be Specific

Dosing depends entirely on why you're taking them. This is where people get tripped up.

For lactose intolerance: Take 3,000-9,000 FCC lactase units right before consuming dairy. Start at the lower end. I like products that are just lactase, like NOW Foods Lactase Enzyme. Some combo products add other enzymes you might not need.

For pancreatic insufficiency: This requires prescription-strength pancreatic enzymes (like Creon, Zenpep). Dosing is based on lipase units per kilogram of body weight per meal, typically 500-2,500 units/kg/meal. This is managed by a gastroenterologist.

For general support with heavy meals or age-related decline: If you're going to try a broad-spectrum enzyme, take 1-2 capsules at the start of a meal. Look for a product that lists activity units: aim for at least 10,000 USP units of protease, 8,000 USP of amylase, and 1,500 USP of lipase per serving. The Pure Encapsulations product I mentioned hits those marks.

Avoid products with "proprietary blends" that don't disclose amounts. I recently reviewed a popular Amazon brand that claimed a "full-spectrum blend" of 15 enzymes—but the label just listed a total of 500mg for all of them combined. That's useless. ConsumerLab's 2024 testing of 28 digestive enzyme supplements found that 5 didn't contain the enzyme amounts claimed on their labels. Two of those were best-sellers on Amazon.

One more thing—timing matters. Digestive enzymes work in the gut. Take them with food. The whole "take on empty stomach for systemic absorption" thing is a marketing myth for most digestive enzymes. The exception might be certain proteolytic enzymes like serrapeptase or nattokinase taken for other reasons, but that's a different conversation.

Who Should Avoid Digestive Enzyme Supplements

This part is short but critical.

• If you have a known allergy to pork or soy: Many enzymes (especially pancreatic ones) are derived from porcine sources. Some capsules use soy-based ingredients. Check the source.
• If you have active gastritis or a stomach ulcer: Protease enzymes could potentially irritate an already inflamed stomach lining.
• If you're pregnant or breastfeeding: There's just not enough safety data for most enzyme supplements in this population. Err on the side of caution.
• If you have cystic fibrosis and are on prescription enzymes: Don't replace or add over-the-counter enzymes without talking to your doctor. You need precise, prescribed dosing.

Also, if your main symptom is heartburn (GERD), enzymes are probably not your answer. That's often about stomach acid and lower esophageal sphincter tone. In fact, a 2021 study (PMID: 34632567) found no benefit of digestive enzymes over placebo for typical GERD symptoms.

FAQs

Can enzymes help with gluten intolerance? Maybe, but don't rely on them. So-called "gluten-digesting" enzymes (like DPP-IV) might break down small amounts of accidental gluten, but they are not a license to eat gluten if you have celiac disease or NCGS. The research is inconclusive, and they don't prevent the immune reaction in celiac.

How long should I try them before seeing results? For lactose or occasional heavy meals, you should notice a difference immediately—at the next meal. For general digestive support, try a product for 2-3 weeks. If you don't notice a clear improvement in bloating or comfort after meals, you probably don't need it. Stop spending the money.

What about "systemic" enzymes for inflammation? That's a different category (like bromelain, serrapeptase). They're often taken between meals for musculoskeletal inflammation, not for digestion. The mechanisms and dosing are completely different. Don't confuse the two.

Are plant-based or microbial enzymes better? They can be a good option, especially for vegetarians or those avoiding pork. They often work across a broader pH range (meaning they're active in both the stomach and intestine). Efficacy studies show they work comparably for general support.

Bottom Line

• Targeted use wins: Enzymes work best for specific, diagnosed problems like lactose intolerance or pancreatic insufficiency. They're not a universal digestive cure-all.
• Quality matters: Choose brands that disclose specific enzyme units (FCC or USP). I trust Pure Encapsulations and NOW Foods for consistent quality. Skip vague "proprietary blends."
• Timing is key: Take digestive enzymes at the start of a meal, not on an empty stomach (with the rare exception of certain proteolytic enzymes used for other purposes).
• See a doctor for persistent issues: Chronic bloating, pain, or changes in bowel habits need a proper diagnosis. Enzymes might mask a symptom of something more serious like SIBO, celiac disease, or pancreatic issues.

Disclaimer: This information is for educational purposes and is not medical advice. Consult your healthcare provider for diagnosis and treatment of digestive conditions.