Digestion and assimilation of nutrients is a complex process that occurs over several hours, starting from the moment that you place food into your mouth. The pancreas is not actually an organ, but a long, triangular-shaped gland located deep inside the abdomen, between the spine and the stomach. Part of the pancreas comes up against the curve of the duodenum, the first part of the small intestine. The duodenum is the site where many digestive juices enter the GI tract and help break down the foods you eat. The pancreas is essential in both digestion and absorption of nutrients, since it secretes pancreatic enzymes that facilitate the breakdown of foods into smaller molecules — allowing the body to actually use fats, vitamins, minerals, amino acids and so on. (1)
The pancreas also helps control blood sugar levels by secreting hormones such as insulin and glucagon. What enzymes are produced in the pancreas? The major ones include amylase, lipase and protease.
What are some reasons you may be experiencing pancreatic enzyme insufficiency? Common causes include pancreatitis, cystic fibrosis, autoimmune disorders, alcoholism or surgery that affects the GI tract. If you’re not making enough of these pancreatic enzymes, below you’ll learn about why you can benefit from either taking enzyme supplements or potentially prescription-strength enzymes.
What Are Pancreatic Enzymes?
The pancreas secretes a digestive “juice” that is composed of two products: digestive enzymes and bicarbonate. Bicarbonate helps neutralize stomach acid and makes pancreatic secretions more alkaline.
All enzymes are catalysts that enable molecules to be changed from one form into another. Digestive enzymes are substances that are secreted by the body to help turn larger molecules (the macronutrients we call proteins, carbohydrates and fats) into smaller ones. In addition to digestive enzymes, bile and hydrochloric acid also help with digestion.
There are more than 2,700 different types of enzymes in the human body, and each has its own unique role. We make most digestive enzymes in the pancreas, although they are also made in other parts of the digestive system too. We have different enzymes for breaking down different types of molecules founds in foods, including proteins, fats, carbs, fibers and acids. According to the Pancreatic Cancer Action Network, “a normally functioning pancreas secretes about 8 cups of pancreatic juice into the duodenum, daily.” (2)
What are the three pancreatic enzymes? The major categories of enzymes produced by the pancreas include amylase (breaks down starch/carbs), protease (breaks down protein peptide bonds) and lipase (breaks down fats). (3)
There are also other digestive enzymes that have unique roles, including ribonuclease, deoxyribonuclease, gelatinase, phytase, pectinase, lactase, maltose and sucrase. These help break down things like gelatin, the sugar found in milk, phytic acid, and other sugars like sucrose and maltose.
Benefits and Functions
1. Digestion of Starch/Carbohydrates
Amylase (or alpha-amylase) is an enzyme secreted by the salivary glands and the pancreas that helps with digestion of carbohydrates. Amylase hydrolyses starch into smaller molecules called maltose (a glucose-glucose disaccharide) and trisaccharide maltotriose. Some pancreatic amylase is present in saliva, helping to begin the digestive process when you start chewing your food, but the majority is produced in the pancreas. A lack of amylase can cause digestive issues such as bloating, loose stools and diarrhea. (4)
2. Breaking Down Proteins Into Smaller Peptides
Proteases are a category of enzymes that help with digestion of proteins. There are several different kinds, including trypsin, chymotrypsin and carboxypeptidase. They work by breaking down proteins (peptide bonds) into smaller and smaller peptides. Peptidases, which are located on the surface of small intestinal epithelial cells, are then able to break down peptides into single amino acids (the “building blocks of proteins”). (5)
Pancreatic proteases are secreted into the lumen of the small intestine, where they must be converted to their active form before taking over digestion of protein. Protein digestion begins in the stomach, where the enzyme called pepsin helps start the process.
3. Digestion of Fats and Absorption of Fat-Soluble Vitamins
Lipase is produced by the pancreas, and this enzyme helps break down fat. It turns triglycerides into 2-monoglycerides and two free fatty acids so it can be absorbed through the lining of the intestines. Pancreatic lipase is secreted into the lumen of the gut. In order for lipase to do its job properly, bile salts must also be present to aid in fat absorption. A lack of lipase interferes with fat digestion and absorption of essential fat-soluble vitamins (vitamins A, E, D and K). It can also cause GI issues, including diarrhea and/or fatty stools. (6)
4. Protection Against Microbes and Support for the Immune System
In addition to breaking down protein, proteases support the immune system by fighting parasites such as bacteria, yeast and protozoa in the intestines. A lack of protease and other pancreatic enzymes can contribute to allergies and intestinal infections. These enzymes can modulate inflammatory processes in a number of ways, for example by reducing swelling of mucous membranes, improving circulation, transporting harmful waste products away from traumatized tissues, decreasing capillary permeability and dissolving blood clot-forming deposits. (7)
Sources and Dosages
The pancreas makes enzymes to digest the foods we eat, but enzymes can also be obtained using enzyme supplements. Pancreatic enzymes are manmade mixtures of the enzymes naturally produced by the pancreas: amylase, lipase and protease.
In supplement form, these mixtures are sometimes called pancrelipase and pancreatin. They are taken to help you break down fats, proteins and carbohydrates when you’re not making enough enzymes on your own. They can also be used to help reduce symptoms like diarrhea, boating, inadequate nutrition and weight loss.
Pancreatic enzyme supplements are derived from both plant and animal sources, including papaya, pineapple and livestock. One example of pancreatic enzymes are proteolytic enzymes, which digests protein by breaking it down into amino acids. Proteolytic enzymes are usually derived from papaya.
Both prescription and non-prescription pancreatic enzymes are available. Prescription pancreatic enzyme products are regulated by the United States Food and Drug Administration (FDA), while non-prescription enzymes are not considering they are treated like supplements.
What is the recommended dosage for pancreatic enzymes?
- The dosage of enzymes that’s appropriate for each person depends on factors like medical history and body weight. You should start with the smallest dose necessary and adjust according to your reaction and the severity of your pancreatic insufficiency.
- Pancreatic enzymes are usually dosed according to the units of lipase that the product contains. Always read directions carefully, since different doses are recommended depending on the brand. (8)
- It’s recommended that adults begin taking pancreatic enzymes in doses of 10,000–20,000 lipase units with smaller meals/snacks, or between 20,000–40,000 lipase units with bigger/main meals.
- Due to the potential for negative reactions, you should not exceed 2,500 lipase units per kilogram of your body weight per meal. This means that if you are a man or woman who weighs 150 pounds (68 kilograms), you should not take more than 170,000 units of lipase per meal. (9)
- Take your enzymes prior to eating. Enzyme capsules can be taken by mouth or opened so you can mix the contents with something like applesauce (you don’t want to directly mix enzymes with any alkaline food since this can cause them to be inactivated).
- Be sure to keep enzyme products in a cool, dry place. Avoid having them get moist, since this can change how they work. Check for expiration dates to make sure the product is still good.
A benefit of using pancreatic enzyme replacement therapy (PERT) compared to pancreatic enzyme supplements is that PERT manufacturing is regulated by the FDA, ensuring that the products contain a certain level of enzymes. If you’re taking prescription pancreatic enzymes (more on these below), then your dose will be determined by your doctor. Since dosage needs can change as your body adjusts, continue to discuss any concerns or reactions you’re having with your doctor.
Pancreatic Enzymes vs. Digestive Enzymes
- Pancreatic enzymes, sometimes along with other digestive enzymes, are used to treat GI issues in people who have conditions that cause poor absorption of nutrients.
- Digestive enzymes are now being taken by an increasing number of people to help treat health conditions like acid reflux, gas, bloating, leaky gut, irritable bowel syndrome, Crohn’s disease, ulcerative colitis, diverticulitis, malabsorption, diarrhea or constipation.
- Digestive enzymes can help break down difficult-to-digest proteins, starches and fats. This can reduce some of the work that the stomach, pancreas, liver, gallbladder and small intestine have to do.
- Who are digestive enzymes appropriate for? They can help people with age-related enzyme insufficiency, low stomach acid, liver disease or inflammatory bowel disease.
- Digestive enzyme products are derived from several sources, with the most common being fruits (usually pineapple or papaya), animals (usually pigs, ox or hogs), and plants like probiotics, yeast and fungi.
- Full-spectrum enzyme blends can be used for general digestive improvement. Most products contain some level of pancreatin, which is a combination of all three pancreatic enzymes. The best type of digestive enzyme for you ultimately depends on the symptoms/condition you’re trying to treat.
Who Needs Them?
People can struggle with digestive problems for all sorts of reason — for example, due to inflammation, malfunctioning of one or more digestive organs, allergies, stress, aging and so on. One reason that digestive issues can emerge is due to having the wrong level of enzymes (either too much or too little). For example, someone with pancreatitis might produce too little enzymes, making it difficult to break down foods properly.
Pancreatic insufficiency (also called exocrine pancreatic insufficiency, or EPI) is a condition characterized by difficulty digesting foods due to a lack of digestive enzymes produced in the pancreas. EPI affects roughly eight per 100,000 men and two per 100,000 women. Another way to describe this condition is pancreatic enzyme deficiency. This can result in malnutrition because you aren’t able to absorb fats and certain vitamins and minerals properly. (10) EPI will make it hard to digest all three macronutrients (carbs, proteins and fats), but it affects fat digestion most.
Reasons that someone may have insufficient production of pancreatic enzymes can include:
- Chronic pancreatitis (when your pancreas get’s inflamed). Chronic pancreatitis is the most common cause of EPI in adults. This can sometimes occur due to a blockage or narrowing of the pancreatic or biliary duct. Chronic pancreatitis is most common in people between the ages of 30 and 40 and is more common in men than women. If you have pancreatitis, you may be told that your pancreas levels are high.
- Other chronic diseases, including cystic fibrosis and autoimmune diseases.
- Being elderly, since low stomach acid or enzyme insufficiency are more common in older adults.
- Pancreatic cancer.
- Pancreatic or duodenal tumors.
- High levels of inflammation.
- High levels of triglycerides (a type of fat in the blood).
- Parasitic infections.
- Being a heavy drinker/alcoholic.
- Having surgery to remove the pancreas or one of the other digestive organs.
When enzymes are not being produced properly, they must be obtained from an outside source. Enzymes can be taken as pills or capsules to facilitate absorption of nutrients, especially if someone has chronic pancreatitis. Supplementing with enzymes is also capable of reducing pain associated with this disease.
How would you know if you had pancreatitis? For example, what does the pain of pancreatitis feel like? Symptoms that your pancreas is damaged, inflamed and/or malfunctioning can include:
- Pain or tenderness in your abdomen
- Bad-smelling bowel movements
- Indigestion, cramping and stomach pains
- Diarrhea, loose stools or frequent stools
- Gas and stomach bloating
- Feeling full easily
- Loss of appetite and weight loss
- Changes in poop color, including yellow or orange stool
Supplements vs. Replacement Therapy
Pancreatic enzyme replacement therapy (PERT) is the most common way to treat pancreatic insufficiency. It’s also recommended for use in patients with pancreatic cancer, since prescription enzymes are closely regulated and usually more potent.
Compared to taking over-the-counter pancreatic enzymes, PERT involves taking prescription pills that supply the enzymes your pancreas is not making enough of, helping to aid to in digestion. Pancreatic enzyme replacement therapy is taken with every meal and snack to aid in absorption of nutrients. The prescription enzymes are usually sourced from pigs, making them very similar to those produced by humans. Prescription pancreatic enzymes are enteric coated, which means they have a special coating that prevents the stomach from breaking them down, allowing them to reach the part of the GI tract they are intended to.
In addition to PERT, some people also take painkilling medications or over-the-counter drugs to reduce pain and/or antacids to help stop stomach acid from destroying enzymes.
All enzyme supplements contain pancreatin, which is a mixture of the pancreatic enzymes called lipase, amylase and protease. (11) Currently there are several PERT prescriptions available that have been approved by the FDA. These include: (12)
PERT products may be taken in higher doses than enzyme supplements. A common starting dose is between 50,000 to 75,000 units of lipase with a meal and 25,000 units with a snack. Usually each PERT capsule contains about 25,000 units, so several may need to be taken at once. This dose may seem high, but it’s estimated that a normally functioning pancreas releases about 720,000 lipase units with every meal.
PERT capsules should be swallowed whole and taken with a cold drink (ideally cold water), since heat can potentially damage the enzymes. You shouldn’t take your enzymes with coffee, tea or fizzy drinks. Take the capsules before you start eating rather than in the middle of a meal. Don’t take the capsules on an empty stomach or if you’re only having one to two bites of food.
Foods to Eat and Avoid to Support the Pancreas
In addition to taking pancreatic or digestive enzymes if needed, you should also eat a healthy diet to support your pancreas and other digestive organs.
What foods benefit your pancreas?
- High-antioxidant foods, including raw veggies and fruits. This includes leafy green veggies; all berries; orange and yellow veggies like carrots, peppers, squash and sweet potatoes; tomatoes; artichoke; asparagus; broccoli; cauliflower; etc.
- Pineapple, papaya and kiwi, which are excellent sources of digestive enzymes.
- Ginger and other fresh herbs and spices.
- Fermented/probiotic foods like sauerkraut, yogurt, kefir, natto, miso and miso soup.
- Healthy fats like coconut or olive oil, grass-fed butter, ghee, and avocado. Healthy fats are energy-dense, so they can be useful for adding calories to your diet and preventing weight loss. (13) Try spacing out your fat intake throughout the day, which will be easier for your digestive system to handle.
- MCT oil. If someone has a very hard time digesting fats, MCT oil can be beneficial because it doesn’t require the same amount of digestion as other oils. MCT is easily absorbed and a good calorie/fat source for providing energy and preventing weight loss.
- Raw juices made with fresh veggies and fruits.
- Nuts and seeds, ideally soaked to help with nutrient absorption.
- Uncooked or slightly cooked grain products, such as wheat germ.
- Clean proteins, including grass-fed meat, pastured poultry, wild-caught fish and free-range eggs.
In addition to eating a nutrient-dense diet, you should also try to space out your meals each day to help aid digestion. Aim to eat five or six small meals per day instead of only several big meals. Your doctor might also recommend taking a multivitamin to help prevent deficiencies in key vitamins, including fat-soluble vitamins like vitamin A, D, E and K.
What foods are bad for your pancreas?
- Fried foods and very fatty or oil foods
- Foods that are overly cooked and preserved, including roasted, broiled or canned foods, which lose some of their nutrients due to high-heat exposure
- Processed foods that contain synthetic additives
Rather than relying on taking pancreatic or digestive enzymes, traditional medicine systems emphasized treating poor digestion holistically. This involves removing any known causes that hindering enzyme production, improving your diet, removing inflammatory foods, managing stress and using herbs that may be helpful.
Before enzymes were available in supplement/capsule form, traditional medicine systems encouraged consumption of foods that naturally contain enzymes. For example, papain is a protease enzyme derived from papaya that can help stimulate the digestion of fats and proteins. In Ayurvedic medicine, papain is said to reduce bloating, act as a diuretic and help decrease inflammation.
Other suggestions to improve enzyme production and general digestive health according to Ayurveda include: (14)
- Eating seasonal, local foods.
- Relaxing while eating.
- Chewing food thoroughly.
- Eating food at room temperature or slightly above (not very cold or leftover foods), including warm foods like soups, well-cooked veggies and stews are encouraged.
- Using warming spices, such as ginger, rosemary, sage, oregano, turmeric, cumin, coriander, fennel, cardamom, fenugreek, cinnamon and clove.
- Allowing three hours between meals to take stress off the digestive system.
- Drinking water a half hour before meals but not with meals.
- Eating at least two hours before bed.
- Waiting at least two hours after eating to exercise. Yoga, exercise and stretching are beneficial for increasing hunger and “digestive fire.”
In Traditional Chinese Medicine (TCM), plant-based enzymes are also used to improve digestive “energy” and rebalance the body’s yin and yang qualities. Enzymes have mostly yang qualities because they are a “driving force” behind just about every biochemical process in the body. Enzymes derived from plants can be used with herbs to support many aspects of digestion, including improving appetite, the breakdown of large molecules, absorption of nutrients and reducing stress on the organs. Fresh/raw enzymes are emphasized most because heat is said to destroy plants’ delicate enzymes. (15)
The goal of using enzymes in TCM is to support the stomach/spleen and to improve “Qi,” or vital energy. Acupuncture and herbs complement the use of plant-based enzymes and are important for maintenance of a healthy body. Enzymes can be obtained from eating whole foods (especially raw fruits and lightly cooked veggies) or taken in water extracts or alcohol tinctures, but these should not be made at temperatures above 118 degrees Fahrenheit. Other recommendations for supporting the pancreas and digestive system include always choosing whole, organic, unprocessed, non-GMO foods; limiting intake of liquids and cold foods; and chewing foods thoroughly. (16)
Pancreatic enzymes have been used since the 1800s medicinally in the treatment of exocrine pancreatic insufficiency and other digestive disorders. Today, the World Health Organization considers pancreatic enzymes to be safe and essential medicines for preventing malnutrition in certain patients.
In 2006, the FDA changed the way that pancreatic enzyme replacement products (PERTs) were sold in the United States. The FDA required pharmaceutical companies with pig/porcine-derived PERT products to submit new drug applications for each product before they could be available to consumers. Risk Evaluation and Mitigation Strategy (REMS) and Medication Guides were all issued make sure that porcine-derived PERT products were safe and effective.
Since this time six brand name PERT products have made it to market. These are believed to be safe for pregnant women and can be life-saving for people with serious digestive conditions that affect their ability to absorb key nutrients.
Risks and Side Effects
While pancreatic enzymes should help improve digestion, they can also potentially cause side effect like constipation, nausea, abdominal cramps or diarrhea. Talk to your doctor about your reaction to taking enzymes, including any side effects or weight changes you experience. You should work closely with your doctor to adjust the type and dosage of enzymes that you take depending on how they work for you. It’s also a good idea to meet with a nutritionist/dietician if you need help with meal planning and preventing weight loss.
Keep in mind that because PERT products are sourced from pig/porcine. People with allergies or religious objections to consuming pig products should not take these products. If this applies to you, discuss other options with your doctor.
- Pancreatic enzymes are secreted by the pancreas as part of “digestive juices” that contain enzymes and bicarbonate. Their job is help turn larger molecules from the foods we eat into smaller ones that can be absorbed and used for energy.
- The major categories of enzymes produced by the pancreas include amylase (breaks down starch/carbs), protease (breaks down protein peptide bonds) and lipase (breaks down fats).
- Benefits of pancreatic enzymes include digesting starch, protein and fats; preventing malnutrition and nutrient deficiencies; and supporting the immune system by killing dangerous pathogens.
- Pancreatic enzymes are available in over-the-counter supplements and prescription products called PERTs (pancreatic enzyme replacement therapy).
- People who can benefit from taking pancreatic enzymes include those with the following health problems: chronic pancreatitis, pancreatic cancer, pancreatic or duodenal tumors, high levels of inflammation, high levels of triglycerides, parasitic infections, alcoholism, or recent surgery to remove the pancreas.