Research suggests that at least 50% of Australian adults experience unpleasant digestive symptoms such as bloating, gas and constipation, and 1 in 7 experience distressing symptoms which affects their day-to-day lives.¹ Digestion can be adversely impacted by a multitude of different factors including poor diet, excessive alcohol consumption, stress, prescription medications, disease, inadequate chewing, eating ‘on the run’, eating too late in the day and ageing.²

Digestive enzyme insufficiency can cause or exacerbate a number of digestive problems, including food allergies and sensitivities, intestinal fermentation, maldigestion and malabsorption, peroxidation, putrefaction and increased intestinal permeability.³ Digestive enzyme supplementation, when indicated, may provide a reliable help as an adjuvant treatment of several disorders characterised by an impairment of digestive functions.⁴

Historically, digestive enzymes have been derived from animal sources, with extracts of porcine pancreas being the mainstay therapy for pancreatic exocrine insufficiency (PEI). However, such a treatment approach rarely eliminates pancreatic steatorrhea, requires numerous capsules per meal, can cause allergic reactions, and may not be accepted by some patients who have objections to consuming animal products.⁵

More recently, clinical trials have demonstrated the efficacy of microbial-derived enzymes in improving the digestion and absorption of fats, protein and carbohydrates and for the beneficial treatment of malabsorption and steatorrhea under a wide variety of conditions.^3,6,7

A human crossover RCT of patients with severe exocrine pancreatic insufficiency (EPI) and steatorrhea, compared the effects of a nonenteric-coated pancreatic enzyme preparation (360,000 lipase units/day), an enteric-coated pancreatic enzyme preparation (100,000 lipase units/day), and a fungal enzyme preparation (75,000 lipase units/day). Despite the disparity in dosage between the microbial derived lipase and the conventional pancreatin preparations, all three enzyme preparations yielded a significant (p<0.05) reduction in the total daily faecal fat excretion. The fungal enzyme preparation produced similar benefit at three-fourths the dose of enteric-coated pancreatic enzyme and one-fifth the dose of the nonenteric-coated pancreatic enzyme preparation.⁸

Microbial derived enzymes are produced by fermentation of microorganisms. For example, Aspergillus oryzae yields amylase, protease and tilactase; Rhizopus oryzae yields lipase; and Trichoderma longibrachiatum yields cellulase. These strains have been meticulously characterised and determined to be non-pathogenic and non-toxigenic, with a well-documented history of being safe.⁹ During the end phases of production, the microorganisms are destroyed prior to removal of the enzyme material to avoid contamination, thus ensuring that the final product consists only of pure enzymes.¹⁰

Advantages of Microbial Derived Enzymes 3

• Stable across a wide pH range (from pH 2-10), and therefore active in both the acidic stomach environment and that of the alkaline intestines
• Yield a broad spectrum of different enzymes including amylase, protease, lipase, tilactase and cellulase
• Suitable for vegetarians

Digestive disorders remain a common complaint from patients to healthcare practitioners in Australia. These findings highlight the need for practitioners to consider the beneficial role of microbial-derived enzymes in supporting patients with compromised digestive function.

Practitioners should consider the following treatment approaches

• Dosing before meals with a microbial-derived enzyme formula containing amylase, protease, lipase, tilactase and cellulase in combination with digestive-supporting herbs such as dandelion root and ginger.
• Consider adjunctive therapy with:
  • Glutamine in combination with a prebiotic (i.e. inulin, Larch arabinogalactans, pectin, kiwi fruit) to prevent local gut inflammation and permeability to support structural integrity and function of the gastrointestinal tract in patients with compromised digestive function.
  • A multi-strain probiotic provide natural microbial diversity and support gastrointestinal health.
• Educate patients on diet and lifestyle habits that negatively affect digestion, such as an increased intake of highly processed foods and alcohol, cigarette smoking, eating on the run or when stressed, and not chewing their food adequately.
• Encourage patients to support digestion by incorporating bitter and fermented foods to their meals.

 

References

1. Belobrajdic, D., et al., Gut health and weight loss: An overview of the scientific evidence of the benefits of dietary fibre during weight loss. 2018, CSIRO: Australia.
2. Conlon, M.A. and A.R. Bird, The impact of diet and lifestyle on gut microbiota and human health. Nutrients, 2014. 7(1): p. 17-44.
3. Rachman, B., Unique Features and Applications of Non-Animal Derived Enzymes. Clinical Nutrition Insights, 1997. 5(10): p. 1-4.
4. Ianiro, G., et al., Digestive Enzyme Supplementation in Gastrointestinal Diseases. Current Drug Metabolism, 2016. 17(2): p. 187-193.
5. Lowe, M.E. and D.C. Whitcomb, Next Generation of Pancreatic Enzyme Replacement Therapy: Recombinant Microbial Enzymes and Finding the Perfect Lipase. Gastroenterology, 2015. 149(7): p. 1678-1681.
6. Glade, M.J., D. Kendra, and M.V. Kaminski, Jr., Improvement in protein utilization in nursing-home patients on tube feeding supplemented with an enzyme product derived from Aspergillus niger and bromelain. Nutrition, 2001. 17(4): p. 348-50.
7. Roxas, M., The Role of Enzyme Supplementation in Digestive Disorders. Alternative Medicine Review, 2008. 13(4): p. 307-314.
8. Schneider, M.U., et al., Pancreatic enzyme replacement therapy: comparative effects of conventional and enteric-coated microspheric pancreatin and acid-stable fungal enzyme preparations on steatorrhoea in chronic pancreatitis. Hepatogastroenterology, 1985. 32(2): p. 97-102.
9. Ravindran, R. and A.K. Jaiswal, Microbial Enzyme Production Using Lignocellulosic Food Industry Wastes as Feedstock: A Review. Bioengineering (Basel, Switzerland), 2016. 3(4): p. 30.
10. Australian Government, CMEC 47, Department of Health and Ageing, Editor. 2004, Complementary Medicines Evaluation Committee.