KEY POINTS:

  • Many people with celiac disease are lactose intolerant. 1 Without supplemental lactase enzymes, eating dairy foods that contain a lot of lactose, like milk and yogurt, may cause gas, abdominal bloating and diarrhea. Taking a lactase enzyme supplement can allow some people to tolerate lactose.
  • Pancreatic insufficiency is a digestive enzyme deficiency that can be associated with celiac disease.2 Pancreatic insufficiency can be diagnosed through stool testing. Without supplemental enzymes, fats are not absorbed, which can lead to on-going digestive symptoms (usually diarrhea or steatorrhea ) and malabsorption, despite being strictly gluten-free. Stool may float, be foul-smelling, frothy, greasy, and unformed.
  • There are no universally accepted units of measurement of the activity for enzymes supplements; therefore, it can be very difficult to compare one product to another or to know how strong a particular formula is.
  • Digestive enzyme are generally safe, but can be combined with ingredients like hydrochloric acid which can irritate the stomach.

The protease enzyme, DPP IV, is available over the counter as a gluten digesting enzyme supplement under several different brands. Be warned, there is no evidence that it is strong enough to digest gluten in the body; therefore, it does not make eating gluten safe for those with celiac disease.

  • Some digestive enzymes, specifically pancreatic enzymes, are taken between meals to try to get them in to the blood stream with the goal of decreasing systemic inflammation. They are primarily marketed as popular pain and arthritis formulas and their product name often includes “zyme”. If you take these pills with a meal, they will not have any anti-inflammatory effect, and will act only as a digestive enzyme.

TAKE HOME MESSAGES:

  • Some conditions, like lactose intolerance and pancreatic insufficiency, are treated with specific diets and supplemental enzymes.
  • It is difficult to compare or know how strong a formula is because there are no generally accepted units of measurement for enzyme potency.
  • Talk to your doctor or dietitian about the possible benefits/risks of digestive enzymes for you.

References:

  1. Jankowiak C, Ludwig D. Frequent causes of diarrhea: celiac disease and lactose intolerance. Med Klin (Munich). 2008 Jun 15;103(6):413-22.
  2. Sadr-Azodi O, Sanders DS, Murray JA, Ludvigsson JF. Patients with celiac disease have an increased risk for pancreatitis. Clin Gastroenterol Hepatol. 2012 Oct;10(10):1136-1142.e3.

Revision Date: 5-2-13 
Authors: Christine Doherty, N.D. 
Editors: Melinda Dennis, MS, RD, LDN and Daniel Leffler MD, MS

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