If you are digestively challenged, avoiding the food you don’t digest well is the surest way to resolve symptoms. Yet this can be difficult in daily life. Supplemental digestive enzymes, which are forms of enzymes that help with digestion, can offer relief. However, we don’t recommend purchasing random digestive enzyme supplements that other people or companies claim are beneficial—it is important to identify which foods are driving your symptoms and to match a supplement accordingly. Only a limited number of enzyme supplements are backed by evidence to help with specific conditions, and they are not meant for everyone.
Work with a healthcare provider to clarify the nature of your discomfort in order to determine whether a digestive enzyme will help you and, if so, which one to take. When selecting the best digestive enzymes to recommend, our registered dietitian (who works specifically with patients with gastrointestinal conditions) considered the most common health conditions that may benefit from supplementation as well as supplement ingredients and effectiveness.
Will You Benefit from a Digestive Enzyme Supplement?
“Digestive enzyme” is an umbrella term that includes many types of enzymes, each with their unique function. If you are experiencing digestive issues, you will only benefit from a digestive enzyme supplement if it contains the enzyme or enzymes that are targeted for your specific condition.
The first step in considering whether or not you need a digestive enzyme and, if so, which type you need, is clarifying what is causing your symptoms. “It’s hard to identify intolerances like these yourself,” says Shira Hirshberg MS, RDN, LDN. “Meeting with a registered dietitian who specializes in gastrointestinal difficulties can help you identify whether enzyme products might be helpful.”
In addition to diet assessment, a variety of medical tests can be performed by a gastroenterologist to pinpoint the issue.
A digestive enzyme supplement may be beneficial for the following individuals:
Those with lactose intolerance: Lactase enzyme supplement
Lactose intolerance is when your body does not produce enough of the enzyme lactase needed to break down lactose, or the sugar naturally found in milk and milk products. Taking a lactase enzyme supplement can be helpful if you have lactose intolerance and want to eat lactose-containing foods.
Those with dietary fructose intolerance (DFI): Xylose isomerase/glucose isomerase supplement
To improve fructose digestion, those with DFI can take an enzyme called xylose isomerase (aka glucose isomerase) when eating fructose-containing fruits, vegetables, and sweetened foods.
Those with fiber-rich diets who experience bloating: Alpha-galactosidase supplement
If you regularly consume legumes (i. e. , chickpeas, beans) or cruciferous vegetables (e. g. , broccoli, cauliflower, cabbage) and notice bloating afterward, you may be sensitive to certain types of fiber known as galacto-oligosaccharides (GOSs). Alpha-galactosidase is a supplemental enzyme derived from yeast that can break down GOS when taken with a meal.
Those with irritable bowel syndrome (IBS): FODMAP enzyme cocktail and/or possible lipase supplement
If you have IBS and have a sensitivity to FODMAP-rich foods, you may want to try a “cocktail” of FODMAP enzymes such as lactase, xylose isomerase, and alpha-galactosidase when you consume a FODMAP-rich meal. A very small amount of research also suggests that lipase supplementation, the fat-digesting enzyme, may also be of help in those with IBS.
Those with active (untreated) small intestinal bacterial overgrowth (SIBO): individual digestive enzymes or FODMAP enzyme cocktail supplement
If you have active SIBO, the bacteria in your small intestine can interact with FODMAPs and cause a variety of unpleasant symptoms including gas, bloating, and diarrhea. Low-FODMAP diets are often recommended until SIBO is treated. Short-term supplementation with individual digestive enzymes or a “cocktail” mix of multiple enzymes may help with the digestion of FODMAP-rich foods, such as lactose, fructose, or GOS.
Those with histamine intolerance: diamine oxidase (DAO) supplement
The body relies on an enzyme called diamine oxidase (DAO) to break down histamine, a naturally occurring substance found in certain foods such as aged cheese, canned fish, spinach, and eggplant. However, if you have a DAO deficiency or you take in more histamine than DAO can break down, you may experience a variety of digestive symptoms including diarrhea, bloating, skin reactions, and chest tightness. In some cases, delayed reactions can occur and may be worse during allergy season. Those with MAST cell activation syndrome (MCAS) or those on medications that block DAO are more likely to have histamine intolerance. In addition to histamine-blocking medications and dietary histamine avoidance, you may use supplemental DAO to help break down histamine in the body.
Those with fat sensitivity: possible lipase supplement
If your pancreas is working normally, but high-fat foods (e. g. , greasy, oily, fried foods) consistently trigger digestive issues, it is unclear whether enzyme supplementation will improve symptoms. Limited research has shown that symptoms may improve if you supplement with lipase before a high-fat meal, though more data is needed to create standardized recommendations.
Those with functional dyspepsia (FD): Potential lipase supplement
Functional dyspepsia is a condition where you have indigestion without a clear cause. While there is no enzyme deficiency with this condition, a small amount of research has shown a benefit of taking lipase before fat-rich meals.
Those unable to restrict their diet: Appropriately selected enzyme for intolerance
While the surest way to feel your best after a meal is to avoid the foods that are known to trigger your digestive symptoms, there are a variety of reasons why diet restriction is not possible. In these cases, an appropriately selected enzyme for your intolerance can offer a key tool for dietary freedom. For some people, a limited diet while eating out, traveling, or at social functions may be impractical or stressful, while for others long-term dietary restriction is not recommended. For example, those with food intolerances that are in recovery from an eating disorder may benefit from having a digestive aid instead of cutting foods out of their diet. Those who have strong cultural ties to certain foods may also benefit from a supplement to help digest a food that is an important part of their diet and heritage.
Who May Not Benefit from [Over-the-Counter] Digestive Enzymes
If you do not have digestive symptoms, an enzyme supplement is unlikely to provide a noticeable benefit. Although many products are marketed as improving digestion, there is no evidence for general health or for those who are symptom-free.
Some medical conditions require treatment beyond over-the-counter products. Additionally, certain digestive enzyme supplements may not be safe for:
Those with a genetic condition called galactosemia (avoid alpha-galactosidase)Those who take diabetes medications, such as Precose (acarbose)Those who are pregnant or lactating
Some conditions require prescription enzyme replacement therapy. “True enzyme replacement therapy is a prescription medication that is FDA approved and tested, and contains much higher doses of the requisite enzymes,” notes gastroenterologist Yevgenia Pashinsky, MD. If you have any of the following conditions, work with a healthcare provider to determine the best treatment option:
Pancreatic insufficiency: The pancreas makes key digestive enzymes—protease, amylase, and lipase. A condition called exocrine pancreatic insufficiency causes a deficiency in these enzymes, resulting in poor nutrient digestion, particularly of fat. Pancreatic insufficiency can also arise from cystic fibrosis, diabetes, chronic pancreatitis, pancreatic cancer, and pancreatic surgery, among other conditions. If you have pancreatic insufficiency, prescription pancreatic enzyme replacement is needed. Congenital sucrase-isomaltase deficiency (CSID): A known sucrase-isomaltase enzyme deficiency calls for a prescription-only enzyme called sacrosidase in order to adequately digest sucrose-containing meals. Temporary sucrase-isomaltase deficiency can also arise from conditions affecting the small intestine, such as untreated celiac disease or active Crohn’s disease.
In addition, there is no evidence of digestive enzymes to help with the following:
Sugar alcohol intolerance: There are currently no digestive enzymes with a proven ability to aid tolerance to sugar alcohols (i. e. , ingredients ending in “ol” such as erythritol, xylitol, sorbitol, and mannitol). If you experience digestive upset with these foods, an over-the-counter enzyme is unlikely to provide relief. Food allergies: If you have mild to severe reactions to foods that are related to a food allergy, a digestive enzyme supplement is not an effective treatment or preventative strategy. For example, a lactase enzyme supplement will not help with a milk allergy. Promptly consult your healthcare provider if you have symptoms such as swelling, difficulty breathing, itching, rashes, or blood pressure changes after eating certain foods. Celiac disease: The only treatment for celiac disease—an autoimmune condition that results in intestinal damage in response to gluten—is a lifelong gluten-free diet. Despite some product marketing claims, there is no digestive enzyme or supplement that makes gluten safe for consumption for people with celiac disease. Products containing dipeptidyl peptidase IV (DPP IV) or those marketed as “glutenase” are not proven aids for gluten consumption, nor for the treatment of symptoms related to gluten exposure, in people with celiac disease. Inflammatory bowel disease (IBD): Active IBD, such as Crohn’s disease and ulcerative colitis, necessitate medical treatment and specific dietary therapies. Digestive enzymes are not indicated for IBD management. However, in some cases, temporary lactose sensitivity is associated with active IBD and may be helped by lactase enzymes if consuming lactose.
FODMATE’s blend contains lactase (for lactose aka milk sugar), xylose isomerase (for fructose sugar), and alpha-galactosidase (for galacto-oligosaccharides). The product contains two extra “bonus” enzymes, inulinase and pectinase, which are thought to help break down additional gas-promoting components of plant foods (though the data is still limited on this).
While avoiding FODMAPs is a known way to prevent symptoms of FODMAP intolerance, it requires excluding a wide variety of healthy and tasty foods and can be difficult for travel, daily life, or other circumstances in which dietary restriction is not suitable.
Each two-pill serving of FODMATE contains 10,000 ALU of lactase, 1,000 GaIU of xylose isomerase, and a 730-milligram blend of the three additional enzymes to support FODMAP digestion. Since FODMAPs include a wide variety of foods from wheat to beans to onions to watermelon, this digestive aid offers digestively sensitive folk the ability to have complex dishes without needing to take separate enzymes.
Price at time of publication: $62 ($1.03 per serving)
Pro Natura’s Fructaid enzyme supplement contains the only enzyme known to help improve fructose absorption: glucose (xylose) isomerase. If you consume excess fructose from foods such as honey, agave nectar, mangos, or asparagus (yes, fructose is in some vegetables too), this enzyme helps convert the fructose into more absorbable glucose, which can prevent digestive discomfort in sensitive people.
Although Fructaid is not a cure for those with hereditary fructose intolerance, this European-born product can be a ticket to dietary freedom for those with temporary fructose intolerance due to active SIBO, or ongoing fructose intolerance associated with IBS.
Many foods that contain fructose also contain other FODMAPs, which this product is not designed for. However, if fructose is your issue, a dose of 130 milligrams of this enzyme has been shown to adequately convert 25 grams of fructose (about the amount in one whole mango or one can of soda). Each Fructaid capsule contains 40 milligrams, so you may need to take four (the standard dose) or more capsules, depending on the fructose content of your meal.
Price at time of publication: $40 ($1.78 per serving)
While a low-histamine diet is one way to improve things, it can be extremely challenging since histamine occurs in so many foods, from spinach to vinegar to deli meat, and the exact amount is unknown. If you are histamine intolerant, you may be interested to know that oral supplementation of DAO has been shown to significantly improve reactions to dietary histamine, such as watery diarrhea, severe bloating, and abdominal pain.
Seeking Health’s Histamine Block comes in a capsule that may improve post-meal reactions and offer dietary freedom. When taken 15 minutes before a histamine-containing meal, this high dose of DAO works to help break down histamine in otherwise delicious and nutritious foods.
Although it is still unclear how much someone with histamine intolerance may benefit from DAO supplementation, promising research suggests it’s worth a try. It’s a pricier product to use regularly, so it might be better only for occasional use. Note that this product is pork-derived.
Price at time of publication: $30 ($1.00 per serving)
Each Kirkland lactase caplet contains 9,000 ALU (lactase units), which is about the amount needed to digest the lactose in 4.5 cups of milk. Compared to other products that contain 3,000 ALU, Kirkland lactase caplets fit the bill for “extra strength” and are suitable for most lactose-containing meals. When taken at the start of eating, the supplement offers a fast hit of lactase to help digest milk sugar that would otherwise be inadequately digested.
Kirkland caplets are a top choice because they do not contain other potential gas-causing ingredients, such as mannitol, which competitor brands often include. Additionally, they are individually wrapped and portable to have on standby for a planned dairy chow-down or surprise lactose-heavy meal.
Price at time of publication: $23 ($0.13 per serving)
Galacto-oligosaccharides (GOS), found in foods like beans, chickpeas, broccoli, cauliflower, and lentils, are one type of highly fermentable fiber. If you eat a lot of these foods, and especially if you have IBS, chronic constipation, or active SIBO, you may notice more digestive distress in response.
Research has confirmed that the enzyme alpha-galactosidase, the active ingredient in Bean-zyme, can help break down fiber before it makes its way down to our gut bacteria. Humans do not produce this unique enzyme, which is derived from a food-grade, plant-derived mold called Aspergillus niger, so external supplementation is the only way to go.
If you eat a very plant-rich diet, have IBS, constipation (e.g., an intestinal traffic jam), or active SIBO, a Bean-zyme tablet at the start of a GOS-rich meal can prevent bloating and gas that may otherwise accompany the fermentation party in your intestines. Bean-zyme is particularly great for sensitive people because it contains no other “gassy” ingredients (e.g., FODMAPs such as mannitol).
Price at time of publication: $14 ($0.09 per serving)
According to recent research, those with IBS or functional dyspepsia may particularly benefit from supplementing with lipase before consuming fat-rich meals. While studies in humans are small, the higher dose of lipase (4,000 units) may be a helpful remedy if fatty foods tend to provoke your symptoms.
Of note, a subset of people with sucrase isomaltase deficiency (SID) may also find a benefit from this product if they are starch intolerant and carefully chewing (for extra amylase production) is not enough to prevent symptoms caused by starchy foods like grains and potatoes.
Price at time of publication: $33 ($0.37 per serving)
We support supplements that are evidence-based and rooted in science. We value certain product attributes that we find to be associated with the highest quality products.
It’s important to note that the FDA does not review dietary supplements for safety and effectiveness before they go to market. Our team of experts has created a detailed, science-backed methodology to choose the supplements we recommend.
What to Look for in a Digestive Enzyme Supplement
Risks of Digestive Enzymes
There are few risks associated with enzyme supplementation. Known side effects include gastrointestinal discomfort, particularly with increased dosage. As with any commercially available supplement, digestive enzyme products are minimally regulated and can include contaminants and doses that do not match the label or vary across brands.
Products with ox and bovine ingredients may present risk of disease transition including bovine spongiform encephalopathy (aka mad cow disease).
Form
Digestive enzyme supplements can be formulas containing:
Broad digestive support: A blend of multiple different digestive enzymes in one (e. g. , FODMAP enzyme products)Individual digestive enzymes: A single enzyme that targets a single nutrient (e. g. , lactase for lactose digestion, xylose isomerase for fructose, etc. )
Over-the-counter digestive enzymes typically come in one of the following physical forms:
CapsulesTabletsChewablesPowder
There is no research suggesting greater efficacy of one form of the supplement over another; however, keep in mind that some chewable and flavored products may contain additional ingredients such as sugar alcohols that can cause extra symptoms.
Ingredients & Potential Interactions
It is essential to carefully read the ingredient list and nutrition facts panel of a supplement to know which ingredients and how much of each ingredient is included, relative to the recommended daily value of that ingredient. Please bring the supplement label to your healthcare provider to review the different ingredients contained in the supplement and any potential interactions between these ingredients and other supplements and medications you are taking.
Digestive enzymes may be derived from plant or animal sources. If you are vegan, vegetarian, or avoid certain animal products for religious reasons, read product labels carefully. Key ingredients to be aware of:
Porcine (pig): Commonly found in enzyme products targeting fat digestion, such as over-the-counter pancreatic enzymes.
- Those who do not eat pork may choose to avoid this ingredient. Ox (cow): Commonly found in enzyme products targeting fat digestion (e. g. ox bile supplements), as well as pancreatic enzyme products.
- Those who do not eat beef may choose to avoid this ingredient. Aspergillus niger: A plant-based mold. Those who are vegan can consume this source. Trichoderma: A plant-based fungus. Those who are vegan can consume this source.
*Over-the-counter pancreatic enzymes are not the same as the high-dose prescription enzyme replacement needed for pancreatic insufficiency.
Some digestive enzyme products may also contain added ingredients such as prebiotics, which can worsen gas and bloating in digestively sensitive people, or sugar alcohols, which can worsen diarrhea. Chewable supplements are more likely to contain one of these ingredients as a sweetener.
Prebiotics (avoid for gas and bloating) include:
Fructo-oligosaccharides (FOS) Inulin (chicory root fiber)
Sugar alcohols (avoid for diarrhea) include:
SorbitolMannitolXylitol Erythritol
Digestive Enzyme Dosage
Digestive enzyme dosage is not standardized across products, and many enzymes do not have research-based guidelines. However, of the enzymes that have been studied in human digestion, the following dosages have been shown to improve symptoms:
Alpha-galactosidase supplements: At least 300 GalU units of alpha-galactosidase enzyme at the start of a meal. Lactase supplements: At least 3,000 ALU (acid lactase units) of lactase enzyme at the start of a meal, though larger portions of lactose-containing dairy may need 6,000-9,000 ALU. Xylose isomerase supplements: 130 milligrams has been shown to help digest 25 grams of fructose (about two medium apples or one can of soda). Diamine oxidase: 4. 2 grams of DAO has been shown to reduce symptoms of histamine intolerance.
Note that products that contain enzyme blends may contain lower amounts of each enzyme, compared to products that contain only one type of enzyme. If you have poor digestion of a single nutrient, such as lactose or fructose, you may benefit most from a product that contains only the necessary enzyme. If you have multiple intolerances (e.g., lactose and fructose) look for an enzyme that contains adequate doses of each enzyme.
How Much Is Too Much?
There are generally no established upper limits for over-the-counter enzymes. Unlike prescription enzymes, there is no standard dosing for commercially available digestive enzymes, and guidelines may vary across different products. Additionally, many products contain ingredients that have not been studied in human digestion and therefore have unknown health risks.
Of the most researched enzyme products, documented side effects include gastrointestinal upset, such as gas, bloating, and nausea. Products should be used under the guidance of a healthcare provider to minimize the risk of excessive use. High-dose lipase intake, in particular, has been shown to cause damage to the colon walls. When it comes to digestive enzymes, there is no “adjustment period,” so if you find one is not working, or especially if you have an allergic reaction to any supplement, stop taking it.
Digestive Enzymes We Do Not Recommend
Numerous digestive products advertise enzymes derived from raw fruits and vegetables, as well as some from animal sources, for digestion enhancement. Although these ingredients may facilitate a chemical reaction (breakdown) outside of the human body, the following enzymes lack evidence as digestive remedies in humans:
Trypsin/chymotrypsinPeptidase Dipeptidyl peptidase IV (DPP IV)InvertaseCellulaseHemicellulasePhytaseBromelainPapainOx bile
Tips for Using Digestive Enzymes Effectively
Digestive enzymes require specific conditions to do their job. A product is most likely to be effective with the following considerations:
Identify the issue: Before adding a digestive enzyme, work with a healthcare provider to assess your digestive problem. If a dietary intolerance or deficiency has been identified, experiment with small amounts of a problem food to test your tolerance. You may find you tolerate a small amount of food without any problems. For example, some people can have small amounts of FODMAP-rich foods without any problems, but a large amount over the course of a meal or day triggers discomfort. Match the problem: Digestive enzymes work to target specific nutrients. Ensure that the product you’ve selected works for the food component you have trouble with. If you adequately select and dose an enzyme but still have symptoms, it’s worth considering whether you’re intolerant to another component of the meal. For example, a lactase enzyme can effectively digest the lactose in ice cream, but it will not help with a fructose issue. Additionally, watch out for added ingredients such as prebiotics and sugar alcohols in supplement products that could add to your symptoms. Time it appropriately: Enzymes must make contact with food to break it down. Enzymes taken too far in advance or after digestion will be ineffective. Most enzyme supplements should be taken within a few minutes of eating. Note: If you have known slow motility (food tends to move slowly through your digestive tract), you may need to experiment further with timing and dosage. For example, taking a digestive enzyme pill at the start of a meal and halfway through, to ensure it can work later on. Look for enteric coating: Enzymes are pH-sensitive, meaning their effectiveness will be affected by the acidity of the environment. Enteric coating is an acid-resistant barrier on a pill or capsule that allows the enzyme to remain intact before reaching the small intestine, where it helps with digestion. Enzyme supplements that are enteric coated are most likely to be effective. Match dosage to food portions: Digestive enzymes have a dose-response relationship to the nutrient they target. For a product to be effective, the dose of the enzyme should be enough to match the amount of the food. Products that are blends of multiple enzymes tend to contain smaller amounts of individual enzymes compared to products that offer a single enzyme. Minimize cost: Commercially available digestive enzymes can come with a high price tag. Look for products that contain the main enzyme(s) needed to help your digestive issue and avoid paying for too many extra ingredients. Consider reserving enzyme supplements for when dietary avoidance is most impractical for you, which might include social events, dining, or travel. Periodically re-test foods without an enzyme to ensure the product is still offering a benefit for you. Customize your regimen: Even when a digestive enzyme is appropriately selected for a digestive issue, individual responses can vary. It may take some experimentation with dosage relative to food portions, and to the speed of your digestive tract, to optimize results. Consider consuming a food both with and without an enzyme supplement, and with different amounts of the supplement, to determine if and how much is helpful. Timing is key: Remember to take enzyme supplements at the start of the meal as they must be in contact with the food in your digestive system. If you have a long stretch of eating, it may be worth adding another dose midway.
Why Trust Verywell Health
Suzie Finkel, MS, RD, CDN is a nutrition consultant specializing in the nutritional management of digestive problems. She holds a master’s degree in nutrition from Columbia University and has trained in numerous clinical gastroenterology settings. As a GI dietitian, she provides evidence-based nutrition services for a wide array of conditions including enzyme deficiencies. Her goal is to demystify nutrition (mis)information and facilitate digestive comfort.
Yet, unlike digestive enzymes, probiotics are not involved in the chemical breakdown of food. If you have a digestive enzyme deficiency or dietary intolerance, probiotic supplements or probiotics added to digestive enzyme supplements are not known to be an effective remedy.
If you have a condition called pancreatic insufficiency, in which the pancreas doesn’t produce enough of the key digestive enzymes (lipase, protease, and amylase), a prescription enzyme regimen (known as pancreatic enzyme replacement therapy or PERT) is advised. Although some over-the-counter digestive enzymes offer the same enzymes found in the prescription formula, the dosage is significantly lower and typically insufficient for improving digestion.
Similarly, if your digestive symptoms stem from sucrose intolerance–a diagnosable condition known as sucrase isomaltase deficiency or CSID–enzymes bought at a store will not meet your needs. A digestive enzyme called sacrosidase (Sucraid) is available by prescription only. It comes in a liquid form that needs to be refrigerated and there is currently no over-the-counter substitute.
“Not all enzyme formulas are created equally and may be targeting different foods,” Dr. Pashinsky says, “so having an understanding of the product, and the expectations one should have from it, is key.”
For those with lactase deficiency, fructose intolerance, or galacto-oligosaccharide sensitivity, supplementing with adequate doses and appropriate timing of the target enzyme has been clinically shown to improve symptoms. If you do not have digestive symptoms, an enzyme supplement is unlikely to provide a noticeable benefit.
