Digestive enzymes - can they help you tolerate FODMAP foods?

Introduction: Commercially available enzymes have increased over the last decade, with a shift in availability, making them more accessible. But are they useful for patients on the Low FODMAP Diet?

Firstly: Why use enzymes?

The Low FODMAP Diet has become a popular approach for managing digestive symptoms, particularly in individuals with conditions like irritable bowel syndrome (IBS). Although the diet is highly successful in reducing gut symptoms, some patients will experience a return in symptoms when they reintroduce certain FODMAP foods, while others are often nervous of reintroducing foods, which can make socialising and eating out difficult.

Enter the enzymes… The primary idea behind using these enzymes is to improve tolerance to certain foods, giving you the potential to expand your diet. By incorporating these enzymes, individuals might find some flexibility, particularly when dining out.

Using enzyme supplements may help you to be able to eat out

Are all enzyme supplements useful?

NO! The type of enzyme you use is absolutely fundamental - there is no point wasting your money on general ‘enzyme’ supplements, You need to use specific products which target specific FODMAP food components.

The best enzymes to use with the Low FODMAP Diet are:

Lactase: Targets lactose found predominantly in milk, yogurt and ice-cream. The European Food Safety Authority recognizes its effectiveness in suspected and symptomatic lactose intolerance. Studies reveal positive outcomes of using lactase supplements when addressing lactose intolerance symptoms.

Lactose intolerance is most common in Asian countries and least common in Northern European countries

If you are not born with lactose intolerance, then it may occur temporarily following a gut infection or gut surgery, or can be caused by a gut-related illness such as coeliac disease.

Alpha-Galactosidase: Targets galacto-oligosaccharides (GOS) found in beans & pulses e.g. lentils, chickpeas, etc. This enzyme has increasing evidence supporting its use when eating these foods. Studies involving patients with irritable bowel syndrome (IBS) and high GOS intake indicate a reduction in symptom response and hydrogen production with alpha-galactosidase supplementation. However, the research shows that it is not of benefit with other FODMAP foods or when used in a normal unrestricted diet.

If your diet relies heavily on beans and pulses then you may find that the enzyme supplement, alpha-galactosidase, is helpful in improving your tolerance to these foods

Inulinases: Target fructans found in wheat, onion, garlic and a variety of fruit and vegetables. The research is limited into the use of this enzyme but preliminary research suggests that it may be helpful. However, its use appears to increase the level of another FODMAP constituent, ‘fructose’, in the gut, and it is still unclear if this may lead to an increase in gut symptoms and hence reduce any benefit. The limited clinical evidence underscores the necessity for further research to validate its effectiveness in providing symptomatic relief in individuals following a low-FODMAP diet.

Inulinases have been traditionally used in the food industry, and there's interest in exploring their application to reduce the effects of fructans in breads.

However, more research is needed before this could be considered.

Are there enzyme supplements to help you digest all types of FODMAP foods?

Unfortunately there is no evidence to support the use of enzymes in reducing the effects of eating other FODMAP foods e.g. those containing polyols and fructose.

Conclusion: Enzymes, particularly alpha-galactosidase and lactase, offer a promising avenue for individuals navigating the Low FODMAP Diet. These tools are not just about symptom relief but about empowering individuals to embrace a wider variety of foods, fostering a positive relationship with food while navigating FODMAP sensitivities. As we tread into this evolving landscape, caution is advised, particularly as there is limited data on real-world effectiveness. It is clear that more research is needed to fully support the use of enzyme supplement in patients with IBS who are using the Low FODMAP Diet… but so far the results look promising for the use of lactase and alpha-galactosidase.

Watch this space for more updates on enzymes supplements…