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Digestive Enzymes
Pat Elliott, ND

Your mother was right when she said, "You are what you eat"... but only to a certain extent.  It is true that the quality of your diet is the initial determinant of your nutritional status. However, there are two other often neglected but crucial intervening steps which ingested nutrients must proceed through before being incorporated into your body. After ingestion, the second step food must pass through is digestion; this is the process by which food is mechanically broken down by the churning motion of the digestive tract and chemically broken down by the secretions of the digestive organs. Digestion functions to break food down into its smallest units - amino acids, carbohydrates, and fatty acids - and to release the vitamins, minerals and other nutrients trapped within the food. Only when digestion is complete, may the released nutrients then pass to the third and final stage - absorption - which is the transport of the processed molecules across the intestinal lining and into the body.

By making wise food choices, many people pay great attention to the first step of good nutrition.  However, many of these same people also assume the rest of the steps of assimilation are automatically proceeding.  After personally testing the digestive enzyme levels of numerous people, I know that this is not always the case.  Despite their excellent diet or nutritional supplements, some people remain inadequately nourished because of unidentified disturbances in digestion and/or absorption.  The end result is that some of what they are taking careful steps to ingest is passing right through their intestinal tracts unutilized.

Of the two assimilation disorders, digestive and absorptive, I find digestive disorders to be much more commonplace.   Include in this general category are stomach acid deficiencies, intestinal cell digestive enzyme deficiencies, and pancreatic digestive enzyme deficiency.  Any problem in this category will lead to insufficiently broken down food particles which are too large to be absorbed properly. On the other hand, absorption disorders are less common, more serious, and are usually due to small intestinal inflammation, infection or disease; this undermines the health of the small intestinal lining cells and their ability to perform their nutrient transport duties properly.   In these absorptive disorders, even properly pre-digested nutrients will not be able to be efficiently absorbed into the body by the ailing intestinal cells.  Treatment of these disorders involves medical therapies directed at the underlying intestinal disorder.

Treatment of the more common problem of disordered digestion is fortunately relatively simple and straightforward.  Because the largest contributor to digestive activity by far is the pancreas, treatment of digestive disturbances often involves supporting the function of the pancreas.  The pancreas produces a wide array of digestive chemicals, called enzymes, which function to break down fat, carbohydrates and proteins.   Because of the broad spectrum of the pancreatic enzyme action, a deficiency in pancreatic enzyme function can be very disturbing to overall digestion.  When suspected or identified, treatment of low pancreatic enzyme production (sometimes called pancreatic insufficiency) is accomplished through the regular use of supplemental digestive enzymes taken with meals.

How can one determine if they may have insufficient digestive enzymes?  There are often clues which make physicians suspicious of pancreatic enzyme deficiency.  These are the following:

There are also particular populations of people who are most at risk for pancreatic enzyme deficiency:

The suspicion of pancreatic enzyme deficiency can be confirmed through laboratory testing.  Because nutritional status is one of the important determinants of health, I frequently evaluate the digestive enzyme function of my patients, including patients without apparent digestive tract symptoms. I find that many people who are experiencing chronic health problems have lowered digestive enzyme output. Treatment of this deficiency by the use of supplemental digestive enzymes meal can often improve any indigestion symptoms present and, by helping to improve nutritional status, add a crucial step in the recovery of their health.

In some people, digestive enzyme disturbance related to chronic illness or hormonal disturbance resolves as the overall health improves. Therefore, I periodically recheck patients throughout their treatment and recovery and withdraw enzyme therapy when symptoms and/or testing reveals improvement.  Other people, especially those over age 50, however, appear to have permanent pancreatic insufficiency which requires long-term supplementation for ideal health.

There are many types of digestive enzyme formulas available.  Basically they can be divided into two general categories - those derived from animal pancreatic enzymes, also called "pancreatin" and the newer type derived from various fungi, also called "plant enzymes".  In addition, many formulas contain other digestive chemicals, like hydrochloric acid (stomach acid), pepsin (a stomach enzyme) or ox bile (an animal-derived fat digesting chemical produced by the liver and secreted by the gallbladder).  In the case of suspected or verified pancreatic enzyme deficiency, a formula of adequate strength should be used which contains at least amylase (carbohydrate), lipase (fat) and protease (protein) digesting activity.   Supplemental digestive enzymes are taken regularly at the end of meals.

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Pat Elliott, ND
Elliott Health Care
1155 N State ST Suite 610
Bellingham, WA 98225
(360) 647-0228

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