Digestive Enzymes vs. Probiotics

What are probiotics?

As per the World Health Organization (WHO) and the Food and Agriculture Organization (FAO), probiotics are living microorganisms that, when administered in sufficient amounts, have many health benefits.^1,2 Probiotics are well known for their advantageous nature. They help preserve intestinal microorganisms' stability and activate and regulate the immune system.^3,4 Due to their well-established benefits, many probiotics have now been broadly used to boost animal and human health.^3,5 Numerous studies investigated different probiotic types and their health impact. The most widely used probiotic species are Bifidobacterium, Lactobacillus, and yeast.⁶

After understanding the term probiotics, it is essential to learn how they benefit human health. Probiotic species are experts in forming short-chain fatty acids like butyrate, propionates, acetates, and lactic acids. This acidic environment is unfavourable for the growth of pathogenic bacteria.⁷ Hence, probiotics help to confer against the diseases caused by pathogenic bacteria. Probiotic species also show variation in relation to immunomodulation like the enlargement of the gut mucosal barriers to maintain intestinal homeostasis, anti-inflammatory responses, constructive activity on gastrointestinal microbes, and a reduction of allergic reactions. Probiotics also have the potential to enhance the stability of epithelial tight junctions, thereby decreasing epithelial permeability to pathogens, regulating the intestinal epithelial cells or modulating immune responses to prevent the development of gastrointestinal diseases.⁸

What are digestive enzymes? 

Enzymes are proteins that help speed up any chemical reaction occurring in our bodies. Digestive enzymes are those enzymes which are involved in the digestion of food. Digestive enzymes help break down the food into various nutrients: carbohydrates, fats and proteins. These enzymes are also implicated in the distribution of the extracted nutrients to different cells in our body, where they are further used for growth and repair. From the simple act of chewing food to digestion and removal of waste, all these processes require the help of various digestive enzymes. 

Types of digestive enzymes

The main three types of digestive enzymes are amylases, proteases and lipases. All of these enzymes are made in the pancreas, but they have varying functions depending on the part of the digestive tract involved. ⁹

Oral Cavity

• Salivary amylase digests starch into maltose and maltotriose at a pH of around 6.7 to 7.0.
• Lingual lipase, also present in the saliva, hydrolyzes the ester bonds in triglycerides which leads to the formation of diacylglycerols and monoacylglycerols.

Stomach

• In the acidic medium (pH 2-3), pepsin (protease) is activated, which acts on the internal peptide bonds of proteins. 

Intestine

• Pancreatic amylase breaks down starch into maltose and maltotriose.
• Pancreatic lipase, along with coenzyme colipase, hydrolyzes the ester bonds in triglycerides to form diacylglycerols and monoacylglycerols.
• Trypsin, chymotrypsin, and elastase (endopeptidases) hydrolyze internal peptide bonds of proteins, while the carboxypeptidases (exopeptidases) hydrolyze terminal peptide bonds on proteins.
• Maltase, lactase and sucrase (disaccharidases) cleave the glycosidic bond in maltose, lactose and sucrose respectively.
•  Dipeptidase digests the peptide bond in dipeptides.

Relationship between probiotics and digestive enzymes

As explained above, digestive enzymes are natural proteins the body produces to aid food digestion. In contrast, probiotics are living organisms that, when ingested in the right amount, help maintain the concentration of good gut bacteria and also help regulate immune response against various diseases.¹⁰ With increasing age, presence of certain conditions or genetic mutations, the levels of digestive enzymes can decrease in our body, leading to food intolerances. The most common example is lactase enzyme deficiency which leads to lactose intolerance.¹¹ However, it is also possible to have intolerances to other things such as fatty foods.¹² These enzyme deficiencies can further lead to bloating or indigestion, abdominal discomfort and other bowel-related issues.

Enzyme deficiency can also lead to a weakened immune system due to a lack of nutrients. Another problem is that undigested food can mount up in the intestines. This provides an ideal platform for developing diseases, especially when the body has a low amount of good bacteria to fight them. Research is now conducted to identify the role of probiotic supplementation in these cases.^3,10 Therefore, despite probiotics and digestive enzymes working in different manners, together, they are essential for human health.

Supplements for probiotics

As discussed above, probiotics help maintain homeostasis in the gut microbiome. Probiotics alter the host’s gut microbiota by defying the colonisation of pathogenic bacteria.¹³ The common signs that signify that the body needs probiotic supplementation are intense bloating, recent use of antibiotics, severe headaches or migraines, serious digestive issues, and even basic skin conditions that can signal an increased harmful bacteria colonisation in the body.

Uses of probiotic supplements: Initially, research in the area of probiotics was focused on their nutritive functions as a form of food or dietary supplement.¹⁴ However, the trend has now shifted to the use of probiotics for therapeutic and medicinal purposes.¹⁵ Research on animals and humans has shown some potentially favourable benefits of probiotics: 

• Altering the number and diversity of useful gut microbiota. ¹⁶
• Decreasing the symptoms associated with various gastro-intestinal disorders like inflammatory bowel disease, irritable bowel disease. ^17,18
• Removal mycotoxins. ¹⁹
• Increasing levels of blood cholesterol and refining the blood lipid profile. ²⁰
• Decreasing the blood pressure and risk of hypertension. ²¹
• Boosting mental state and cognitive functions. ²²
• Stabilising blood glucose levels and controlling diabetes. ²³
• Improving symptoms associated with non-alcoholic fatty liver disease (NAFLD) by regulating amino acid, creatinine metabolism, and nucleic acid degradation while reducing glycemic levels and inflammation. Studies have observed improvement in hepatic inflammation, levels of liver enzymes, hepatic fibrosis and steatosis. ²⁴
• Alleviating respiratory tract infections and increasing immune responses against viruses.²⁵
• Reducing inflammation in rheumatoid arthritis patients.²⁶
• Reducing the frequency of urinary tract infections in women and children.^27.28

The benefits of probiotic supplements are not limited to the above-mentioned diseases. This field is still in its infancy, with numerous ongoing studies. There is still a long way to go before these tiny sets of microorganisms can replace the vast and harmful world of antibiotics.

Probiotics are available in the market as dietary supplements in the form of capsules, tablets or powders and as fermented dairy products, including yoghurt and milk. Their effectiveness relies on their capability to survive the passage from the gastrointestinal tract and subsequently colonise the gut. To prevent damage by gastric acid and intestinal bile salts, some of the marketed probiotic preparations may be microencapsulated. For proper colonisation to happen, these probiotics must contain living and viable organisms and also must be ingested on a daily basis in order to maintain effective concentrations and gain maximum results.²⁹ However, the manufacturing process may decrease the viability of these living organisms, thus reducing their effectiveness. Quality, quantity, and purity of the bacteria or yeast in probiotics generally vary among products due to the complexity of quality control associated with maintaining the live microorganisms and also due to the lack of universal quality-assurance programs and guidelines.³⁰ Some examples of probiotics that are commercially available are S. boulardii (Florastor, Biocodex, Inc., Beauvais, France), LGG (Culturelle, Amerifit Brands, Fairfield, NJ), VSL#3 and B. infantis (Align, JB Laboratories, Holland, MI).

Since probiotics contain live microorganisms, simultaneous administration of antibiotics could kill a large number of the organisms and reduce their effectiveness. Therefore, patients should be instructed to keep a gap of at least 2 hours between the intake of antibiotics and probiotics. Also, probiotics should be used vigilantly in patients consuming immune suppressants, such as azathioprine, cyclosporine, and chemotherapeutic agents; these probiotics could cause an infection in immune-compromised patients.³⁰ Thus, it is highly recommended that probiotic supplements should be taken under the guidance of a personal physician. 

Supplements for digestive enzymes

Digestive enzymes are produced and secreted by the gastrointestinal system to degrade proteins, fats, and carbohydrates. Their supplementation may aid the treatment of several disorders that are characterised by problems in digestive functions.

One of the common examples of digestive enzyme use is lactose intolerance. Any kind of damage to small intestinal villi leads to a decreased level of lactase enzyme and malabsorption. Substituting the native lactase with microbial exogenous lactase (isolated from yeasts or fungi) may be considered a therapeutic option. These are now widely available on the market, and several studies have investigated and confirmed their effectiveness.^31,32 Another example of digestive enzyme supplementation is in exocrine pancreatic insufficiency (EPI) in pancreatic cancer, chronic pancreatitis, or cystic fibrosis (CF).^33,34 Exogenous pancreatic enzymes are mainly extracted from bovine or porcine sources. Lipase may also be made from microbial sources, like Aspergillus oryzae and Rhizopus arrhizus. People sometimes consider enzyme supplements (i.e. vitamin supplements) and primarily take them once in the morning. However, these digestive enzymes need a substrate (food) in order to catalyse food digestion. Hence, it is very important to take enzymes as directed by a doctor or physician. In most cases, digestive enzyme supplements are taken with food. As discussed above, supplements for lactose intolerance contain the enzyme (lactase) that digests milk sugars; therefore, it should be taken along with dairy products. Similarly, amylase helps the body digest the complex sugars that are found in vegetables and legumes. Hence, amylase supplements should be taken with or just before eating these foods.

Things to consider before taking supplements

Getting an adequate amount of nutrients every day is very important for health. Nutrients give our body the energy to complete daily tasks, repair body tissue, build muscle, prevent infection and maintain a healthy weight. The addition of supplements in our daily life ensures that we are getting all of these nutrients. Both the probiotic and digestive enzyme supplements work in sync to make the gut healthy. Even though their mode of action is quite different, the outcome of their action is quite similar. As discussed before, these two supplements work in a different manner hence, their intake time can be quite different. Probiotics can be taken on an empty stomach, whereas digestive enzyme supplements should be taken with or before the meal for them to provide the best results. The guiding dietician or a health professional is the best representative to guide the patient on the dosage as well as how and when to take the supplements.

Natural sources of probiotics and digestive enzymes 

Probiotics: Some of the most common fermented foods, like kefir, kimchi, sauerkraut, yoghurt, dry fermented sausage, kombucha, cheese, and miso, are the main natural sources of probiotics. These usually contain viable cells in remarkable quantities (10⁶ - 10⁹ cells/g or cells/ml). The ingestion of fermented foods possibly increases the numbers of microbes in the diet by up to 10 000-fold.³⁵

Digestive enzymes:  Some of the natural sources of digestive enzymes are papaya (papain: protease), mango (amylase), avocado (lipase), bananas (glucosidases), pineapple (bromelain: protease), miso (lactase, protease, amylase), and kefir ( lipase, lactase, protease).

Summary

Both probiotics and digestive enzymes form an essential part of our gastrointestinal system. They both aid digestion in their own way. Even though many natural sources of both are available, these supplements should be taken under the proper guidance of a physician or dietitian to ensure the best outcome for each individual.