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Are Digestive Enzyme Supplements Effective in Relieving Heartburn?

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Exploring the Potential of OTC Digestive Enzyme Supplements

My Personal Journey with Spicy Food and Heartburn

At one point in my life, I had a passionate love affair with spicy food. However, as the years went by, it seemed that age and perhaps an excess of jalapenos had taken a toll on me. I started experiencing heartburn when I indulged in meals with a fiery flare. Seeking medical advice, my doctor confirmed that there was no underlying condition causing my discomfort and suggested avoiding trigger foods. Easier said than done, right?

h3>An Intriguing Solution: Over-the-Counter Digestive Enzyme Supplements

My interest was piqued when a friend recommended trying an over-the-counter (OTC) digestive enzyme supplement. It didn't take long for me to realize the abundance of advertisements for these pills and powders. It turns out that the market for OTC digestive enzymes, promising relief from heartburn, is booming. Sales for these supplements are anticipated to reach a staggering $1.6 billion by 2025.

The Breakdown of OTC Digestive Enzymes

OTC digestive enzymes claim to assist in the breakdown of food, similar to the digestive enzymes naturally produced by our bodies, primarily in the pancreas. These enzymes include:

  • Lipase: Breaks down fats
  • Amylase: Breaks down carbohydrates
  • Proteases and Peptidases: Break down proteins

Supplemental versions of these enzymes can be derived from various sources, such as plants and animals. Plant-based enzymes include bromelain from pineapples, papain from papayas, and lactase obtained from purified yeasts or fungi. Animal sources, on the other hand, utilize enzymes derived from the pancreases of pigs, cows, or lambs.

The Uncertainty Surrounding Supplement Contents

However, a notable concern arises when considering these digestive enzyme supplements: the lack of regulation by the FDA. The absence of regulation means that there's no way to guarantee the exact composition or enzyme amounts within these pills. Dr. Kyle Staller, a renowned gastroenterologist at Harvard-affiliated Massachusetts General Hospital, firmly warns consumers that it's a "buyer beware" market.

Untangling the Relationship between Digestive Enzymes and Heartburn

Although our bodies sometimes fail to produce an adequate amount of digestive enzymes, resulting in slower digestion and uncomfortable symptoms, the efficacy of OTC digestive enzymes for managing heartburn remains uncertain. Dr. Staller reveals that there is minimal evidence supporting the claim that these over-the-counter supplements effectively alleviate heartburn. However, he notes that OTC digestive enzymes can prove beneficial for conditions like the inability to digest specific sugars. For instance, individuals lacking the enzyme alpha-galactosidase, required for breaking down sugar found in beans, may benefit from taking an alpha-galactosidase supplement like Beano or Bean Relief.

Similarly, those lacking the enzyme lactase, necessary for digesting lactose (the sugar in milk and milk products), may find relief with a lactase supplement such as Lactaid or Lactrase. Dr. Staller explains that without adequate lactase, undigested lactose reaches the colon, leading to increased fluid intake and gas production by colonic bacteria. This, in turn, results in bloating, flatulence, and diarrhea. In such cases, a lactase supplement might offer assistance.

The Role of Prescription Enzymes

Prescription-strength digestive enzymes may be recommended by doctors in specific circumstances. These enzymes are typically prescribed when an individual has low levels of digestive enzymes due to a health condition like chronic pancreatitis or cystic fibrosis. By taking prescription digestive enzyme medications, enzyme levels can be restored to normal. However, it's important to note that these medications are not intended for treating heartburn.

A Personal Decision: Using OTC Digestive Enzyme Supplements

Being the persistent individual that I am, I asked if using an OTC enzyme supplement for occasional heartburn could be worth a try. Both my doctor and Dr. Staller provided the same response: in most cases, it is unlikely to cause harm, but spending a significant amount of money on such supplements is not advisable. In other words, though it may not be harmful, its effectiveness remains uncertain. Therefore, investing heavily in this treatment would be unwise.

With a dubious green light and fueled by curiosity, I decided to try an OTC enzyme supplement made from papaya. Surprisingly, it helped! As a health reporter, I acknowledge that the positive outcome could be attributed to personal hope (the placebo effect) or sheer coincidence.

However, it is vital to heed my doctor's advice and not overlook the importance of avoiding spicy foods, which trigger my heartburn symptoms, even if they may not have the same effect on others. Ignoring this guideline could result in esophageal damage. Instead, I view OTC digestive enzyme supplements as a backup plan, to be used when necessary, with an understanding that they may or may not provide relief.

In conclusion, while OTC digestive enzyme supplements have their place, I won't rely on them as a long-term solution. I have come to appreciate heartburn-free living and accept that I must exercise caution when it comes to spicy foods. My new mantra is to savor milder flavors, fondly reminiscing about the days when jalapenos were my fiery love.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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