My love affair with spicy food came to a sad end a few years ago. Age — and I'm guessing too many jalapenos — have left me prone to heartburn if I eat meals with a fiery flare. My doctor says there's no underlying condition causing the problem, and advises me to avoid the foods that seem to trigger symptoms. But that's tricky sometimes.
So I was particularly interested when a friend suggested that an over-the-counter (OTC) digestive enzyme supplement might help. I learned pretty quickly that there are lots of ads for the pills and powders. It's a booming business, with sales for OTC digestive enzymes of all kinds expected to reach $1.6 billion by 2025.
About the supplements touted for heartburn relief
OTC digestive enzymes claim they can help you break down food, just like digestive enzymes your own body makes (mostly in the pancreas). For example, the enzymes produced by the pancreas include:
- lipase, which breaks down fats
- amylase, which breaks down carbohydrates
- proteases and peptidases, which break down proteins.
The supplement versions of these enzymes come from plants and animals. Plant sources include bromelain, derived from pineapples; papain, derived from papayas; and lactase that's obtained from purified yeasts or fungi. Animal sources include enzymes from the pancreases of pigs, cows, or lambs.
But there's no way to know what's really in supplements. The FDA does not regulate them, therefore you can't be sure what the pills are really made of or the exact amounts of enzymes they may contain. "It's buyer beware," warns Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.
Do supplements help heartburn?
Sometimes the body doesn't make enough digestive enzymes. This can slow the digestion process and lead to uncomfortable symptoms.
Would a digestive enzyme supplement help treat the symptoms of occasional heartburn, caused by acid reflux, slow stomach emptying, or an unknown reason (like I have)? The answer is that we don't know. "Unfortunately, there is little evidence that OTC digestive enzymes are helpful for heartburn," says Dr. Staller.
But we do know that OTC digestive enzymes can help manage other conditions. For example, if you don't make enough of the enzyme alpha-galactosidase, needed to digest the sugar in beans, you may benefit from taking an alpha-galactosidase supplement (Beano, Bean Relief).
Or if you don't make enough of the enzyme lactase, needed to digest lactose — the sugar in milk and milk-based products — you may benefit by taking a lactase supplement (Lactaid, Lactrase). "If you don't have lactase, the undigested lactose goes to the colon, which leads to more fluid entering the colon and more gas produced by bacteria in the colon. That creates bloating, flatulence, and diarrhea," explains Dr. Staller. "A supplement might help."
What about prescription enzymes?
Sometimes doctors recommend taking prescription-strength digestive enzymes. These may be necessary when digestion enzyme levels are low because of a health condition such as chronic pancreatitis or cystic fibrosis.
Taking prescription digestive enzyme medications helps bring levels back to normal. "People with known deficiencies clearly get a benefit," says Dr. Staller.
But these medications are not appropriate treatments for heartburn.
The rest of my story
Because I am persistent, I asked if it would hurt to try an OTC digestive enzyme for occasional heartburn. Both my doctor and Dr. Staller had the same answer: "In most cases, it's unlikely to be harmful. But don't spend a lot of money on them," Dr. Staller advised. In other words, it won't hurt, but we don't know if it will help. So don't make a big investment in the treatment.
With that dubious green light and a lot of curiosity, I tried an OTC enzyme made from papaya. And guess what — it helped! But as a health reporter I know that this could have been the result of my own personal hope (the placebo effect) or just a happy coincidence.
I also know that ignoring my doctor's orders to avoid spicy foods (which is my heartburn trigger, but may not be someone else's) would be foolish, and could cause damage to my esophagus. So would using digestive enzymes as a crutch to eat anything I want.
The lesson for me is that the OTC digestive enzyme supplement is there if I need it in a pinch, and that it might or might not work.
But I won't make a habit of using it. I'll keep the spice factor dialed down to a lower heat, and l'll just have to learn to love being symptom-free the way I once loved those jalapenos.