People of every age experience digestive issues from time to time, but as we get older, annoyances like constipation, diarrhea and gas can become increasingly common. Aspects of our physical health change naturally with age, but poor diet, reduced digestive enzymes and unbalanced gastrointestinal flora can wreak havoc on both our digestive and immune systems. There are countless products on the market to help improve gut health and immune function, but do any of them actually work? Which options are best for a senior’s unique issues?

At my integrative medicine practice in New York City, I focus on all factors that influence a patient’s health and utilize therapies and interventions from many different scientific and medical disciplines, including nutrition, acupuncture, herbal medicine and mind-body stress reduction techniques. In conjunction with conventional internal medicine and diagnostics, these methods help my patients regain and maintain optimum health.

What Happens to the Digestive System as It Ages?

With age often comes reduced amounts of gastric, pancreatic and other digestive system secretions. Additional problems like poor dentition, inadequate diet and an unhealthy microbiome can set the stage for weak digestion and reduced nutrient absorption. This can lead to reduced immune function and leakage of unwanted molecules into the circulatory system (aka leaky gut), which can cause adverse outcomes for other systems of the body. Occasional gas, bloating, abdominal discomfort, poor elimination, temporary fatty stool, fatigue, headache, and numerous other local and systemic outcomes may be indicators of gut health decline.

The Importance of Digestive Enzymes

Generally speaking, enzymes are catalysts that speed up biological reactions. Digestively speaking, they lower the amount of energy that is required to transform the foods we eat into molecules that are small enough to pass through the intestines and into circulation. These can be our own self-produced enzymes or enzymatic supplements taken with meals.

Examples of the most common enzymes are amylases that digest carbohydrates, lipases that digest fats, and proteases that digest proteins. Without these enzymes, we’d be unable to break the molecular bonds that hold our food together to unlock the nutrients and energy within. While our bodies do produce their own enzymes, it is clear that production can decrease with age and ill health. Fortunately, wise diet and lifestyle choices play a role in the way we age and may be of great help in supporting digestive and overall wellbeing.

Do I Need to Take Supplemental Enzymes?

There are a few instances when enzyme supplementation is clearly beneficial. Individuals with pancreatic insufficiency require supplements because they are unable to produce enzymes naturally and digest food properly. In other cases, specific enzymes can help us consume the foods we enjoy with minimal digestive distress after the fact. For example, people suffer from lactose intolerance because they do not produce enough of the enzyme lactase that is needed to digest the specific kind of sugar found in dairy. Lactase supplements (most commonly known by the brand name Lactaid) help minimize this sensitivity.

Those who stick to primarily plant-based, high-fiber diets can experience frequent gas and bloating. A little bit of this is normal, but it can be irritating and embarrassing. Another enzyme supplement (known by the brand name Beano) contains alpha-galactosidase, which breaks down sugars in notoriously gassy foods like legumes and cruciferous vegetables and minimizes discomfort that results from their digestion. Enzymes can help many people, but deciding whether to try them depends on one’s health, unique dietary habits, lifestyle factors and digestive symptoms.

How to Buy Digestive Enzymes

Since we are all unique and our dietary choices vary widely, there really is no one “right” or best enzyme formula everyone. When seeking an enzyme supplement, it may be wise to take an initial look at the types of foods you regularly consume and seek out a formula designed for a diet like yours. You may also want to obtain another formula designed for foods you avoid or eat infrequently because they cause you problems. If you eat very small meals or are very sensitive to new supplement inclusions, then a gentler potency product may be a good fit.

For example, someone who has had their gall bladder removed or who experiences difficulty properly digesting and absorbing fats may benefit from a high lipase formula. This would help them utilize essential fatty acids that are part of a well-rounded diet. Someone who eats a vegan or vegetarian diet that is rich in legumes, grains and vegetables, or simply wishes to enjoy some cuisine rich in these fibrous, often gas-forming foods, should look for a formula that includes more amylase and cellulase enzymes for breaking down larger starches.

If you’ve tried a high-potency full-spectrum formula (one that includes proteases for proteins, lipases for fats, amylases for carbohydrates and cellulases for fiber) but are still experiencing digestive difficulty, then wheat, dairy or some other dietary intolerance may be the culprit. You might wish to use a formula designed to address specific food intolerances instead. These formulas include enzymes like DPP-4 (for gluten and dairy casein), alpha-galactosidase (for starches in beans), lactase (for lactose in dairy), and xylanase (for fiber). You can use them in addition to the more generalized enzymes mentioned above.

Some high-quality formulas even provide teams or blends of enzymes within the same category, like multiple proteases, multiple amylases and multiple lipases. Each enzyme can generally only perform in a specific digestive environment, but blending many of them together allows the teams to perform digestive functions in all settings throughout the GI tract.

Other formulas contain enzymes along with adenosine triphosphate (ATP), which is the body’s energy currency. ATP is very important for facilitating digestive processes like enzyme production, gastric acid secretion, peristalsis, transportation of nutrients across intestinal linings and more. We all make ATP, but production tends to decline with age. ATP is found in raw foods, but, like enzymes, it is destroyed through cooking and processing mechanisms, so supplementation may assist in gut function. Still other formulas contain both blended digestive enzymes and probiotics along with ATP. These combination formulas can be a convenient, cost-effective way to give yourself more complete digestive support.

How Are Enzymes Different from Probiotics?

Both enzymes and probiotics are essential for efficient digestion and overall wellness, but there are significant differences between the two. Probiotics are living organisms, while enzymes are non-living proteins composed of amino acids. Probiotic supplements can enter the gastrointestinal tract and take up residence there, cohabitating with the body’s own cells. Enzyme supplements also enter the GI tract but cannot function as a permanent resident. This explains why the body needs a regular supply of enzymes each time a meal or snack is ingested. Probiotics are similar to the good bacteria found in the human digestive tract and are associated with numerous health benefits, such as supporting our immune system.

Probiotics make limited amounts of certain enzymes, which can support digestion. However, the amounts that probiotics make may pale in comparison to the amounts that the pancreas releases or that enter the digestive tract through supplementation. Probiotics also play a role in helping the cells of the small intestine absorb nutrients that the enzymes release from the foods we eat. They are very important to the production of many other beneficial molecules, such as neurotransmitters, and help to create a healthy immune system—70 percent of which is located in the gut. As you can see, both probiotics and enzymes are critical for good gut health.


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Types of Probiotics

The term probiotic covers many different families and species of beneficial bacteria. Just like different types of plants within one family can vary greatly, and different members within your own family each have their own unique features, each probiotic has its own traits. There are so many varieties that listing all the benefits or mechanisms of action for each one would be too massive an undertaking for a single article such as this.

One of the most well-known species right now, Lactobacillus acidophilus DDS-1, produces cellulase, lactase and protease, which assist with the digestion of fiber, milk sugar (lactose) and protein respectively. Some probiotics serve to nourish intestinal cells and encourage their growth and health, thereby improving nutrient absorption. Overall, probiotics improve digestion, make for a healthier gut lining and help keep the immune system strong.

How to Buy Probiotics

A two-in-one digestive supplement formula that contains both enzymes and probiotics will cover all your bases. But if your enzyme formula contains no probiotics and you eat very few fermented, cultured and raw foods (such as kefir, yogurt, kimchi, sauerkraut and kombucha) that are naturally high in probiotics, you may wish to take a probiotic supplement.

Once again, there is no one-size-fits-all formula. It is important to select products that guarantee potency until their expiration date, not just at the time of manufacture. Look for products containing species that are well-researched and either known to withstand the harsh stomach acids and bile secretions of the gall bladder or that come in encapsulated pills to ensure the bacteria make it all they way to your colon. The Lactobacillus family, in general, is the mainstay of probiotic formulas (DDS-1, GG, and rhamnosus are some subspecies of these). Bifidophilus and Bacillus species can also be added. I recommend looking for a formulation with at least one billion CFU (colony forming units) per serving.

The Impact of Food and Age on Digestion

The foods we eat have changed considerably over many decades. In fact, nutrient levels in crops today are markedly lower than they were 50 years ago. There’s not only less of what should be in foods, but also more of what shouldn’t be (think pesticides, herbicides, preservatives, etc.). Cooking, processing and preserving foods can further diminish nutrients and destroy the enzymes, probiotics and ATP that naturally occur in fresh, raw ingredients. All these beneficial components are either significantly lower or non-existent in cooked, processed products.

Of course, a diet consisting of nutrient-dense choices is critical, but even the best of selections and intentions do not guarantee optimal nutrient, enzyme, probiotic and ATP intake. As mentioned previously, the aging process may only add to the minimized digestibility of foods and reduced nutrient uptake. Fortunately, enzyme and probiotic supplementation may play a key role in working with the body’s own natural processes to fortify digestive and overall wellbeing.

If you are considering trying enzyme and/or probiotic supplements, speak with your primary care physician, a dietician or a gastroenterologist to see if these treatments might be a good fit for you.