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October 2015
The Question of Digestion
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Current trends and top products in the competitive digestive health market.
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Written By:
For consumers, retailers and product makers alike, digestive health can be a tough category.
(http://www.wholefoodsmagazine.com/supplements/features/supplementing­
Tim Person
There are enough natural options to satisfy every complaint or concern, but there’s also
yourself­sleep)
View more articles in: enough complexity to make connecting consumers with the right products a tall task.
Some might even be reticent to let their needs be known, but that’s changing. “While a few
shoppers may feel unnecessarily sheepish about buying or asking about digestive health
Oral Care (http://www.wholefoodsmagazine.com/hbc/features/dirt­
dental­health)
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products at retail, that awkwardness seems to be dissipating with each passing year,” says
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Dan Lifton, CEO of Quality of Life Labs, Purchase, NY. Make it all easier for your customers to
hp)
digest by knowing your way around top products like probiotics, enzymes, fiber, botanicals
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Navigating Digestive Health
Skin Energizing Gel
There are enough twists and turns in the digestive health category to rival the digestive tract itself. Many of these issues and
(/hbc/new‐
trends concern probiotics: how they’re delivered, what their role is and what consumers know about them.
products/skin‐
Some worry that certain products might be counterproductive. “My biggest concerns are the presence and use of ingredients and
energizing‐gel)
nutrients that tend to have a negative effect on digestive health in digestive health products,” says Kiran Krishnan, head of
...
scientific affairs for Thrive Probiotic, Park Ridge, IL. Fermented drinks, for example, often have an unusual taste, and Krishnan
notes that many companies add sugars to overcome it. But, research shows that sugar can be disruptive to the ecology of the
gut. He also points out that most probiotics sales still come out of the dairy aisle, but many people are sensitive to dairy and
dairy has been linked with gut inflammation.
Flavored Tofu
(/grocery/new‐
products/flavored‐tofu)
Another concern, according to Krishnan, is that (http://www.solgar.com) many fermented beverages don’t necessarily contain
...
clinically relevant dosages of probiotics, making them a more passive option for addressing dysbiosis (i.e., bacterial imbalance).
He presents the analogy of taking a complete multivitamin each day versus drinking a bottle of vitaminwater.
Yet, many consumers feel they are supporting their digestive health effectively by grabbing a yogurt or fermented beverage
when the mood strikes them. “This is why the beverage­ and dairy­based probiotic sector sales are upwards of $30 billion per
year, yet capsule­based probiotic sales are barely $1 billion per year,” Krishnan says. If those figures were reversed, he argues,
the prevalence of digestive health issues would be greatly reduced.
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Of course, probiotics in foods and beverages are still of great
Acquisitions, mergers, awards,
value to our health. “Fermented foods have been around for
charity work,...
thousands of years and we as Westerners could maintain better
health if we ate more fermented foods on a daily basis,” says Guy
Devin, Ph.D., CCN, national sales manager and educator for
New Products
Probium LLC, Wausau, WI. Lifton agrees, saying that fortified
foods with levels of digestive­support ingredients that are
efficacious and in keeping with published research can provide a
good foundation for digestive health.
But a yogurt here or there is not usually going to make a big
impact. “This is because the cells of our intestinal lining
constantly shed, and in order to keep a sufficient supply of
probiotics in the system, daily use is suggested,” says Todd
Beckman, cofounder and COO of GoodBelly, Boulder, CO. He says
(/products)
Grocery (/grocery/new­products)
Gourmet
that while food industry practices in industrialized countries have
(http://www.wholefoodsmagazine.com/
eliminated the bad bacteria in foods, we’ve lost the good bacteria
category/gourmet/new­products)
as well. His company’s probiotics are grown in a controlled
environment and added to its functional drink products after the
drinks are pasteurized, so only good bacteria are present.
The probiotic market is too focused on astronomical numbers and refrigeration, believes Tina Anderson, president of Thrive
Probiotic. Many tend to be influenced by the number of live cultures in a probiotic product (50 billion, 100 billion, etc.) or
whether a supplement needs to be refrigerated. Anderson isn’t sure that either these high numbers or refrigeration are
necessary for an effective probiotic product.
Supplements
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HABA (/hbc/new­products)
Suppliers (/suppliers/new­
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Miscellaneous
(/miscellaneous/new­products)
Despite the scientific and public interest in learning more about the human microbiome, there are still numerous gaps in the
consumer’s understanding of probiotics, according to Susan Hazels Mitmesser, Ph.D., director of nutrition research at Solgar,
Leonia, NJ. She concurs with the notion that more probiotics in a product does not always equate with more health benefits.
Hazels Mitmesser also explains that not all probiotics are created equal, and that consumers need to understand that different
strains of probiotics have very different health impacts. Likewise, she says, there is no single “magic” probiotic strain that can
cure all ills.
(http://www.thriveprobiotic.com) The manufacturing of probiotics is a delicate process
that requires great care, says Devin. The selection of probiotic strains, the way
the strains are cultured and achieving shelf stability in the end product are all
key elements in making a premium quality probiotic product, he explains.
Due to issues of product stability and formulation, the numbers of probiotic bacteria that can be delivered alive after many
months on the shelf are often exaggerated, says Dallas Clouatre, Ph.D., consultant for R&D to Jarrow Formulas, Inc., Los
Books (/books/new­products)
Angeles, CA. One culprit are the herbal ingredients often combined with
probiotics. Clouatre sasy many herbs and extracts bring high water activity or are
directly toxid to probiotics, thus reducing probiotic shelf life. Green tea catechins
are one example.
Consumers are not positioned to be aware of these issues, and simply rely on
labels and marketing, Clouatre points out. "Therefore, it is at least partly the
responsibility of retailers to educated themselves maintain a level playing field
in which the reality of products match the claims and marketing," he says.
As a category, probiotics are becoming more technical, says Neil E. Levin, CCN,
DANLA, nutrition education manager for NOW Foods, Bloomingdale, IL. Research
into probiotics needs to show clinical efficacy, Levin says. It also must prove that
a given product is bile­ and acid­resistant to ensure that the probiotics can
survive the trip though the gastrointestinal system.
Furthermore, ID testing of probiotic strains and substrains is now standard, so
Levin says to look for labels that detail the specific strains included in the
product. The Latin binomial name for probiotics (like Lactobacillus acidophilus) is
no longer sufficient to indicate which of the hundreds of potential substrains is being delivered. Lactobacillus acidophilus La­14,
for example, is a strain that can have its identity verified. “We can look up those strains in PubMed and find studies proving their
efficacy in human health, so their benefits are real, not merely theoretical,” says Levin.
Michael Bush, senior vice president of Ganeden Biotech, Mayfield Heights, OH, says that when his company owned consumer
brands (now sold by Reckitt Benckiser as the Digestive Advantage brand), it learned about what’s resonating with shoppers in
this market. “We have found that consumers are looking for alternatives to pills and yogurts and are really enjoying being able
to meet their digestive health needs through the daily consumption of products such as kombucha, tea, meal replacement
shakes and bars, trail mixes and frozen desserts,” says Bush.
He adds that there are several primary concerns for consumer packaged goods companies looking to enter the digestive health
space. These include whether the digestive support ingredient they are choosing is generally recognized as safe by the U.S.
Food and Drug Administration (FDA); whether it is supported by published, peer­reviewed science; and if the ingredient supplier
is adequately supporting the brand.
Beckman says the uptick in consumer interest in probiotics has presented an opportunity for products like those sold by his
company. He thinks there is potential for growth in products like functional beverages that can be integrated into a variety of
lifestyles and suit all tastes and needs.
Prebiotic ingredients, which serve as “food” for beneficial bacteria, are also trending, according to Joseph O’Neill, president and
general manager of BENEO Inc., Morris Plains, NJ. O’Neill says the Mintel Global New Products Database shows that prebiotics
are popping up in a range of food and drink categories including infant formula, dairy products, breakfast cereals, baked goods,
ice cream and beverages.
While the average consumer understands the (http://www.afisupplements.com) relationship between traditional fiber and regularity,
Bush says we have a ways to go before the story that prebiotic
fibers are “food” for probiotics is widely understood. “The
prebiotic concept is relatively new and has been found to be
confusing to consumers,” says Bush.
“We have noticed a greater interest in enzymes from consumers,
retailers and the media as more people become aware of the
overall benefits of enzymes, especially for digestive support,” says
Maday Labrador, Ph.D., vice president of education at Enzymedica,
Venice, FL.
These three prongs of the digestive support market (though other
products, such as botanicals, are also important options) were the
primary segments examined in a market report cited by Jay Levy,
director of sales, Wakunaga of America Co., Ltd., Mission Viejo,
CA. The market for prebiotics, probiotics and enzymes is expected
to reach $495.3 million in 2015, and should be enjoying an
estimated compound annual growth rate of 13.2% (1). “This
indicates a very bright future for the supplement industry as well
as for retailers,” Levy says.
Focusing on Heartburn
A recent report says heartburn and indigestion remedies represent the largest and most dynamic corner of the digestive health
market, so retailers should pay it some special attention (2). The solutions of choice for people with heartburn and indigestion
are most often OTC and prescription proton pump inhibitors and antacids. But these can cause unwanted side effects and many
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consumers may simply want to know what else is out there. What solutions does the natural channel offer?
Before we get into the options, it’s important to note that acid is not the enemy. Indeed, acid reflux is seldom due to excess
stomach acid, according to Martie Whittekin, CCN, author, radio host, and member of the scientific advisory board of Essential
Formulas, Irving, TX, makers of Dr. Ohhira’s Probiotics. “We desperately need stomach acid for digestion of protein, the
assimilation of minerals and for triggering the manufacture of B12,” she says.
Heartburn is as common as it is unpleasant, and it can happen to anyone, young or old, male or female, says Trisha Sugarek
MacDonald, B.S., M.S., director of R&D and national educator for Bluebonnet Nutrition Corporation, Sugar Land, TX. Many
experience it for the first time while pregnant. “It can make you feel as though someone has lit a small bonfire in your chest,
and it’s burning its way up to your neck,” Sugarek MacDonald says.
Whittekin says that the acid­blocking medications often advertised on television are only safe to use for a few weeks, and not
over the course of years. In her book on heartburn, she details how long­term use can increase the risks of hip fracture,
dementia and pneumonia (3). Given these issues, moderating heartburn with options like probiotics, enzymes and aloe vera
makes more sense, she says.
(http://www.nowfoods.com) In researching a booklet on aloe vera,
Whittekin says she found that the polysaccharides in the gel can
help heal the lining of the intestinal tract. Good digestive support
supplements, she explains, often contain polysaccharides with a
variety of molecular weights.
One common natural heartburn remedy is calcium carbonate,
which happens to be the active ingredient in many OTC antacids
like TUMs, according to Sugarek MacDonald. She says chewing
calcium carbonate can extinguish the burn in minutes.
Many herbs are thought to quell indigestion. “Herbs like
marshmallow root can soothe an upset stomach,” says Devin.
Sugarek MacDonald lists angelica, caraway, clown’s mustard
plant, German chamomile, greater celandine, lemon balm,
licorice, milk thistle and peppermint. She adds that
peppermint oil may actually worsen heartburn, so it is not a good
option for those suffering from gastroesophageal reflux disease
(GERD). Peppermint tea is beneficial due to its menthol content,
which acts as a kind of anesthetic for the stomach, she says.
Spearmint has similar effects to peppermint, though it is milder.
A combination of a proprietary licorice root extract (GutGard from Natural Remedies) and artichoke leaf extract can relieve
the abdominal discomfort, bloating and fullness of indigestion, says Lifton. He points to a double­blind, placebo­controlled
human study that found GutGard reduced symptoms of occasional heartburn significantly versus placebo (4).
“Chamomile is an herbal tea traditionally used for calming and relaxation, and to help support digestion,” says Gene Bruno, M.S.,
MHS, VMS formulation, Twinlab Corporation, New York, NY. Fennel tea is used to help alleviate bloating and gas. A ginger and
peppermint herbal tea combination can be used to soothe an unsettled stomach, Bruno adds.
According to Sugarek MacDonald, the mechanism behind ginger’s soothing qualities isn’t well understood, but it’s theorized that
compounds in ginger inhibit the aggregation of platelets and stem inflammation by inhibiting the COX­2 enzyme, which can
provide digestive relief.
Turmeric, known for its active ingredient curcumin, has long been used for gastrointesinal support, Levin says.
Combinations of herbs, minerals and enzymes can be effective, according to Labrador. She says her company offers a blend of
enzymes, marshmallow root, papaya leaf, prickly ash bark, gotu kola and zinc carnosine for occasional heartburn and
indigestion. Marshmallow has been found to help normalize mucous secretions, papaya leaf actually contains proteolytic (act on
proteins) enzymes, prickly ash is known to support the tissue of the gastrointestinal tract, gotu kola is rich in B
(http://www.superbakrill.com) vitamins and potassium and is known to support the gastric mucosal barrier. “Zinc carnosine has been
shown to strengthen the mucosal lining of the stomach,” says Labrador. According to Levin, a patented zinc carnosine (PepZin
GI) has been shown to promote a healthy stomach lining and support proper gut repair.
Clouatre says d­Limonene, usually extracted from citrus fruits, has seen use as an alternative to proton pump inhibitors, though
doctors must always be advised before any change in treatment regimen. Another option, according to Clouatre, is extract of
Chinese honeysuckle flower. Combinations of extracts from botanicals like Iberis amara, Matricaria chamomilla, Carum
carvi, Mentha piperita, Glycyrrhiza glabra, Melissa officinalis, Chelidonium majus, Silybum marianum and Angelica archangelica
have also shown benefits, he says..
Levin says that as a potent free radical scavenger, melatonin
protects against oxidative stress throughout the digestive tract. It
can also help support healthy gastric pH levels, support pepsin
production and help regulate intestinal motility.
“A probiotic containing bacillus spores not only helps alleviate the
symptoms of heartburn and indigestion, but it also helps fix the
problem that the symptoms are stemming from,” says Anderson.
Popular OTC products temporarily relieve symptoms, she says, but
do not correct underlying dysbiosis in the gut as bacillus spore­
based probiotics can.
Probiotic Prowess
Health through probiotics. Probiotics are known to be integral
in maintaining overall digestive well­being. Piles of research are
also showing their utility in helping to improve specific digestive
conditions and disorders. Bush believes probiotics should be
viewed through both of these lenses. Maintaining a healthy gut is
especially important because the digestive system is “ground
zero” for many of the body’s most vital functions. In addition,
depending on the strain, Bush says probiotics can help in the
effort to avoid or alleviate specific issues.
Probiotics are among the first supplements people should consider taking, as healthy gut flora is critical to the utilization of all
the food we eat and other supplements we may take, says Devin. If someone happens to be dealing with a condition like
irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), he suggests they consult with their doctor about using
probiotics.
Robert Kay, Ph.D., chief science officer of Renew Life, Palm Harbor, FL says that individuals with conditions like IBS and IBD
should be treated by a gastroenterologist, because they are in fact disease entities. “Their causes can be very serious and only a
well­trained healthcare practitioner is capable of fully diagnosing the problem,” says Kay. Probiotics, he adds, are dietary
supplements and should be consumed by those that want to increase their intake of beneficial microorganisms.
Using an oft­cited figure, Krishnan tells us that over 10 times more bacterial cells are present in the human gut than actual
human cells. Humans in modern societies inflict a daily assault on the friendly bacteria in their gut, he explains. Flouride­
enriched water, antibiotics, excessive sterilization, processed foods, artificial dyes and flavorings, household chemicals,
environmental pollutants, alcohol, smoking and other factors all can disrupt the growth and colonization efforts of probiotics,
says Krishnan, adding that these disruptions directly lead to disease. Levy elaborates on this unfortunate drawback of antibiotic
medication. “Antibiotics, which indiscriminately kill bacteria, are probably the best known threat to your gut’s good bacteria,” he
says.
(http://www.nutraceutix.com) Probiotics should be respected for their ability to reverse
some of this harm and positively impact overall health, Krishnan argues, stating,
“Clearly, other extrinsic factors such as diet play a role, but probiotics are a central
figure in this fight to maintain digestive balance.”
The proper due for probiotics has been more forthcoming lately. “Scientists and
even mainstream medicine are finally giving probiotics the attention and the
respect that they deserve,” says Whittekin. The search for answers to life­
threatening, antibiotic­resistant infections like Methicillin­resistant Staphylococcus
aureus (MRSA) and Clostridium difficile has tacked a sense of urgency onto
probiotic research, she says. Beyond these practical matters, she says scientists
seem to be realizing that microorganism balance in the gut is fundamental to our
health.
The studies that made up the recently concluded Human Microbiome Project
represent some of the most intriguing, cutting­edge science today, says Devin. The
results of this government­funded project show the validity of using beneficial
bacteria to alleviate the suffering of people with various health issues.
The use of prebiotics and probiotics has been critical in the developing world to help those with diarrheal diseases, says
Sugarek MacDonald. Diarrhea that lasts several days can lead to a fatal loss of water and electrolytes, and diarrhea remains a
primary cause of preventable death in children under five, she says. She says a 2010 Cochrane review examined 63 probiotics
trials that included over 8,000 people with infectious diarrhea. It found that those who took probiotics were sick 25 hours less
on average, without any adverse side effects (5).
Research in areas like these is ongoing, and results do not always agree. “The largest and best­designed study to date,
published in The Lancet in 2013, found that probiotics were no better than a placebo in preventing diarrhea in older people
taking antibiotics,” Sugarek MacDonald notes (6).
In order to produce benefits for the body, probiotics play quite a multifaceted role. Hazels Mitmesser says that the complex
ecosystem of intestinal bacteria is involved in a variety of functions: synthesizing vitamins, producing digestive enzymes, aiding
in the absorption of nutrients, maintaining the integrity of the colon lining and supporting the immune system.
According to Levy, they provide protection against harmful microbes, fungi and viruses by producing compounds like lactic acid,
acetic acid and hydrogen peroxide that increase the acidity of the intestines. Probiotics also produce bacteriocin, a natural
antibiotic that kills harmful microorganisms and enhances immunity by boosting disease­fighting cells, he says.
Whittekin calls the beneficial compounds that probiotics produce “postbiotics.” She explains that probiotics begin producing
them after they implant in the digestive tract, find food and multiply. Significant amounts of “postbiotics” can be delivered in
supplement capsules, but only if the probiotic has been fermented for years on a vegetable food supply, she says.
“By consuming high­quality, diverse, high­potency probiotics, a
person enables the digestive system to respond to changes in diet,
stress (which can negatively impact the microbiota), and other
internal insults in a more optimal manner,” says Kay. The digestive
system should be able to counter the microbial pathogens
occasionally found in foods more effectively. In these scenarios,
“good” bacteria coat the digestive tract and help prevent
problematic microorganisms from attaching to the inner gut wall.
The same holds true, Kay adds, for people who travel. The
different foods and microbes in the traveling environment can be
problematic for the digestive system, not necessarily because the
microbes are disease­causing, but simply because they are
different than what the body is accustomed to.
Companies frequently offer a range of probiotic products designed
to provide either general or specific support, says Clouatre. For
example, his company offers serval products (like Jarro­Dophilus
EPS) for broad­spectrum support, along with products like Ideal
Bowel Support 299v for more focused support.
Clouatre points out, however, that the actual research literature on probiotics seldoms makes these distinctions. Instead, it will
include observations and conclusions that meld together general support and alleviation of specific issues. "Indeed, this is an
FDA­constructed dichotomy and not one taken from the research," he says.
A major consequence of this FDA­imposed paradigm is that all of the benefits associated with probiotics don’t necessarily make
it onto the labels of supplements and other products. While manufacturers are restricted from making certain health claims, the
studies backing them up certainly exist, Levin points out. “This creates a gap between what we know and what we can tell
people about our products’ possible benefits, and lessens the opportunity for people to optimize their own digestive health by
knowing how best to restore probiotic balance,” he says. Specific probiotic substrains have shown evidence of reducing gas and
bloating, for example, but Levin says these studies have been done on people with conditions like GERD. Marketers must be
cautious in making label claims to avoid the products being classified as unapproved drugs.
Strain­based support. Each strain or even substrain may deliver health benefits that others do not, Levin explains. The only
way to establish these distinctions is through systematic in vitro and in vivo studies, followed by human clinical trials, he says.
Bifidobacterium lactis HN019, according to Levin, has been clinically validated to support regularity and reduce bloating.
Saccharomyces cerevisiae subsp. boulardii (S. boulardii) has been shown to promote a balanced inflammatory response from
the intestinal epithelium and support overall gut ecology. He says S. boulardii is a yeast that can support digestive health when
the balance of gut flora has been disrupted, and can take up space in the ecosystem of the gut that might otherwise be
occupied by harmful microorganisms like Candida albicans.
Lifton says that a proprietary strain of Bifidobacterium longum (Morinaga BB536 from Maypro), can be of benefit for episodic
complaints like constipation, loose stools and bloating, while also contributing to overall digestive health. A strain of
Lactobacillus acidophilus (DDS­1 from Maypro) has been shown in human, animal and test­tube research to support the
digestion of dairy products, along with other health benefits, according to Lifton.
Top Digestive Support
Others provide us with a few recent samples from the vast body of probiotic
research. Some of the most significant pools of research surround genera
of probiotics like Lactobacillus and Bifidobacteria, according to Bruno. He
cites a study that found a proprietary strain of Lactobacillus reduced
gastrointestinal complaints in male athletes (7).
In a review of five controlled studies published in the World Journal of
Gastroenterology, researchers found that strains of B. lactis and L. casei
American Health: Chewable Probiotics, Liquid
Culture Probiotics, Probiotic Acidophilus with
improved stool consistency and frequency in people suffering from
constipation, says Sugarek MacDonald (8).
Pectin Capsules, Probiotic CD Veg. Tablets,
Bush says his company’s patented probiotic ingredient (GanedenBC30) has
Chewable Papaya Enzymes, Digest HPE Veg.
20 published, peer­reviewed studies behind it that show a myriad of
Capsules, Enzyme Probiotic Complex Veg.
benefits. A recent investigation found the ingredient increased populations
Capsules, Ester­C 1000 mg with Probiotics Veg.
of beneficial bacteria in fecal samples from elderly volunteers (9). The
Tablets.
authors noted that gut populations of beneficial microbes can markedly
Beneo: Inulin, Oligofructose.
Bluebonnet Nutrition Corp.: Betaine Hcl Plus
Pepsin, Dairy­Zymes, Full Spectrum Optimum
Enzymes, Power­Zymes, Super Bromelain 500
mg, Advanced Probiotics Chewable Acidophilus
Wafers, Milk­Free Probiotic Acidophilus Plus FOS
Powder and Vcaps.
Enzymedica: Digest Basic, Digest Gold, Digest
Gold + Probiotics, Digest Spectrum, GlutenEase,
Lacto, PhenolGest, BeanAssist.
Essential Formulas: Dr. Ohhira’s Probiotics
Original Formula, Dr. Ohhira’s Propolis PLUS.
Ganeden Biotech: GanedenBC30.
decline with age.
There is evidence that low levels of beneficial bacteria are associated with
the development of digestive disorders like diarrhea, constipation, Crohn’s
disease, ulcerative colitis and IBS, says Levy. Repopulating the gut with
probiotics can benefit these issues while enhancing the immune system, he
says.
Levy cites a recent meta­analysis of 23 clinical trials involving over 1,700
participants that concluded probiotics significantly increased the remission
rate in patients with active ulcerative colitis and reduced relapses in those
with pouchitis (inflammation of a surgically created ileal pouch) (10). Levy
also points to a 2015 study that suggests probiotics can help reduce
bloating in people using proton pump inhibitors (11).
There is an enormous variety of probiotic strains for which other claims are
made, says Bruno. Research on these proposed benefits is largely in the
early stages, however, and time will tell if they are borne out by further
GoodBelly: GoodBelly Probiotic Juice Drink,
investigation, he adds.
PlusShot, StraightShot, SuperShot.
Consumers should be reminded of the fact that specific strains are tied to
Jarrow Formulas: Jarro­Dophilus EPS, Ultra
specific benefits, and companies must do their part by sufficiently proving
Jarro­Dophilus, Ideal Bowel Support 299v, Jarro­
any claim they decide to make. “Before promoting any one product for a
Zymes, Bile Acid Factors, Inulin FOS,
particular health benefit there must be substantial evidence to support the
Saccharomyces Boulardii MOS, Yum­Yum
claim,” says Beckman. For instance, he says his company’s beverages use
Dophilus.
Lactobacillus plantarum 299v (from Swedish supplier ProBi), which is also
Maypro Industries: Morinaga BB536, DDS­1 L.
acidophilus, Benegut, Colostrum.
used in the most popular probiotic juice product in Sweden. Beckman says
this strain has been proven to survive passage through the stomach’s acidic
environment to support the rest of the digestive system.
NOW Foods: Dairy Digest Complete, Gluten
Digest, Papaya Enzyme Chewable , NOW Protein
Digest, NOW Gluten Digest, NOW Super Enzyme,
NOW Plant Enzymes, NOW Optimal Digestive
System, NOW ChewyZymes, Digest Platinum,
Acid Comfort, DGL Lozenges, Chewable NOW
Ulcetrol, NOW Clinical GI Probiotic.
For their innate ability to survive the harsh gastric environment, Krishnan
says his company turned to spore­based probiotics. They naturally possess
the capacity to make it to the intestines alive and go to work, while other
probiotic products utilize technologies like microencapsulation or enteric
coating to achieve this. Bacillus spores are the most well­known type of
spore­based probiotic, he says, and they have been used in Europe and Asia
as prescription probiotics for over 60 years. They have the dual benefit of
Probium LLC: Probium Probiotics Single Blend
targeting bad bacteria and producing nutrients that allow good bacteria to
6B, Dual Blend 6B, Multi Blend 12B, Ten Strain
flourish, Krishnan explains. “If we were to think of our flora as a very
Blend 50B, Pro­Cran Blend 6B with Crantiva
diverse garden, we can think of spore­based probiotics as the gardener,” he
Cranberry Juice Powder & D­Mannose, Wildberry
says.
Chewable 6B – For Kids 2+.
Prebiotics, too. A trend to keep an eye on is the combination of probiotics
Quality of Life Labs: Peptisol, ProbioPure.
Renew Life: Ultimate Flora probiotics line,
DigestMORE Ultra, CandiZYME, HeartburnSTOP,
IndigestionSTOP, Digest Smart enzyme line.
with prebiotics in single products. Sugarek MacDonald refers to the
resulting combinations as synbiotics, and says this concept has been linked
with benefits for IBD, IBS and a host of other conditions not directly related
to digestion, like allergies. “However, the scientific literature has little to
offer us when it comes to timing the consumption of probiotics in
Solgar Vitamin and Herb: Probi 20 Billion and
combination with prebiotics for digestive health,” she says. While the idea
30 Billion Vegetable Capsules, Comfort Zone
of these combination formulas stands to reason, studies don’t currently
Digestive Complex Vegetable Capsules.
indicate they are necessary, she adds. But, preliminary data does suggest
that synbiotic formulas can have a greater impact on gastrointestinal
Thrive Probiotic: Just Thrive Probiotic and
health than probiotics or prebiotics alone.
Antioxidant.
Some research, like one study cited by Clouatre, has investigated the
Twinlab Corp.: Super Enzyme Caps,
precise combinations of probiotics and prebiotics that may be effective for
Allerdophilus Caps, FiberSol Caps, Betaine HCL
conditons like IBS (12).
Caps, Pancreatin, Mega Bromelain Caps, Colon
“Prebiotics like inulin and oligofructose contribute greatly to digestive
Care.
health and a healthy metabolism,” says O’Neill. They help the body absorb
Wakunaga of America Co., Ltd.: Kyo­Dophilus
more calcium for stronger bones. They can be used for “classic” fiber
probiotics line, Kyo­Dophilus Plus Enzymes,
enrichment as well, helping consumers bridge the common “fiber gap” while
Probiata Digestion Support, Probiata Critical
proving handy to manufacturers as fat and sugar replacements.
Care.
In fact, O’Neill goes on to say, ”Inulin and oligofructose are the prebiotics
with the strongest and widest scientific base.” Their influence on the
composition of gut ecology has been proven in human intervention trials.
They selectively increase beneficial bacteria, especially Bifidobacteria, and sometimes promote Lactobacillus colonies as well.
Fermented inulin and oligofructose have been shown to contain beneficial metabolite profiles, explains O’Neill. Specifically,
they contain short­chain fatty acids, lactic acid and other compounds considered beneficial to digestion.
Enzymatic Action
Digestive enzymes work hand in hand with probiotics, according to Devin. “Enzymes help with breaking the food down and work
in concert with your good bacteria to create co­factors that support the body’s many functions,” he says.
If people are experiencing symptoms like gas, bloating or heartburn after eating certain things, like dairy or protein, Levin says
they may be deficient in the specific enzymes necessary to digest them. Proteins are complicated molecules that take a long
time and multiple enzymes, such as pepsin and trypsin, to digest into free form and peptide­bound amino acids, he says. “By
comparison, carbohydrate and fat absorption are simpler processes,” he says. Pancreatic enzymes including protease (for
protein), amylase (for carbohydrates) and lipase (for fats) work in the neutral pH of the small intestine to release nutrients from
foods. Levin cautions that taking oral pancreatic enzymes can reduce our own natural production of these same enzymes.
Because of these distinctions, Sugarek MacDonald says it’s important to note that shoppers with lactose intolerance,
wheat/gluten intolerance or heartburn would not use the same enzyme formulas. To improve digestive intolerance, she says the
goal is to provide the body with enzymes and/or hydrochloric acid to help the person digest that particular food. Some of these
issues, like lactose or gluten intolerance, can be due to genetics, and these people often benefit from enzyme supplements.
The ability to digest lactose (a sugar found in milk and other dairy products) past infancy and into adulthood is an inherited
genetic trait, Sugarek MacDonald says. Lactose intolerance is therefore not the same as a milk allergy, since the condition
doesn’t involve a faulty immune response or sentence people to a life without dairy food. She says those who, for genetic
reasons, do not synthesize the enzyme lactase, or only do so in small amounts, can benefit from lactase in supplement form, as
well as protease and lipase to help digest the other compounds in dairy.
Gluten­intolerance is a generic term that includes gluten sensitivity, wheat allergy and celiac disease, according to Sugarek
MacDonald. Celiac disease is an autoimmune condition, and its sufferers will not benefit from enzymes in the same way as
those with other conditions. She says that for those with wheat allergy or gluten sensitivity, the recent development of
supplemental enzymes like aspergillopepsin (ASP), dipeptidyl peptidase IV (DPP­IV) and cysteine endoprotease (EP­B2) holds
promise for relief. She adds that these developments may open the door for future studies that could help people afflicted with
celiac.
Aspergillus niger prolyl­endoprotease, according to Clouatre, has been found to support the digestion of occasional or
inadvertent gluten consumption (13).
Enzymes can also help with the digestion of foods that would otherwise aggravate an existing condition like GERD or a peptic
ulcer and trigger heartburn, says Sugarek MacDonald. Heartburn results, she says, when the gut can no longer secrete adequate
hydrochloric acid or protein digesting enzymes. She says her company offers a combination of hydrochloric acid and the enzyme
pepsin to help digest protein so that acid reflux can be avoided.
Some enzymes can be employed to help with occasional digestive upset, or dyspepsia. “One example is the enzyme alpha­
galactosidase, which breaks down the sugars from legumes and other foods that create gas and bloating,” says Labrador. While
enzymes are most often used for cases of dyspepsia and to aid in basic digestion, Levy says some evidence shows they can help
manage more acute conditions. One trial cited by Levy, for example, found that an oral pancreatic enzyme beneficially
influenced the course and outcome of acute pancreatitis (14).
Ideally, food enzymes should be consumed just prior to a meal, according to Kay. This puts them in the best position to assist
our natural digestive processes. “Think of food enzymes as ‘little helpers’ who help us get more out of our food,” he says. This is
especially true for those who don’t chew food adequately (“gulpers”), eat too much in one meal or eat too quickly.
What to look for in a food enzyme product? Kay suggests one that contains proteases, starch­digesting enzymes (a whole class
of enzymes, he says), lipases, fiber­digesting enzymes (several different enzymes) and even sugar­digesting enzymes (again,
several different enzymes).
There are issues attending natural enzyme production that can make supplements a valuable option. Typically, Levy says, we
produce all the enzymes we need. “But, because the secretion of saliva, gastric fluid and pancreatic juice decreases as we get
older, supplementing with these digestive enzymes may be the best way to ensure digestive health as we age,” he says. Some
of the most important enzymes take the hit, according to Hazels Mitmesser. “The production of some digestive enzymes may
decrease with age, including lipase, amylase and lactase,” she says.
Sourcing is also a key consideration for retailers in the enzyme category. Levy says that many enzyme products are currently
sourced from animal sources, such as hog stomach and beef pancreas, but this opens the door to the possibility of viral
infection and contamination.
Labrador says that while animal enzymes like pancreatin and plant­sourced enzymes like bromelain and papain are available,
fungal­sourced enzymes (which are often called plant­based) are the most popular. This is because they’ve been shown to work
in a broad pH range, which is an important factor that defines how long enzymes will remain active in the body.
Levin says that because they can work in a wider pH range, these enzymes can begin digesting fats and carbohydates in the
stomach, rather than wait for pancreatic enzymes to begin their work in the intestines. They add to, rather than replace, our
own digestive capabilities because they don’t produce feedback signals to the pancreas. But while supplemental enzymes can
help us digest foods, Levin says they can’t replace the essential functions of stomach acid, including the release of nutrients
from food and non­chelated minerals.
According to Labrador, a combination approach is best when it comes to enzymes. “Blends of enzymes produce a much more
successful formula for supplementation than a single enzyme product,” she says. WF
See wholefoodsmagazine.com/supplements (http://wholefoodsmagazine.com/supplements) for more coverage of the supplements
category.
References
1. “U.S. Digestive Health Enzymes, Prebiotics & Probiotics Market (2010 – 2015),” MarketsandMarkets, Nov. 2010,
http://www.marketsandmarkets.com/Market­Reports/digestive­health­225.html
(http://www.marketsandmarkets.com/Market­Reports/digestive­health­225.html) , accessed Feb. 28, 2015.
2. “A Bloated Market: Trends and Developments in Digestive Remedies,” Euromonitor, Feb. 2014,
http://www.euromonitor.com/a­bloated­market­trends­and­developments­in­digestive­remedies/report
(http://www.euromonitor.com/a­bloated­market­trends­and­developments­in­digestive­remedies/report) , accessed Mar. 1, 2015.
3. M. Whittekin, Natural Alternatives to Nexium, Maalox, Tagamet, Prilosec & Other Acid Blockers: What to Use to Relieve Acid
Reflux, Heartburn, and Gastric Ailments, (Square One Publishers, New Hyde Park, NY, 2012).
4. K.R. Raveendra, et al., “An Extract of Glycyrrhiza glabra (GutGard) Alleviates Symptoms of Functional Dyspepsia: A
Randomized, Double­Blind, Placebo­Controlled Study,” Evid. Based Complement Alternat Med. 2012, 216970 (2012).
5. S.J. Allen, et al., “Probiotics for Treating Acute Infectious Diarrhoea,” Cochrane Database Syst. Rev. 10(11), CD003048 (2010).
6. S.J. Allen, et al., “Lactobacilli and Bifidobacteria in the Prevention of Antibiotic­associated Diarrhoea and Clostridium Difficile
Diarrhoea in Older Inpatients (PLACIDE): A Randomised, Double­blind, Placebo­controlled, Multicentre Trial,” Lancet 382(9900),
1249­57 (2013).
7. N.P. West, et al., “Lactobacillus Fermentum (PCC) Supplementation and Gastrointestinal and Respiratory­tract Illness
Symptoms: A Randomised Control Trial in Athletes,” 10, 30 Nutr. J. (2011).
8. A. Chmielewska, H. Szajewska, “Systematic Review of Randomised Controlled Trials: Probiotics for Functional Constipation,”
World J. Gastroenterol. 16(1), 69–75 (2010).
9. E.P. Nyangale, et al., “Effect of Prebiotics on the Fecal Microbiota of Elderly Volunteers after Dietary Supplementation
ofBacillus coagulans,” Anaerobe, 30(12), 75–81(2014).
10. J. Shen, Z.X. Zuo, A.P. Mao, “Effect of Probiotics on Inducing Remission and Maintaining Therapy in Ulcerative Colitis, Crohn’s
Disease, and Pouchitis: Meta­analysis of Randomized Controlled Trials,” Inflamm. Bowel. Dis. 20(1), 21­35 (2014).
11. D. Compare, et al., “Lactobacillus paracasei F19 Versus Placebo for the Prevention of Proton Pump Inhibitor­induced Bowel
Symptoms: A Randomized Clinical Trial,” Dig. Liver. Dis. [Epub ahead of print] (2015).
12. A.C. Ford, et al., “Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic
Constipation: Systematic Review and Meta­analysis,” Am. J. Gastroenterol. 109(10), 1547­61 (2014).
13. V. Montserrat, et al., “Influence of Dietary Components on Aspergillus niger Prolyl Endoprotease Mediated Gluten
Degradation,” Food Chem. 174, 440­5 (2015).
14. S. Kahl, et al., “The Effect of Oral Pancreatic Enzyme Supplementation on the Course and Outcome of Acute Pancreatitis: A
Randomized, Double­blind Parallel­group Study,” JOP. 15(2), 165­74 (2014).
Published in WholeFoods Magazine, April 2015