In my years of practicing as a naturopathic physician who specializes in digestive health, the two supplements I see confused most often by patients are probiotics and digestive enzymes. While these supplements can both be very helpful in treating uncomfortable GI symptoms, they actually have very different actions in the body. Today I want to break down the difference between these two supplements and talk about why people might need each type.
Probiotics:
Probiotics are typically the first thing patients try at home when they are having digestive discomfort. Probiotics are beneficial bacteria that colonize the large intestine (aka colon). Our large intestine is home to an estimated 38 trillion bacteria (1). In healthy people, the bacteria present live in harmony with the body and provide significant health benefits. But if this healthy flora gets killed off, there are now “empty parking spaces” along the intestinal lining that can be filled by pathogenic (bad) bacteria. When this happens, we now have a condition called intestinal dysbiosis.
What kills off our good flora? It turns out quite a few things. The top-ranking killer of beneficial bacterial is of course antibiotics. While antibiotics are sometimes necessary, they often kill off most of our good bugs when killing the bad bugs they were prescribed for. This is why I always recommend patients use a high-potency and broad-spectrum probiotic after taking an antibiotic. This can often prevent a host of severe illnesses down the road. Other things that can lead to intestinal dysbiosis are (2):
- Eating a diet without a variety of fibers, fruits and vegetables
- Lack of intake of prebiotic fibers (food for the probiotics)
- High alcohol intake
- Gastrointestinal infections
- Lack of physical activity
- Smoking
- Stress
- Poor sleep quality
While probiotics are often a critical part of treating intestinal dysbiosis, they are often not strong enough to kill off the existing bad bacteria that are occupying their “parking spots”. I find that many patients need to start with herbs and supplements that are antimicrobial (bug killers) first, and then fill in those empty spots with probiotics once the bad bacteria are gone.
Enzymes:
While probiotics primarily function at the end of the intestinal tract, digestive enzymes function at the beginning. When we eat food, our stomach, pancreas, and gallbladder increase their production of enzymes. The function of these enzymes is to break down food into small particles that can then be absorbed in the small intestine.
If we don’t put out enough enzymes when we eat, food will move into the small intestine while it is still in large peices. These large particles are too big to be properly absorbed. This can lead to uncomfortable symptoms like gas, bloating, reflux, and even malnutrition if the problem is bad enough. Many of my SIBO (small intestinal bacterial overgrowth) patients have low digestive enzyme output. This creates a perfect environment for pathogenic bacteria to take root: low acid levels fail to kill bacteria that enter through the mouth when we eat, and low pancreatic enzymes allow food to pass through undigested and feed these bacteria instead of us.
What causes low digestive enzyme output? While we don’t fully understand this condition, here are some things that we know that decrease digestive enzyme production (3):
- Stress
- Aging
- Intestinal surgeries
- Celiac disease
- Inflammatory bowel disease
- Diabetes
- Chronic pancreatitis
I find very often patients who really need digestive enzymes are taking probiotics instead, and often they are getting very little relief from this. This is why it can be very helpful to work with a physician who is skilled in gastrointestinal diagnosis. Once we identify the underlying cause of your symptoms, we can carefully choose medications and supplements that will have the best chance of successfully treating your specific condition.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington, Oregon, and Arizona using telemedicine. For more information, visit our contact page or schedule a free 15-minute consultation online.