If you watch the TV ads, you might think that a good probiotic is the answer for all your digestive problems. Don’t believe it.

While it is true that probiotic supplements can help relieve gas and diarrhea—and boost your immunity—when your intestinal bacteria are out of whack, that’s not always the issue.

Perhaps your gut has plenty of “friendly” bacteria, but you are still plagued by gut-related problems such as flatulence, heartburn, lactose intolerance, diarrhea or abdominal pain. What then?

It is time to think about taking digestive enzymes.* These supplements not only help relieve the digestive problems described above, they can also have powerful healing effects for other ailments, such as arthritis and sinusitis, that have nothing to do with the digestive system.

When to consider taking a digestive enzyme—most are available at drugstores or health-food stores…

TIME FOR DIGESTIVE ENZYMES

  • Flatulence. Most people have heard of the over-the-counter flatulence preventive known as Beano, but they do not necessarily know how it works. This product is actually a digestive enzyme called alpha-galactosidase. Taken just before consuming gassy foods, such as cabbage, beans, cauliflower and broccoli, it breaks down some of the complex carbohydrates into easily digestible sugars, thus preventing intestinal gas.
  • Heartburn. I have seen some great responses in patients with frequent heartburn who take digestive enzymes along with—or instead of—over-the-counter remedies such as Tums with calcium, which tightens the valve between the stomach and esophagus. It is not clear how these enzymes help. It is possible that they deactivate some of the body’s pepsin, a stomach enzyme that plays a crucial role in digestion but that surges upward from the stomach in some patients, damaging tissue in the esophagus. This is what causes the “burn” in heartburn.
    What to try: A blend that includes different enzymes, such as lipase, protease and amylase. Some good products include AbsorbAid powder, Botanic Choice Digestive Enzyme Complex and Twinlab Super Enzyme Caps.

    How to use it: Take the supplement with or just after meals.

  • Dairy Sensitivity. It’s estimated that up to 50 million Americans have symptoms of lactose intolerance, a sensitivity to dairy foods that can cause bloating, gas, cramps and other digestive problems. Humans are born with high levels of lactase, the enzyme that is required to digest a sugar (lactose) in dairy foods. But the levels drop in the first years after birth, so by adulthood, many people don’t have enough lactase to comfortably digest dairy.

    What to try: Supplemental lactase will replace the enzyme that’s missing from the intestine. People who take lactase supplements can usually enjoy dairy foods without discomfort.

    How to take it: Chew or swallow a tablet just before eating dairy…for milk and other liquidlike dairy, you can use lactase drops if you prefer. Yet another option: Lactaid Milk, which comes with added lactase.

  • Gluten Intolerance. If you are one of the millions of Americans who is sensitive to gluten, a protein that is contained in wheat, barley and rye, you already know that a simple slice of bread or a bowl of wheat cereal can lead to hours of digestive problems, such as diarrhea, stomach cramps and flatulence.

    Important: Many people who think that they’re gluten-intolerant actually have fructose malabsorption, which occurs when the small intestine can’t absorb fructose, a plant sugar. Get checked by a doctor before assuming that gluten is the problem. Fructose malabsorption is typically diagnosed with a hydrogen breath test—after ingesting a fructose solution, the amount of hydrogen in your breath is measured. An increase in hydrogen means that the fructose has not been properly digested.

    What to try: If you are sensitive to gluten, you can try taking a supplement such as GlutenEase, which contains a blend of protease enzymes. You might be able to eat small amounts of wheat and other gluten-containing foods without discomfort.

    How to use it: Take one capsule with meals. Double the dose if one capsule isn’t effective.

    If your gluten sensitivity is caused by celiac disease: Don’t depend on any supplement. Patients with celiac disease must avoid even trace amounts of gluten, and supplements are unlikely to help.

RELIEF FOR OTHER PROBLEMS

  • Arthritis. A study published in Clinical Rheumatology found that a European product known as Phlogenzym, a blend of the enzymes bromelain and trypsin and rutosid (a flavonoid), was as effective at treating osteoarthritis of the knee as a commonly prescribed anti-inflammatory drug. Researchers believe that this particular mix of enzymes may help with all forms of osteoarthritis.

    What to try: Consider buying Phlogenzym online from a European pharmacy. Take two capsules three times daily, on an empty stomach. Phlogenzym’s major ingredients—bromelain, trypsin and rutosid—also can be found in US health-food stores. Follow dosage instructions on the product .

    Caution: If you take these enzymes for arthritis relief, be sure to do so only under the supervision of a physician. In some individuals, the protein-digesting components can damage the lining of the stomach.

  • Sinusitis. Bacterial sinusitis usually responds to antibiotics, but some people can have chronic sinusitis that lasts 12 weeks or more—even when they are taking medication.

    What to try: Bromelain or other protease enzymes (with protease or trypsin on the label). They are not a replacement for antibiotics if you have a stubborn bacterial infection, but they can help to reduce inflammation and discomfort while the infection is active and even while you are taking an antibiotic.

    How to take it: Follow the directions on the product label. The dosing directions will depend on the specific enzymes, concentrations, etc.

IT’S NOT WHAT YOU EAT—IT’S HOW YOU EAT

If your gut acts up during or after a meal, you may want to change how you eat before trying a digestive enzyme. What to do…

  • Eat slowly and chew your food well. This gives the enzymes in your saliva a better chance to start breaking down your food before it reaches your stomach.
  • Enjoy your food and relax. People who are stressed have an increase in dopamine and adrenaline, hormones that inhibit normal digestion.

    Be aware of any tension you feel in your body…relax your shoulders and jaw…and breathe slowly (your abdomen should expand and your chest should not rise when you breathe in).

  • Take a walk after eating. It increases metabolism and helps you digest more efficiently. It also stimulates motility, the intestinal movements that move food (and wastes) through your system. Walk for at least five minutes—a leisurely pace is fine to promote digestion.

WHAT ARE DIGESTIVE ENZYMES?

Digestive enzymes are present in saliva, the stomach and the small intestine. Their job is to break down the food you eat into smaller components.

After about age 50, the pancreas produces only about half the amount of digestive enzymes that it did when you were younger. Some individuals find that they have less gas, bloating or fullness when they take an enzyme supplement during or after meals.

*Digestive enzymes are generally safe, but check first with your doctor if you have a chronic condition or regularly take any medication or supplement.