Whether instinct or intuition, one’s gut reaction is often a guide to making the right decisions. In addition, the gut’s reaction is essential to making sure the body is fed. For many, eating is a simple action of chewing and swallowing. To others, constipation, diarrhea and gas are among the most common nuisances of having a digestive issue tied to this simple routine. While supplements cannot cure or treat diseases, with more than 70 million Americans plagued by a digestive condition, it’s important to stay current with the different options that may help customers feel better (1).

Common ConditionsTrue to the saying, you are what you eat, everything ingested into the GI tract has an impact on the body. And for those suffering from a gastrointestinal infection this particular saying rings true. Caused by a variety of microorganisms that include: salmonella, E. coli, rotavirus and more, gastrointestinal infections can be either bacterial, viral or the result of a parasite. Symptoms linked with gastrointestinal infections are abdominal pain, vomiting and diarrhea.

Chronic constipation is another condition that leads to several days without a normal bowel movement. The condition typically occurs from the colon being unable to pass or move stool through the digestive tract. For those suffering with the condition, symptoms may include bloating, fewer yet painful bowel movements and abdominal pain.

Another digestive condition is irritable bowel syndrome (IBS). While causes of IBS are unknown, an estimated 10 to 15% of people worldwide suffer from IBS and have symptoms such as constipation, diarrhea, and hard, dry stool (2).

Feeling a burning pain in the middle of your chest at night? If so, this may be a condition called acid reflux, in which stomach acids back up into the esophagus. This common condition happens to everyone once in a while, but if symptoms seem to occur at least twice a week or have started to affect your daily routines, then this could be a sign of gastroesophageal reflux disease (GERD), a chronic digestive disease that affects 20% of Americans (3).

A common condition that can affect anyone of any age is inflammatory bowel disease (IBD), a chronic inflammation that affects all or part of the digestive tract. Two primary types of IBD include:

Crohn’s disease: An incurable condition that can affect any part of the digestive tract, but most commonly affects the terminal ileum, a connector between the end of the small bowel and the start of the colon. According to the Crohn’s & Colitis Foundation, 780,000 Americans are affected by Crohn’s and suffer from symptoms that include diarrhea, weight loss, abdominal pain, rectal bleeding and pain. While the cause of the disease is unknown, genetics and family history are said to play a likely part.

Ulcerative colitis: An incurable condition that affects the inner lining of the large intestine (colon) and rectum. According to the Crohn’s & Colitis Foundation 907,000 Americans suffer from this disease, which includes symptoms such as abdominal cramps, pain, rectal bleeding, and blood in stool.

Why the Digestive System Can Be ProblematicOne factor in particular is age. As we grow older, our stomachs begin to produce less acid (4). Without such acids as hypochlohydria, taking certain medications and even ingesting certain foods can become harder. Additionally, like the muscles throughout the body, researchers theorize that the muscles in the GI tract — along with the esophagus and bowel — slow down, leading to increased symptoms such as acid reflux and constipation (5). “Our gut microbiome is also susceptible to changes as we age,” says Hannah Braye, NT (DipCNM, BANT, CNHC), technical advisor, Protexin, Somerset, United Kingdom. “Excessive growth of certain unbeneficial bacteria and yeast and a depletion of beneficial bacteria become more common.”

Another cause that affects everyone at any age is stress. “Stress has been shown to increase intestinal permeability/leaky gut, which then causes chronic immune activation in the mucosa,” says Kiran Krishnan, microbiologist, Just Thrive Probiotic, Park Ridge, IL. “This chronic immune activation is a major source of intestinal inflammation and a major driver of food intolerance as well. In addition, stress increases the production of epinephrine and norepinephrine and these hormones can cause changes in your gut flora, including increasing virulence of pathogenic bacteria and viruses.”
 In many cases enzyme supplementation may be more useful than dietary changes.

— Michael T. Murray, N.D., Enzymedica
Since our gut is also considered our second brain and has been officially named the enteric nervous system (ENS), Alan Cheung, executive director, Belle and Bella, Lexington, MA, says stress can cause the two thin layers of over 100 million nerves cells lining the GI tract (from esophagus to rectum) to trigger a digestive condition. Jay Pasricha, M.D., director, John Hopkins Center for Neurogastroenterology agrees. He has conducted several studies that found evidence the GI tract may send signals to the central nervous system, triggering an emotional shift that may contribute to one’s digestive problem (6).

“One’s pH also plays an important role in the body’s intracellular activity, as well as the way our body uses enzymes, minerals and vitamins,” says Naeem Shaikh, vice president, research and innovation, National Enzyme Company, Forsythe, MO. Because the “human digestive tract is acid in nature and is not constant as in each zone of increasing acidity, there lay different digestive enzymes and beneficial microbes,” adds Shaheen Majeed, president, Sabinsa Worldwide, based in East Windsor, NJ. “[When the] pH of the digestive system gets disturbed it may hinder absorption of protein, fat, vitamins and minerals and also makes a person infection-prone. However, supplementation with digestive enzymes and probiotics can help balance the pH of the digestive system.”

Digestive EnzymesProtein, fat and carbohydrates are typically what our diets are made of. When food enters our digestive tract, “digestive enzymes are produced and secreted by the gastrointestinal system (from the mouth to the intestines) to degrade fats, proteins and carbohydrates, allowing us to absorb their nutrients,” says Braye. “Problems can occur when there is a dysfunction in the ability of the pancreas and other organs to produce enzymes or the body’s demand for enzymes exceeds the supply. If we do not produce enough digestive enzymes, incomplete digestion of food can result in digestive problems such as bloating, diarrhea, stomach pains and cramps.”

Normally, supplemental digestive enzymes contain amylase (present in saliva), lipase (a butter fat enzyme), cellulases (breaks down simple sugars) and protease (breaks down protein) (7). In addition to these enzymes, digestive enzyme supplements will sometimes also contain bromelain (breaks down protein), glucoamylase (breaks down sugar), lactase (breaks down lactose), diastase (breaks down starch into sugar), papain (breaks down proteins), and invertase (breaks down sugar), to help increase the amount of food broken down so that food can pass into the colon and is then better available for absorption (7).

Important factors that all retailers and consumers looking for a digestive enzyme should keep in mind are the origins of the digestive enzymes. According to Majeed, “Enzymes are isolated from a variety of sources, such as the pancreas of higher animals (e.g. swine and cattle), from vegetables and microorganisms, including bacteria and fungi.” If having a non-animal source is important, then retailers and consumers must consciously seek one out.

Before picking out the best origin that matches one’s lifestyle, the first step is to identify if the problem you’re facing can be helped by digestive enzyme supplementation. Michael T. Murray, N.D., chief science office, Enzymedica, Venice, FL, believes “not only can digestive enzyme supplementation make the dietary approaches to food intolerance work better; in many cases enzyme supplementation may be more useful than dietary changes.” As an example of why those with a food intolerance could benefit from a digestive enzyme, Murray uses lactose, a sugar in milk that is broken down by the enzyme lactase, [which is] produced in the small intestine. “If the lactose is not broken down by the enzyme lactase it can produce a lot of gastrointestinal symptoms especially gas, bloating, cramping pain, and diarrhea, explains Murray. “Taking supplemental lactase enzyme can help digest the lactase and allow people with lactose intolerance to eliminate these symptoms of food intolerance. Keep in mind, however, that many people who are lactose intolerant also have trouble breaking down milk proteins as well. Therefore, products that combine lactase with protein digesting enzymes (proteases) are usually a much better choice.”

However, lactose is not the only food intolerance that a supplemental digestive enzyme can support. Murray also states that those suffering from a gluten intolerance may also benefit due to a blend of the enzymes protease and dipeptidyl peptidase (DDP-IV). These two key enzymes have the ability to target casein and gliadin and eliminate the proteins, which in turn may help reduce discomfort.

Though reading the product label and/or experimenting may be the best way to determine when the optimal time will be to take a supplemental digestive enzyme, Braye suggests since digestive enzymes spring into action when in contact with food, then “for digestive purposes, taking them at the beginning or just before a meal is advisable.” Of course the composition of the capsule may also affect the timing, so Braye believes those taking vegetable-based capsules should consume them around 30 minutes before eating (so the capsule has time to dissolve). However, since gelatin capsules tend to dissolve immediately, taking one right at the start of a meal is best.

Probiotics Probiotics — live bacteria and yeast that are naturally found in your body — have certainly gained popularity in recent years, though these friendly bacteria are nothing new. While probiotic actions are wide-ranging, essentially they act to “aid in balancing the flora, lower the pH of the intestinal tract, reduce intestinal inflammation, and aid in digestion by producing enzymes that break down food,” says Krishnan.

The most common strains of bacteria in use in probiotics are: • Lactobacillus: A bacteria normally found in the genital-, digestive- and urinary systems. Commonly used to ease diarrhea (8). • Bifidobacterium: A group of bacteria found in the intestines and used to ease ulcerative colitis symptoms as well as pouchitis. (9 ). • Saccharomyces boulardii: A yeast commonly used to treat general digestive problems such as IBS and IBD.

When choosing a probiotic, the most common concern today will be with the amount of bacteria in each formula, which is referred to as the colony forming unit (CFU) count. However, according to Trisha Sugarek MacDonald, BS, MS, senior director of research & development/ national educator, Bluebonnet Nutrition Corp., Sugarland, TX, this should not be the priority. Instead, the quality of the probiotic and the specific strains application should be. When starting the process of picking a probiotic, MacDonald believes it’s important to look at these specific features: • Scientifically Supported Probiotic Strains: With multiple strains of just a single probiotic and different probiotic bacteria that are not only specific to a certain age group, but also to a specific gender, finding a probiotic that has been shown to scientifically provide the benefits one is searching for is crucial. • DNA-Verification: DNA identification is the best way to ensure that the specific probiotic needed is the exact one being supplied. • Symbiotic Probiotic Strains: Since there are more than one strain in a formula of probiotics, compatibility is essential, due to one strain working more effectively than another or even complementing one another while in the body. • Made to Survive: Looking for probiotics with advanced technologies, such as freeze-dried strains, which help protect the integrity of the probiotic, will ensure the probiotic is protected from conditions such as the acidity of the GI tract and reach the small intestine without difficulty.

Since each strain is unique and interacts differently in each formula, would a probiotic’s potency change depending on whether it is refrigerated or shelf stable. To answer it simply, Robert Dadd, master herbalist and product information supervisor, Flora, Inc., Melville, NY says, “It’s mainly convenience – especially when travelling.” Concurring with Dadd, David Keller, vice president, scientific operations, Ganeden Inc., Mayfield Heights, OH also believes “Because probiotics were previously only found in refrigerated products or supplements, many consumers (and even manufacturers) still assume they must stay refrigerated or be encapsulated.”

When using a probiotic for the first time, Krishnan points out that an effective probiotic typically works a couple of hours after ingestion. Since most probiotics do not colonize in the gut, instead “move out at the speed of food,” Krishnan says, then taking a probiotic at the same time of a meal would be optimal.

Prebiotics and FiberPrebiotics, not to be confused with probiotics, are non-digestible carbohydrates that pass through the small intestine and instead reach the large intestine (colon) where they become a source of fuel for probiotic bacteria, such as Lactobacilli and Bifidobacteria. “Due to this, bacterial mass and water content of the feces increase,” says Jon Peters, president, Beneo, Morris Plains, NJ. ”This leads to softer and regular stools, but not diarrhea.” The most common type of prebiotic is from the soluble dietary fiber inulin, which is found in many vegetables such as garlic, onions, and artichokes. When ingesting, Peters suggests taking the formula with a meal or in-between, due to prebiotics’ ability to stay intact during the normal digestion process, yet being able to break down while in the colon. This allows the prebiotic to start working as food is being digested. As for how long before results are seen, “the influence on the microbiota composition starts on day one with measurable outcomes after about one week of adaptation of the microbiota,” Peter explains.

One prebiotic fiber that may be especially helpful is psyllium, a soluble fiber commonly used as a bulking agent in laxatives. According to Fred Jung, CEO, Yerba Prima, Dryer, IN,“Psyllium cleanses the digestive system and in doing so, promotes better absorption. It also helps lower cholesterol, helps cleanse the circulatory system and promotes balance throughout the body.” This may be due to psyllium’s ability, when in contact with water, to swell and form a gelatin-like mass that can help carry waste out of the intestinal tract (10). While studies have been conflicting, several — such as the 2009 randomized placebo controlled trial, titled “Soluble or Insoluble Fibre in Irritable Bowl Syndrome in Prmary Care?” published in the British Medical Journal, found out of 275 patients, aged 18-65, those taking psyllium found a significantly greater response while using psyllium.

HerbsThe root or rhizome of ginger has been a popular herbal medication for various ailments. In particular, ginger is known for its ability to calm an upset stomach, nausea and diarrhea. According to the University of Maryland Medical Center, researchers believe the volatile oils and pungent phenol compounds, such as shogaols and gingerols, are the active components that help relieve these symptoms. Shaikh says, “Gingerol-related derivatives may be attributed to increased mucosal prostaglandins synthesis in the gut wall. Endogenous prostaglandins are known to play a crucial role as mediators of mucosal protection.”

Often used to treat headaches and nausea, peppermint is also used as an ingredient to help treat diarrhea and abdominal cramps. Researchers suggest two main ingredients in peppermint — menthol and methyl salicylate — have an antispasmodic (muscle spasm suppressant) effect, which can calm the GI tract (11).

For thousands of years, Chamomile has been used to treat conditions including sore throats, anxiety, insomnia, minor burns, stomach ulcers and digestive problems. These include gas, acid reflux symptoms, nausea, diarrhea and more. In a 2006 review of studies, chamomile was seen as quite effective in helping those with acid-reflux, though the extract was not the only herb in the particular study (12). Other herbs, fruits and plants in the study included greater celandine herb, licorice root, peppermint leaf, lemon balm leaf, bitter candy tuft, caraway fruit, angelic root, and milk thistle fruit.WF

References1. American Nutrition Association, “Digestive Issues,” http://americannutritionassociation.org/newsletter/digestive-issues, accessed July 28, 2017. 2. International Foundation for Functional Gastrointestinal Disorders, “Facts About IBS,” https://aboutibs.org/facts-about-ibs.html, accessed July 28, 2017. 3. U.S. Department of Health and Human Services, “Definitions & Facts for GER & GERD,” https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts, accessed July 28, 2017. 4. Britton, E., et al., “Aging and the gut.” Proc Nutr Soc. 2012 Nov 12:1-5. 5. Didier Remond, et al., Understanding the Gastrointestinal Tract of the Elderly to Develop Dietary Solutions That Prevent Malnutrition,”Oncotarget, Jun 10; 6(16): 13858–13898. (2015) Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546438/, accessed July 28, 2017. 6. The John Hopkins University, “The Brain-Gut Connection,” http://www.hopkinsmedicine .org/health/healthy_aging/healthy_body/the-brain-gut-connection, accessed July 28, 2017. 7. Science Learning Hub, “Digestive Enzymes,” https://www.sciencelearn.org.nz/resources/1840-digestive-enzymes, accessed July 28, 2017. 8. “Lactobascillus.” https://medlineplus.gov/druginfo/natural/790.html. 9. “Bifidobacterium.” https://medlineplus.gov/druginfo/natural/891.html. 10. University of Maryland Medical Center, “Psyllium,” October 19, 2015. http://www.umm. edu/health/medical/altmed/supplement/psyllium, accessed July 28, 2017. 11. University of Maryland Medical Center, “Peppermint,” July 6, 2017. http://www.umm. edu/health/medical/altmed/herb/peppermint, accessed July 28, 2017. 12. Janmejai K. Srivastava, et al., “Chamomile: A Herbal Medicine of the Past with Bright Future,” Molecular Medicine Reports. Nov 1: 3(6): 895-901. (2010) Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/#R54, accessed July 28, 2017.

Published in WholeFoods Magazine September 2017