When you eat a meal and still feel bloated, gassy, or like your stomach is sitting like a rock afterward, it’s easy to blame the food. But sometimes, the problem isn’t what you ate - it’s what your body can’t break down. Digestive enzymes are the body’s natural tools for turning food into usable nutrients. When they’re missing or not working right, symptoms like diarrhea, floating stools, or constant discomfort can follow. For some people, enzyme supplements make a real difference. For others, they’re just another expensive placebo. So when do they actually help?

What Digestive Enzymes Actually Do

Your body makes enzymes every day - mostly from your pancreas. Think of them as molecular scissors. Amylase cuts up carbs, protease breaks down proteins, and lipase handles fats. Without enough of these, undigested food moves into your colon, where bacteria feast on it and produce gas, bloating, and loose stools. This isn’t just "indigestion." It’s malabsorption.

Prescription enzyme replacements, like Creon or Zenpep, are made from pig pancreas and contain precise amounts of lipase, protease, and amylase. They’re coated to survive stomach acid so they work in the small intestine where digestion happens. Over-the-counter (OTC) enzymes? Many are made from fungi or plants. They’re cheaper, easier to get, but often less reliable. Some don’t even contain what’s on the label.

When Enzyme Supplements Work - And When They Don’t

If you have exocrine pancreatic insufficiency (EPI), enzyme supplements aren’t optional - they’re life-changing. EPI happens when your pancreas doesn’t make enough enzymes. It’s common in people with chronic pancreatitis, cystic fibrosis, or after pancreatic surgery. Studies show prescription enzymes reduce fatty stools by 70-85% in these patients. One Reddit user, u/PancreasWarrior, said after starting Creon: "I went from losing 20 pounds in 3 months to eating normally again. It’s not a supplement. It’s medicine." But EPI only affects 1-5% of the general population. Most people with digestive issues don’t have it.

For those with lactose intolerance, a simple lactase enzyme (like Lactaid) works well. About 82% of users report being able to eat dairy without symptoms. That’s solid science.

For IBS? The picture is murkier. Some people find relief from OTC enzymes like Digestive Gold. Dr. Russell Havranek, a gastroenterologist, recommends them as a first step for IBS-related bloating and gas. In one 2021 study, OTC enzymes reduced symptoms in 50-60% of IBS patients. But another 2022 survey found 41% of IBS users quit within three months because they didn’t feel better.

Here’s the catch: if your symptoms are caused by small intestinal bacterial overgrowth (SIBO), adding enzymes can make things worse. More undigested food = more fuel for bad bacteria = more bloating. That’s why self-treating without a diagnosis can backfire.

Prescription vs. Over-the-Counter: What’s the Real Difference?

| Feature | Prescription PERT (Creon, Zenpep) | OTC Enzymes (NOW Foods, Enzymedica) | |---------|----------------------------------|-------------------------------------| | Enzyme Source | Porcine (pig pancreas) | Fungal, plant, or bacterial | | Lipase per capsule | 10,000-40,000 units | 10,000-20,000 units (often less) | | Enteric coating | Yes - survives stomach acid | Usually no - breaks down in stomach | | Dosage consistency | FDA-regulated, exact amounts | 20-30% batch variation; 15-25% underdosed per ConsumerLab | | Cost per dose | $1.50-$3.00 (often covered by insurance) | $0.50-$1.00 | | Proven for EPI | 70-85% effective | 30-40% effective | | Proven for IBS/lactose | Limited evidence | 50-60% symptom reduction in some studies | Prescription enzymes are drugs. OTC enzymes are supplements. That means the FDA doesn’t require OTC brands to prove they work before selling them. In 2022, the FDA issued 12 warning letters to enzyme companies for making false claims like "boosts metabolism" or "detoxifies the gut." Those claims aren’t just misleading - they’re illegal.

How to Use Enzymes Right (If You’re Going To)

If you’re trying enzymes, timing matters more than the brand. Take them right before you eat - not 30 minutes before, not after. The goal is to have them in your small intestine when food arrives. If you’re a slow eater, split the dose: take half at the start of the meal, half halfway through.

Start low. Begin with 10,000 lipase units per meal. Wait a week. If symptoms don’t improve, increase by 10,000 units. Most people find their sweet spot between 25,000 and 50,000 units per meal. Don’t go over 80,000 unless your doctor says so.

Also, pay attention to fat. Lipase needs to match your fat intake. One gram of fat needs about 500 lipase units. A cheeseburger? You’ll need more than a salad. Keep a simple food and symptom log for two weeks. Note what you ate, when you took enzymes, and how you felt.

Who Should Avoid Enzymes?

Don’t use them if you have acute pancreatitis. Enzymes can trigger more inflammation. Also, avoid them if you’re on proton pump inhibitors (PPIs) like omeprazole without talking to your doctor. Stomach acid helps activate some enzymes. If you’ve lowered your acid too much, the enzymes might not work right.

People with allergies to pork should avoid prescription enzymes. There are plant-based alternatives, but they’re harder to find and often less effective.

And if you’re taking them because you think they’ll help you lose weight? That’s a myth. No study shows enzymes boost metabolism or burn fat. That’s marketing, not science.

What to Do If You’re Still Not Sure

If you’re regularly bloated, gassy, or have oily stools that float, see a doctor. Get tested for EPI with a fecal elastase-1 test. It’s simple, non-invasive, and covered by most insurance. If that’s negative, ask about SIBO testing or food intolerances.

Don’t treat symptoms without knowing the cause. Enzymes can mask problems like celiac disease, Crohn’s, or even pancreatic cancer. Early diagnosis saves lives.

The Bottom Line

Digestive enzyme supplements aren’t magic pills. But they’re not useless, either. For people with EPI or lactose intolerance, they’re essential. For others, they might help - but only if used correctly and with realistic expectations.

If you’re considering OTC enzymes, choose brands that have been independently tested (like those certified by ConsumerLab or USP). Avoid anything promising "detox," "weight loss," or "gut healing." Stick to the basics: protease, amylase, lipase, and maybe lactase if dairy bothers you.

And remember: if symptoms persist after a few weeks, stop. Talk to a doctor. There’s probably a better explanation - and a better solution - than another bottle of pills.