There are many digestive enzyme supplements out there but which ones are the best and what is the best way to use them? In this article, I’ll be covering my 3 favorite digestive enzyme supplements and the way I use them in my practice. I’ll also dispel some of the myths and misconceptions about digestive enzyme supplements.

Digestive enzymes are an important part of my practice because most of my patients have gut issues that are connected to their thyroid and autoimmune problems. I have found them to be a vital part of my gut healing protocols. Let’s jump in and cover the details of each product I recommend.

Betaine HCL

Supplemental betaine HCl helps to optimize hydrochloric acid levels in people with low stomach acid and can help to improve digestive function and comfort in patients of all ages. Many symptoms of digestive distress such as acid reflux, heartburn, gas, bloating or nausea after eating may be due to abnormally low or non-existent gastric acid secretion (hypochlorhydria and achlorhydria, respectively.) Endogenous HCl production naturally decreases with age but other factors such as illness, highly processed and acidic diets, overuse of antacids and high stress physiology in general may impair the body’s ability to generate healthy HCl levels. In addition to impaired digestion, hypochlorhydria has been associated with bacterial overgrowth, enteric infection, low vitamin B12 levels and an increased risk of gastric neoplasms.

Hydrochloric acid is secreted by parietal cells in response to the presence of food in the stomach. HCl activates the conversion of pepsinogen to pepsin, an enzyme required for the digestion of proteins. Gastric HCl also works directly on protein molecules to assist in their breakdown and helps to separate nutrients from their carrier compounds (e.g. releasing vitamin B12 from protein molecules, and cleaving calcium from carbonate.) By helping to support efficient breakdown of proteins, betaine hydrochloride can help to prevent large peptide molecules from entering the intestines where they may contribute to inflammation and leaky gut pathologies.

Adequate HCl levels in the stomach also help to minimize food sensitivities. In one study, 25% of patients taking acid-lowering drugs for dyspeptic disorders exhibited increased IgE formation towards commonly ingested foods. The same study suggested that food allergenicity could be reduced up to 10,000-fold by enhanced gastric digestion.

Gastric hydrochloric acid plays a role in immune defense by destroying foodborne pathogens and microbes such as Helicobacter pylori, implicated in the pathogenesis of stomach ulcers. Although stomach ulcers are typically associated with excess acid production and treated with acid-blocking drugs, insufficient gastric HCl may, in fact, be a predisposing factor in ulcerative pathology. H. pylori is, of course, only one biological organism that multiplies in the absence of sufficient gastric HCL levels. Many species of bacteria and fungi overpopulate in the high gastric pH environment caused by low hydrochloric acid production, contributing in turn to a variety of metabolic and dysbiotic symptoms both within and beyond the digestive tract.

Based on molecular weight, Betaine HCl is composed of 76.26% betaine and only 23.74% HCl. Hence we propose that the betaine component of the supplement may play a key role in its functionality. Nutritionally, betaine (also known as trimethylglycine) is obtained from beets and other sources—either as betaine directly or as synthesized endogenously from choline-containing foods. By serving as a methyl donor, betaine helps to support proper liver function, cellular replication and liver detoxification. Betaine also serves as a critical cofactor in the conversion of homocysteine to methionine. Betaine is well known to help reduce high homocysteine, associated with increased risk of Alzheimers and cardiovascular disease.

Patients with sub-optimal thyroid function may also benefit from supplementation with Betaine HCl, since thyroid hormones play an important role in the regulation of methyl group and homocysteine metabolism. Research suggests that decreased hepatic betaine-homocysteine S-methyltransferase, the betaine-dependent enzyme that catalyzes folate independent remethylation of homocysteine, may be a cause of T(3)-mediated hyperhomocysteinemia. In addition, high cortisol levels have been negatively associated with plasma betaine concentrations while increased dietary betaine intake has been suggested to reduce systemic inflammation.

I usually have patients take 1-2 capsules with each meal. Some patients do best taking 3 with each meal as long as this doesn’t cause any burning or stomach discomfort.

Pancreatin Select

Pancreatin Select provides synergistic support for enhanced digestive function with meaningful levels of pancreatic enzymes and lipase plus Betaine HCl, Ox Bile and two high quality researched and traditional herbal bitters: Artichoke and Gentian. This suite of ingredients works together to help support the complete digestion of proteins, carbohydrates and fats, and to help promote digestive ease, comfort and functionality within both gastric (stomach) and intestinal environments.

Of the many factors that contribute to compromised digestive capacity, insufficient stomach acid and diminished pancreatic enzyme production are two of the most common and widespread. Age alone is a primary cause in most people. Achlorhydria and pancreatic insufficiency are associated not only with digestive discomfort but with complications such as malnutrition and small intestine bacterial overgrowth (SIBO). The ingredients in Pancreatin Select can help boost the body’s natural ability to break down and metabolize food in the critical early stages of digestion, directly following a meal, to help promote healthy nutrient absorption, inhibit the growth of pathogenic microbes and improve overall digestive comfort.

PANCREATIN 4X is a concentrated blend of pancreatic protease, lipase and amylase intended to help facilitate the breakdown of proteins, fats, and carbohydrates, respectively. Supplemental pancreatic enzymes help to offset reduced enzymatic output by the exocrine pancreas, an organ which is strained by modern diets high in processed foods and low in enzyme-rich raw and fermented foods. Diets high in sugars and starches similarly overstress the endocrine pancreas, which must constantly produce hormones needed to balance blood glucose levels. Pancreatic insufficiency, common in celiac disease and other digestive disorders, is a major cause of nutrient malabsorption. Taking pancreatic enzymes augments the body’s natural output, promoting the thorough breakdown of nutritional components in chyme entering the duodenum. Additional LIPASE enzyme is added to help support complete and enhanced fat digestion. The Lipase and Pancreatin 4X concentrates used in Pancreatin Select are true, animal-based enzymes derived from natural porcine pancreas.

OX BILE provides a BSE-free source of bile acids. Bile, which is naturally synthesized from cholesterol in the liver before being stored and concentrated in the gallbladder, enables healthy fat emulsification and absorption. Bile acids have been suggested to help regulate fat metabolism by stimulating the production of active thyroid hormone within fat cells. Supplemental conjugated bile acid has been shown clinically to help increase both fat absorption and calcium absorption. Taking ox bile may be of particular benefit to people whose gallbladder has been removed, people with compromised liver or gallbladder function and people taking medications that sequester bile acids.

ARTICHOKE & GENTIAN are bitter herbs that help to stimulate digestive function by increasing saliva production and promoting the secretion of gastric acid, bile and digestive enzymes. Research suggests artichoke extracts offer significant benefits to digestion, particularly when bile production is low due to liver or gall bladder malfunction. Gentian has been shown to stimulate cephalic and gut receptors, positively influencing gastric phase digestion.

As with Betaine HCL, I usually recommend 1-2 capsules with each meal but sometimes certain patients with compromised digestion need 3 with each meal.

Digest Select

Digest Select offers a comprehensive, potent blend of vegetarian digestive enzymes to help support and strengthen healthy digestive function. The eleven distinct enzymes in Digest Select work together to help support the complete breakdown and assimilation of proteins, carbohydrates and fats in a range of pH environments—from the acidic upper stomach down through the more alkaline intestinal tract.

Many people today suffer from compromised digestive capacity. Causes range from diets high in sugar and processed starches to lifestyles high in chronic stress, as well as the diminishing ability of the pancreas to produce sufficient enzymes required to break down food, a natural result of aging.

Pancreatic insufficiency also is common in people with gluten intolerance and other digestive disorders of an inflammatory nature. Low pancreatic enzyme levels may result in uncomfortable feelings of fullness after eating, excess gas and bloating. Insufficient digestive enzyme production and activity also may lead to decreased absorption of food nutrients, malnutrition and GI complications such as increased intestinal permeability or small intestinal bacterial overgrowth (SIBO).

Digest Select contains plant-based digestive enzymes intended to help supplement the body’s own production of pancreatic enzymes to help promote digestive comfort and the thorough breakdown and assimilation of nutritional components. It features three specific protease enzymes plus peptidase to work on a variety of proteins and peptides including gluten, lipase to help support complete and enhanced fat digestion,