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Enzyme

Paradigm

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BREASTFEEDING AND digestive enzymes

Digestive enzymes are a vital part of proper nutrient absorption because they break down protein, carbs, and fats into smaller components which can be easily transported for energy.  These enzymes are released in different parts of the body and are triggered by various stages of digestion [1].  Lacking specific enzymes in the body can lead to improper digestion, causing issues such as lactose intolerance [2].  Knowing that, many mom’s look to digestive enzyme supplements in hopes of relieving their little one’s food allergy and intolerance symptoms.  Here, we dig into the science behind whether supplementation can truly make that kind of impact. 

Types of Enzymes

Proteases

Purpose: Break down protein into amino acids and peptides
Types: Pepsin, trypsin, chymotrypsin, carboxypeptidase A & B
Where: Secreted by the stomach and pancreas
Test: Blood analysis
Natural Sources: Pineapples, papaya, raw honey, kefir, kimchi, miso, kiwi, ginger

Amylases

Purpose: Break down carbs into simple sugars
Types: Maltase, lactase, sucrase
Where: Secreted by salivary glands, pancreas, and/or small intestine
Test: Amylase blood levels can detect various pancreas diseases.  Lactase and maltase issues can be detected through a hydrogen breath test.  Sucrose intolerance is tested via small intestine biopsy. 
Natural Sources: Mango, raw honey, banana, kimchi, miso

Lipases

Purpose: Break down fat into three fatty acids and a glycerol
Types:  Pancreatic lipase (PL) and pancreatic lipase related protein 2 (PLRP2)
Where: Pancreas & digestive “juice”
Test: Blood tests for lipase can help diagnose pancreas disorders.
Natural Sources: Avocado, kefir, kimchi, miso

Prescription Digestive Enzymes

Most prescriptions contain pancrelipase which is a combination of all lipase, amylase, and protease.  These pills have a specialized outer coating made to survive passing through stomach acid and release the contents after reaching the small intestine [3].  The enzymes commonly originate from that made from pig pancreas which is regulated by the FDA.  This means that as a medication there are proven clinical trials associated with the efficacy of the product [4]. 

Digestive Enzyme Supplements

Digestive enzyme supplements are also available over the counter in liquid, powder, and pill form.  These may come from plants or animals.  Since they are not regulated by the FDA, there is little proof as to exactly how much enzyme they contain or if they will survive stomach acid to reach the intestine [5].  Non-prescription lactase and alpha-galactosidase which assist with cow’s milk and bean sugar breakdown have been shown to help assist in digestion discomfort and associated symptoms. 

Breastfeeding and Food Allergy/Intolerance

Infants with food allergy or intolerance are most likely reacting to proteins transferred from mom’s diet to her breast milk [6].  If you are unsure if your little is reacting to your milk, read more about this here.  Since this is a protein reaction, a big question among moms is whether protease digestive enzyme supplements will help break down the protein before it enters breast milk.  Unfortunately, there is not any research specifically looking at digestive enzyme impacts on breast milk contents.  However, researchers have tested the efficiency of specific protein breakdown in the gut which can still be helpful to guiding our decision to use the supplements. 

Show Me the Science!

Research indicates that commercially available enzymes lacking the outer coating will not make it past the stomach in order to be effective in assisting digestion in the intestine.  Therefore, suspensions and pills without what is called an “enteric coat” are not effective due to degradation. 

Prescription enzymes are derived from pigs because their enzymes most closely match those found in humans.  Prescription protease concentrations typically range from 50,000-100,000 USP units while the concentration for supplements, especially those derived from plants, are often under 5,000 USP.

In 2015, a lab compared five commercially available digestive enzyme supplements to a purified digestive enzyme for gluten breakdown.  In this study, the supplements were unable to degrade the gluten protein.  All five resulted in a fully intact protein while the control (purified enzyme) was able to degrade the protein [7].

 

Takeaways

Current research does not indicate that taking over the counter enzymes will likely assist mothers in more effective protein degradation and therefore fewer transferable molecules in her breast milk.  If you believe you have a protease imbalance, you can use the above testing methods to diagnose and then receive a clinically proven prescription medication.  Medication which is pig-derived and comes in specialized coating pill form is shown to be most effective. 

References

 

  1. Wier, Heather A., and Robert J. Kuhn. "Pancreatic enzyme supplementation." Current Opinion in Pediatrics 23.5 (2011): 541-544.

  2. Kanabar, D., M. Randhawa, and P. Clayton. "Improvement of symptoms in infant colic following reduction of lactose load with lactase." Journal of Human Nutrition and Dietetics 14.5 (2001): 359-363.

  3. Gubergrits, N., et al. "A 6‐month, open‐label clinical trial of pancrelipase delayed‐release capsules (Creon) in patients with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery." Alimentary pharmacology & therapeutics 33.10 (2011): 1152-1161.

  4. Seiler, C. M., et al. "Randomised clinical trial: a 1‐week, double‐blind, placebo‐controlled study of pancreatin 25 000 Ph. Eur. minimicrospheres (Creon 25000 MMS) for pancreatic exocrine insufficiency after pancreatic surgery, with a 1‐year open‐label extension." Alimentary pharmacology & therapeutics 37.7 (2013): 691-702.

  5. Ianiro, Gianluca, et al. "Digestive enzyme supplementation in gastrointestinal diseases." Current Drug Metabolism 17.2 (2016): 187-193.

  6. Zhu, Jing, and Kelly A. Dingess. "The functional power of the human milk proteome." Nutrients 11.8 (2019): 1834.

  7. Janssen, George, et al. "Ineffective degradation of immunogenic gluten epitopes by currently available digestive enzyme supplements." PloS one 10.6 (2015): e0128065.

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