Digestive health issues are moving to the forefront of American medicine, and for good reason. According to the American Gastroenterological Association, about 81 million chronic digestive health cases are reported each year. These conditions range from heartburn to abdominal pain, constipation, diarrhea, nausea and gastroesophageal reflux disease. To combat these problems, consumers and healthcare providers are turning in greater frequency to dietary enzymes, naturally occurring bacteria and herbal supplements. The Nutrition Business Journal (NBJ) reports that digestive health products have been undergoing double-digit growth recently, with sales up 15% in 2003 and 10% in 2004. According to SPINS data, the total sales for this current year for the Digestive Aids and Enzymes Category (including cleansing and organ supplement herbal formulas) is over $213 million, up 11% from last year.
"Everything starts in the gut," says Tara Levy, N.D., president of the California Naturopathic Doctors Association and one of the first licensed naturopathic doctors in the state.
Levy considers dietary enzymes to be the first weapon in her arsenal of supplements to improve the digestive health of her patients. Digestive enzymes are an up-and-coming area of dietary supplementation, with a 14% increase in sales in 2004 (NBJ).
The basic food-digesting enzymes are protease for proteins, lipase for fats and amylase for carbohydrates. Although everybody has these present in their digestive systems, the amounts of the particular enzymes vary by individual. "Just as everything starts in the gut, enzymes are important because, for many of us, our enzyme production decreases as we age," explains Levy. In addition to age, genetics and lifestyle factors also can influence the amounts of enzymes present, and low amounts of a particular enzyme can lead to digestive distress.
A well-documented example of "enzyme deficiency," or low levels of a particular enzyme, is lactose intolerance. It is especially common among people of African or Asian origin. Some have estimated that as many as 75% of all African-Americans and Native Americans, as well as 90% of Asian-Americans are lactose intolerant to some extent. Additionally, about 30-50 million Americans also are considered lactose intolerant. These people lack or have low levels of the enzyme lactase, which digests milk sugars known as lactose. Lactase deficiency may result in gas, bloating, cramping and diarrhea. Lactase supplementation can halt these symptoms when lactose-containing dairy products are consumed.
One of the most popular digestive enzymes on the market is papaya enzymes, commonly available as chewable tablets. But according to Tom Bohager, president and founder of Enzymedica, which produces a line of high-quality enzyme products, there are vast differences between enzyme products and brands on the market. "Enzymedica makes a popular digestive enzyme product that does not contain papain (the protease enzyme in papaya enzyme products) because papain is not very active at normal pH ranges found in the digestive tract. Papain, rather, is more active at sights of inflammation and, therefore, Enzymedica includes it in our athletic recovery and repair product, called Repair. Enzymedica's digestion product, Digest Gold, contains a blend of various proteases, amylases and lipases that are active at pH ranges likely to be found in the digestive tract," Bohager says.
Supplemental enzymes also provide systemic health support, help combat inflammation and enhance the efficiency of the immune system. According to Harry Friedman, D.O., from the Asante Health Center, enzyme nutrition therapy is a "valuable resource that is often overlooked for cases of inflammation, particularly in chronic arthritis and sports injuries." He explains that enzymes play a crucial role in clearing inflammation from the body and work on a biological level to heal inflammation. Once the enzymes have helped clear cellular debris and inflammatory substances, the repair process can proceed more efficiently and quickly.
Probiotics are the living bacteria in yogurt and similar products that produce helpful enzymes within the digestive system and prevent the overgrowth of harmful bacteria in the gastrointestinal flora, such as E. coli. As probiotics are prone to "die off" between manufacture and consumption, new coatings and encapsulations are being developed to help stabilize them in food products so they are still effective when they reach the intestines. Probiotics are becoming more popular, as evidenced by a 16% increase in sales in 2004 (NBJ).
A new probiotic was launched recently for the professional market called PBC, from Theramedix, that not only includes the common probiotic L. acidophilus, but combines it with seven other species of bacteria that occur in the gastrointestinal tract. One of these, Bacillus subtillus, is the source of nattokinase, the enzyme that helps support cardiovascular health and balance blood viscosity.
Prebiotics are non-digestible food ingredients that may promote the growth or activity of beneficial microflora. Prebiotics are also used in conjunction with manufacturing techniques to improve the processing conditions, performance and survival of probiotics. In a study by Chen, et al. (2005), inclusion of prebiotics within the probiotic microencapsulation resulted in improved protection for the active organisms.
Prebiotics have become so important in digestive health that many of the large industry players are including prebiotics in products, such as Nestle's Baby Cereal and Kellogg's breakfast cereals for kids that contain the prebiotic inulin.
Prebiotics fall within the broader category of dietary fibers, which are one of the mainstays of the digestive health category, and steps are being taken to increase the image and popularity of dietary fiber. One such attempt is being made by the California Dried Plum Board in an effort to increase awareness and improve the image of dried plums, formally known as prunes.
One recent strategy it announced in a September 2005 press release is the creation of a website dedicated to educating healthcare professionals, researchers and the general public about the important of digestive health: www.digestivehealthorg.com. The website offers a self-test for the general public to asses its digestive health, as well as professional resources, a literature review on the subject, and proceedings from the organization's March 2005 Digestive Health Summit.
Dried plums contain over 6g of dietary fiber (half soluble/half insoluble) per 100g serving. The types of fiber in dried plums include cellulose, hemicellulose, lignan and pectin. Other important ingredients are phenolic compounds, such as chorogenic acid, neochlorogenic acid and caffeic acid, as well as sugars, such as sorbitol. Beyond their laxative effect, dried plums have other systemic impacts on gastrointestinal health, as well as potential benefits for cardiovascular health and resistance to cancer.
The sales of herbal supplements to promote digestive health have shown mixed results. Sales of herbal combination products have gone up a whopping 50% (NBJ), while some single botanicals in the digestive health category, such as Cascara sagrada and chamomile, experienced a little over a 10% sales increase in 2004. Old mainstays in this area, such as aloe (up 5%) and garlic (down 10%), have not been as promising.
An example of an herbal combination based on traditional medicine and focused on digestive health is Padma Digestin®, a combination of five herbs and spices that is based on an ancient Tibetan herbal formula. This combination is designed to increase the Tibetan concept of "digestive heat,"? thereby relieving feelings of congestion, fullness and flatulence.
Single herbs in the digestive category can sometimes be found in new delivery forms, such as Dyna-Tabs Aloe Vera Extract Digestive Support. Dyna-Tabs are flavored, come in a convenient portable dispenser, and are made with dissolving film technology so the capsules are smaller and easier to swallow.
In direct conflict to the growing knowledge that high-fat foods are dangerous for our digestive health, a recent press release in response to a study in the October 17 issue of The Journal of Experimental Medicine claimed, "Cheeseburgers are good for the gut." The study found that high-fat foods actually might have a soothing effect on inflammation in our guts. This is due to the release of a hormone called cholecystokinin (CCK) during the consumption of high-fat foods. CCK stimulates digestion and gut peristalsis, helping to move the food along the digestive tract, and also triggers a feeling of fullness.
As signified by the new claim that cheeseburgers are gut-healthy foods, the importance of digestive health is just beginning to be understood and appreciated in the U.S. According to the Digestive Health Organization, this is due not only to the climbing rates of digestive diseases, but also due to scientific advances in understanding the impact that digestion has on the well-being of the whole organism.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent disease.
SIDEBAR: Going Global: Fiber and Digestive Health
Few food-health links are better recognized around the world than that of dietary fiber and digestive health, even as international clinical research continues to refine understanding of specific fiber benefits. For example, Spanish researcher F. Guarner published a study in a supplement to the April 2005 issue of the British Journal of Nutrition looking at how inulin and oligofructose may prevent chronic inflammatory intestinal disorders such as Crohn's disease. Japanese researchers also tackled the concern that the animal-derived fiber chitosan may exacerbate intestinal inflammation in Crohn's disease and found that a chitosan and ascorbic acid mixture in patients increased fecal fat excretion without increasing disease activity (Tsujikawa, T, et al. 2003, Nutrition. 19:137).
Food processors long have derived marketing benefits from fiber, sometimes with an interesting twist. In October 2005, Mintel's GNPD noted that Arroz SOS de Mexico's introduced a Fibre Duo cookie under the Tosta Rica Galletas brand that contained added fiber and L-carnitine to help convert fat into energy. In September 2005, Hong Kong's Four Seas Mercantile launched Digestive Crackers into China; they are fortified with a high-fiber, edible seaweed called green laver (Ulva latissima or Ulea lactuca). Kellogg's introduced a more typical All-Bran Plus cereal to South Korea in January 2004, declaring "99.9% all bran (wheat bran 80%)" on its label and making the claim that the product's high fiber content helps support the digestive system. Closer to home, Sunsweet Growers introduced "PlumSmart for Digestive Health" in the U.S. in mid-2004 with the claim that one glass of the 100% juice drink is a good source of fiber for the heart and digestive system. The product is fortified with chicory root extract (in case the plum juice does not do enough for your plumbing).
PHOTOS COURTESY OF MINTEL INTERNATIONAL'S GNPD
On the Web: Digestive Health
- www.digestivehealthorg.com The Digestive Health Organization's new educational website on digestive health intended for healthcare professionals, researchers and the general public
- www.enzymeresearchgroup.net The Enzyme Research Group offers information on enzymes for professionals and consumers, as well as case studies showing the use of enzymes in nutritional practice
- www.enzymeuniversity.com Enzyme University is an educational website on enzymes as they relate to dietary supplements developed by the National Enzyme Company
- www.enzymestuff.com/rtgutresearch.htm A selection of studies on the connection between enzymes and certain neurological conditions
- www.bbc.co.uk/home/d/ Type "digestive enzymes" in the search field; click on BBC/GCSE/Bitesize/Biology/ Digestive Enzymes