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The Therapeutic Use of Digestive Enzymes in Upper GI Symptoms - Heartburn Part 1

Enzymes_For_Upper_GI_Symptoms

Heartburn is referred to in the scientific literature as functional dyspepsia. Functional dyspepsia is a complicated symptom characterised by the feeling of burning in the chest area after eating, typically after high-fat meals. Additional symptoms include involuntary regurgitation of acid into the oesophageal tract, nausea, belching, chronic cough, and voice loss.  Unresolved, these symptoms can develop into Gastro-Oesophageal Reflux Disease (GERD).

 Available data on the prevalence of heartburn is nonspecific due to wide variation in diagnostic criteria. A recent report states that approximately £760 million per annum of health resources is spent on dyspepsia symptoms in the UK. Studies suggest that up to 50-80% of all symptoms of functional dyspepsia are meal related. Digestive enzymes can soothe early reflux symptoms such as heartburn and provide much-needed relief for clients who suffer from occasional symptoms.

Over the counter medications for the symptoms of heartburn tend to focus on neutralising stomach acid. As a side effect, the pH of stomach acid is raised to above 3.5 rendering the digestion of protein, the absorption of minerals, and the neutralising of pathogenic microbes unlikely.  Clients with long-term use of antacids will also have reduced digestive capacity, especially for fat and protein digestion. For occasional heartburn, supporting and enhancing digestion is a healthy first step toward building a protocol that will relieve the client's discomfort, without disabling their digestive system.  

  1. Support Digestive Capacity

Fat is heavily implicated in the generation of heartburn. The breakdown of fat begins with gastric lipase emulsification before further breakdown occurs in the small intestine via pancreatic enzymes and bile.  For clients who are experiencing gastric symptoms within 15 minutes after consuming fat, supplemental support in the form of lipase enzyme blends can be beneficial.

In a 2008 study on 218 patients, researchers found that symptoms would begin to occur and intensify as soon as 15 minutes after eating.[1]   

In a 2008 heartburn challenge study, investigators sought to understand whether the content of a meal was relevant in generating heartburn. 16 participants were put into a fasted state, before receiving either a high carbohydrate or high-fat meal. Those in the high-fat meal group scored substantially higher on heartburn symptom scores of pain, fullness sensations, nausea, and belching. The researchers concluded that high-fat meals are substantially more likely to generate symptoms than high carbohydrate meals.[2]

In a 2016 literature review of dyspepsia, combined clinical trial data from 128 independent studies on functional dyspepsia concluded that heartburn is the most frequently cited symptom in response to high fat rather than high carbohydrate meals.[3]

Clients who have a problem with their gallbladder, pancreas, or low hydrochloric acid may benefit from enzyme supplementation that contains lipase to facilitate better emulsification and digestion of fats.

  1. Provide Protection From Intolerance reactions

Some heartburn episodes may be due to the natural discomfort of exposure to food the client has a known or unknown intolerance to.[4]

Intolerances are frequently caused by ineffective enzymatic breakdown of food molecules into smaller parts for effective digestion within the small intestine. Clients over the age of 60 may begin to experience heartburn due to a natural decline in digestive enzyme production.[5]  

Undigested food particles irritate the intestinal mucosa, producing gas that rises through the digestive tract and generate the sensation of fullness, burping, and burning associated with heartburn.

Therapeutic supplementation with digestive enzymes can alleviate occasional heartburn symptoms, but facilitating better digestion of large molecules before they reach the small intestine.

  1. Support Mucosal Membranes

Gastric mucosa may be affected by poor diet, age, medication use, and chronic irritation from stomach acid can result.  The muscles of the gastric mucosa contain rich amounts of zinc. The zinc action appears to assist the thickening of the membranes responsible for forming a protective barrier against gastric acid.  Small studies on Zinc L-Carnosine to date suggest a protective effect on the gut mucosa.

In a 2008 study, ten voluntary participants received indomethacin, a non-steroidal anti-inflammatory chemical that can produce injury to mucosal membranes in some individuals. In the study, participants who took indomethacin and Zinc L-Carnosine had significantly less injury to their mucosa than those who did not receive supplementation.[6]

In 2015, a Japanese study seeking a route to preventing induced damage to the oesophagus' mucus membranes during radio chemotherapy trialled Zinc L-Carnosine on 19 patients. A separate 19 patients were given a different nutrient. Both groups received radio chemotherapy for four years. After four years, the Zinc L-Carnosine group had significantly retarded development of oesophagitis.[7] 

Combined with digestive enzymes, Zinc L-Carnosine can provide additional support to clients experiencing heartburn, via a direct protective effect to the lining of the membranes that surround the stomach.

  1. Remove Common Irritants To Mucus Membranes

Cigarette smoking, coffee, acidic foods such as tomatoes, garlic and fried foods are all well recorded triggers of heartburn and reflux in sensitive individuals. 

  1. Ensure Adequate Hydration

A lack of adequate hydration can cause hypochlorhydria. Any supplemental program should be supported with a recommendation to increase water intake. 

Acid CalmTM by Enzyme Science has been carefully formulated with vegetarian enzymes and botanicals to support digestion and soothe the symptoms associated with gastrointestinal (GI) distress.

Acid Calm contains amylase, lipase, and cellulase Thera-blend enzymes to enhance carbohydrate, fat, and fibre digestion and membrane protective ingredients including Zinc L- Carnosine to provide relief from occasional heartburn.

References:

[1] Bisschops R, Karamanolis G, Arts J, et al 2008. Relationship between symptoms and ingestion of a meal in functional dyspepsia Gut [Online], 57:1495-1503.

[2] Pilichiewicz, A., Feltrin, K., Horowitz, M., Holtmann, G., Wishart, J., Jones, K., Talley, N. and Feinle-Bisset, C., 2008. Functional Dyspepsia Is Associated With a Greater Symptomatic Response to Fat But Not Carbohydrate, Increased Fasting and Postprandial CCK, and Diminished PYY. The American Journal of Gastroenterology, 103(10), pp.2613-2623.

[3] Azadbakht, L. and Khodarahm, M., 2016. Dietary fat intake and functional dyspepsia. Advanced Biomedical Research, [online] 5(1), p.76.

[4] Davies D, James TG. An investigation into the gastric secretion of a hundred normal persons over the age of sixty. BJM. 1930;i:1–14.

[5] Felicilda-Reynaldo RF, Kenneally M. Digestive enzyme replacement thera- py: pancreatic enzymes and lactase. Medsurg Nurs. 2016;25:182–185.

[6] Mahmood, A., FitzGerald, A., Marchbank, T., Ntatsaki, E., Murray, D., Ghosh, S. and Playford, R., 2021. Zinc Carnosine, A Health Food Supplement That Stabilises Small Bowel Integrity And Stimulates Gut Repair Processes.

[7] Yanase K, Funaguchi N, Iihara H, et al. 2015 Prevention of radiation esophagitis by polaprezinc (zinc L-carnosine) in patients with non-small cell lung cancer who received chemoradiotherapy. Int J Clin Exp Med. 2015;8(9):16215-16222.

 

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