9/2/14 Addition: I’ve refined my thinking about HCl and Enzymes since I wrote this post several years ago. I was seeing people start HCl and enzymes BEFORE they gave the safer and more universally reliable treatments like diet and probiotics a try–and it frustrated the hell out of me. That said, HCl and enzymes can be helpful, but they have a time and place. Ironically, I have found that my stomach needs supplementary HCl and it’s helped me a lot, but I started it well after I implemented diet (SCD), probiotics, Fecal Transplants (FMT), and other treatments.

Before trying HCl, I recommend you talk to a natural or integrative medicine doctor, and read the wonderful book, “Why Stomach Acid is Good for You” by Johnathan Wright.

In continuing with the supplement series, I decided to tackle what I consider to be a controversial recommendation: HCl and Digestive Enzymes.

Why I don’t recommend HCl and digestive enzymes:

I know many doctors and natural healing programs recommend supplementing with HCl and/or enzymes. Indeed enzymes are therapeutic and can be used for treating certain diseases, but for IBD, I still do not believe that we should supplement with digestive enzymes or HCl for the purpose of increasing digestion unless we know that we have enzyme, acid, or other production deficiencies. Many of us have been on acid reducers of some sort, and that may be a reason for investigating your acid production, but before you try buying HCL and enzymes, there are lots of natural ways to improve digestion. I recommend trying those first.

HCl

But, but…it burns!

HCl can be downright dangerous if you do not use it properly, and has been shown to increase diarrhea in people with inflammatory bowel (Crohn’s and Colitis). That said, it can help your HCl production rebound, if it is low, but do not rely solely on a home baking soda test to tell you whether you have low acid production. Relying only on the one home test is like trying to write a novel on a paper napkin: you have just enough to get a few ideas, but the real thing takes lots more work. For example, I failed the baking soda test, but my acid production is just fine as measured by other tests. If I had started HCl based on that test alone, I could have risked taking acid supplements I did not need.

The most likely reason for poor digestion of food, if you have Crohn’s or Colitis, is the increased transit speed caused by (you guessed it) diarrhea. Food simply does not spend the time in your gut it needs to be properly broken down and absorbed. This is where improved digestion can help, but the low hanging fruit here is to stop your diarrhea–that will do the most to improve your digestion. Historically, HCl supplementation has increased, not decreased people’s diarrhea.

With that said, if you think you have low acid production, go see your doctor and have him or her measure your acid production before you start on HCl.

Digestive Enzymes

Your body does not make all the enzymes you need to break down your food—no one’s body does. Historically, humans have not had to produce all of the needed digestive enzymes; they have eaten enough fresh and raw food (which contains its own enzymes) such that we have never developed the evolutionary need to produce a wider variety of enzymes. For hundreds of thousands of years humans have instinctively supplemented those enzymes through their diet.

Further, if we supplement with enzymes, we do not know what that will do to our own enzyme production capabilities. Our bodies have multiple feedback mechanisms by which it measures what is going on around the body. This is how hormone levels are regulated, for example. When you take prednisone or another corticosteroid, your adrenal glands quit or slow cortisol production because the feedback mechanisms signal that, because of the high levels of cortisone in the blood due to your pills, they do not need to produce as much cortisol. So they go to ‘sleep’. This is why you have to wean off of corticosteroids; the weaning process allows your adrenals to wake up and begin producing again. It makes sense that such a complex orchestra like the digestive system would also have feedback loops which measure pH, enzyme levels, fullness, and more (indeed, this is the case). When we supplement with enzymes, then, it makes sense that the body could send feedback that slows or changes our own enzyme production. The bottom line with this is, in the absence of a measurable deficit, who knows better how much enzyme you need when you eat, you or your gut?

With that said, there is precious little written on this topic. The common reference(s) I have found to negative feedback from enzyme supplementation is from nutritionists counseling cancer patients.

The main reason people recommend taking enzymes for IBD is to improve digestion. Improved digestion will, in theory, reduce the residue delivered to the colon, increase absorption, and help with nutrition; all improvements which will help you heal. I agree with that theory. However, the assumption behind this theory is that those with IBD have a higher incidence of poor digestion. That very well may be the case, but we don’t know. What we do know is that poor digestion in people with IBD is first and foremost likely to be from diarrhea. So the first step is not digestive enzymes, but to stop your diarrhea. That said, I believe that people with IBD (and Westerners in general) have poor diet, before they develop poor digestion. Most of their life, they have subsisted on a processed, packaged, canned, and otherwise calorie-rich, enzyme and vitamin-poor diet.

This is the place to start: stop your diarrhea and change your diet, first. Unless you have a measured production deficiency, or physiological hurdle to proper digestion, your digestion should rebound as your diarrhea subsides and your diet gets better.

The dilemma here is that diarrhea (or some other poorly functioning mechanism) gives us poor digestion, which leads to higher colonic residue, which exacerbates our symptoms. Improve your digestion, and you reduce the amount of undigested food in the colon, and you decrease symptoms. Adding more digestive enzymes while you have active diarrhea may (might, maybe, possibly) improve your digestion, but if it does improve things at all, the change will be small. Here’s why: Enzymatic reactions, just like all other chemical reactions take TIME. If insufficient enzyme is present, you can improve the reaction by adding enzyme, but if there isn’t sufficient time for the reactions to take place, no matter how much enzyme is present, you still won’t digest your food. So, I say it again: stop your diarrhea first.

Below I give you some natural (and mostly free) ways of improving your digestion without buying enzymes.

I recognize that when we are sick with IBD, when we are in a flare, it is impossible and often unsafe to eat a diet consisting of 70-80% raw vegetables. But now you have a goal as you heal: eat as much fresh, raw food as your body can handle. The quantity will, ideally, increase as you heal.

In the meantime, here are lots of natural ways to improve digestion without using a supplement. The proponents of enzymes are correct when they say that improving digestion will assist the healing process, but you do not necessarily have to use store-bought enzymes to accomplish that goal.

So unless you have had your gall bladder removed, you have had tests which prove that your pancreas does not perform properly, or you have congenitally low enzyme production levels, then try some of these natural methods of improving digestion, before you jump into yet another supplement:

  1. Increase the amount of natural enzymes in your diet by increasing the amount of raw food in your diet. Raw foods, especially fruits and vegetables, contain lots of enzymes that aid in their digestion. Raw vegetables are not the only source of raw food. Raw honey is also loaded with enzymes, and so are sprouts (sprouts are not SCD-legal). I highly recommend sprouts, if you can handle them, as they contain 30-35% protein (one good source of complete proteins), lots of enzymes, lots of vitamins, and they are considered an anti-oxidant super-food (read: anti-cancer, anti-inflammatory). Grow your own; it is cheap and fun.
  2. Juice it! Those of us with IBD often cannot handle the fiber of a mostly raw food diet. Juicing vegetables allows you to get the vitamins, enzymes, chlorophyll, and micronutrients from the vegetables without the fiber.
  3. Chew (and/or puree). Yep, chew until your food is liquid. In the U.S., we eat way (way) too quickly. Gandhi was quoted as saying, (something like) we should chew our liquids and drink our foods. This takes time, but it is well worth it. I am always the last to finish dinner at our house because I chew so meticulously. Chewing like this also has the added benefit of slowing me down. It helps me linger at meal time and forces me to relax. For example, this weekend, my wife and I went to a wedding rehearsal lunch. Some people finished their entire lunch before I could finish my salad. I had to ask the waiter to keep my plate warm until I was ready for it. You can also puree foods in a food processor, but chewing well mixes the food with your salivary enzymes and improves the digestion of your food more than any other suggestion here. That said, both will increase the digestibility of your food and help to decrease the undigested food residue load to your colon.
  4. Take a teaspoon of apple cider vinegar 15-20 minutes before you eat. This gets your natural enzyme production going—sort of like warming up before you go for a run.
  5. Use bitters. Natural bitter herbs have been used for millennia to stimulate and improve digestion. Again, use these 15-20 minutes before a meal. Just the same, this has also been the traditional function of the pre-dinner salad, which used to contain a variety of greens, many of which were bitter (today’s salads, filled with sweet baby greens or iceberg lettuce, are not nearly as healthy, and do not perform this function; so add some bitter greens to your salad for a healthier, more therapeutic salad). These greens were eaten before the main meal to stimulate digestion.
  6. Eat ginger. Ginger increases the activity of lipase and other digestive enzymes. Gingerols are the source of ginger’s hot and spicy flavor. They stimulate bile flow. They are also responsible for ginger’s anti-inflammatory, anti-nausea and antioxidant properties. Ginger contains a protein-digesting enzyme called zingibain which is one of the most powerful protein digesting enzymes known, every bit the rival of the great papaya enzyme, papain. One of the essential oils in ginger, zingiberene, works in conjunction with gingerols to protect the lining of the stomach. The aromatic oils in ginger are useful for aiding digestion and reducing gas.
  7. Eat more fermented foods. Fermented foods have been used to improve digestion for millennia. Fermented vegetables, for example, are rich in healthy bacteria (bonus!), are high in vitamins (especially vitamin C and B vitamins), and are loaded with helpful enzymes. The bacteria also predigest the vegetables, making them easier to break down in the body.

The bottom line: In dealing with and healing from IBD naturally, we already buy so many supplements—everyone has their favorite, THE supplement without which you cannot heal. Improving your digestion is one area in which you can build good habits and experiment without ever purchasing a single pill.

 

Onward to Health,

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