Enzyme Therapy for Diabetes: Who Really Needs It?

Proper digestion requires certain enzymes, which are secreted by your pancreas. Some medical conditions, including diabetes, can cause your pancreas to malfunction. Should this happen, you'll need to get these vital enzymes from another source.

​Read more:​ Digestive Enzyme Supplement Side Effects

"There are three digestive enzymes made by your pancreas," says Mary Vouyiouklis Kellis, MD, a specialist in the department of endocrinology, diabetes and metabolism at the Cleveland Clinic.

"Most people with diabetes continue to make these enzymes. In some people with long-term diabetes, the pancreas may become too damaged to make enough of these enzymes. In those cases, a doctor may prescribe an enzyme replacement medication."

"The three types of digestive enzymes are called amylase, lipase and protease," she says. "Amylase helps you break down sugars, lipase helps you break down fats and protease helps you break down proteins."

According to the Gastrointestinal (GI) Society, these digestive enzymes are proteins that are secreted from your pancreas into your small intestine when you eat. When this fails to happen, you can develop a condition called pancreatic insufficiency. Your doctor can prescribe digestive enzymes to replace the enzymes you need to break down foods during digestion.

"People with digestive enzyme insufficiency have symptoms like gas and bloating," says Dr. Kellis.

According to the Digestive Disease Center at the Medical University of South Carolina (MUSC), other signs and symptoms of pancreatic insufficiency include:

• Abdominal pain.
• Loss of appetite.
• Weight loss.
• Diarrhea.

Along with digestive enzymes, your pancreas also makes hormones. Think of them as chemical messengers. Insulin is the hormone made by your pancreas that helps move sugar from your blood into your cells, according to MUSC.

Diabetes occurs when your blood sugar is too high because you don't make enough insulin or you become resistant to insulin. Over time, the high level of sugar in your blood causes the health problems of diabetes, states the National Center for Complementary and Integrative Health (NCCIH).

Diabetes can also damage your pancreas enough to cause pancreatic insufficiency, pancreatic cancer and diseases like Crohn's disease or celiac disease, states the GI Society.

Another common risk factor for pancreatic insufficiency is repeated inflammation of the pancreas from long-term abuse of alcohol. This condition, called chronic pancreatitis, can reduce the production of insulin and lead to diabetes, according to MUSC.

The most effective treatment for pancreatic insufficiency is pancreatic enzyme replacement therapy (PERT), such as the drug pancrelipase (Creon, Pancrease, Viokase). It's taken with meals, according to the GI Society.

Lifestyle changes — like eating smaller and more frequent meals and getting fat from healthy sources like nuts, seeds, olives and fatty fish instead of meat — are important for people with pancreatic insufficiency. MUSC adds that, because the inability to break down fat interferes with the ability to absorb important fat-soluble vitamins A, D, E and K, you may need to take supplements of these vitamins.

You should also avoid drinking alcohol and smoking, which increase damage to your pancreas, the GI Society states.

In the absence of pancreatic insufficiency, NCCIH does not include digestive enzymes among supplements that might be helpful for diabetes. "These supplements are unregulated, and I have not seen any evidence that they help," Dr. Kellis says.

There have been many studies on dietary supplements for treating or preventing diabetes, but for most supplements there's little evidence to support them, according to NCCIH. There is some support for the use of alpha-lipoic acid and the minerals magnesium and chromium, but no reliable evidence for the use of herbal supplements. The agency also states that the safety of dietary supplements in diabetes is unknown.

"Talk to your doctor before trying any supplements for diabetes and never substitute over-the-counter supplements for your medical treatment," Dr. Kellis says. "What you can do is eat a lot of fresh fruits and vegetables to help your digestion. Avocados are high in lipase and mangos are a good source of amylase."

Johns Hopkins Medicine recommends additional foods to naturally improve digestion:

• Whole grains.
• Leafy greens.
• Lean proteins.
• Berries.
• Citrus fruits.
• Bananas.

​Read more:​ Foods to Avoid If You Have Pancreatitis