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What are digestive enzymes korte uitleg + linken naar pagina spijsverteringsenzymen

Gezondheidsclaims uitleg/ geoorloofde consumentenclaims

Er is veel klinisch onderzoek beschikbaar over de werking van spijsverteringsenzymen. Hieronder geven we een selectie relevante klinische studies weer over:

  • het enzym Lactase (tablet/capsule);
  • het enzym Lactase (vloeibaar/druppel);
  • het enzym Alpha Galactosidase;
  • het enzym Xylose Isomerase;
  • het enzym Diamine Oxidase (DAO);
  • de enzymen Invertase en Gluco-Amylase;
  • het FODMAP dieet en PDS.

Omdat de artikelen in het Engels zijn gepubliceerd, zijn de samenvattingen (Abstracts) ook in het Engels weergegeven.

het enzym Lactase (tablet/capsule)

Effect of lactase on symptoms and hydrogen breath levels in lactose intolerance: A crossover placebo-controlled study. JGH Open. 2020 Dec 1;5(1):143-148

Samenvatting (Abstract): The aim was to study the effect of lactase chewable tablets on clinical symptoms and hydrogen breath excretion in patients with lactose intolerance. This was a randomized, double-blind, crossover placebo-controlled trial to study the effect of lactase tablets on symptoms and hydrogen breath levels in adults with lactose intolerance, confirmed by Lactose HBT. Forty-seven patients (mean age 33.6 years; 30 males) with lactose intolerance formed the study group. Clinical symptoms, mean clinical score (P < 0.05), and mean hydrogen breath levels (P < 0.05) were improved when the patients were given lactase. Reduction in cumulative hydrogen breath level over 180 min was 55% when patients received lactase compared to placebo. Orally supplemented lactase enzyme significantly reduced the clinical symptoms and hydrogen breath excretion in patients with lactose intolerance.

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Effects of Exogenous Lactase Administration on Hydrogen Breath Excretion and Intestinal Symptoms in Patients Presenting Lactose Malabsorption and Intolerance. Biomed Res Int. 2014;2014:680196.

Samenvatting (Abstract): The aim is to establish whether supplementation with a standard oral dose of Beta-Galactosidase affects hydrogen breath excretion in patients presenting with lactose malabsorption. Ninety-six consecutive patients positive to H2 Lactose Breath Test were enrolled. Results: Following the oral administration of Beta-Galactosidase, in 21.88% of the cases, H2 Lactose Breath Test became negative (Group A), while mean peak H2 levels in 17.71% (Group B) were still positive, with the H2 level 20 ppm above the baseline, but the peak H2 levels were significantly lower than those observed at the baseline test.

The conclusion is, the response to oral administration of Beta-Galactosidase in patients with symptoms of lactose malabsorption presents a significant variability.

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het enzym Lactase (vloeibaar/druppel)

Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet. 2007 Oct;20(5):509

Samenvatting (Abstract): Transient lactose intolerance has been identified as a possible causative factor in infant colic. A double-blind randomised placebo-controlled crossover study to investigate this has been undertaken in 53 babies with symptoms of colic. Pre-incubation of the feed with lactase resulted in breath hydrogen levels and total crying time which were both at least 45% lower than figures with placebo treatment, in 26% of the full trial group, and in 38% of compliers. These findings suggest that infant colic may have a multiple aetiology, and that in a significant number of cases the immediate cause is transient lactose intolerance, in which cases pretreatment of feeds with lactase can result in considerable symptomatic benefits.

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Clinical Efficacy Of Lactase Enzyme Supplement In Infant Colic: A Randomised Controlled Trial. J Pak Med Assoc. 2018 Dec;68(12):1744-1747.

To determine the efficacy of lactase enzyme supplement in infant colic. The double-blind randomised clinical trial was conducted from November 2014 to June 2017 at Kharadar General Hospital, Karachi, and comprised infants aged 0-6 months with infant colic, excessive crying lasting at least 3 hours a day on at least 3 days a week for at least 3 weeks. After two-week intervention, significant improvement was seen in the duration of crying in group A 45(86.5%) compared to group B 31(59.6%) (p<0.05). Significant improvement was seen in the duration of crying in infants who received lactase enzyme supplement.

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het enzym Alpha Galactosidase

Samenvatting (Abstract): Bloating, abdominal distention, and flatulence represent very frequent complaints in functional disorders. Patients frequently associate these symptoms with excessive intestinal gas and the reduction of gas production may represent an effective strategy. The aim was to evaluate the effect of α-galactosidase administration, in a randomized double-blind placebo-controlled protocol. Eight healthy volunteers ingested 300 or 1200 GalU of α-galactosidase or placebo during a test meal containing 420 g of cooked beans. The administration of 1200 GalU of α-galactosidase induced a significant reduction of both breath hydrogen excretion and severity of flatulence. A reduction in severity was apparent for all considered symptoms, but both 300 and 1200 GalU induced a significant reduction in the total symptom score. α-Galactosidase reduced gas production following a meal rich in fermentable carbohydrates and may be helpful in patients with gas-related symptoms.

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Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by α-Galactosidase Treatment. Am J Gastroenterol. 2018 Jan;113(1):124-134

Samenvatting (Abstract): Galacto-oligosaccharides (GOS) are dietary FODMAPs (fermentable carbohydrates) associated with triggering gastrointestinal symptoms in patients with irritable bowel syndrome (IBS). This randomized, double-blind, placebo-controlled, cross-over trial aimed to assess whether oral α-galactosidase co-ingestion with foods high in GOS and low in other FODMAPs would reduce symptoms. Thirty-one patients with IBS completed the study. Of those who received full-dose enzyme, overall symptoms reduced and bloating. Oral α-galactosidase taken with high GOS foods provides a clinically significant reduction in symptoms in GOS-sensitive individuals with IBS. This strategy can be translated into practice to improve tolerance to high GOS foods as an adjunct therapy to the low FODMAP diet.

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het enzym Xylose Isomerase

Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption – a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2012 Nov;36(10):980-7.

Samenvatting (Abstract): Incomplete resorption of fructose results in increased colonic hydrogen production and is a frequent cause of abdominal symptoms. The only treatment available is diet.

The aim of this article is to study whether orally administered xylose isomerase (XI), an enzyme that catalyses the reversible isomerisation of glucose and fructose, can decrease breath hydrogen excretion in patients with fructose malabsorption.

Conclusions: Oral administration of xylose isomerase significantly decreased breath hydrogen excretion after ingestion of a watery fructose solution. Nausea and abdominal pain were significantly improved by xylose isomerase.

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Fructose malabsorption: causes, diagnosis and treatment. Br J Nutr. 2022 Feb 28;127(4):481-489.

Samenvatting (Abstract): This review intends to act as an overview of fructose malabsorption (FM) and its role in the aetiology of diseases including, but not limited to, irritable bowel syndrome (IBS) and infantile colic and the relationship between fructose absorption and the propagation of some cancers. Our knowledge of FM is limited by our understanding of the biochemistry related to the absorption of fructose in the small intestine and FM’s relationship with small intestinal bacterial overgrowth. It is important to consider the dietary effects on FM and most importantly, the quantity of excess free fructose consumed. The diagnosis of FM is difficult and often requires indirect means that may result in false positives. Current treatments of FM include dietary intervention, such as low fermentable oligo-, di-, monosaccharides and polyols diets and enzymatic treatments, such as the use of xylose isomerase. More research is needed to accurately diagnose and effectively treat FM. This review is designed with the goal of providing a detailed outline of the issues regarding the causes, diagnosis and treatment of FM.

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het enzym Diamine Oxidase (DAO)

Diamine oxidase supplementation improves symptoms in patients with histamine intolerance. 2019, Food Sci Biotechnol.

Samenvatting (Abstract): Histamine intolerance (HIT) is thought to be caused by a disproportionate amount of histamine in the body. The enzyme diamine oxidase (DAO) is considered for the gastrointestinal degradation of histamine. For this open-label interventional pilot study, we identified 28 patients with HIT. For 4 weeks, they were instructed to take DAO capsules before meals. Then, throughout a follow-up period, they were instructed not to take the DAO. We used a questionnaire that included 22 symptoms, which were divided into 4 categories, as well as a symptom severity score. All symptoms improved significantly during the oral supplementation of DAO. During the follow-up period, without DAO supplementation, the symptoms sum scores increased again. The symptom intensity score was reduced for all symptoms. We have demonstrated, a significant reduction of every HIT-related symptom and its intensity due to DAO oral supplements.

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Low-histamine diet supplemented with exogenous Diamine Oxidase enzyme is useful for treating migraine in patients with DAO deficiency. Ann Nutr Metab 2018;73(suppl 2):1–93.

Samenvatting (Abstract): Low-histamine diets and/or exogenous diamine oxidase (DAO) supplementation are currently used to treat symptoms of histamine intolerance (IH), a disorder in histamine homeostasis that increases its plasma levels, mainly due to DAO deficiency. Headache is the most recognized symptom. Objectives: To assess the effectiveness of a low-histamine diet plus a DAO enzyme supplement on the remission of migraine in subjects with DAO deficiency. Most subjects showed an improvement in migraines after the 3-month treatment: 34.9% reported complete remission and another 35.8% had a reduced number of migraine episodes per month, of less duration and pain intensity. The treatment was less successful in 29.3% of patients. On average, when comparing baseline and final values after treatment, all outcomes were significantly reduced. Conclusions: A low-histamine diet supplemented with the DAO enzyme for three months was useful in reducing the number of attacks, duration and intensity of pain in migraineous patients with DAO deficiency. 

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de enzymen Invertase en Gluco-Amylase

Diarrhoea due to sucrase and isomaltase deficiency. Gut, 1967, 8, 373.

Samenvatting (Abstract): The purpose of this paper is to report an case of diarrhoea in an adult due to deficiency of intestinal sucrase and isomaltase because of the apparent rarity of this condition and because there are a few features of this case which may add to our knowledge of the disease. Management of the patient consisted first in trying replacement therapy with Bi-myconase, a commercial preparation of sucrase and amylase, and secondly in trying a diet without sucrose and low in starch. Taking Bi-myconase the patient was symptomatically improved, the numbers of stools per day fell from between three and six to one or two, she had less rumbling in the abdomen, and the daily stool weights were reduced. She was then put on a sucrose-free diet with a restricted starch intake. There was even greater improvement in symptoms on this diet, with only one normal stool per day with normal stool weights and no abdominal pain or discomfort. The patient commented that she had not realized what it was like to be so completely symptomfree.

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13C-Breath Tests for Sucrose Digestion in Congenital Sucrase Isomaltase Deficient and Sacrosidase Supplemented Patients. J Pediatr Gastroenterol Nutr. 2009 Apr; 48(4): 412–418.

Samenvatting (Abstract): Congenital sucrase-isomaltase deficiency (CSID) is characterized by absence or deficiency of the mucosal sucrase-isomaltase enzyme. Specific diagnosis requires upper gastrointestinal biopsy with evidence of low to absent sucrase enzyme activity and normal histology. The hydrogen breath test (BT) is useful but is not specific for confirmation of CSID. We investigated a more specific 13C-sucrose labeled BT. Objectives were to determine if CSID can be detected with the 13C-sucrose BT without duodenal biopsy sucrase assay and if the 13C-sucrose BT can document restoration of sucrose digestion by CSID patients after oral supplementation with sacrosidase (Sucraid®). Classification of patients by 13C-sucrose BT % CGO agreed with biopsy sucrase activity. The breath test also documented the return to normal of sucrose digestion and oxidation after supplementation of CSID patients with Sucraid®.

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het FODMAP dieet en PDS

Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897-906

Samenvatting (Abstract): Functional gastrointestinal symptoms such as abdominal pain, bloating, distension, constipation, diarrhea and flatulence have been noted in patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). A novel treatment option for IBS and IBD currently generating much excitement is the low FODMAP diet. The aim of this meta-analysis was to determine the evidence of the efficacy of such a diet in the treatment of functional gastrointestinal symptoms. Six RCTs and 16 non-randomized interventions were included in the analysis. There was a significant decrease in IBS SSS scores for those individuals on a low FODMAP diet in both the RCTs and non-randomized interventions. In addition, there was a significant improvement in the IBS-QOL score for RCTs and for non-randomized interventions. Further, following a low FODMAP diet was found to significantly reduce symptom severity for abdominal pain, bloating and overall symptoms in the RCTs. In the non-randomized interventions similar findings were observed.

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Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Sep; 9(9): 940.

Samenvatting (Abstract): Irritable bowel syndrome (IBS) affects 7–15% of the general population. A recently devised dietary approach consists of restricting foods high in FODMAPs, which can trigger and/or exacerbate IBS symptoms.

The results showed that in the RCTs, the patients receiving a low-FODMAP diet experienced a statistically significant pain and bloating reduction compared with those receiving a traditional diet; as regards to stool consistency, there was no significant difference between treatments. A significant reduction in abdominal pain and bloating were described by patients receiving a low-FODMAP diet compared with those receiving a high-FODMAP diet. In cohort studies, pain and bloating were significantly reduced after treatment compared with the baseline diet. We conclude that there is evidence that a low-FODMAP diet could have a favourable impact on IBS symptoms, especially abdominal pain and bloating. However, it remains to be demonstrated whether a low-FODMAP diet is superior to conventional IBS diets, especially in the long term.

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