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Walking the Digestion Trail

Digestion Digestion
DaVinci Laboratories

Practitioners can share the word about the up-to-date ways their patients can keep their digestive tracts healthy.

The importance of one’s digestive system is unquestionable—the number of gut issues that can occur—ranging from constipation to irritable bowel syndrome (IBS)—seem immeasurable.

In a study published in February 2019 in Nature Microbiology, the manuscript titled “The Neuroactive Potential of the Human Gut Microbiota in Quality of Life and Depression,” describes the first population-level study on the relationship between gut bacteria and mental health determined specific gut bacteria that is linked to depression, which reportedly provides evidence that a range of gut bacteria can generate neuroactive compounds.

“The relationship between gut microbial metabolism and mental health is a controversial topic in microbiome research,” said Professor Jeroen Raes (Belgium-based Flanders Institute for Biotechnology, VIB-KU Leuven), who, alongside his team, put together the manuscript. “The notion that microbial metabolites can interact with our brain—and thus behavior and feelings—is intriguing, but gut microbiome-brain communication has mostly been explored in animal models, with human research lagging behind. In our population-level study, we identified several groups of bacteria that co-varied with human depression and quality of life across populations.”

These results still have to be confirmed experimentally, but this study at the very least demonstrates just how impactful the gut can potentially be towards overall health.

Keeping this in mind, practitioners can consider a multitude of supplements and remedies that can help patients not only feel better, but also have a healthy digestive tract.

Making an Impact

As previously noted, there are a plethora of health issues that can affect one’s digestive system—some of which revolve around a lack of enzymes and our modern-day diet, and can result in a domino effect of other complications.

“There are so many I don’t even know where to start,” explained Liz Cruz, MD, a holistic gastroenterologist who practices in Arizona under her company Dr. Liz Cruz Partners in Digestive Health. “Not digesting our food properly in the stomach (due to a lack of enzymes) can cause heartburn, reflux, gas, bloating, constipation and/or diarrhea. Other side effects that come with not digesting our food properly is an increase in food allergies due to having leaky gut syndrome. There are so many more food allergies today than ever before because of the types of foods we are eating (processed foods/fast foods—not real food), which the body doesn’t know how to digest. This food does not get broken down in the stomach and in turn creates small tears in the small bowel causing the body an immune function reaction. On a separate note, not having enough good bacteria in the gut can cause gas, bloating, constipation and/or diarrhea. It can also be the precursor to very bad digestive diseases such as colitis and or Crohn’s.”

Peter Huang, R&D manager with California-based Bio Essence Herbal Essentials, who offers DigestionCE, natural enzymes that are derived from MCP, ginger, fennel, turmeric and peppermint, was in agreement. He also illustrated that problems with the gut can be tied to a weakened immune system.

“The most common form of problems with gut health is bloating, gas and diarrhea,” he said. “These are the most common forms of problems in the number of healthy bacteria living inside your digestive tract. Gas, in particular, is a sign that food in your gut is starting to ferment, as there is not enough stomach acid to break down the foods you’ve eaten. The most impactful of gut health problems is diabetes and a suppressed immune system. This is caused by the inability of the gut to break down glucose and gluten respectively from their systems, leading to the suffering of those gut health problems.”

However, the silver lining is that these conditions have raised cognizance when it comes to stomach concerns.

“Food insensitivities such as gluten-intolerance, celiac disease and leaky gut syndrome have also helped to drive customer awareness of digestive health issues,” commented Hank Cheatham, vice president of marketing and sales at Daiwa Health Development, Inc. (California), manufacturers of Daiwa Gastro Health. “‘Leaky gut syndrome’ is said to have symptoms including bloating, gas, cramps, food sensitivities, and aches and pains. But it’s something of a medical mystery. Sales of food products for gluten sensitivity are estimated to reach $14.4 billion in 2019, according to NBJ (Nutrition Business Journal).”

Luckily, patients need not fear—there are a plethora of solutions at their disposal.

Alternative Solutions

In terms of remedies, Huang provided various suggestions, including peppermint, dandelion and ginger:

• Peppermint (Mentha piperita) – known to help with indigestion, stomach ache and colicky diarrhea; peppermint oil can be used to treat IBS (helping to ease bloating, cramps, spasms)

• Dandelion (Taraxacum officinalis) – has diuretic properties that have been scientifically confirmed. Promotes a healthy digestive system and restores potassium, and described by Huang as “one of the best herbs for digestion.” Can also be used to treat premenstrual bloating that occurs as a result of excess fluid before a menstrual period.

• Ginger (Zingiber officinale) – used to relieve nausea, upset stomach and stomach cramps

Another option to consider is digestive enzymes, supplements that patients can expect a quick turnaround with.

“Digestive enzymes are the go-to for many consumers looking for digestive support,” opined Ryan Sensenbrenner, director of marketing at Enzyme Science, Inc., Florida. “Unlike many other supplements that may take time to take effect, most enzymes are felt very rapidly. This is important because the digestive health consumer expects fast results.

“One recent innovation we are excited about is the Enzymedica formula (Enzyme Science is a subsidiary of the company) Heartburn Relief. It combines alginic acid with a series of other ingredients to stop occasional heartburn. Many individuals feel results in seconds, and the formula lasts for up to four hours.”

It’s important for practitioners to keep in mind that the proper solution to solving gastrointestinal difficulties will have to be determined on a case-by-case basis. Once this is determined, recommending the proper diet could be a potential starting point.

“The most beneficial remedy or supplement for each individual will vary depending on the digestive issues at hand,” Hannah Braye, registered nutritionist (Dip CNM, mBANT, CNHC) and senior technical advisor at Florida-based ADM Protexin pointed out. “There are numerous contributing factors to digestive discomfort. For example, pathogenic overgrowth, hidden food intolerances, sub-optimal hydrochloric acid, digestive enzyme or bile secretion, dysbiosis (an imbalance of bacteria in the gut), increased intestinal permeability or mechanical issues may all be playing a role. Consulting a qualified nutrition professional who is trained to take a full case history, identify relevant imbalances and can provide a suitable protocol may therefore be beneficial, and should help prevent you from wasting time on money on remedies that don’t work.

“The starting point with any digestive condition is always to improve the diet. Processed foods contain many hidden sugars, additives and emulsifiers thought to have a negative impact on the balance of bacteria in our gut, and a pro-inflammatory effect.1 Many people notice a rapid improvement in their digestion just by cutting out processed foods and instead switching to home-cooked wholefoods diet. A nutritional professional will also be able to offer guidance as to whether certain aggravating foods should be eliminated for a period of time.”

Braye also went on to provide some general supplements to consider, stating that “there are numerous digestive aids on the market which may be beneficial, for example, anti-microbial agents, designed to eradicate pathogenic overgrowth, prebiotics to feed beneficial species of bacteria in the gut, digestive enzymes, betaine hydrochloride (the building blocks for stomach acid), bitters and bile supplements designed to help us better digest our food, and nutrients which help to strengthen the gut lining. In particular, fermented foods and probiotics (live bacterial supplements) are showing particular promise in many digestive conditions, due to their ability to support multiple aspects of digestive function.”

Probiotics have continued to receive praise, but if choosing to use them, quality must be considered. Patience is also key.

“Simply put, do your homework! exclaimed Terrence O. Tormey, CEO of Kibow Biotech, Inc. (Pennsylvania). “Not all probiotics are the same! Not all strains are the same. The amount of beneficial bacterial delivered is not the same. Finally, give it some time. The use of probiotics is not like taking two Advil and your headache goes away. It takes time to build a concentration in the gut for the full benefits of the bacteria to have an impact.”

Dr. Cruz, who also stressed the use of probiotics, enzymes and diet, also advocated for daily consumption of water, which can often be forgotten.

“Take a medical grade probiotic every day preferably on an empty stomach, take medical grade enzymes with every meal,” she advised. “Try to eat cleaner (less food that comes from a bag, box or can and more real vegetables or minimally processed foods). Finally, the absolutely best thing you can do for your health is drink more water and less of everything else. At least half of your body weight in ounces per day has changed people’s lives.”

The Market Looks Bright

The digestive health market is continuing to thrive, mainly due to consumers’ diets and the challenge of modern-day living. Market value is expected to grow, as demonstrated by the numbers.

“People look to digestive remedies to help with the side effects of unhealthy diets and stressful lifestyles,” Cheatham noted. “These trends, in addition to greater health consciousness and literacy among consumers, are likely contributing to the increased popularity of fiber and probiotics supplements, according to Euromonitor International. Dietary supplements and health and wellness products positioned for digestive health are among the most popular platforms by value, trailing behind only general health/wellbeing, weight management (for health and wellness), and heart health (for dietary supplements).

“Significant growth is anticipated in the digestive health category. With the awareness of the connection among gut health and overall health and cognitive function, as well as athletic performance, growth seems to be a sure thing. In addition, researchers have only just begun to identify methodology to define a healthy microbiome; as this investigation evolves, growth in the market will occur, [not only] potentially in personalized medicine, but overall. Furthermore, consumers are becoming aware of the connection between probiotics and digestive health, and therefore the demand is increasing—global sales of probiotics foods and supplements are predicted to grow 6.8 percent every year through 2019. This product category has increased 48 percent from 2011 through 2016. Probiotic foods were a nearly $7 billion industry in 2013, according to NBJ, and is projected to jump to nearly $10 billion by 2019. The probiotics supplements market, which brought in approximately $1.2 billion in 2013, is expected to almost double in size by 2019. The change in focus is driven by the research that suggests that digestive and overall health are driven by a balanced microbiome.”

As for Kibow Biotech, the company is observing rapid growth in this regard, with technology playing a major role.

“From our perspective, it is growing exponentially! The world is waking up to the importance of what is commonly referred to as the ‘gut,’ and the role probiotics play,” Tormey said. “Their role is not limited to just digestion, or even immune boosting. Here at Kibow Biotech, we have shown that select strains of beneficial bacteria (probiotics) can reduce the circulating blood levels of uremic toxins impaired kidneys are not filtering. The Kibow scientist[s] discovered this over a decade ago and have patented the technology and it is called ‘Enteric Dialysis.’ Our technology is helping thousands of patients across the world with kidney illness by using the gut to removing toxins like BUN, uric acid, creatinine, and even reducing levels of C-reactive protein! All of this is done with a non-Rx, all-natural, non-GMO (genetically modified organism) and readily available product called Renadyl.”

From a broader point of view, natural medication in the digestive sphere is being impacted, due to quality issues and the abundance of over-the-counter options.

“There are a myriad of natural supplements on the market that support digestion,” Dr. Cruz pointed out. “For example, probiotics and digestive enzymes. The problem is most of them are very cheaply made and have a lot of fillers. There are by far more over-the-counter medications (not natural) available today which is what most people depend on to manage their digestive issues. For example, Imodium, GasX, Tums, Miralax, PPIs (proton-pump inhibitors) like Pepcid, Pantoprazole, etc. Although these medicines can eliminate symptoms, they are unfortunately making the process of digestion worse over time, therefore doing more damage to the body than good.”


ADM Protexin utilizes research as a major component when it comes to creating new products, especially since it can serve as an indicator of how effective they will be towards patients.

“Research forms the basis of new product development at ADM Protexin, and we work with various leading researchers across the globe, investigating the microbiome and the potential beneficial effects of our strains on human health,” Braye said. “For example, the 14 strains in our Bio-Kult Advanced Multi Strain Formula were recently used in the largest-ever double-blind randomized controlled trial of probiotics in IBS-diarrhea type patients ever-conducted. The study in 400 people found that Bio-Kult significantly improved overall symptom severity in IBS patients and was well tolerated. Abdominal pain and frequency reduced by an average of 69 percent, and 34 percent of participants were completely symptom free at the end of the five-month trial. Significantly though, as well as relieving IBS-D symptoms, Bio-Kult was also shown to markedly improve all aspects of Quality of Life. This includes psychological issues such as anxiety about health, depression, lack of enjoyment of life and feelings of having to avoid stressful situations.

“The Bio-Kult strains have also been shown to be of benefit in numerous other clinical trials for a range of digestive conditions including constipation,2 acute gastroenteritis,3 colic4 and h-pylori infection,5 and we have a number of other trials currently underway in other digestive and non-digestive conditions, for example anti-biotic associated diarrhea and urinary tract infection prevention.

According to Huang, Bio Essence is particularly interested in studies where enzymes and botanical herbs show the most benefit for gut health and a healthy digestive system—a majority of the company’s studies on digestion come from the ingredients that are utilized in its formulas.

Interestingly, he noted that the approach to digestive health research initally focuses on western diet, followed by the importance of probiotics and enzymes.

“Recently,” he said, “the most active research in gut health is associated with the ‘Westernization’ lifestyle of higher intakes of processed meats, butter, fats and refined sugars. The leading fields are finding new enzymes that would help better break down the excess in diets that would lead to becoming overweight. With currently, the largest topic around natural medication that supports digestion surrounds the amount of colony-forming units (CFU) and enzymes. These CFUs are what create the prebiotics and probiotics that create a healthier gut bacteria environment. This would help in giving the body more time to digest and absorb the nutrients from meals. The enzymes are generally used to help break down gas, bloating and other general stomach discomforts.

“The gut is the ‘forgotten organ’ impacting health and disease conditions, including digestion, inflammation and immunity, to obesity. There is also strong evidence that the gut communicates with the central nervous system through neural, endocrine and immune pathways. Probiotics and prebiotics can affect the microbiota-gut-brain axis and regulate mood, anxiety, cognition and pain.”

However, sometimes it can be a challenge for practitioners to treat with alternative solutions due to the lack of scientific substantiation.

“Most doctors are not doing what we are doing in our office with the more holistic approach,” Dr. Cruz pointed out. “Doctors are taught how to diagnose and how to treat with medicine. We aren’t even taught about enzymes and probiotics in med school. When I talk to colleagues about what I’m doing, they think it’s ‘fine’ for me, but they wouldn’t consider it because the studies just aren’t there. It’s too bad because my approach that has shifted from medicine-based to natural supplement based has helped so many of our patients get well. And isn’t that the point?”

Despite the hurdles, companies such as Enzyme Science are doing what they can to make sure that they successfully impact as many customers as possible.

“While we do believe that enzymes are central to digestion, we have done extensive research on the human microbiome and its impact on all functions of the body,” Sensenbrenner concluded. “Recently, we launched a suite of omega-3 fish oil formulas that are the first of their kind—they are optimized to support the microbiome. Consumers and practitioners alike are appreciating this groundbreaking work.”


1 Chassaing B, Koren O, Goodrich J, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature 2015; 519: 92.

2 Fateh R, Iravani S, Frootan M, Rasouli MR, Saadat S. Synbiotic preparation in men suffering from functional constipation: A randomised controlled trial. Swiss Med Wkly 2011; 141: 1–7.

3 Yala ET. The clinical efficacy of multi-strain probiotics (Protexin) in the management of acute gastroenteritis in children two months to years old. Pidsp 2010; 11: 86–91.

4 Kianifar H, Ahanchian H, Grover Z, et al. Synbiotic in the management of infantile colic: A randomised controlled trial. J Paediatr Child Health 2014; 50: 801–5.

5 Khodadad A, Farahmand F, Najafi M, Shoaran M. Probiotics for the treatment of pediatric Helicobacter pylori infection: a randomized double blind clinical trial. Iran J Pediatr 2013; 23: 79–84.

Healthy Take Aways

• Sales of food products for gluten sensitivity are estimated to reach $14.4 billion in 2019, according to NBJ.
• Pathogenic overgrowth, hidden food intolerances, sub-optimal hydrochloric acid, digestive enzyme or bile secretion, dysbiosis (an imbalance of bacteria in the gut), increased intestinal permeability or mechanical issues may all be playing a role in digestive discomfort.
• Global sales of probiotics foods and supplements are predicted to grow 6.8 percent every year through 2019.

For More Information:

ADM Protexin, www.bio-kult.com
Bio Essence Herbal Essentials, www.bioessence.com
Daiwa Health Development, Inc., www.dhdmed.com
Dr. Liz Cruz Partners in Digestive Health, www.drlizcruz.com
Enzyme Science, Inc., www.enzyscience.com
Kibow Biotech, Inc., www.kibowbiotech.com