The Use of Digestive Enzymes in Chronic Renal Disease

You are what you eat however, there is a lot more that is happening inside of our bodies that are just as important.

Digestion is a core function of the human body of which digestive enzymes and other chemicals are an essential component in the metabolism and absorption of vitamins, minerals and other nutrients from our food that are required by our body to perform its important tasks and functions.

I am sure that most of us have experienced issues with our digestion at one point in time, from bloating, nausea or changes in our bowel movements however some issues with digestion can be chronic causing a significant impact on our quality of life and increasing the risk for further complications with health.

It is now well recognised that chronic kidney disease (CKD) affects the gastrointestinal function which can lead to changes in the microbiome, loss of gut barrier function and integrity increasing uremic acid and other toxins in the bloodstream. Kidney disease is a multifactorial condition however strong evidence suggests that regardless of the type of kidney disease, toxins, inflammation and the immune system play a significant role in the cause and development of CKD.

Identifying digestive dysfunction and supporting the body with supplements including digestive enzymes may help to treat and prevent symptoms of CKD as well as help balance the microbiome and reduce toxic load and inflammation.

Let’s explore further the role of the digestive system, gut function and how digestive enzymes can help.

The Digestive Process

Digestion is a complex process within the body that begins as soon as food enters the mouth with chewing. From the mouth, the food passes through the oesophagus, to the stomach and down to the small intestine where any waste products from the digestive process are excreted through the large intestine (as stools) and out of the body.

As our food passes through our digestive tract the body produces and secretes digestive enzymes and other chemicals to help break down the food into smaller molecules. Upon reaching the small intestine, these smaller molecules can then be absorbed into the bloodstream and delivered to the body.

Seems simple…right?

Unfortunately due to a variety of factors (environmental, dietary, lifestyle, age, health) issues with the digestive process can occur and is very common. This can impact one’s quality of life and there can be other consequences of poor digestion.

Possible Signs of Poor Digestion:

A deficiency in digestive enzyme secretion can be associated with many health conditions and is now acknowledged as a contributing factor in many diseases. Some of these include:

• Asthma
• Celiac disease
• Diabetes
• Autoimmune conditions
• Anaemia
• Eczema &allergies
• Gastritis
• Rheumatoid arthritis
• Kidney Disease

There are a variety of symptoms that can present with poor digestive function with

Common signs and symptoms include

• Bloating • Nausea (especially when taking supplements) • Burping/belching • Reflux/indigestion • Flatulence • Diarrhoea

• Iron and nutrient deficiencies • Cracked fingernails • Chronic infections • Undigested food in stools • Gut infections and overgrowths • Acne

Our Microbiome – The Good, Bad and Ugly…

The microbiome (gut bacteria) is rich and diverse and is composed of many different species and strains of gut microbiota which help to maintain healthy gut function and health. The gut microbiota produces many different beneficial metabolites (eg. short-chain fatty acids, butyrate) that are able to interact with intestinal gut barrier epithelial cells (gut wall cells) and our immune cells.

Did you know that 70% of our immune cells are located in the gut!

The intestinal tract (gut barrier wall) is a single layer of cells that are held tightly together with tight junctions forming a barrier against toxins, inflammatory substances, pathogenic microbes and larger food proteins. Loss of integrity to this gut barrier increases the permeability and these substances can pass into our internal environment causing disrupted immune responses and systemic inflammation.

Despite gut bacteria remaining relatively stable (in the right conditions) they readily adapt to changes in our environment, health and diet causing inflammation, disrupting our gut barrier function and impacting our immune function and health.

It is well established that chronic inflammation is the driver of many diseases including cardiovascular disease, obesity, diabetes, and asthma (among many others) with a link now acknowledged with kidney disease.

The gut is the seat of health and immune function with systemic inflammation associated with significant shifts and changes in the gut microbiota.

The Gut-Kidney Axis

In recent years that has been increased research and acknowledgement of the gastrointestinal tract contributing as a major source of chronic inflammation in kidney disease.

Chronic kidney disease affects gastrointestinal function and it is well recognised that these changes can result in disruption of the microbiome and gut barrier function and integrity.

Disruption to the gut microbiota and changes in the gut barrier permeability has been found to contribute to the progression of CKD as the metabolites (toxins) produced by the bacteria can drive inflammation and further imbalances and readily pass through the barrier wall which can impact upon health including kidney function.

There are many factors that contribute to changes in gut microbiota and impair gut barrier function which include:

• slow intestinal transit time (constipation)
• poor digestive capacity (ability to break down foods)
• increase in toxins in the gut (microbes)
• increase in production of uremic toxins
• medications and antibiotics
• diet

Disruption to the gut microbiota can cause an increase in uremic toxin production which is well known to promote CKD. Additional changes in the gut barrier function and permeability allow for the passage of other toxins and bacteria into our internal system driving chronic inflammation and contributing to other disease states including cardiovascular disease.

The importance of optimal digestion and breakdown of food, gut bacteria balance and reduction of inflammation cannot be underestimated in the prevention and treatment of disease – including CKD!

Pathways that lead to changes in gut microbiome and inflammation in CKD

www.karger.com/Article/Pdf/381990

What Are Digestive Enzymes And How Do They Work?

Digestive enzymes are simply biological catalysts – meaning they are proteins that speed up the chemical reactions to help break down our food. For good digestion and metabolism to occur it is essential that we have good digestive enzyme secretion to break down our food into nutrients and substances to enable optimal absorption across the digestive tract.

Digestive enzyme secretion occurs throughout the digestive tract which occurs in different stages of the digestive process and in different organs.

Some of the most important enzymes and their function are listed below:

Organ	Digestive enzymes produced	Food molecules broken down
Mouth	Amylase, lipase	Starches
Stomach	HCL (Hydrochloric Acid), Protease, Lipase, Amylase	Starches, protein, carbohydrates, fats
Small intestine border	Protease, lactase, lipase, peptidase, scares	Starches, protein, carbohydrates
Pancreas	Protease, Lipase, Amylase	Starches, protein, fats
Liver	Bile	Fats

Impaired or insufficient digestive enzyme production and secretion can cause many symptoms including dyspepsia, heartburn, and reflux (I am sure many have experienced this before!)

The longer-term consequences of impaired digestion, however, can have significant impacts on health including changes in gut bacteria and increased inflammation contributing to chronic disease conditions (including CKD).

Benefits of Digestive Enzymes in Chronic Kidney Disease

There can be many factors contributing to the insufficient production and secretion of digestive enzymes.

Listed below are some of the most common causes:

• Alcohol consumption
• Stress
• Diet (processed foods, high sugar)
• Mediations
• Age – as we age our capacity to produce digestive enzymes reduces
• Smoking
• Gut bacteria imbalances (dysbiosis)/infections
• Food intolerances/allergies

Abnormal upper gastrointestinal motility and digestion enzyme secretion has been demonstrated in several studies with people diagnosed with CKD and can become worse with advanced CKD. The absorption and elimination of medications and nutrients have been also shown to be abnormal in CKD which can contribute further to the production of toxins and inflammation.

Optimising and improving digestive enzyme capacity can be of great benefit, not only for acute symptoms of bloating, pain and dyspepsia but also for preventive treatment through improved gut health, reduced inflammation and increased nutritional absorption.

Digestive enzyme supplementation is a great treatment option with enzyme supplementation enhancing the normal actions of digestive enzymes within the gastrointestinal tract.

Natural sources of digestive enzymes are also important to consider and include in the diet as they can help to support the natural production of digestive enzyme secretion.

Some great natural options include:

• Honey – especially raw
• Mangoes
• Bananas (high in potassium)
• Papaya
• Avocados (contains potassium in medium levels)
• Fermented foods (sauerkraut)
• Pineapples

Natural Solutions for Improving Digestion and Gut Function

Over the past decade, the research into gut health and how to improve and maintain good digestion and diverse gut microbiota have exploded!

Several important nutrients and other supplements are now well known to have a positive impact on digestion and gut health.

Some of the key natural recommendations include

• Zinc supplementation
• Specific probiotic supplementation (bacteria species have different actions within the gut)
• Prebiotic fibres in the diet and supplementation – both insoluble and soluble fibres from a diverse range of plant-based foods

Digestive enzymes improve the breakdown of nutrients and reduce inflammation.

Alongside supplements and digestive enzymes, there are other steps you can take to help your body naturally improve digestive acid secretion, metabolism and absorption. (These also help with many other areas of health!)

• Chew your food thoroughly to help begin the digestive process
• Movement and exercise
• Reduction of stress
• Ensuring a good night’s sleep
• Avoid drinking liquids with meals as this dilutes your digestive enzymes
• Add some apple cider vinegar to a little hot water and drink 10 minutes before meals – this stimulates your own digestive enzyme production.

Supplementing with Digestive Enzymes

There are two main areas of enzyme support that we often prescribe as naturopaths when looking to support the body’s own production of digestive enzymes.

These include supporting food breakdown in the stomach and the second focuses on supporting enzyme production in the pancreas and small intestines.

The stomach being highly acid relies mostly on the enzymes Pepsin and Hydrochloric Acid. You would think about using these as a supplement if your symptoms started immediately after eating if you experienced a lot of burping, upper digestive discomfort and heartburn.

The pancreas and small intestines produce the enzymes Protease, Lipase, Amylase. You would think about supplementing with these enzymes if your symptoms come on 2 hours or more after eating, if you experience food allergies, bloating, nausea, inflammation, gas, cramping or diarrhea.

As always we recommend discussing any new supplements with a qualified health care practitioner.

Testing

There are stool tests that you can do that will help you pinpoint which area of the digestive tract needs support and possible supplementation with enzymes. Speak to a qualified naturopath or integrative doctor if this is something you wish to have examined.

Conclusion

It is well established that the gut microbiota plays a key role in regulating gut barrier function, immune health and inflammation and if becomes disrupted can contribute to chronic inflammation and disease.

Digestion begins in the mouth and ensuring optimal digestive enzyme production and secretion is essential for the breakdown of food and assimilation of nutrients. Not only is this essential for good nutritional status but also for maintaining gut bacteria balance.

Changes in digestive enzyme secretion and absorption can potentially have a broad impact on the prevention and treatment of both CKD and its complications.

Optimising digestive enzyme secretion through lifestyle changes and supplementation can be key to improving digestion and reducing the risk of chronic disease.

We always recommend discussing any changes to your treatment with your doctor.

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