The Role of Digestive Enzymes in Gut Health and Histamine Balance

In this episode of the Histamine Well Podcast, host Joanne Kennedy delves into the significance of digestive enzyme deficiencies in managing histamine intolerance and chronic gut issues like SIBO. 

Joanne explains the critical roles of hydrochloric acid, pancreatic enzymes, and bile acids in maintaining a healthy digestive system, and how their insufficiencies can lead to increased histamine levels and poor gut health. 

The episode covers the symptoms, causes, and solutions for enzyme deficiencies, emphasizing the importance of proper enzyme supplementation. 

Joanne also shares insights into the impacts of stress, diet, and specific medications on enzyme production. This episode is a must-listen for those looking to better understand and manage their digestive health and histamine levels.

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Transcript

Joanne Kennedy: 0:00

Hi, it's Joanne. If you're struggling with histamine intolerance or chronic gut issues like SIBO, it's very likely that you're also dealing with deficiencies and crucial digestive enzymes. Correcting these deficiencies is key to addressing both your chronic gut issues. And the histamine imbalances, they can trigger. These enzymes play a vital role, not just in breaking down food, but also in regulating the pH of your stomach and small intestine, as well as supporting your immune system. Deficiencies in these enzymes can arise from common factors like stress, prolongs use of proton pump inhibitors like Nexium. And long-term antihistamine use. So stick around as we dive deeper into how these factors impact your gut health and histamine levels. Welcome to the Histamine Well Podcast designed for practitioners and patients alike. This is your trusted source for insights on histamine intolerance, methylation, gut health, women's hormones, and much more. I'm Joanne Kennedy. Your host, naturopath, author, and educator. Passionate about breaking down complex science into clear, accessible knowledge. Whether you are a health professional or navigating your personal wellness journey, the Histamine Well Podcast bridges the gap between cutting edge research and practical understanding to empower you with the tools to thrive. Hi everyone. Welcome back to the show. Today's episode is all about digestive enzymes and how an insufficiency in important digestive enzymes, including hydrochloric acid, pancreatic enzymes, and bile acids, can either cause or contribute to high histamine levels. You'll also learn the signs and symptoms of digestive enzyme insufficiency, as well as the major causes, which will help you pick up if any of these digestive enzymes are an issue for you. So I'm gonna start with my favorite. And it's funny that I've got a favorite digestive enzyme, but I do. Which is hydrochloric acid. Hydrochloric acid is a strong acidic fluid, and it's secreted by the cells of the stomach, and it's there to break down protein. Now interestingly, I found this out when I was doing research from my book. I actually did this deep dive one day. To all this research on the evolution of human stomach acid and why humans have very acidic stomachs. And it's because we've been exposed to rotting carcasses in the past, so we've had to deal with all of the bacteria that can be created from consuming a rotten carcass. We've actually evolved to have such highly acidic stomachs, more than many other animals, and in fact, just as acidic as vultures. So when I thought about that, I was like, this acidic nature and this antimicrobial nature of hydrochloric acid is so fundamentally important. It's really preventing pathogens from moving into the small intestine. I also think about hydrochloric acid as the conductor of the digestive enzyme orchestra. So what happens when you chew your food? It releases hydrochloric acid and that sends a message. To the pancreas to take pancreatic juice into the small intestine. And that alkalizes the small intestine. And you need an alkaline environment for pancreatic enzymes to work. And pancreatic enzymes break down carbohydrates, fats, and proteins. The same thing happens with the gallbladder. So when you chew your food, it releases hydrochloric acid. A message gets sent to the gallbladder to take bile acids into the small intestine. And bile acids are important for breaking down fats. Bile is also a natural laxative and it's also very antimicrobial. So going back to hydrochloric acid, if there is deficiency in hydrochloric acid, you get this knock-on effect whereby you have issues with the other digestive enzymes and that entire environment in the small intestine when it's too acidic and not alkaline. Is a breeding ground for SIBO bacteria and SIBO is a major cause of high histamine. And then when you don't break down your animal protein properly, particularly red meat. If you don't have enough hydrochloric acid, it sits rots and ferments which will release histamine. Animal proteins do contain histamine, and the fresher it is, the less histamine it has. So I always encourage my patients to go to the butcher. Get the meat fresh that day. Consume it that day. If you can't eat it that day, you could put it in the freezer. Then you thaw it and you eat it that day that you thaw it. Otherwise it can start releasing histamine. Now if you do that and you are still having issues with histamine reactions, particularly from eating red meat, that is a real sign there is a potential issue with your hydrochloric acid. So it really, in my mind, is indicating low hydrochloric acid levels. Other symptoms of low hydrochloric acid are bloating, reflux, heartburn, flatulence after meals, poor protein digestion, as I said. A prolonged sense of fullness after eating, diarrhea or constipation, a feeling of incomplete, emptying, nausea, indigestion, and undigested food in stools. You can also see that on a stool test. Okay? You can often see these microbiome mapping tests will look for meat fibers in the stool, which does indicate low hydrochloric acid. It's funny, one of the classic signs that I see, and I always ask my patients this, do you get incomplete emptying? I have time and time again found that incomplete emptying is such a key indicator of low hydrochloric acid. Simply when we get the hydrochloric acid in and you have complete bowel motions, like complete emptying, we can really, really see an improvement in overall gut health, including histamine. So incomplete emptying is constipated. I mean, I know you can be constipated, not going for like several days, but if it's incomplete, it's just you are not pooping out everything. You're not getting rid of a buildup of toxins. You're certainly not pooping out all your food properly and you can't get rid of SIBO when you're constipated. Also, if you're not pooping properly, you can have a buildup of oxalates and hormones amongst other things. So high estrogen, high oxalate, sibo, undigested food not moving through. These are all major causes of high histamine. And having low hydrochloric acid is contributing to those problems. Sometimes causing them. And in other times is absolutely just making the whole issue worse. From a blood test point of view, vitamin B12 deficiency is a classic sign of low hydrochloric acid. It's also a sign of sibo. So we can clearly see that when you've got these gut issues and these gut symptoms. It is very important to start supplementing with hydrochloric acid. There's one important thing I need to say before you just go and start supplementing with hydrochloric acid is that if you have heartburn, what is often happening is you're getting a rebound effect. So effectively your low hydrochloric acid, which is causing SIBO or causing you not to be able to break down your food properly, that will cause a histamine reaction. Histamine stimulates the histamine two receptor, which will releases hydrochloric acid. This is not happening when you're sitting down eating a steak necessarily. It can be happening at any time. So please don't supplement hydrochloric acid until you've got your histamines down. If that is you, what I find very efficacious is doing a SIBO low histamine diet to get your histamine bucket down. If you're interested, I do have that diet as part of my e bundle which you can find on my website. That is just do not take hydrochloric acid until you've got the histamines down. Which you'll notice that the heartburn will stop. Will go down significantly, and in a lot of instance, it will just completely go from that diet. Before we go any further, I want to speak directly to the practitioners and students listening. If you're intrigued by histamine and methylation and eager to expand your knowledge in this fascinating area, we offer the Histamine and Methylation online group coaching course. The only program of its kind. It covers everything you need to know about histamine and methylation, providing both the theory and guidance you need to treat these issues effectively in clinical practice. We cover sibo, hormonal imbalances, oxalates, M-T-H-F-R, the four pathways of methylation, including the folate pathway, methionine pathway, tetrahydro biopterin pathway, and the all important transsulfuration pathway and much more. The program is delivered by detailed online webinars and handouts for you to keep. And for eight weeks you'll meet with me for live coaching calls in a private community space with other practitioners from all over the world dealing with histamine and methylation issues in their patients every day. Together we learn so much. To learn more and apply, visit joanne kennedy naturopathy.com. Low hydrochloric acid is common. And do you know why it's common? Because it's so often caused from stress. So simply when you are in fight or flight. You are not in rest and digest which reduces the excretion of your hydrochloric acid. And hydrochloric acid being the conductor of the orchestra of all the digestive enzymes. This can cause a knock on effect whereby you also have deficiency in pancreatic juice, pancreatic enzymes, and bile acid. What I also see is people that eat in front of the computer or they eat on a run. They're just not sitting down, chewing their food properly, allowing their digestive enzymes to be secreted properly. Aging can also cause a reduction in hydrochloric acid. Zinc deficiency. We need zinc to make hydrochloric acid. Helicobacter Pylori infection and gastritis can cause low hydrochloric acid. The use of proton pump inhibitors such as Nexium and the use of antihistamine type two receptor blockers, such as Zantac, as well as metformin, can also cause low hydrochloric acid. These are all really, really common things that we see in clinical practice every day. I am gonna now move on to pancreatic enzymes and pancreatic enzymes are carried in pancreatic juice. Pancreatic juice is really important. It contains sodium bicarbonate. This creates an alkaline environment in the small intestine. And having an alkaline environment in the small intestine allows for the proper action of the pancreatic enzymes and the pancreatic enzymes, digest protein, fat, carbohydrate, and starch in the small intestine. So when there's low hydrochloric acid and a reduction in pancreatic juice. And your pancreatic enzymes are not working properly,'cause there's not enough pancreatic juice to alkalize the small bowel, effectively the whole environment for your digestive enzymes to work in the small bowel is not optimal. It's interesting when you see a complete microbiome mapping test or a stool test that can give you markers of pancreatic enzyme insufficiency. Sometimes it just doesn't come back as low. And I see it clinically. Because when people take the enzymes, they're, they're doing much better is that they might come back adequate. They might be producing enough. But the environment in the small intestine is too acidic for them to work effectively. So these tests are helpful, but I always take them with a grain of salt because there's nothing like signs and symptoms, and then supplementing with something to provide some support for a particular amount of time and seeing an improvement. That's enough evidence that I need. So when I'm thinking about pancreatic enzymes and a defic potential deficiency, I'm always thinking, gosh, it's very likely that that person has sibo. And with sibo, you know, it's FODMAP foods which are carbohydrates and starch. So resistant starch is feeding the SIBO bacteria and you need pancreatic enzymes to break those foods down. Also if the environment in the small bowel is acidic, which is often happens with sibo, therefore it's so obvious that you have increased requirement for pancreatic enzymes and is also the environment that's not working properly. So this is why supplementing with pancreatic enzymes, along with brush borderer enzymes can really, really help when it comes to SIBO. Brush border enzymes are made locally in the small intestine, and then they're there to break down carbohydrates and starch into even smaller molecules. So they can also be affected when there's SIBO and the environment is too acidic. I will often prescribe hydrochloric acid along with pancreatic enzymes at the same time a. There is a supplement that I love. It's called Pure Encapsulations Digestive Enzymes Ultra. It has hydrochloric acid and pancreatic enzymes, and it has quite a few of those brush border enzymes, so that's why I supplement with that. If you've worked with me, you know I love that supplement because it's just giving you everything that you need. For SIBO, I'll talk about bile acids in a minute. But that supplement is very efficacious for treating sibo. Now something I wanna say is do not take bicarb soda to try and alkalize your small intestine because it's just going to alkalize the stomach. And the last thing you need is an alkaline stomach.'cause I've seen many patients be told from practitioners or they read it online to take bicarb soda to potentially help with acid reflux. I mean it potentially is helping, but you are alkalizing your stomach, which is gonna cause a massive knock on effect. And it's just going to completely disrupt the pH of the stomach and the small intestine to an unfavorable environment where SIBO bacteria will start to thrive. Plus you won't be able to break down your animal protein properly. You can also have a deficiency in vitamin B12 and nutrients that are required that require hydrochloric acid. So it's just not a good idea to do that. The signs of pancreatic enzyme insufficiency. They cause bloating, abdominal pain, fatty stools, a deficiency in fat soluble vitamins, A, D, E, and K. Also a deficiency in essential fatty acids, calcium deficiency, and magnesium deficiency. You know, a classic sign of calcium magnesium deficiency is muscle cramps. It's not just magnesium, it's also calcium. You need calcium to actually drive magnesium into the cell. So if you are getting muscle cramps, that is such a classic sign of calcium and magnesium deficiency. Folate deficiency as well as zinc deficiency can also be signs of pancreatic enzyme insufficiency. When we look at the research, pancreatic enzyme insufficiency is often caused from more serious conditions or surgery. Things like chronic pancreatitis, pancreatic resection, inflammatory bowel disease, that's Crohn's disease and ulcerative colitis, celiac disease, cystic fibrosis, or gastric resection. So these things are more serious presentations, but I just want you to think clinically, does your patient have sibo? If they do, then it's very likely that pancreatic enzymes are something that they're gonna benefit from taking. Or if you are a listener and you do have sibo, then just taking pancreatic enzymes can really help break down your food properly in the small intestine. If someone comes to me, oh, do do they or do they not need them? It can make all the difference with getting SIBO under control within a three to four month timeline. If you get the hydrochloric acid and pancreatic enzymes in. So you just don't wanna miss it. Because if you are just not breaking down the food properly, if the environment in the small intestine is not allowing these enzymes to work properly. If you've had a lot of stress, for instance, you really need the hydrochloric acid, so that hydrochloric acid, pancreatic enzyme combination. I give to 99% of my SIBO patients,'cause I just don't want them to do that three to four month protocol. And then we retest and it's still there. So I'm really into prescribing digestive enzymes throughout that whole process. So we're gonna move on to bile acids. Bile acids are made in the liver and then sent to the gallbladder. And they're stored in the gallbladder until released for the digestion of fats in the small intestine. Like hydrochloric acid and pancreatic juice, bile acids have anti-microbial properties. So this prevents unwanted bacteria from growing in the gut. Understanding sIBO and bile is just a little bit tricky. So first of all, bile acid deficiency can contribute to sibo. But what can also happen is that SIBO bacteria can de conjugate bile acids. It means it can break bile acids. And when they're broken, they can damage the lining of the gastrointestinal tract and this will release histamine. So you don't wanna be pushing bile too much with taking herbs to stimulate bile flow or, or ox bile or TUDCA to move your bile with active sibo. I get the SIBO bacteria down first. And if there's no liver gallbladder issues, often the loose stools that you see in SIBO from a potential bowel issue can just be a deficiency in one of the pancreatic enzymes, which is called lipase or the fact that the environment is so acidic that these pancreatic enzymes aren't sort of working effectively. I very rarely do BILE support until I've got the SIBO bacteria down. And then the person will come back and they're still highly reactive to fats. And also if they've had their gallbladder removed, then we can go in with taking OX bile to give them some actual bile acid. Signs and symptoms of bile acid insufficiency are diarrhea, fatty stools, fecal urgency, fecal incontinence, abdominal pain deficiency in fat soluble vitamins A, D, E, and K. Weight loss, fatigue. Weakness as well as eastern dominance. So you actually need bile to bind up your estrogen and help extract it and expel it through the bowels. The main causes of bile acid insufficiency is SIBO via deconjugation, as I said. High estrogen. Having a gallbladder removed celiac disease, inflammatory bowel disease, chronic pancreatitis, the use of proton pump inhibitors, including nexium, the use of antihistamine type two receptor blockers, including Zantac. As well as poor methylation because we really need healthy methylation for healthy liver function and to help make phosphocholine, which is a component of bile acids. What I recommend you do is write down the different signs and symptoms of hydrochloric acid insufficiency, pancreatic enzyme insufficiency, bile acid insufficiency and just have a think if you do have some of these signs and symptoms. One is of each is just a classic that there is a problem. Also, consider the major causes stress being a really significant one. And as long as you don't have active heartburn, supplementing with hydrochloric acid can be a game changer because it's actually giving your stomach that acidic environment it needs. It's also gonna just stimulate the other digestive enzymes. The one I use in Australia is Plex Hydro Zyme. It's about 500 milligrams per tablet. I just do one with each meal overseas. I use the thorn or pure encapsulations. Hydrochloric acid, it's betaine hydrochloride. They're usually one gram per tablet, and I find that that is fine. I actually don't see much difference between taking 500 and one gram. I really don't because we're obviously working with everything else we need to do with the gut. So I use that if you want to layer in pancreatic enzymes, which I usually recommend. Then in Australia I use Orthoplex DEF. I dunno what DEF stands for, but it's DEF. Just one to two with each meal. Overseas, I'll usually use the pure encapsulations digestive enzymes ultra, the hydrochloric acid and the pancreatic enzymes in there, and they've also got the brush border enzymes in there, which I really love. My Aussie patients, I do use that supplement for you as well. You just gotta bring it in from New Zealand and sometimes it takes ages and it's expensive, so I don't always use it. That's why'cause the orthoplex ones are fine. Good in fact. If you're concerned about your gallbladder, so if you are someone who knows that they've got gallbladder issues, they're getting gallbladder pain, you are, you've been flagged to potentially have gallbladder surgery. I highly recommend you listen to my episode with Olivia Hass. She's a gallbladder specialist in the US and if you need further support with your gallbladder, she does one-on-one consults. She's also got two online programs, one around saving your gallbladder and one about what to do if you've had your gallbladder removed. Because it's just not a benign thing. It can cause a lot of havoc. Your gut if your gallbladder function is not optimal and your bowels not optimal. If you do just simply require support with, or if you've had your gallbladder out and you know that you need support, just taking ox bile or use the one called nutricology. It's 175 milligrams. I just use one with each meal. It seems to help. I rarely do the 500 milligram one. I just find the 100, and I think it's 125 or 175. You'll able to see it online. You'll actually be able to see which one I'm talking about. So thank you for joining me. I hope you found this episode beneficial. Be sure to subscribe to the histamine well so you don't miss an episode. Leave a review and you can also share this episode with someone who could benefit. If you have any questions you'd like answered. Or have a topic you'd like me to discuss, please go to my website, joanne kennedy naturopathy.com where you can provide us with that information. Until next time, take care and be well.