Should You Take a Digestive Enzyme Supplement?

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After an unpleasant reaction to CVS Beanaid, I have tried to brainstorm why this simple enzyme makes my bowels and digestive tract feel like crap. What I’ve gathered below is part of my research. I definitely need to be on the low FODMAP diet, though I seem to have less of a problem with fructose.

Alpha-galactosidase (α-GAL, also known as α-GAL A; E.C. 3.2.1.22) is a glycoside hydrolase enzyme that hydrolyses the terminal alpha-galactosyl moieties from glycolipids and glycoproteins. Glycosidase is an important class of enzyme catalyzing many catabolic processes, including cleaving glycoproteins and glycolipids, and polysaccharides. Specifically, α-GAL catalyzes the removal of the terminal α-galactose from oligosaccharides.[1]

The enzyme is encoded by the GLA gene.[2] Two recombinant forms of human alpha-galactosidase are called agalsidase alpha (INN) and agalsidase beta (INN). A mold-derived form is the primary ingredient in gas relief supplements.

Enzyme supplements can help improve food tolerance, but only if you match the product to the problem.By Tamara Duker Freuman, MS, RD, CDN|June 17, 2020, at 10:10 a.m.Share

U.S. News & World Report

Digestive Enzyme Supplements

I spend my workdays talking with people who suffer a wide array of digestive problems. Many have been in distress for quite some time. It’s pretty common for people on a journey for “inner peace” to experiment with dietary supplements along the way, often based on internet research, recommendations from alternative health practitioners or testimonials from others for whom the supplement has worked wonders.

Jug of milk with an old country table, a white drink is poured into a glass

(GETTY IMAGES)

Products marketed as digestive enzymes are particularly popular in the digestively-disturbed crowd, and my patients often ask me whether these products are something I recommend.[ 

SEE: Best Foods to Eat With an Upset Stomach. ]

What Is a Digestive Enzyme?

I think it helps to first understand what an enzyme actually is: a protein that facilitates a particular chemical reaction. In the case of human digestion, our bodies produce a wide range of different enzymes to facilitate the chemical breakdown of different food components into their smaller, absorbable building blocks.

An important thing to know about enzymes is that each one is specific to a particular type of biochemical reaction. In other words, a protein-digesting enzyme – called a protease – cannot break down things that aren’t proteins, like carbohydrates, fats, sugars or fiber. And even within the family of protein-digesting enzymes our bodies produce, different ones are required to attack the chemical bonds at different locations and configurations within a protein’s chain.

Without getting too mired down in biochemistry, these characteristics of enzymes highlight an important point:

An enzyme will only help improve digestion of a food if it’s the right type of enzyme for the right type of food.

Relatedly, digestive enzymes will also only help improve digestive symptoms if those symptoms are indeed related to maldigestion of particular nutrients.

One of the issues I help patients understand is whether poor digestion of certain foods is indeed the cause of their bloating, gas, diarrhea or general digestive distress. And if it is, are there are enzyme supplements available that target the poorly-digested nutrients effectively to help alleviate symptoms? After all, if your problem is poor digestion of a fiber found in beans called oligo-saccharides, then taking a fat-digesting enzyme isn’t going to help you. And so on.[ 

SEE: How Often Should I Poop, and Other Toilet Topics. ]

The Most Common Maldigested Nutrients

The most commonly maldigested nutrients that can cause adverse gastrointestinal symptoms include:

  • Lactose is a natural sugar found in milk and other dairy products. When people do not manufacture enough lactase enzyme in their small intestines, lactose cannot be absorbed properly in the gut, leading to gas, bloating and diarrhea several hours later. Taking supplemental lactase enzyme with the first bite of dairy foods can help prevent this.
  • Fructose is a sugar found in certain fruits and sweeteners – from honey and agave to high fructose corn syrup. Sodas, juices, soft drinks and candy can be particularly concentrated sources of fructose. When people lack enough receptors in their small intestines to absorb fructose adequately, it leads to gas, bloating and diarrhea several hours later. Taking supplemental xylose isomerase enzyme (also known as glucose isomerase) just before eating fructose-containing foods can help prevent this. The enzyme converts fructose to glucose, a different type of sugar that’s easily absorbed through a different pathway.
  • Fructans are a type of carbohydrate found in onions, garlic, artichokes, jicama, wheat, barley, rye and a type of fiber called inulin (or chicory root fiber), which is often added to bars, low-carb foods, “healthy” ice creams and a variety of processed foods. Fructans are also marketed as “prebiotic fiber” and sold as gut health supplements. Human beings do not have enzymes to break down this particular carbohydrate – essentially a chain of linked fructose molecules – and sensitive individuals may find it to produce uncomfortable gas pain and bloating several hours after consuming it. Unfortunately, there are no commercially available enzyme supplements that are effective digestive aids for fructan-containing foods.
  • Sucrose, also known as white sugar or just plain sugar. While sucrose intolerance – caused by deficiency of the enzyme that breaks down sucrose into its absorbable component parts – is not nearly as common as lactose intolerance or even fructose intolerance, it’s also not as rare as previously believed. The symptoms of sucrose intolerance mimic those of lactose/fructose intolerance and will onset several hours after consuming certain fruits, vegetables, juices, sweetened foods and beverages. A supplemental enzyme called sacrosidase is available by prescription only for people diagnosed with sucrose intolerance via breath testing or intestinal biopsy.
  • Galacto-oligosaccharides are complex carbohydrates found in certain plant-based foods – like Brussels sprouts, chickpeas, beans, peas, beets and cashews – that give these healthy foods their gassy reputations. Humans don’t make the enzyme required to digest these microbiome-feeding fibers, but certain species of fungi do. Alpha-galactosidase enzyme, derived from a type of mold, is available as a dietary supplement (such as Beano) and has been demonstrated in controlled studies to significantly reduce the intestinal gas associated with bean intake.
  • Fat is primarily digested via lipase enzyme, which is manufactured in your pancreas. But in cases where the pancreas does not produce or secrete enough lipase, incomplete digestion and the resulting malabsorption of fat results in symptoms like floating, orangey or oily stools, diarrhea, malodorous gas, and/or unintentional weight loss. One such cause of this is a condition called pancreatic insufficiency, which is diagnosed via stool testing. While over-the-counter digestive enzyme supplements do typically include lipase among their ingredients, the doses are not typically sufficient (or standardized) to effectively treat pancreatic insufficiency. If you’ve been diagnosed with pancreatic insufficiency, prescription pancreatic enzyme replacements are advisable to ensure the adequate dose of needed enzymes are delivered to the intestine in a properly-coated, protective capsule.

You may encounter a variety of other ingredients in supplements marketed as digestive enzymes, though most of them are not likely to be helpful as digestive aids. This is because they are redundant to your body’s own very unlikely-to-be-impaired production, or because the food compounds they purport to digest don’t generally cause gas and bloating to begin with.

Some ingredients, like betaine HCl, bromelain (derived from pineapples) and papain (derived from papayas), are commonly included in products marketed as dietary supplements. None of them have ever been studied in human beings to determine what effect, if any, they may have on digestion. Any marketing claims that they aid in either nutrient breakdown or digestive system motility are therefore based on speculation, not actual evidence.[ 

SEE: Which Doctor Should I See for Digestive Issues? ]

For Those With Gluten Problems

Lastly, you may encounter a digestive supplement marketed as a “gluten degrading enzyme,” sometimes nicknamed “glutenase.” It’s typically targeted at people with celiac disease or suspected wheat/gluten intolerance who need to eat a gluten-free diet. Because there is no actual human digestive enzyme called “glutenase,” these products are not mimicking or replacing a deficient enzyme in the human body.

They may contain one of several ingredients selected by their manufacturers. The most common such ingredient in these products is dipeptidyl peptidase IV, or DPP IV. Of note, DPP IV has barely even been studied in humans, and the available data suggest that it does not degrade gluten substantially enough – and in some studies, even at all – to render it safe for people with celiac disease.

Because these dietary supplements are also unregulated, there is a risk that they could contain undeclared wheat ingredients, as so many other dietary supplements have been found to. Any dietary supplement marketed as a gluten-digesting enzyme does not make gluten consumption safe for people with celiac disease and should be avoided.

What Are Fructans? Signs of Fructan Intolerance & How to Overcome It

By Rachael Link, MS, RD

April 18, 2018 Dr. Axe on Facebook22  Dr. Axe on Twitter5  Dr. Axe on Pintrest199  Share on EmailPrint Article

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Fructans - Dr. Axe

Found in abundance throughout the food supply — both in natural food sources and added into processed foods — most of us get a hearty dose of fructans in our daily diets without even realizing it. Not only is fructan plentiful in grains and wheat products, but it’s also present in many types of fruits, vegetables and even beverages that you may be consuming on a daily basis.

While most of us have no problem at all tolerating this sneaky source of inulin fiber, it has been known to wreak havoc on the digestive health of many. Some research has also found that it may be a hidden culprit of certain food intolerances and persistent gastrointestinal troubles. Plus, other studies suggest that many people who may think they have a sensitivity to gluten may actually have a fructan intolerance instead.

If you suffer from constant bloating, gas or abdominal pain, cutting back on your fructan intake is something you may want to consider. Here’s what you need to know about this tricky type of carbohydrate and where it may be lurking in your diet.


What Are Fructans?

The official fructans definition is “a type of polymer of fructose molecules found in certain fruits.” Putting aside the scientific jargon, though, fructans are simply a type of carbohydrate made by a chain of fructose molecules strung together.

Fructans can be found in many types of fruits and vegetables, such as onions, artichokes, garlic and ripe bananas, as well as several different kinds of cereal and grains. Food manufacturers also sometimes add fructans to foods to increase the fiber content of their products.

Because humans don’t have the fructan digestive enzyme, fructans cannot be effectively digested in the small intestine like other nutrients. Instead, they are fermented by the beneficial bacteria in your gut.

There have been a number of health benefits associated with soluble sources of fiber like fructans. A high intake of fiber may help protect against conditions like coronary heart disease, high blood pressure, diabetes, obesity and even some gastrointestinal disorders.

Fiber can also help promote regularity and prevent constipation, plus support satiety and keep your appetite under control to aid in weight loss. Not only that, but it also helps improve the health of your gut microbiome, which is associated with everything from enhanced immunity to reduced inflammation.

However, despite the impressive array of health benefits attributed to fiber, certain types of fiber like fructans may have an adverse effect on health as well.

In fact, although some people may tolerate fructan-frich foods just fine, they can trigger some serious gastrointestinal issues in others. Bloating, diarrhea, pain and constipation can be common symptoms of an intolerance to fructans.

Note that fructan intolerance is not the same as fructose malabsorption or a fructose “allergy.” This is caused by a reaction to the units that make up fructans, which are a form of simple sugars known as fructose. Although they can cause similar symptoms, the main difference between fructan vs. fructose is that fructose is found primarily in fruits, fruit juices, agave nectar, honey, molasses, table sugar and high fructose corn syrup, while fructans are found in certain types of grains, vegetables and processed foods.

It’s also important to remember that a sensitivity to fructans is not the same as small bacterial overgrowth, or SIBO. This is a condition characterized by an excessive amount of bacteria in the small intestine, which can cause issues like diarrhea and malabsorption if left untreated. With a fructan intolerance, the main problem isn’t your gut bacteria, but the way that your body handles fructans.


Fructans vs. Gluten

While fructans are a type of carbohydrate, gluten is actually type of protein found in many cereal grains and wheat products. For those with celiac disease or a sensitivity gluten, eating gluten can cause a slew of negative gluten intolerance symptoms, such as diarrhea, fatigue, gas and even bone loss.

However, emerging new research has recently found that many gluten sensitivity symptoms may actually be caused by impaired fructans digestion instead. This is because fructans are also found in many gluten foods and can cause symptoms that are similar to those triggered by a gluten allergy.

Gluten sensitivity, in particular, is a condition that is especially difficult to officially diagnose. Many people with a sensitivity to gluten find that they feel better when cutting out gluten-containing foods from their diets, but it’s unclear if this may be due to the elimination of gluten or a reduced intake of other ingredients, such as fructans.

Interestingly, a recent 2018 study published in the journal Gastroenterology looked at 59 people without celiac disease who were following a gluten-free diet. They were randomly assigned to receive a bar containing either gluten, fructans or a placebo for seven days before switching groups. At the end of the study, they actually found that consuming fructans resulted in more symptoms of irritable bowel syndrome, such as gas, bloating, abdominal pain and bowel changes, than gluten, indicating that cutting back on fructans may be the key to gastrointestinal relief for those with a gluten sensitivity. (6)


Signs of Fructan Intolerance

Conditions like fructan and fructose intolerance are relatively common, but they can be difficult to recognize and manage. Breath tests are the most common tool used for diagnosis, which work by measuring the production of gases produced following the consumption of a small amount of fructans.

Properly identifying your symptoms can also aid in diagnosis. An intolerance to fructans can cause many symptoms, which may include:

  • Gas
  • Bloating
  • Stomach pain
  • Constipation
  • Diarrhea
  • Abdominal discomfort
  • Nausea
  • Cramps

If you suffer from these symptoms, reducing your intake of fructans. Trying out a fructan elimination diet can also help determine if you may have a sensitivity to foods high in fructans.Fructans fructan intolerance - Dr. Axe


High-Fructan Foods to Avoid

Switching up your diet is the best fructan intolerance remedy. By eliminating fructans foods from your diet, you can start to sidestep unpleasant gastrointestinal symptoms and help find relief.

Use this fructans list as a guide for which foods you should limit if you have an intolerance to fructans. A few of the most common high-fructan foods include:

Breads/Grains:

Vegetables:

Fruits:

Nuts/Seeds:

Legumes:

  • Chickpeas (dried)
  • Lentils (dried)
  • Beans (dried)
  • Soybeans

Other:

  • Instant Coffee
  • Chicory Coffee
  • Chamomile Tea
  • Fiber-enriched foods or foods containing inulin

Low-Fructan Foods and Low-FODMAP Diet to Follow

FODMAPs, which is short for “fermentable oligo-, di-, mono-saccharides and polyols,” are a type of short-chain carbohydrate that is poorly absorbed by the body. The fructose that makes up fructans is one type of FODMAP, along with other carbohydrates, such as lactose and sugar alcohols.

The FODMAP diet focuses on limiting consumption of foods high in these short-chain carbs and emphasizing the consumption of foods that are easily digested instead.

The FODMAP diet can also be used as a short-term solution to help figure out which foods you may be sensitive to. During the initial period of the diet, all high-FODMAP foods are eliminated completely. After several weeks, they can be slowly reintroduced one at a time and assessed for tolerance.

Although the list of fructan foods is pretty extensive, there are plenty of options that you can still enjoy on a low-FODMAP diet plan. Here are some nutrient-rich options that you can easily incorporate into your diet:

Meat/Poultry/Seafood:

  • Beef
  • Canned tuna fish
  • Chicken
  • Fresh Fish
  • Lamb
  • Turkey

Breads/Grains:

  • Arrowroot
  • Buckwheat
  • Millet
  • Oats
  • Quinoa
  • Rice
  • Sorghum

Vegetables:

  • Avocados
  • Bell Peppers
  • Cauliflower
  • Celery
  • Carrots
  • Cucumber
  • Eggplant
  • Lettuce
  • Mushrooms
  • Olives
  • Potatoes
  • Pumpkin
  • Swiss Chard
  • Spinach
  • Rutabaga
  • Sweet Potatoes
  • Watercress
  • Yams
  • Zucchini

Fruits:

  • Blueberries
  • Cantaloupe
  • Clementines
  • Grapes
  • Guava
  • Kiwi
  • Lemon
  • Lime
  • Mandarin Oranges
  • Oranges
  • Passion Fruit
  • Papaya
  • Raspberries
  • Strawberries
  • Tamarind Fruit

Nuts/Seeds:

  • Walnuts
  • Pumpkin Seeds
  • Chia Seeds
  • Macadamia Nuts
  • Peanuts

Legumes:

  • Chickpeas (canned)
  • Beans (canned)
  • Lentils (canned)
  • Tempeh

Other:

  • Regular Tea
  • Regular Coffee

Recipes to Combat Fructan Intolerance

Just one look at a FODMAP diet chart could scare just about anyone out of trying a low-FODMAP diet. Fortunately, however, there are tons of tasty, FODMAP-friendly foods and recipes out there that are low in fructans to help minimize your symptoms.

You can also make some easy swaps in your diet to make it even easier to cut down on your fructan intake. Here are a few simple switches that you can try out:

  • Trade in your morning slice of toast for a bowl low-fructan oats instead.
  • Enjoy a soothing cup of black, white or green tea instead of chamomile tea.
  • Instead of dried beans or lentils, use canned varieties. The liquid in canned foods leaches out the fructans, resulting in a lower content of FODMAPs. You can also try fermented foods like tempeh or natto, which are also low in fructans.
  • Use arrowroot flour instead of white flour to thicken soups and stews, whip up delicious puddings and act as a binder for recipes like meatloaf or veggie burgers.
  • In place of garlic and onions, try seasoning your foods with the tops of scallions, garlic-infused oils, or healthy herbs and spices like cumin, paprika, basil or rosemary.
  • Finally, if you’re looking for a fructan-free bread, give sourdough a try. While not entirely free of fructans, one study found that it may contain up to 90 percent fewer FODMAPs than regular bread.

Need some more inspiration? Here are a few delicious, low-fructan recipes to get you started:

Fructans fructan intolerance - Dr. Axe


History

There are two types of fructans found throughout nature. Those composed of shorter chains of fructose units are called fructo-oligosaccharides, often abbreviated as FOS. Longer chains with at least 10 units of fructose molecules, on the other hand, are known as inulin.

Inulin is found in more than 36,000 species of plants and is used to store energy in vegetables like onions, artichokes and asparagus. It was originally discovered in 1804 by a scientist named Valentin Rose, who discovered it while boiling the roots of an herb called Inula helenium, also known as elecampane.

Today, inulin is often used by food manufacturers to bump up the fiber content of foods. It’s a common ingredient in high-fiber bars, cereals and meal replacements and can also be found in a variety of other ultra-processed foods as well. It’s sometimes listed under other names like chicory extract and chicory root.


Precautions

Note that not everyone is sensitive to fructans, and soluble types of fiber like fructans have actually been associated with a wide range of beneficial effects on health. If you don’t experience gastrointestinal symptoms after eating fructan-rich foods, you can still enjoy these nutritious fruits and veggies as part of a balanced diet.

If you do suffer from irritable bowel syndrome or non-celiac gluten sensitivity, however, cutting fructans out of your diet and seeing if symptoms persist may be beneficial. If you have been diagnosed with celiac disease or wheat allergy symptoms, keep in mind that you should also be sure to keep gluten out of your diet as well.

Additionally, although there have been some studies showing a connection between fructans and IBS symptoms, other foods on the FODMAP chart can also contribute to symptoms. If you eliminate fructans from your diet but still experience persistent bloating, gas or diarrhea, you may want to consider trying out a FODMAP elimination diet to determine if other types of short-chain carbohydrates may also be triggering these side effects.

Because fructans are often found in nutrient-dense foods, such as fruits, vegetables and whole grains, it’s important to avoid eliminating these entire food groups altogether. Instead, include low-fructan foods from these food groups to get in the important vitamins and minerals that you need. You can easily swap out cabbage for Swiss chard or enjoy oranges instead of nectarines to make sure you’re meeting your micronutrient requirements.


Final Thoughts


  • What is fructan? Fructan is a type of carbohydrate made up of fructose molecules that is found in many types of food.
  • Humans cannot digest fructans, so they are instead fermented by the bacteria in the gut. While this can provide health benefits to some, it may cause gastrointestinal distress in others.
  • Studies show that some gluten allergy symptoms may actually be caused by fructan malabsorption.
  • Research also shows a link between fructans and stomach pain, bloating, gas, constipation and diarrhea.
  • Fructans are in foods like wheat, barley and rye, as well as several different types of fruits and vegetables. They are also sometimes added to processed foods to increase the fiber content as well.
  • If you think you may suffer from a sensitivity to fructans, limiting your intake of fructans or trying out a FODMAP diet may be useful.

Naturopathic pediatrics and genetic testing

Posted on  Author Britt Hermes18 Comments

genetic testing personalized medicine

Naturopaths think they can treat genetic diseases. This is incredible, considering naturopaths are not taught genetic testing, let alone understand the basics of genetics and pathophysiology—they are self-taught.

Self-study cannot replace real medical training. Such deficiencies are on full display any time naturopaths speak publicly about the details of their medicine.

I just listened to a webinar in which Jared Skowron, N.D. shared elaborate stories about diagnosing and treating children with Fabry disease and schizophrenia. His talk was hosted by the Association of American Naturopathic Medical Colleges to hook prospective students into attending naturopathic school. (Naturopathic school is a bad value.)

Skowron began by bragging about his short work week and how much he loves his job. He went on to describe how he diagnosed patients with genetic mutations and treated them naturally. The details of one case in particular showed how ignorant naturopaths can be about the scientific plausibility of their methods.


In 2009, Skowron appeared on an episode of Animal Planet to discuss how he cured a mitochondrial disorder in a young girl named Kaylyn, using naturopathy. In the video, Kaylyn’s mom expresses that she thought Kaylyn would die. Mom got Kaylyn a dog, and then looked to Skowron for help, who implemented a natural treatment plan that included the dog.

Kaylyn’s mom said that within days, it was as if her daughter had been “reborn.” But her cure was short-lived.

In the webinar today, Skowron explained that after that episode aired, Kaylyn had a “relapse” that required extensive testing. This led Skowron to diagnose Kaylyn with a serious genetic disorder called Fabry disease.

Fabry disease is an X-linked lysosomal storage disorder. Lysosomes are cellular compartments that contain enzymes that degrade molecules. In Fabry disease, a mutated copy of the GLA gene impedes the enzyme alpha-galactosidase A from breaking down a molecule called globotriaosylceramide. The excessive build-up in lysosomes causes patients to have kidney disease, eye problems, deafness, gastrointestinal issues, and a host of other severe symptoms. The disease can be life-threatening if untreated.

fabryl disease
Fabry disease progresses throughout life with tragic consequences.

Patients with Fabry disease are treated with enzyme replacement therapy—an intravenous infusion of the alpha-galactosidase A enzyme. The therapy is expensive; it costs about $200,000 per year in the United States.


FROM WIKIPEDIA:

Treatment

There are two treatment options for Fabry disease: recombinant enzyme replacement therapy and pharmacological chaperone therapy.

Recombinant enzyme replacement therapy (RERT)

RERT was approved as a treatment for Fabry disease in the United States in 2003.[9][10][11]

Two recombinant enzyme replacement therapies are available to functionally compensate for alpha-galactosidase deficiency. Agalsidase alpha and beta are both recombinant forms of the human α-galactosidase A enzyme and both have the same amino acid sequence as the native enzyme. Agalsidase alpha and beta differ in the structures of their oligosaccharide side chains.[12]

In Fabry disease patients, 88% percent of patients develop IgG antibodies towards the injected recombinant enzyme, as it is foreign to their immune system. One suggested approach to solving this problem involves converting the paralogous enzyme α-NAGAL (NAGA) into one that has with α-GAL activity. Because patients still have a functional NAGA gene, their immune system will not produce NAGA antibodies.[13]

Agalsidase alpha

The pharmaceutical company Shire manufactures agalsidase alfa (INN) under the trade name Replagal as a treatment for Fabry disease,[14] and was granted marketing approval in the EU in 2001.[15] FDA approval was applied for the United States.[16] However, in 2012, Shire withdrew their application for approval in the United States citing that the agency will require additional clinical trials before approval.[17]

Agalsidase beta

The pharmaceutical company Genzyme produces synthetic agalsidase beta (INN) under the trade name Fabrazyme for treatment of Fabry disease. In 2009, contamination at Genzyme’s Allston, Massachusetts plant caused a worldwide shortage of Fabrazyme, and supplies were rationed to patients at one-third the recommended dose. Some patients have petitioned to break the company’s patent on the drug under the “march-in” provisions of the Bayh–Dole Act.[16]

Pharmacological chaperone therapy

Chaperone mode of action[18][19]

Fabry patients who display neurological symptoms cannot receive RERT because recombinant enzymes cannot normally pass the blood-brain barrier. Thus, a more suitable alternative treatment is used: pharmacological chaperone therapy.

It has been shown that more potent competitive inhibitors of an enzyme can act as a more powerful chemical chaperone for the corresponding mutant enzyme that fails to maintain proper folding and conformation, despite its intact active site. These chemical chaperones bind to the active site of the mutant enzyme, which can help promote proper folding and stabilize the mutant enzyme. Thus, this results in functional mutant enzymes that will not be degraded via the ubiquitin-proteasome pathway.

1-Deoxygalactonojirimycin (DGJ) has been shown to be both a potent competitive inhibitor of α-GAL and an effective chaperone to for Fabry disease, increasing intracellular α-GAL’s activity by 14-fold.[20][21]


PREVIOUS ARTICLE CONTINUED. . .

When Skowron briefly ran listeners through the story of Kaylyn and Fabry disease, a few things stuck out. First, he mentioned that the medical and genetic experts involved in Kaylyn’s case disagreed with his diagnosis. He decided to treat her “naturopathically” anyway. Second, Skowron grossly overstated the price of enzyme replacement therapy, saying it costs patients $200,000 per month. Lastly, he mischaracterized the presentation of Fabry disease in girls, whom scientists now know can suffer from the disease even if carrying one defective copy of the gene. While Skowron claims to know better than the experts, he has already gotten so much wrong. And it gets worse.

For Kaylyn, he prescribed the over-the-counter anti-gas supplement Beano, which he calls an affordable and ingenious treatment that has reduced her symptoms and helped her lead a healthy life.


Why does Lactaid milk help while Beano gives me digestive upset?

Lactase produced commercially can be extracted both from yeasts such as Kluyveromyces fragilis and Kluyveromyces lactis and from molds, such as Aspergillus niger and Aspergillus oryzae.[10] Its primary commercial use, in supplements such as Lacteeze and Lactaid, is to break down lactose in milk to make it suitable for people with lactose intolerance,[11][12] However, the U.S. Food and Drug Administration has not formally evaluated the effectiveness of these products.[13]

General

In general, alpha-D-galactosidase is made from a safe, food grade mold. However, if a rare sensitivity occurs, use should be discontinued.[Ref]

Beano contains the enzyme α-GAL, which is derived from the fungus Aspergillus niger. The enzyme works in the digestive tract to break down the complex or branching sugars (polysaccharides and oligosaccharides) in foods such as legumes (beans and peanuts) and cruciferous vegetables (cauliflowerbroccolicabbage, and brussels sprouts, among others). The enzyme breaks those complex sugars into simple sugars, making these foods somewhat more digestible, and reducing intestinal gas.[1]

The polysaccharides and oligosaccharides found in these foods might otherwise pass through the small intestine unaffected. Once in the large intestine, those sugars may be metabolized by intestinal florafermenting to produce the gases that cause discomfort and flatulence.

Two randomized controlled trials show reduction in gas by subjects taking oral α-GAL.[2][3]


PREVIOUS ARTICLE CONTINUED. . .

Beano products contain alpha-galactosidase, the same enzyme that does not function properly in Fabry disease. Beano is not a drug. As far as I can tell, it is not used to treat Fabry disease. I looked. Perhaps I was unable to find anything because using Beano to treat Fabry disease makes no sense.

For Beano to work as enzyme replacement therapy, the alpha-galactosidase would have to survive digestion, and then pass into the bloodstream through the gastrointestinal tract at a high enough rate to populate lysosomes and breakdown the excess globotriaosylceramide. It it just not feasible that oral alpha-galactosidase could substitute for intravenous enzyme replacement therapy.

I studied Fabry disease last year in my Master’s program and also took a genetics course. But I never studied Fabry disease or genetics in naturopathic school at Bastyr. And I was never taught how to interpret genetic testing. Neither was Skowron.

I asked him in this webinar how he received his training in genetics. He responded that he “followed somebody who was in the know.”

I asked for the name of this expert, but the webinar mediator declined to ask Skowron my question. Skowron then went on to say this about learning genetics as a naturopath:

By ordering these tests on patients and having other experienced doctors interpret this stuff, we learn by watching.

Watching someone interpret complicated genetic test results does not count as receiving expert training in the field of medical genetics. But what can I expect from a guy who thinks an over-the-counter anti-gas pill is a substitute for enzyme replacement therapy that must be delivered intravenously? If any of Skowron’s patients really do have Fabryl disease and are not being treated with the standard of care, then they are risking their lives.

Skowron has already appeared on television inaccurately describe issues with MTHFR mutations. It is clear that he is not an expert in genetics or medicine. His treatments are misleading and could be dangerous for his patients. I am especially troubled because he brands himself as a naturopathic pediatrician who was also a co-founder the Pediatric Association of Naturopathic Physicians. He also endlessly promotes himself on NBC in Connecticut.

Children do not deserve to be treated by charlatans. This is yet another example of why naturopaths should be banned from treating children.

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