NASHVILLE — A commercially available enzyme combination supplement targeting fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) — known triggers of irritable bowel syndrome (IBS) — showed significant benefits in improving symptoms in a prospective pre-post-intervention study.
“We observed clinically meaningful improvements in symptom severity over four weeks, including improvements in abdominal pain and bloating, which are often among the most bothersome symptoms for patients,” said first author Eden Koo, MD, of the Division of Gastroenterology and Hepatology at the University of Michigan in Ann Arbor. Medscape Medical News.
“What is particularly interesting is the potential of this approach to help patients manage food-related symptoms without necessarily having to eliminate these foods from their diet,” he said.
Koo presented the study this week at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting.
The challenge of dietary approaches
IBS can be particularly difficult to manage because symptoms are often influenced by multiple factors, including diet, and responses to existing treatments can vary significantly between patients.
Dietary approaches, notably the low FODMAP diet, show encouraging effectiveness, but compliance with dietary restrictions over the long term can be difficult.
Targeted digestive enzymes such as lactase and alpha-galactosidase have long been available and can be beneficial in helping manage food triggers while maintaining greater flexibility in food choices, Koo explained.
The current combination “offers a way to simultaneously target multiple common dietary triggers,” including fructan, he said.
Additionally, unlike traditional IBS therapies that focus primarily on symptom management, the enzymatic approach aims to act early to address certain dietary carbohydrates before they contribute to symptoms. However, there is limited evidence supporting targeted fructan degradation and combined enzyme formulations for the overall management of IBS symptoms.
Target 3 FODMAPS out of 5
Koo and colleagues conducted a single-group prospective study, recruiting 442 participants with IBS – either self-reported, physician-diagnosed and/or meeting Rome IV criteria – who completed baseline assessments and 4-week follow-up.
During the 4 weeks, participants used the supplement (Fodzyme, Kiwi Biosciences), which targets 3 of the 5 FODMAPs of fructans, galacto-oligosaccharides and lactose. The supplement is designed to be mixed or sprinkled directly into food to help break down key FODMAPs during digestion, Koo explained.
Participants had a mean age of 50.3 years and the majority (86.0%) were women. Among them, 46.6% followed a low FODMAP diet at baseline and for 4 weeks.
For the primary outcome, over the 4 weeks of the study, participants’ average IBS symptoms, based on the IBS Symptom Severity Score (IBS-SSS), decreased significantly, from 269.7 to 167.3 at 4 weeks, for a mean change of -102.4 (P. <0.001), with improvements in abdominal pain, bloating and food satisfaction.
Improvements were observed in various domains of IBS-SSS, including pain severity (50.0 at baseline vs. 38.3 at 4 weeks), pain frequency (5.9 vs. 3.9, respectively), distension severity (61.7 vs. 43.2), bowel dissatisfaction (71.2 vs. 47.2), and life interference (60.8 vs. 38.4; P. < .001 for all).
Benefits were also consistently seen across IBS subtypes: IBS-C (with significant constipation), IBS-D (with significant diarrhea), and IBS-M (mixed bowel habits).
Significant improvement, defined as a reduction of at least 50 points on the SCI-SSS, occurred in 69.2% of participants, while 52.3% achieved a reduction of at least 100 points.
In other assessments of the Patient-Reported Outcomes Measurement Information System score, abdominal pain decreased from a score of 62.8 to 57.9, while bloating decreased from 63.2 to 58.7 (both P. < 0.001). Up to 43.7% of abdominal pain responders showed an improvement of at least 5 points, and 41.0% of bloating responders showed an improvement of at least 5 points.
Of note, participants reported an increase in satisfaction with their diet over the 4 weeks, from 2.7 to 3.0 (an average improvement of 0.28), with no significant differences based on IBS subtype.
“We were encouraged by the magnitude of symptom improvement seen in our study,” Koo said. He cautioned, however, that “an important distinction is that our study was observational and did not include a placebo or control group.”
“I think our results provide an encouraging signal that this approach merits further evaluation, ideally through randomized, placebo-controlled trials,” he said.
“If future controlled studies confirm these findings, targeted enzyme supplementation could become a useful addition to our existing dietary management strategies, potentially allowing patients greater dietary flexibility while maintaining symptom control.”
Attractive, but not ready for clinical recommendation
Commenting on the research, gastroenterologist V. Raman Muthusamy, MD, clinical professor of medicine at the David Geffen School of Medicine at UCLA, Los Angeles, agreed that the results are intriguing.
“If there is a prophylactic measure that can be taken as a supplement or simply incorporated into your diet, that might be of interest to patients and providers,” Muthusamy said. Medscape Medical News.
However, “while the preliminary results are, I would say, hypothesis-generating, I think more work needs to be done to get this to the point where we could recommend it in clinical practice,” he said. “We will need to see more data.”
Koo and Muthusamy had no revelations to report. One member of the study team was an employee of Kiwi Biosciences.
Gn Health
