Health Effects of Amylase Enzyme Levels
Amylase is an enzyme that helped our ancestors adapt to digesting complex carbs. Low levels have been linked to insulin resistance, metabolic syndrome, obesity, and diabetes. High amylase can be due to issues with the salivary glands or the pancreas, which produce this enzyme. Interestingly, your amylase genes can tell if you do better on a high- or low-starch diet. Read on to learn more.
What is Amylase?
Amylase is an enzyme that breaks down complex carbs into simpler ones. Digestion of carbs is extremely important since carbs are ultimately broken down to glucose – the main energy source that fuels our bodies.
Salivary amylase is produced by salivary glands and it starts digesting food as you chew it. Pancreatic amylase is produced by the pancreas and helps digest complex sugars in your gut [R].
Apart from amylase, the pancreas also produces other enzymes that help digest food, such as lipase (to break down fats) and protease (to break down protein). The pancreas also makes insulin, a hormone that helps lower blood glucose and transports it into cells [R].
Amylase, Insulin, and Diabetes
Since amylase breaks down carbs, it is no surprise that the more amylase you have (within the normal range) the better your body is at digesting and making use of complex carbs. Higher amylase levels are linked to better glucose tolerance after eating starch-rich meals [R, R].
One study illustrates this nicely: 7 people with high amylase levels and 7 people with low amylase levels were given a starch-rich meal. In those with high amylase, insulin increased and blood glucose didn’t spike. But in those with low amylase, insulin didn’t increase and blood glucose did [R].
Amylase doesn’t affect blood glucose levels after eating simple sugars, like glucose or sucrose. It only digests complex carbs – starches. Both people with high and low amylase will react the same to glucose [R].
This means that people with low amylase levels are at a greater risk of insulin resistance and diabetes on starch-rich diets [R].
Insulin can affect amylase activity. People with diabetes whose insulin-secreting beta cells in the pancreas are working well have higher amylase levels (within the normal range). Animal studies show that insulin increases amylase production [R, R, R].
Amylase and Obesity
Low amylase and obesity can spiral down a vicious cycle.
On the other hand, being obese lowers amylase levels, possibly by affecting insulin production and sensitivity. One way to put an end to this harmful loop is weight loss, which increased amylase levels in a subset of 4 obese people monitored over a year [R].
Amylase and Athletic Performance
In a study of 43 people running a half-marathon, those with higher amylase levels performed much better and finished the race faster. Higher amylase at the start was also linked to more stable blood glucose levels and lower lactic acid (a measure of muscle fatigue) at the end of the run [R].
Is Amylase a Measure of Stress?
Some researchers think that salivary amylase could be used as a simple marker of sympathetic, fight-or-flight activity. Its release is, in part, triggered by the fight-or-flight response, increased during stress [R, R].
Some researchers hope that it may prove to be a reliable stress biomarker with more research. Getting your salivary amylase tested by providing a small saliva sample would certainly be less of a hassle than doing blood tests. But so far, the data are not too convincing. Plus, the methods used in most studies were somewhat unreliable.
The fight-or-flight response increases alertness, focus, and arousal. In a study of 12 sleep-deprived women, those with lower salivary amylase were less vigilant and did worse on a simulated driving test. Higher amylase was linked to increased alertness and better performance, possibly due to increased fight-or-flight activity [R].
In another study, young people with anxiety had increased sympathetic activity measured by salivary amylase. This is because an overactive fight-or-flight response increases restlessness and anxiety in the long run [R].
One study even suggested that salivary amylase should be used as a marker of parasympathetic activity [R].
Although salivary amylase has been linked to stress, this seems to be just one small part of the puzzle. Salivary amylase levels depend on a number of other factors, including your genes (discussed below), your insulin function, and body weight, to list a few.
Amylase Tests and Normal Ranges
Blood/Serum Total Amylase
- Moderate to severe abdominal or back pain
- Loss of appetite
- Oily stools
However, if you want to know for certain whether you have pancreatitis, the amylase test is not the best test to take. This is because amylase can be increased or decreased by a myriad of causes, many of them pancreas-unrelated. Lipase, for example, is a better test of pancreas function.
The normal range for blood (serum) amylase can differ somewhat between laboratories. Generally, it’s around 30 – 120 U/L (units per liter).
Taking into account what we know about the relationship between amylase, insulin, obesity, and athletic performance, you would probably want your levels somewhere on the higher end of the normal range.
Salivary and Pancreatic Amylase
Apart from the total amylase, some tests can differentiate between pancreatic and salivary amylase. These tests can zero in on exactly what is going on in your body with greater precision [R].
- For salivary amylase, the normal range is around 11 – 83 U/L
- For pancreatic amylase, the normal range is 10 – 53 U/L
These can also vary slightly between laboratories.
Finally, there is also a urine amylase test.
Kidneys eliminate amylase from the blood into the urine. When blood levels are high, the urine levels will also increase, unless the kidneys are not functioning properly – in which case the kidneys are not able to remove amylase efficiently [R].
When needed, urine amylase may be used instead of the blood test because it’s less invasive [R].
The normal range for urine amylase is 24 – 400 U/L.
High Amylase Levels
High levels of amylase in the blood (hyperamylasemia) are caused by either too much of the enzyme entering the bloodstream or not enough of it being cleared (by the kidneys) [R]. Amylase will usually build up in the blood as a result issues with the salivary glands or the pancreas.
High amylase levels will not cause any specific symptoms. Instead, any potential symptoms will be related to underlying conditions. For example, people with pancreatitis may experience pain, nausea, or vomiting.
The following are possible causes of high amylase levels:
- Acute or chronic inflammation of the pancreas, known as pancreatitis. Pancreatitis is the most common cause of high blood amylase levels, which will often increase more than three-fold [R, R]
- Inflammation of the gallbladder (cholecystitis) and gallstones, which can block the release of pancreatic enzymes into the gut [R, R]
- Intestinal obstruction, when something is blocking the small or large bowel [R, R]
- Other gut issues, including gut inflammation (gastroenteritis), celiac disease, inflammatory bowel disease (IBD), and peptic ulcers [R, R, R, R, R, R, R, R]
- Inflammation of the appendix (appendicitis) [R]
- Gut injury or trauma [R, R]
- Food allergies [R]
- Mumps, due to swelling of the salivary glands [R]
- Eating disorders such as bulimia or anorexia [R, R, R, R]
- Kidney disease [R, R, R, R]
- Diabetic ketoacidosis [R, R]
- An overactive parathyroid gland (hyperparathyroidism) [R, R]
- Ectopic pregnancy [R]
- Different types of cancer (including pancreatic, salivary, prostate, breast, lung, colon, ovarian tumors, and multiple myeloma) [R, R, R, R, R]
- Radiation therapy for cancer [R]
Genetic or Rare Disorders
- Macroamylasemia, a rare condition in which amylase binds to immunoglobulins in the blood [R, R, R]
- Familial hyperamylasemia, rare genetic benign increase in amylase levels [R]
- Insecticide (organophosphate and carbamate) poisoning [R, R]
- Heavy alcohol use/chronic alcoholism [R]
The following drugs can also increase amylase levels:
- Opioids such as morphine and tramadol (Ultram), used to treat moderate to severe pain [R, R, R]
- Methyldopa (Aldomet), used to treat high blood pressure [R]
- Antipsychotics aripiprazole (Abilify) and risperidone (Risperdal), used in the treatment of schizophrenia and bipolar disorder [R, R]
- Sertraline (Zoloft), an antidepressant and selective serotonin reuptake inhibitor (SSRI) [R]
- Atomoxetine (Strattera), a norepinephrine inhibitor used to treat ADHD [R]
- Carbamazepine (Tegretol), used to treat epilepsy and neuropathic pain [R]
- The antibiotic clarithromycin (Biaxin) [R]
- Lithium [R]
To decrease high amylase levels, it’s important to address the underlying issue. More often than not, this is due to an inflamed pancreas.
Pancreas inflammation is a serious condition that requires immediate medical attention. Your doctor will help diagnose the problem and prescribe the appropriate treatment.
Other than that, when your amylase is high you should:
- Avoid alcohol [R, R].
- Make sure you are hydrated (unless instructed otherwise). Hydration helps with pancreas recovery [R, R].
- Make appropriate fasting or dietary modifications if necessary [R, R]. These will be outlined by your doctor.
The following plant extracts may reduce pancreas inflammation and/or decrease amylase, based on animal studies:
Low Amylase Levels
Low blood amylase is linked to poor insulin activity, either due to the pancreas is not producing enough insulin or due to tissues becoming resistant to it [R].
Low amylase can be found in people with:
- Obesity [R]
- High triglycerides (hypertriglyceridemia) [R]
- Insulin resistance [R]
- Metabolic syndrome [R, R, R]
- Prediabetes or diabetes (type 1 and type 2) [R, R, R, R, R, R]
- Nonalcoholic fatty liver disease (NAFLD) [R]
- Chronic pancreatitis [R, R]
- Cystic fibrosis [R]
- Diabetes in pregnancy (gestational diabetes) [R]
These therapies can also decrease amylase levels:
- The antibiotic gentamicin (Cidomycin, Septopal, Genticyn, Garamycin) [R]
- Chemo and radiotherapy in people with stomach cancer [R]
Consult your physician to see if your low amylase is caused by an underlying health issue. If that’s the case, it’s important to resolve or improve the underlying health issue.
You can increase amylase by:
- Doing more exercise. A review of 54 studies showed that moderately intense exercise increases amylase levels [R].
- Losing weight. In a study with 160 subjects, obese and overweight people had lower amylase, which increased with weight loss [R].
- Ditching cigarettes and tobacco. Smokers have lower amylase levels compared to nonsmokers (70 subjects) [R, R].
- Avoiding late-night meals/snacks. Eating late in the evening was linked to low amylase in 2.5k subjects [R].
Avoid the following amylase blockers until your levels return to normal:
- Tea – extracts of black, green, and mulberry teas (animal and cell studies) [R, R]
- Kombucha tea (animal study) [R]
- Kidney bean extract (human study) [R]
- Kiwifruit (cell study) [R]
- Grape seed extract [R]
Hacking Your Diet With Amylase Genetics
Do you thrive on complex carbs? Your genes may hold the answer.
Salivary amylase is produced by the AMY1A, while pancreatic amylase is produced by the AMY2A and AMY2B genes. Many people have multiple copies of these genes. Having multiple copies is an evolutionary adaptation to eating carbs (starch-rich diets). For example, you may have anywhere from one to about 20 copies of AMY1A [R, R, R].
Populations that historically consumed more starch, such as agricultural societies, carry larger numbers of copies compared to societies with a pre-agricultural lifestyle, such as rainforest and polar region hunter-gatherers [R].
The Benefits of Higher Amylase Gene Activity
Importantly, people with a low number of AMY1A copies are more likely to have a higher body mass index (BMI) and obesity. This was shown in multiple studies with over 7,500 people. For example, a person with less than 4 copies would have an eight-fold higher risk of obesity compared to a person with over 9 copies [R, R, R, R, R]!
Genetic variations (SNP) in AMY1 (rs11185098) that predispose people to higher amylase were associated with weight loss. When put on a diet, people with the higher amylase, A variant lost more weight than people without the A variant. The study included over 800 obese participants monitored for 2 years [R].
Higher amylase activity is also linked to better glucose tolerance after eating starch. It decreases the risk of insulin resistance, metabolic syndrome, and type 2 diabetes, according to studies of over 3.5k people [R, R].
In addition, scientists have found a link between AMY1A copies and gut bacteria. People with more copies have more bacteria fermenting resistant starch and more beneficial short-chain fatty acids such as butyrate in the gut [R, R].
On the other hand, those with fewer copies may have glucose malabsorption. They are less able to digest and use complex carbs [R].
How can you use all this information to hack your diet?
Some companies offer AMY1 copy number testing and rs1185095 genotype testing.
If you have a low copy number or an rs11185095 GG genotype (these are often linked), you are likely not able to process complex carbs efficiently. Your body also responds to complex carbs less favorably. You will probably feel and do better on a low-carb diet.
If you have a higher copy number and at least one rs11185095 A variant (AG or AA genotypes), you can tolerate more dietary carbs and your body will respond to them more favorably.
Starchy carbs that require amylase to be broken down and used in the body include:
- Grains (including whole grains)
- Bread, pasta, and pastry