WholeHealthMD


< Supplements Main | Previous Page
digestive enzymes

What Is It?
Health Benefits
Forms

Dosage Information

Guidelines for Use

General Interaction

Possible Side Effects

Cautions

References
Evidence Based Rating Scale

 What Is It?

Digestive enzymes are proteins specially tailored to break down foods into nutrients that your body can then readily digest. The human body produces some 22 different digestive enzymes. Many more are found in fruits, vegetables, meats, grains, and other foods. A number of digestive enzymes –­ from both plants and animals – are also sold as supplements.

When you eat a meal, digestive enzymes that are released from your salivary glands, stomach, and small intestine immediately get to work to speed up the digestive process. Each Enzyme acts on a specific type of food. A variety of different proteases, for example, break down the components of Protein. Amylases help digest carbohydrates; lipases break down fats; and cellulases, which are found in plants, digest fiber.

Nutritionally oriented doctors often turn to digestive enzyme products to promote good digestion and enhance nutrient absorption. They contend that many people are lacking enzymes because of inadequate diets, over-refined foods, environmental toxins, excess use of antibiotics, and poor health. Such symptoms as bloating, gas, heartburn, and indigestion are thought to be a common result. Taking this one step further, some practitioners also believe that even in the absence of symptoms many people can benefit from routinely taking extra enzymes to maintain peak digestion and enhance stores of vital nutrients.

Conventional physicians, including gastroenterologists, sometimes recommend enzymes as well, although much less frequently than nutritionally oriented practitioners do. In general, conventional doctors believe that most people get all the enzymes they need, except in the case of a true enzyme deficiency, which can be detected by a stool analysis. For example, doctors sometimes prescribe Pancreatin, a digestive enzyme that comes from the pancreas of pigs, to treat chronic pancreatitis, a fairly uncommon condition in which the enzyme production in the pancreas steadily declines. Far more commonly, however, conventional doctors recommend over-the-counter enzyme products such as Lactaid for lactose (dairy-related) intolerance or Beano for chronic gas.

Alternative practitioners may recommend plant-based digestive enzymes, such as bromelain (from pineapples), papain (from papayas), and enzymes grown on the fungus aspergillus. They also prescribe animal-based products (often called pancreatic enzymes because they are derived from the pancreas, the tongue-shaped digestive organ that sits under the stomach) either alone or together with plant-based enzymes.

Health Benefits

Nutritionally oriented doctors recommend digestive enzyme supplements for various ailments, from simple heartburn and bloating to more persistent problems, such as chronic indigestion and irritable bowel syndrome. The supplements also are given as digestive aids for patients battling cancer, and sometimes for non-digestive complaints, such as the skin ailment rosacea. Some practitioners even advise patients to take enzymes daily in the belief that doing so will result in peak digestive performance.

Specifically, digestive enzyme supplements may help to:

  • Treat flatulence, heartburn, irritable bowel syndrome, and other digestive complaints. Nearly all types of digestive problems can benefit from enzyme therapy. This is especially true if the body’s own enzyme production and/or supply is deficient, which can occur with age or underlying health conditions, such as digestive complaints. In the case of heartburn, for example, the thinking is that any means of accelerating the stomach's emptying of food may well reduce stomach acid and lessen irritation along the digestive tract. The enzyme bromelain may enhance the effect of enzymes such as trypsin or pepsin (especially when the pancreas is producing insufficient amounts of them) thus easing heartburn that’s caused by a shortage of digestive enzymes. In the case of pancreatic insufficiency, taking a combination of enzymes (such as amylase, lipase, pancreatin, and/or protease) has been shown to reduce some digestive complaints. An article published in Lancet in 1991 and an in vitro study in the 1993 indicate taking lipase in combination with amylase and protease reduces steatorrhea (excess Fat or gas in the stool) and improves digestion in patients with pancreatic insufficiency due to cystic fibrosis (caused by inherited enzyme deficiencies). (1, 2) And in 1998, the American Society of Health-System Pharmacists deemed pancreatin, which contains amylase, lipase and protease, effective as replacement therapy in pancreatic insufficiency due to cystic fibrosis, chronic pancreatitis, or pancreas removal. (3) However, pancreatin was not found effective for treating digestive disorders from causes other than pancreatic insufficiency. (3, 4) Anecdotal evidence from a long history of patient usage indicates efficacy in treating common digestive complaints. More research is needed to confirm these results.

  • Treat autoimmune problems such as Inflammatory Bowel Disease, Ulcerative Colitis and Crohn’s disease. Results have been promising regarding enzyme therapy in the treatment of digestive complaints related to autoimmune conditions, such as Inflammatory Bowel Disease (IBD), Crohn’s disease or ulcerative colitis. Individual enzymes and enzyme combinations are useful in inflammatory conditions because they help limit damage from Inflammation, aid in healing damage, and promote new, healthy tissue formation. Acting as inflammation activators, rather than inhibitors, enzymes accelerate the inflammatory process that is necessary for wound healing, resulting in fewer side effects of some digestive conditions. For example, preliminary research indicates bromelain may be useful in treating (IBD). Anecdotal evidence from the Annals of Internal Medicine in 2000 indicates enzymes such as bromelain may improve some symptoms of ulcerative colitis in persons who have persistent disease despite ongoing use of standard therapy. (5) And a 2008 pilot laboratory study led by Duke University researchers assessed the effectiveness of bromelain on tissues from the colon biopsies of 51 patients. The biopsies were divided into three groups: 8 from controls, 20 from patients with ulcerative colitis (UC) and 23 from patients with Crohn’s disease (CD). The biopsies were treated with bromelain in the lab and production of the enzymes that fuel IBD was measured. Bromelain reduced the production of these enzymes and could potentially do the same in the body. (6)

  • Provide nutritional support for cancer patients. Although definitive studies are lacking, some practitioners prescribe high-dose enzyme therapy as adjunctive (supportive) treatment for cancers of the pancreas, colon, lung, and other organs. Some physicians who use alternative therapies to treat cancer include high doses of enzymes because they believe the enzymes can have a direct effect on the cancer itself. Enzymes are also given to soothe side effects from harsh chemotherapy and radiation regimens. Among the different enzymes being tested for facilitating cancer treatment is one combination called Wobe-Mugos E, a highly concentrated blend of thymus and pancreatic enzymes that has shown some early promise against cancer, particularly in multiple myeloma. In a 1999 trial, patients with chronic multiple myeloma were treated with three tablets of Wobe-Mugos E three times a day 30 to 40 minutes before meals for two to four weeks following chemotherapy treatment. The treatment improved red blood cell function. Treatment was well tolerated by patients, and no side effects were reported. (7) And in a 2001 retro-elective cohort study, researchers evaluated the impact of an oral preparation of Wobe-Mugos E given in combination with chemotherapy for the treatment of multiple myeloma stages I-III. Additive therapy with Wobe-Mugos E treatment for longer than six months decreased the hazard of death for patients at all stages of disease by about 60%. For stage III patients, survival time was 47 months in the control group versus 83 months for the patients treated with Wobe-Mugos E. The enzyme treatment was generally well tolerated, with only 3.6% of patients experiencing mild to moderate gastrointestinal symptoms). (8) Wobe-Mugos E is not yet available in the United States.

    Digestive enzymes also have been shown to be useful in treating other types of cancer. Perhaps the most significant application may be in the use of pancreatic enzymes to extend the survival rates in patients with pancreatic cancer, which typically is diagnosed at an advanced stage. Survival rates of pancreatic cancer are extremely low: most people die within five years after diagnosis. In 1995, a 2-year-long pilot study on 11 patients with inoperable, biopsy-proven pancreatic cancer found enzyme supplements increased survival time compared to survival rates reported in the National Cancer Database the same year. (9) Nine (81%) of the patients survived one year vs. 25% at one year in the database; five (45%) survived two years compared to 10% in the database; and four survived three years. (10) In fact, patients in this study lived an average of 17 months, which is three times longer than patients with this type of cancer usually survive. (11)

    A 1998 study published in Life Science found that treatment with Wobe-Mugos E cured cancer in 30% of mice with melanoma and prolonged survival time by 58.3% in the rest of the mice compared to the control group (from an average survival time of 24 days in the control group to 38 days in the test group). (12) In another study the same year, digestive enzymes slowed the rate of tumor growth and increased survival rate in mice with lung cancer. Three groups of animals were given the enzymes at various times relative to tumor removal and a fourth was the control group. None of the control animals survived for 100 days, while 100% of animals given the enzymes within 24 hours of tumor inoculation survived. (13) And a 2001 retrospective analysis of parallel groups of breast cancer patients who were post-surgical intervention and undergoing hormonal, radio- or chemotherapies found that digestive enzymes reduced symptoms of cancer and side-effects of cancer treatments. 239 (37%) were treated with an oral enzyme preparation (OE) in addition to their conventional therapy, and a control group of 410 patients did not receive the OE treatment. Symptoms of cancer and side-effects of cancer therapies were significantly less in patients on OE – 75% of the test group compared to 55% of the control group showed no signs or symptoms after treatment. Side effects of OE were rare and included only mild to moderate gastrointestinal symptoms. (14)

  • Ease symptoms of candida overgrowth syndrome. This controversial illness, thought to be due to runaway growth of Candida yeast in the intestines, can cause diarrhea, gas, bloating, joint aches, and many other discomforts. Plant-based digestive enzymes may help to restore good digestion. Preliminary laboratory studies in animals indicate the potential efficacy of digestive enzyme supplementation in the absence of adequate stomach acid or pancreatic enzymes. (15, 16) However, persuasive research is lacking. More research is needed in this area.

  • Reverse the digestive upset that can occur with normal aging. Many practitioners contend that digestive problems often develop in later decades because stores of digestive enzymes decline with advancing age. Preliminary evidence is beginning to confirm these results. For example, a 2008 laboratory study evaluating serum enzyme activity in young, middle-aged and elderly women found levels of digestive enzymes decline with age. (17) Taking supplemental enzymes may help to restore good digestion by replenishing these dwindling supplies. While many doctors contend that anyone over age 45 or so with virtually any digestive problems may benefit from adding digestive enzyme supplements to every meal, more scientific evidence is needed to confirm these benefits.

 Forms

  • tablet

  • powder

  • liquid

  • cream

  • capsule   

Dosage Information

  • For poor digestion due to normal aging: Take 2 to 4 pills with meals.

  • For common digestive complaints, such as flatulence, heartburn, or irritable bowel syndrome: Take 1 to 2 pills with smaller meals; 2 to 4 with large meals.

  • For Inflammatory Bowel Disease: Take 2 to 4 pills with meals.

  • To enhance digestion during cancer treatment: Take 2 to 4 pills with meals.

  • For candida overgrowth syndrome: Take 1 to 2 capsules with meals

Special Tips:

When buying a digestive enzyme product, look for one that mixes several enzymes (enzymes all end in the letters "ase"). The highest quality products contain amylase (for starches), lipase (for fats), protease (for protein), and lactase (for dairy). Bromelain (from pineapples) and papain (from papayas) are two plant-based digestive enzymes frequently found in enzyme mixtures as well. Clearly, patients with a particular problem with specific foods (say, dairy), should look for that specific enzyme (lactase helps digest dairy products).

--If using digestive enzymes for a serious condition, e.g. as part of cancer therapy, care should be guided by an experienced practitioner to insure that a high quality product and appropriate dosage are used.

--Enzymes are taken orally and no other route of administration should be attempted unless you're under the supervision of a physician familiar with enzyme therapies.

--For most ailments, the dosage of plant-based digestive enzymes recommended is 2 to 4 capsules with each meal. Higher amounts are needed for larger meals. Specific needs vary from person to person, however, so experiment until you find the right dose to relieve your symptoms.

--Check the label carefully for "activity units." Examples include GDUs (gelatin digesting units) and MCUs (milk clotting units). Ounce for ounce, products with the highest activity levels are the most potent--and the best buy.

Guidelines for Use

  • For digestion-related complaints, take an enzyme product at the start of a meal.

  • For non-digestive complaints, such as skin Inflammation, doctors typically recommend taking digestive enzyme supplements on an empty stomach to enhance absorption.

  • Some sources recommend that people with digestive problems take another supplement called betaine chloride in conjunction with digestive enzymes. The purpose of this strategy is to add more stomach acid to the digestive process, a remedy that older people and many people with heartburn appear to benefit from. However, you should contact your doctor before taking this supplement; it's may not be safe if you have had a peptic ulcer at any point or any condition associated with excess acidity.

  • Wait a couple hours after taking digestive enzymes before taking an antacid, since acid neutralizers (such as TUMS or Mylanta) may interfere with the activity of certain enzyme supplements. However, various acid-blocking drugs (such as cimetidine (Tagamet) or omeprazole (Prilosec)) will not interfere with enzyme function.

  • If symptoms do not improve after using digestive enzymes for a month or so, discontinue taking them and check with a doctor. Enzymes may not be right for everyone.

General Interaction

  • Most digestive enzymes have no known drug or nutrient interactions associated with their use.

  • Pancreatin, a pancreatic enzyme from pigs that is prescribed as a drug, may interfere with diabetes medicines such as miglitol (Glyset).

  • Patients taking anticoagulants or other blood-thinning medications should consult a doctor. Some enzymes, such as bromelain, can thin the blood further and possibly cause complications.

 Possible Side Effects

Digestive enzyme products have a good safety record, and serious side effects are rare. Even when several pills are ingested, the body rapidly eliminates the enzymes. Side effects tend to be minimal. Cramping, diarrhea, or digestive upset may arise during the first few days or so of treatment but typically subside rather quickly. If any reaction is severe or persistent, however, consult a doctor.

Cautions

  • Some people are highly sensitive to enzyme supplements. See a doctor if severe stomach, intestinal distress or other worrisome symptoms develop.

  • Stop taking the supplements if a rash, sore throat, or red eyes develop; it could be an allergic reaction. Don't use a particular enzyme if you know you're allergic to its source, such as bromelain (from pineapples), papain (from papayas), ficin (from figs), or pancreatic enzymes (from pigs, cows, or oxen).

  • Until benefits are proven, do not take enzyme supplements as a substitute for conventional, and potentially lifesaving, treatments for cancer and other serious maladies. Enzyme products are best suited as a nutritional complement to standard therapies.

  • People with diabetes should consult their doctors before taking digestive enzyme supplements, since they can alter levels of nutrients and sugars obtained from foods.

  • Like many supplements, enzymes have not been tested extensively in pregnant or breast-feeding women. Patients who are pregnant or are planning to have a child should consult a doctor.

 References

1. Owen G, Peters TJ, Dawson S, Goodchild MC. Pancreatic enzyme supplement dosage in cystic fibrosis. Lancet. 1991;338:1153.
2. Thomson M, Clague A, Cleghorn GJ, Shepherd RW. Comparative in vitro and in vivo studies of enteric-coated pancrelipase preparations for pancreatic insufficiency. J Pediatr Gastroenterol Nutr. 1993;17:401-13.
3. McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
4. Gennaro A. Remington: The Science and Practice of Pharmacy. 19th ed. Lippincott: Williams & Wilkins, 1996.
5. Kane S, Goldberg MJ. Use of bromelain for mild ulcerative colitis. Ann Intern Med. 2000;132:680.
6. Onken JE, Greer PK, Calingaert B, et al. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro. Clinical Immunology 2008 Mar;126(3):345–52.
7. Kolomoiets’ MIu, Antofiichuk MP. [The efficacy of the multienzyme preparation Wobe-Mugos E in lymphoproliferative diseases.] Lik Sprava. 1999 Jun;(4):150-4.
8. Sakalové a, Bock PR, Dedik L, et al. Retroelective cohort study of an additive therapy with an oral enzyme preparation in patients with multiple myeloma. Cancer Chamother Pharmacol. 2001 Jul;47 Suppl:S38-44.
9. Gonzalez NJ, Isaacs LL. Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with nutrition and detoxification support. Nutr Cancer. 1999;33:117-24.
10. Niederhuber JE, Brennan MF, Menck HR. The National Cancer Data Base report on pancreatic cancer. Cancer. 1995;76:1671-77.
11. Preventing heart disease and stroke: Addressing the nation’s leading killers. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Preventing. Available online at www.cdc.gov/nccdphp/aag/aag_cvd.htm [accessed April 10, 2003].
12. Wald M, Závadová E, Poucková, et al. Polyenzyme preparation Wobe-Mugos inhibits growth of solid tumors and developmental of experimental metastases in mice. Life Sci. 1998;62(3):PL43-8.
13. Wald M, Olejér T, Poucková P, Zadinová M. Proteinases reduce metastatic dissemination and increase survival time in C57BI6 mice with the Lewis lung carcinoma. Life Sci. 1998; 63(17):PL237-43.
14. Beuth J, Ost B, Pakdaman A, et al. Impact of complementary oral enzyme application on the postoperative treatment results of breast cancer patients – results of an epidemiological multicentre retrolective cohort study. Cancer Chemother Pharmacol. 2001 Jul;47 Suppl:S45-54.
15. Rubinstein E, Mark Z, Haspel J, et al. Antibacterial activity of the pancreatic fluid. Gastroenterology. 1985;88:927-932.
16. Sarker SA, Gyr K. Non-immunological defense mechanisms of the gut. Gut. 1992;33:987-993.
17. Paczek L, Michalska W, Bartlomiejczyk I. Trypsin, elastase, plasmin and MMP-9 activity in the serum during the human ageing process. Age Ageing. 2008 May;37(3):318-23.

Evidence Based Rating Scale 

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

 

  

 

 

 

 

 

 

 

 

  

Aging

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

Preliminary evidence indicates supplementation may replenish dwindling supplies of digestive enzymes and improve age-related digestive problems. More research is needed to confirm these results. (17)

 

 

 

 

 

 

 

 

 

 

 

 

Cancer 

 

 

 

 

 

 

 

 

 

 

 

Several preliminary animal and human studies indicate efficacy in treating cancer, extending survival rates, improving symptoms of cancer and symptoms of cancer treatments. Larger studies are needed to confirm these results. (7-14)

 

 

 

 

 

 

 

 

 

 

 

 

Candida overgrowth

 

 

 

 

 

 

 

 

 

 

 

 

 

Preliminary evidence in animals indicates potential efficacy in restoring digestion in the absence of adequate stomach acid or pancreatic enzymes. More research  is needed to confirm efficacy in humans. (15, 16)

 

 Celiac Disease  

 Small studies indicate efficacy of pancreatic

enzymes to enhance benefit of gluten-free diet

and protect against exposure to gluten. More

research and larger studies are needed.

 

Crohn’s Disease

 

 

Anecdotal and laboratory evidence indicate potential efficacy. More research is needed in this area. (5, 6)

 

 

Heartburn

 

 

Anecdotal evidence indicates potential efficacy, but research is lacking.

 

Ailments Dosage
Aging
2-4 pills with each meal
Cancer
2-4 capsules with each meal
Candida Overgrowth Syndrome
1-2 capsules 3 times a day with meals
Crohn's Disease 2-4 capsules with each meal
Flatulence
1-2 capsules with a small meal, 2-4 capsules with a larger one. Consider sprinkling contents of capsules over food.
Heartburn
2 pills 3 times a day
Irritable Bowel Syndrome
1-2 pills with a small meal, 2-4 pills with a larger one. Consider sprinkling contents of capsules over food.

Drug/Nutrient Interactions
View Drug Interactions



Date Published: 4/19/2005
Date Reviewed: 7/14/2009



Previous | Next



> Printer-friendly Version



Healing Centers
Aging
Cancer
Candida Overgrowth Syndrome
Celiac Disease
Crohn's Disease
Flatulence
Heartburn
Irritable Bowel Syndrome
© 2000-2014. WholeHealthMD.com, LLC. 21251 Ridgetop Circle, Suite 150, Sterling, VA 20166. All rights reserved. Reproduction in whole or in part without permission is prohibited. Privacy Policy

Disclaimer: All material provided in the WholeHealthMD website is provided for educational purposes only. Consult your physician regarding the applicability of any information provided in the WholeHealthMD website to your symptoms or medical condition.