Also indexed as: Pancreatic Enzymes, Pancreatin, Papain, Proteolytic Enzymes
Digestive Enzymes are complex proteins involved in digestion that stimulate chemical changes in other substances. They work optimally at specific temperature and pH. Digestive enzymes include pancreatic enzymes, plant-derived enzymes, and fungal-derived enzymes. There are three classes of digestive enzymes: proteolytic enzymes needed to digest protein, lipases needed to digest fat, and amylases needed to digest carbohydrates.
In several conditions that cause malabsorption, such as pancreatic insufficiency and cystic fibrosis, doctors sometimes prescribe digestive enzymes to improve absorption of food.
Doctors often tell people to try using pancreatic enzymes with meals when they have symptoms of indigestion that cannot be attributed to a specific cause. In a double-blind study, microencapsulated pancreatic enzymes were shown to reduce gas, bloating, and fullness after a high-fat meal.
According to one theory, allergies are triggered by partially undigested protein. Proteolytic enzymes may reduce allergy symptoms by further breaking down undigested protein to sizes that are too small to cause allergic reactions. Limited scientific evidence supports this theory. Proteolytic enzymes such as trypsin, chymotrypsin, and bromelain are partially absorbed by the body. Once absorbed, they have anti-inflammatory activity and may even demonstrate antitumor effects. In one preliminary study of a handful of pancreatic cancer patients, the combination of proteolytic enzymes and other cancer treatments appeared to extend survival, despite the fact that most of the patients died.
Proteolytic enzymes may also improve immune system function, for example, in people with shingles (herpes zoster), though this area of research has not been adequately explored.
Where are they found? Only small amounts of the animal-based proteolytic enzymes, trypsin and chymotrypsin, are found in the diet; however, the pancreas can synthesize these enzymes. The plant-based proteolytic enzyme bromelain comes from the stems of pineapples and is useful in many conditions. Papain comes from unripe papayas. All of these enzymes are available as supplements.
Enzymes have been used in connection with the following conditions (refer to the individual health concern for complete information):
Pancreatic insufficiency (including pancreatitis) The mainstay of treatment for pancreatic insufficiency is replacement of digestive enzymes, using supplements prepared from pig pancreas (pancrelipase) or fungi.Enzyme supplements have been shown to reduce steatorrhea associated with pancreatitis, while pain reduction has been demonstrated in some, though not all, double-blind studies. Digestive enzyme preparations that are resistant to the acidity of the stomach are effective at lower doses compared with conventional digestive enzyme preparations. Some enzyme preparations are produced with higher lipase enzyme content for improved fat absorption, but one controlled study of chronic pancreatitis found no advantage of this preparation over one with standard lipase content. People with more severe pancreatic insufficiency or who attempt to eat a higher-fat diet require more enzymes, but large amounts of pancreatic digestive enzymes are known to damage the large intestine in some people with diseases causing pancreatic insufficiency. Therefore, a qualified healthcare practitioner should be consulted about the appropriate and safe amount of enzymes to use.
Many, otherwise healthy people suffer from indigestion, and some doctors believe that mild pancreatic insufficiency can be a cause of indigestion. A preliminary study of people with indigestion reported significant improvement in almost all of those given pancreatic enzyme supplements. One double-blind trial found that giving pancreatic enzymes to healthy people along with a high-fat meal reduced bloating, gas, and abdominal fullness following the meal.
Sprains and strains (chymotrypsin, trypsin) Proteolytic enzymes, including bromelain, papain, trypsin, and chymotrypsin, may be helpful in healing minor injuries such as sprains and strains because they have anti-inflammatory activity and appear to promote tissue healing.
Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions using either bromelain, papain from papaya, or a combination of trypsin and chymotrypsin. Double-blind trials have reported faster recovery from athletic injuries, including sprains and strains, and earlier return to activity using eight tablets daily of trypsin/chymotrypsin, four to eight tablets daily of papain, eight tablets of bromelain (single-blind only), or a combination of these enzymes. However, one double-blind trial using eight tablets per day of trypsin/chymotrypsin to treat sprained ankles found no significant effect on swelling, bruising, or overall function.
Who is likely to be deficient? People with pancreatic insufficiency and cystic fibrosis frequently require supplemental pancreatic enzymes (which include proteolytic enzymes, lipases, and amylases). In addition, those with celiac disease or Crohn’s disease and perhaps some people suffering from indigestion15 may be deficient in pancreatic enzymes. As bromelain and papain are not essential, deficiencies do not exist.
How much is usually taken? The digestive enzymes—proteolytic enzymes, lipases, and amylases—are generally taken together. Pancreatin, which contains all three digestive enzymes, is rated against a standard established by the U.S. Pharmacopeia (USP). For example, “4X pancreatin” is four times stronger than the USP standard. Each “X” contains 25 USP units of amylase, 2 USP units of lipase, and 25 USP units of protease (or proteolytic enzymes). Three to four grams of 4X pancreatin (or a lower amount at higher potency) with each meal is likely to help digest food in some people with pancreatic insufficiency.
Those with chronic pancreatitis need to discuss enzyme intakes with their physician. Under medical supervision, seriously ill people with pancreatic insufficiency caused by pancreatitis are given very high levels of enzymes to improve fat digestion. In one successful trial, enough pancreatin was used with each meal to supply slightly over 1,000,000 USP units of lipase. Because pancreatin is rapidly emptied from the stomach during digestion, people taking these enzymes may obtain better results by spreading out supplementation throughout the meal.
Supplemental enzymes that state only product weight, but not activity units, may lack potency.
Are there any side effects or interactions? The most important digestive enzymes in malabsorption diseases are usually fat-digesting enzymes called lipases. Proteolytic enzymes can digest, as well as destroy, lipases. Therefore, people with enzyme deficiencies may want to avoid proteolytic enzymes in order to spare lipases.18 If this is not possible (as most enzyme products contain both), people with malabsorption syndromes should talk with their doctor to see if their condition warrants finding products that contain the most lipase and the least protease.
In theory, too much enzyme activity could be irritating because it could start to “digest” parts of the body as the enzymes travel through the digestive system. Fortunately, that does not happen with supplemental amounts. Research has not determined the level at which such problems might arise.
A serious condition involving damage to the large intestines called fibrosing colonopathy has resulted from the use of pancreatic enzymes in children with cystic fibrosis. In some cases, the problem was linked to the use of high supplemental amounts of enzymes. However, the amount of enzymes used has not been linked to the problem in all reports. In some cases, lower amounts of enzymes have caused fibrosing colonopathy if the enzymes are enteric-coated. Some researchers now believe that some unknown interaction between the enteric coating and the enzymes themselves may cause damage to the intestines of children with cystic fibrosis. Until more is known, children with cystic fibrosis needing to take pancreatic enzymes should only do so under the careful supervision of a knowledgeable healthcare professional.
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