Digestive Enzymes

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This supplement has been used in connection with the following health conditions:

Used for	Amount	Why
Pancreatic Insufficiency	Consult a qualified medical practitioner	Digestive enzymes are the mainstay of pancreatic insufficiency treatment and have been shown to reduce pain and steatorrhea associated with pancreatitis.
Pancreatic Insufficiency Consult a qualified medical practitioner The mainstay of treatment for pancreatic insufficiency is replacement of digestive enzymes, using supplements prepared from pig pancreas (pancrelipase) or fungi.¹ Enzyme supplements have been shown to reduce steatorrhea² ^{, 3} associated with pancreatitis, while pain reduction has been demonstrated in some,⁴ ^{, 5} though not all,⁶ ^{, 7} 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.⁸ 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.⁹ People with more severe pancreatic insufficiency or who attempt to eat a higher-fat diet require more enzymes,¹⁰ but large amounts of pancreatic digestive enzymes are known to damage the large intestine in some people with diseases causing pancreatic insufficiency.¹¹ ^{, 12} ^{, 13} 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.¹⁴ 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.¹⁵ Stomach surgery patients often have decreased pancreatic function, malabsorption, and abdominal symptoms, including steatorrhea, but digestive enzyme supplementation had no effect on steatorrhea in two of three double-blind studies of stomach surgery patients,¹⁶ ^{, 17} ^{, 18} although some other symptoms did improve.¹⁹ ^{, 20} Patients who have surgery to remove part of the pancreas often have severe steatorrhea that is difficult to control with enzyme supplements.²¹ In one double-blind study, neither high-dose nor standard-dose pancreatin was able to eliminate steatorrhea in over half of the pancreas surgery patients studied.²² Learn More

Used for	Amount	Why
Celiac Disease	Consult a qualified healthcare practitioner	Some evidence suggests that enzyme supplements may be useful at the beginning of dietary treatment for this disease.
Celiac Disease Consult a qualified healthcare practitioner People with celiac disease often do not produce adequate digestive secretions from the pancreas, including lipase enzymes²³ In a double-blind trial, children with celiac disease who received a pancreatic enzyme supplement along with a gluten-free diet gained significantly more weight in the first month than those treated with only a gluten-free diet.²⁴ However, this benefit disappeared in the second month, suggesting enzyme supplements may only be useful at the beginning of dietary treatment. Learn More

Used for	Amount	Why
Indigestion, Heartburn, and Low Stomach Acidity	Consult a qualified healthcare practitioner	Lipase, a pancreatic enzyme, aids in the digestion of fats and may improve digestion in some people.
Indigestion, Heartburn, and Low Stomach Acidity Consult a qualified healthcare practitioner Lipase, a pancreatic enzyme, aids in the digestion of fats and may improve digestion in some people. In a double-blind trial, a timed-release form of pancreatic enzymes was shown to significantly reduce gas, bloating, and fullness after a high-fat meal.²⁵ Participants in this study took one capsule immediately before the meal and two capsules immediately after the meal. The three capsules together provided 30,000 USP units of lipase, 112,500 USP units of protease, and 99,600 USP units of amylase. However, the amount of pancreatic enzymes needed may vary from person to person, and should be determined with the help of a doctor. Learn More

Used for	Amount	Why
Osteoarthritis	90 mg of bromelain and 48 mg of trypsin, with 100 mg of rutosid, taken in enteric-coated pills three times per day	In one study, people with painful OA of the knee who received an oral enzyme-flavonoid preparation saw more improvement in pain and joint function than those who took a nonsteroidal anti-inflammatory (NSAID).
Osteoarthritis 90 mg of bromelain and 48 mg of trypsin, with 100 mg of rutosid, taken in enteric-coated pills three times per day In a double-blind study, a group of people with painful OA of the knee received an oral enzyme-flavonoid preparation or a nonsteroidal anti-inflammatory (NSAID) for six weeks. While both treatments relieved pain and improved joint function, the enzyme-flavonoid product appeared to be slightly more effective than the NSAID. No serious side effects were seen.²⁶ The enzyme-flavonoid product used in this study was Phlogenzym (Mucos Pharma, Geretsried, Germany). Each enteric-coated tablet contained 90 mg of bromelain, 48 mg of trypsin, and 100 mg of rutosid (a derivative of the flavonoid rutin); one tablet was given three times a day. Learn More

Used for	Amount	Why
Tendinitis	Several tablets per day of proteolytic enzymes	Supplementing with digestive enzymes may reduce the severity of symptoms and speed healing.
Tendinitis Several tablets per day of proteolytic enzymes Alternative healthcare practitioners frequently recommend proteolytic enzymes for various minor injuries. Research demonstrates that these enzymes are well absorbed when taken by mouth,²⁷ ^{, 28} and preliminary²⁹ ^{, 30} ^{, 31} ^{, 32} and double-blind³³ ^{, 34} ^{, 35} ^{, 36} trials have shown their effectiveness for reducing pain and swelling associated with various injuries and for speeding up the healing process. Unfortunately, many of these studies did not specifically identify the patients’ injury, so it is unclear whether the positive results included improvements in tendinitis. Learn More

Used for	Amount	Why
Acne Rosacea	Refer to label instructions	Digestive enzymes have been reported anecdotally to improve rosacea symptoms.
Acne Rosacea Some people with rosacea have been reported to produce inadequate stomach acid.³⁷ In a preliminary trial, supplemental hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with low stomach-acid production.³⁸ Similarly, improvement in rosacea has been reported anecdotally after supplementation with pancreatic digestive enzymes, and a controlled study found that rosacea patients produced less pancreatic lipase than healthy people.³⁹ Controlled trials are needed to evaluate the effects of hydrochloric acid and digestive enzyme supplements in rosacea. Hydrochloric acid supplements should not be taken without the supervision of a healthcare practitioner. Learn More

Used for	Amount	Why
Allergies and Sensitivities and Food Allergies	Refer to label instructions	Proteolytic enzymes may theoretically reduce allergy symptoms by breaking down undigested protein to sizes that are too small to cause allergic reactions.
Allergies and Sensitivities and Food Allergies 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.⁴⁰ Preliminary human evidence supports this theory.⁴¹ Hydrochloric acid secreted by the stomach also helps the digestion of protein, and preliminary research suggests that some people with allergies may not produce adequate amounts of stomach acid.⁴² ^{, 43} ^{, 44} However, no controlled trials have investigated the use of enzyme supplements to improve digestion as a treatment for food allergies.

Used for	Amount	Why
Chronic Candidiasis	Refer to label instructions	Digestive enzymes inhibit the overgrowth of candida and prevent it from becoming established in the small intestine.
Chronic Candidiasis It is unknown if taking pancreatic enzymes or betaine HCl (hydrochloric acid) tablets is beneficial for chronic candidiasis. Nonetheless, some doctors recommend improving digestive secretions with these agents. Hydrochloric-acid secretion from the stomach, pancreatic enzymes, and bile all inhibit the overgrowth of Candida and prevent its penetration into the absorptive surfaces of the small intestine.⁴⁵ ^{, 46} ^{, 47} Decreased secretion of any of these important digestive components can lead to overgrowth of Candida in the gastrointestinal tract. Consult a physician for more information. Learn More

Used for	Amount	Why
Crohn’s Disease	Refer to label instructions	Supplementing with enzymes might improve the nutrient malabsorption that is often associated with Crohn’s disease.
Crohn’s Disease People with Crohn’s disease may be deficient in pancreatic enzymes, including lipase.⁴⁸ In theory, supplementing with enzymes might improve the nutrient malabsorption that is often associated with Crohn’s disease. However, people with Crohn’s disease considering supplementation with enzymes should consult a doctor. Learn More

Also indexed as:

digestive system,
gastrointestinal system,
GI system

About this treatment

How to Use It

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.

Where to Find It

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.

Possible Deficiencies

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 indigestion may be deficient in pancreatic enzymes. As bromelain and papain are not essential, deficiencies do not exist.

Interactions

Last Review: 05-11-2011

Learn more about Aisle7, the company.

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2011.

© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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