what are digestive enzymes

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Digestive Enzymes

Also indexed as: Pancreatic Enzymes, Pancreatin, Papain, Proteolytic

Enzymes

See also: Bromelain, Drug interactions

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.1

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.2 Limited scientific evidence

supports this theory.3 Proteolytic enzymes such as trypsin,

chymotrypsin, and bromelain are partially absorbed by the body.4 5 6

Once absorbed, they have anti-inflammatory activity and may even

demonstrate antitumor effects.7 8 9 10 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.11

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.12

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):

Rating Health Concerns

Low back pain (chymotrypsin, trypsin)

Pancreatic insufficiency (including pancreatitis)

Sprains and strains (chymotrypsin, trypsin)

Celiac disease

Indigestion (Lipase)

Tendinitis (proteolytic enzymes)

Acne cea

Chronic candidiasis

Crohn's disease

Food allergies

Gastroesophageal reflux disease (GERD)

Low back pain (papain)

Sprains and strains (papain)

Reliable and relatively consistent scientific data showing a

substantial health benefit.

Contradictory, insufficient, or preliminary studies suggesting a

health benefit or minimal health benefit.

For an herb, supported by traditional use but minimal or no

scientific evidence. For a supplement, little scientific support

and/or minimal health benefit.

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

disease13 or Crohn's disease14 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.16 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.17

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.19 20 21

However, the amount of enzymes used has not been linked to the

problem in all reports.22 In some cases, lower amounts of enzymes

have caused fibrosing colonopathy if the enzymes are enteric-

coated.23 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.24 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.

Are there any drug interactions?

Certain medicines may interact with digestive enzymes. Refer to drug

interactions for a list of those medicines.

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References

1. Suarez F, Levitt MD, Adshead J, Barkin JS. Pancreatic supplements

reduce symptomatic response of healthy subjects to a high fat meal.

Dig Dis Sci 1999;44:1317-21.

2. Oelgoetz AW, Oelgoetz PA, Wittenkind J. The treatment of food

allergy and indigestion of pancreatic origin with pancreatic enzymes.

Am J Dig Dis Nutr 1935;2:422-6.

3. McCann M. Pancreatic enzyme supplement for treatment of multiple

food allergies. Ann Allergy 1993;71:269 [abstr #17].

4. Ambrus JL, Lassman HB, DeMarchi JJ. Absorption of exogenous and

endogenous proteolytic enzymes. Clin Pharmacol Ther 1967;8:362-8.

5. Avakian S. Further studies on the absorption of chymotrypsin. Clin

Pharmacol Ther 1964;5:712-5.

6. Izaka K, Yamada M, Kawano T, Suyama T. Gastrointestinal absorption

and anti-inflammatory effect of bromelain. Jpn J Pharmacol

1972;22:519-34.

7. Deitrick RE. Oral proteolytic enzymes in the treatment of athletic

injuries: a double-blind study. Pennsylvania Med J 1965;Oct:35-7.

8. Seligman B. Bromelain: an anti-inflammatory agent. Angiology

1962;13:508-10.

9. Cichoke AJ. The effect of systemic enzyme therapy on cancer cells

and the immune system. Townsend Letter for Doctors and Patients

1995;Nov:30-2 [review].

10. Wolf M, Ransberger K. Enzyme Therapy. New York: Vantage Press

1972, 135-220 [review].

11. 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.

12. Kleine MW, Stauder GM, Beese EW. The intestinal absorption of

orally administered hydrolytic enzymes and their effects in the

treatment of acute herpes zoster as compared with those of oral

acyclovir therapy. Phytomedicine 1995;2:7-15.

13. Patel RS, Johlin FC Jr, Murray JA. Celiac disease and recurrent

pancreatitis. Gastrointest Endosc 1999;50:823–7.

14. Gullo L. Indication for pancreatic enzyme treatment in non-

pancreatic digestive diseases. Digestion 1993;54(suppl 2):43–7.

15. Suarez F, Levitt MD, Adshead J, Barkin JS. Pancreatic supplements

reduce symptomatic response of healthy subjects to a high fat meal.

Dig Dis Sci 1999;44:1317–21.

16. Nakamura T, Tandoh Y, Terada A, et al. Effects of high-lipase

pancreatin on fecal fat, neutral sterol, bile acid, and short-chain

fatty acid excretion in patients with pancreatic insufficiency

resulting from chronic pancreatitis. Int J Pancreatol 1998;23:63–70.

17. CJ, Hillel PG, Ghosal S, et al. Gastric emptying and

intestinal transit of pancreatic enzyme supplements in cystic

fibrosis. Arch Dis Child 1999;80:149–52.

18. Layer P, Groger G. Fate of pancreatic enzymes in the human

intestinal lumen in health and pancreatic insufficiency. Digestion

1993;54(suppl 2):10–4.

19. s JC, Maguiness KM, Hollingsworth J, et al. Pancreatic

enzyme supplementation in cystic fibrosis patients before and after

fibrosing colonopathy. J Pediatr Gastroenterol Nutr 1998;26:80–4.

20. Oades PJ, Bush A, Ong PS, Brereton RJ. High-strength pancreatic

enzyme supplements and large-bowel stricture in cystic fibrosis.

Lancet 1994;343:109 [letter].

21. CA, Forrest J, Muscgrove C. High-strength pancreatic

enzyme supplements and large-bowel stricture in cystic fibrosis.

Lancet 1994;343:109–10 [letter].

22. Milla CE, Wielinski CL, Warwick WJ. High-strength pancreatic

enzymes. Lancet 1994;343:599 [letter].

23. R, lin K, Spicer R, Berry J. Colonic strictures in

children with cystic fibrosis on low-strength pancreatic enzymes.

Lancet 1995;346:499–500 [letter].

24. CJ. Pancreatic enzymes and fibrosing colonopathy. Lancet

1999;354:251 [letter].

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Copyright © 2004 Healthnotes, Inc. All rights reserved.

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The information presented in Healthnotes 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 December 2005.

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