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.
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):
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 disease1 or Crohn’s disease2 and perhaps some
people suffering from indigestion3
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.4 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.5
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.6 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.789
However, the amount of enzymes used has not been linked to the problem in all
reports.10 In some cases, lower amounts of enzymes have caused fibrosing
colonopathy if the enzymes are enteric-coated.11 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.12 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.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Patel RS, Johlin FC Jr, Murray JA. Celiac disease and recurrent
pancreatitis. Gastrointest Endosc 1999;50:823–7.
2. Gullo L. Indication for pancreatic enzyme treatment in non-pancreatic
digestive diseases. Digestion 1993;54(suppl 2):43–7.
3. 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.
4. 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.
5. Taylor 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.
6. 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.
7. Stevens 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.
8. 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].
9. Campbell CA, Forrest J, Muscgrove C. High-strength pancreatic enzyme
supplements and large-bowel stricture in cystic fibrosis. Lancet
1994;343:109–10 [letter].
11. Jones R, Franklin K, Spicer R, Berry J. Colonic strictures in
children with cystic fibrosis on low-strength pancreatic enzymes. Lancet
1995;346:499–500 [letter].
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 June 2009.
