Digestive Enzymes

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Latest Edit: Hector 2014-03-17 (EDT)

See Also Food Supplements

Digestive enzyme supplementation involves the use of exogenous animal, microbe, and plant derived enzymes in the treatment of gastro-intestinal complaints where there is suboptimal digestive function.[1] Pancreatic enzymes including chymotrypsin, trypsin, pancreatin, and pancrelipase are the most commonly used digestive enzymes and are normally produced from porcine or bovine sources, but are also able to be synthesized using some microbes. Lipase and lactase are commonly used and are generally derived from microbial sources. Plant based enzymes include bromelain obtained from pineapples, and papain from papayas which both contain complexes of numerous enzymes with proteolytic, amylolytic, and lipolytic activity.[1]


The many uses of digestive enzymes include: Malabsorption

  • Digestive enzyme supplementation is a standard treatment for pancreatic insufficiency which manifests as abdominal pain, steatorrhea, and weight loss due to malabsorption. Generally pancreatic insufficiency is associated with chronic pancreatitis, diabetes, and is common in chronic alcohol abuse. Generally pancreatic digestive enzymes are enteric coated so they can be active in the small intestine, while bromelain may be active in both the stomach and small intestine due to its tolerance of a broad pH range. Several studies have shown both pancreatic enzyme preperations and bromelain are effective in reducing steatorrhea, decreasing total stool weight, and improvement in flatulence and abdominal discomfort.[1]

Lactose Intolerance

  • A decrease in endogenous lactase activity is extremely common and may afffect from 75-90% of individuals worldwide. Lactose intolerance causes uncomfortable bloating, gas, and diarrhea when individuals consume dairy products. Supplementation with endogenous lactase has been shown in studies to be extremely effective for the treatment of lactose intolerance.[1]

Celiac Disease and Gluten Intolerance

  • Digestive enzymes have been shown to be effective in resolving symptoms associated with [Celiac Disease|celiac disease]] and gluten intolerance. Even after elimination of gluten, intestinal wall atrophy can persist in patients and cause malabsorption. As discussed, supplementation of digestive enzymes can improve symptoms associated with malabsorption. [1]


  • In a double blind RCT oral enzyme supplementation was compared with NSAID therapy in the treatment of osteoarthritis of the hip. Over a six week period oral enzyme therapy was found to be non-inferior to NSAID therapy. [2]. Similair results were confirmed in a study investigating use of enzyme therapy with osteoarthritis of the knee [3]

Rheumatoid Arthritis

  • Clinical trials have shown that oral enzyme supplementation decreases markers of inflammation in patients with rheumatoid arthritis. Symptomatic improvement was seen in patients receiving enzyme supplementaiton, including decreased morning stiffness.[4]


  • Proteolytic enzymes from plant extracts have been used traditionally in cancer treatment, and more recently pancreatic enzymes have been used as adjunctive therapy. Studies have shown that enzyme therapy can help to mitigate side effects of radiation and chemotherapy including mucositis, loss of appetite, and fatigue. Some studies suggest enzyme therapy may increase survival time in some types of cancer. It is postulated that the beneficial effects of enzyme therapy in the treatment of cancer can be attributed to both anti-inflammatory actions and positive impacts on repair mechanisms.[4]

Prescribing Considerations

Bromelain - Dosage is recommended with an enzymatic level of at least 2,000 m.c.u/g, which is typical in a daily dosage of 200-2,000 mg/day in divided dosese.

Pancreatic and Microbe-derived Enzymes- Dosage ranges are from 25,000-40,000 units of porcine lipase, but in general a specific dosage range is difficult to provide as enzymes vary by type, activity, srength, and requirement based on patient need. Consulting a health care practitioner is required for proper supplementation.


Enzyme side effects are rare and typically occur only with excess dosing.

  • GI upset is the most common side effect with excess dosing.
  • Allergic reaction to source (porcine, microbe, or pineapple) may present issues in some patients, so confirming allergies before prescription is recommended.
  • Drug Interactions
  • Bromelain - improves efficacy of certain chemotherapeutics including 5-fluorouracil and vincristine. It may potentiate bleeding when used with anticoagulants, and increase plasma and urine levels of tetracycline.[5]
  • Nutrient Interactions
  • none known


  1. 1.0 1.1 1.2 1.3 1.4 Roxas M (2008) The Role of Enzyme Supplementation in Digestive Disorders. Alt Med Rev:(13)4:307-14.
  2. Klein et al. (2006) Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip; A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol;(1):25-30.
  3. Akhtar NM (2004) Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee--a double-blind prospective randomized study. Clin Rheumatol;23(5):410-15.
  4. 4.0 4.1 Leipner J, Saller R (Apr 2000) Systemic Enzyme Therapy in Oncology. Drugs;59(4): 769-780.
  5. Brinker, F (2001) Herbal Contraindications and Drug Interactions: Plus Herbal Adjuncts With Medicines, 4th Edition].