Herbs & Supplements:
Proteolytic Enzymes
Supplement Forms / Alternate Names
•
Bromelain, Papain, Trypsin, Chymotrypsin, Pancreatin, Digestive Enzymes
Principal Proposed Uses
•
Digestive Aid, Dyspepsia, Sports and Other Minor Injuries, Recovery from Surgery, Osteoarthritis, Chronic Musculoskeletal Pain, Shingles (Herpes Zoster)
Other Proposed Uses
•
Easy Bruising, Food Allergies, Rheumatoid Arthritis
Proteolytic enzymes help you digest the proteins in food.Although your body produces these enzymes in the pancreas, certain foods also contain proteolytic enzymes .
Papaya and pineapple are two of the richest plant sources, as attested by their traditional use as natural "tenderizers" for meat. Papain and bromelain are the respective names for the proteolytic enzymes found in these fruits. The enzymes made in your body are called trypsin and chymotrypsin.
The primary use of proteolytic enzymes is as a digestive aid for people who have trouble digesting proteins. However, proteolytic enzymes also appear to reduce pain and inflammation, which has made them popular in Europe as a treatment for sports injuries and as an aid in recovery from surgery.
Many practitioners of alternative medicine believe that proteolytic enzymes can be helpful for food allergies and autoimmune diseases. However, there is little to no scientific evidence as yet that they really work for these conditions.
Sources
You don't need to get proteolytic enzymes from food, because the body manufactures them (primarily trypsin and chymotrypsin). However, deficiencies in proteolytic enzymes do occur, usually resulting from diseases of the pancreas. Symptoms include abdominal discomfort, gas, indigestion, poor absorption of nutrients, and passing undigested food in the stool.
For use as a supplement, trypsin and chymotrypsin are extracted from the pancreas of various animals. You can also purchase bromelain extracted from pineapple stems and papain made from papayas.
Therapeutic Dosages
When you purchase an enzyme, the amount is expressed not only in grams or milligrams but also in activity units or international units. These terms refer to the enzyme's potency (i.e., its digestive power).
Recommended dosages of proteolytic enzymes vary with the form used. Due to the wide variation, we suggest following label instructions.
Proteolytic enzymes can be broken down by stomach acid. To prevent this from happening, supplemental enzymes are often coated with a substance that doesn't dissolve until it reaches the intestine. Such a preparation is called "enteric coated."
Therapeutic Uses
The most obvious use of proteolytic enzymes is to assist digestion. However, a small double-blind placebo-controlled trial found no benefit from proteolytic enzymes as a treatment for dyspepsia (indigestion).1
Proteolytic enzymes have been tried for a number of other conditions as well. Evidence suggests that they can be absorbed into the body and may help reduce inflammation and pain.2,44-46
For example, several studies suggest that proteolytic enzymes might be able to improve the rate of recovery from various types of injuries,3–7,14 and reduce pain and discomfort in chronic pain conditions such as neck pain, back pain, shoulder pain and osteoarthritis.41-43 Proteolytic enzymes have also been evaluated as an aid to recovery from surgery, with mixed results.8–13,36–40 Two studies suggest that proteolytic enzymes might be helpful for the treatment of the painful condition known as shingles (herpes zoster).15,16
It has also been suggested that proteolytic enzymes may help reduce symptoms of food allergies, presumably by digesting the food so well that there is less to be allergic to; however, there is no scientific evidence for this proposed use.
Proteolytic enzymes have also been proposed as a treatment for rheumatoid arthritis and other autoimmune diseases. According to a theory popular in alternative medicine circles, these diseases may be made worse by whole proteins from foods leaking into the blood and causing an immune reaction. Digestive enzymes may help foil this so-called "leaky gut" problem. However, again there is no real evidence as yet to substantiate this use.
What Is the Scientific Evidence for Proteolytic Enzymes?
Most of the studies described in this section used combination products containing various proteolytic enzymes plus other substances, such as the bioflavonoid rutin.
Sports Injuries
A double-blind placebo-controlled study of 44 individuals with sports-related ankle injuries found that treatment with proteolytic enzymes resulted in faster healing and reduced the time away from training by about 50%.17 Three other small double-blind studies, involving a total of about 80 athletes, found that treatment with proteolytic enzymes significantly speeded healing of bruises and other mild athletic injuries as compared to placebo.18,19,20 In another double-blind trial, 100 individuals were given an injection of their own blood under the skin to simulate bruising following an injury. Researchers found that treatment with a proteolytic enzyme combination significantly speeded up recovery.21
A double-blind placebo-controlled trial of 71 individuals with finger fractures found that treatment with proteolytic enzymes significantly improved recovery.22
Surgery
Numerous studies have evaluated various proteolytic enzymes as an aid to recovery from surgery, but the results have been mixed.
A double-blind placebo-controlled trial of 80 individuals undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling.23
Another double-blind placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in 80 individuals undergoing oral surgery.24 The results showed reduced pain, inflammation, and swelling in the treated group as compared to the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery,36 as well as in one study involving only bromelain.13
A double-blind placebo-controlled study of 204 women receiving episiotomies after childbirth found evidence that a mixed proteolytic enzyme product can reduce inflammation.37 Bromelain was also found effective for reducing inflammation following episiotomy in one double-blind placebo-controlled trial of 160 women,11 but a very similar study found no benefit.38
Other double-blind placebo-controlled studies have found bromelain effective in nasal surgery,25 cataract removal,12 and foot surgery.39 However, a study of 154 individuals undergoing facial plastic surgery found no benefit.40
Osteoarthritis and Other Forms of Chronic Musculoskeletal Pain
Several studies provide preliminary evidence that proteolytic enzymes might be helpful for various forms of chronic pain, including osteoarthritis, back pain, neck pain, and shoulder pain.
For example, a double-blind placebo-controlled trial of 30 individuals with chronic neck pain found that use of a proteolytic enzyme mixture modestly reduced pain symptoms as compared to placebo.41
Other studies enrolling a total of more than 300 individuals compared proteolytic enzymes to the standard anti-inflammatory drug diclofenac for the treatment of shoulder arthritis, back pain and knee arthritis. 42-43 The results showed equivalent benefits.
Shingles (Herpes Zoster)
Herpes zoster (shingles) is an acute, painful infection caused by the varicella-zoster virus, the organism that causes chicken pox. There is some evidence that proteolytic enzymes may be helpful for the initial attack of shingles, for reasons that aren't clear.
A double-blind study of 190 people with shingles compared proteolytic enzymes to the standard antiviral drug acyclovir.32 Participants were treated for 14 days and their pain was assessed at intervals. Although both groups had similar pain relief, the enzyme-treated group experienced fewer side effects.
Similar results were seen in another double-blind study in which 90 individuals were given either an injection of acyclovir or enzymes, followed by a course of oral medication for 7 days.33
Safety Issues
In studies, proteolytic enzymes are believed to have proven to be quite safe, although they can occasionally cause digestive upset and allergic reactions.
One proteolytic enzyme, pancreatin, may interfere with folate absorption.34 In addition, the proteolytic enzyme papain might increase the blood-thinning effects of warfarin and possibly other anticoagulants.35
The proteolytic enzyme bromelain might also cause problems if combined with drugs that thin the blood. In addition, there are concerns that bromelain should not be mixed with sedative drugs. Finally, bromelain may increase blood concentrations of certain antibiotics. For more information, see the full bromelain article.
Interactions You Should Know About
If you are taking
- The proteolytic enzyme pancreatin: You may need extra folate.
- Warfarin, aspirin or other drugs that "thin" the blood: You should not take the proteolytic enzymes papain or bromelain except under a doctor's supervision.
- Sedative drugs: Do not take bromelain, except under a physician's supervision.
View References
Last reviewed April 2002 by Medical Review Board
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