Diet & Fitness

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.¹ 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.

People with celiac disease often do not produce adequate digestive secretions from the pancreas, including lipase enzymes² 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.³ However, this benefit disappeared in the second month, suggesting enzyme supplements may only be useful at the beginning of dietary treatment.

People with Crohn’s disease may be deficient in pancreatic enzymes, including lipase.⁴ 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.

The mainstay of treatment for pancreatic insufficiency is replacement of digestive enzymes, using supplements prepared from pig pancreas (pancrelipase) or fungi.⁵ Enzyme supplements have been shown to reduce steatorrhea^6,7 associated with pancreatitis, while pain reduction has been demonstrated in some,^8,9 though not all,^10,11 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.⁷ 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.¹³ People with more severe pancreatic insufficiency or who attempt to eat a higher-fat diet require more enzymes,¹⁴ but large amounts of pancreatic digestive enzymes are known to damage the large intestine in some people with diseases causing pancreatic insufficiency.^15,16,17 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.¹⁸ 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.¹⁹

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,^20,21,22 although some other symptoms did improve.^22,20 Patients who have surgery to remove part of the pancreas often have severe steatorrhea that is difficult to control with enzyme supplements.²⁵ 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.²⁶

In a double-blind study, a group of people with painful osteoarthritis 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.²⁴ 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.

Alternative healthcare practitioners frequently recommend proteolytic enzymes for various minor injuries. Research demonstrates that these enzymes are well absorbed when taken by mouth,^25,26 and preliminary^27,28,29,30 and double-blind^31,32,33,34 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.

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.^35,36,37 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.

Some people with rosacea have been reported to produce inadequate stomach acid.³⁸ In a preliminary trial, supplemental hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with low stomach-acid production.³⁹ 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.⁴⁰ 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.

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.^41,42,43 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.

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.⁴⁴ Preliminary human evidence supports this theory.⁴⁵Hydrochloric 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.^46,47,48 However, no controlled trials have investigated the use of enzyme supplements to improve digestion as a treatment for food allergies.