• Bromelain, Chymotrypsin, Digestive Enzymes, Pancreatin, Papain, Trypsin
• Pain Conditions:
• Digestive Uses:
Proteolytic enzymes (proteases) 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
The primary use of proteolytic enzymes is as a digestive aid for people who have trouble digesting proteins. However, proteolytic enzymes may also be absorbed internally to some extent and may reduce pain and inflammation.
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 (pancreatic insufficiency). 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.
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 (specifically, its digestive power).
Recommended dosages of proteolytic enzymes vary with the form used. Because of 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.
The most obvious use of proteolytic enzymes is to assist digestion. However, a small
trial found no benefit from proteolytic enzymes as a treatment for
Proteolytic enzymes can also be absorbed into the body whole and may help reduce inflammation and pain;
Studies performed decades ago suggest that proteolytic enzymes may help reduce the pain and discomfort that follows injuries (especially
Proteolytic enzymes have also been evaluated as an aid to recovery from the pain and inflammation caused by
A study tested bromelain for
Some alternative medicine practitioners believe that proteolytic enzymes may help reduce symptoms of
Another theory popular in certain alternative medicine circles suggests that proteolytic enzymes can aid
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
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 neck pain and osteoarthritis.
Studies enrolling a total of more than 400 people compared proteolytic enzymes to the standard anti-inflammatory drug diclofenac for the treatment of
Shingles (Herpes Zoster)
A double-blind study of 190 people with shingles compared proteolytic enzymes to the standard antiviral drug acyclovir.
Similar results were seen in another double-blind study in which 90 people were given either an injection of acyclovir or enzymes, followed by a course of oral medication for 7 days.
Several small studies have found proteolytic enzyme combinations helpful for the treatment of
A double-blind, placebo-controlled study of 44 people 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%.
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
Numerous studies have evaluated various proteolytic enzymes as an aid to
A double-blind, placebo-controlled trial of 80 people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling.
Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in 80 individuals undergoing oral surgery.
A double-blind, placebo-controlled study of 204 women receiving episiotomies during
Other double-blind, placebo-controlled studies have found that bromelain reduces inflammation and pain following nasal surgery,
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
The proteolytic enzyme
Interactions You Should Know About
If you are taking:
- The proteolytic enzyme pancreatin: You may need extra folate.
4. Baumuller M. The application of hydrolytic enzymes in blunt wounds to the soft tissue and distortion of the ankle joint: a double-blind clinical trial [translated from German]. Allgemeinmedizin. 1990;19:178-182.
10. Seltzer AP. Minimizing post-operative edema and ecchymoses by the use of an oral enzyme preparation (bromelain): a controlled study of 53 rhinoplasty cases. Eye Ear Nose Throat Mon. 1962;41:813-817.
16. 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.
17. Baumuller M. The application of hydrolytic enzymes in blunt wounds to the soft tissue and distortion of the ankle joint: a double-blind clinical trial [translated from German]. Allgemeinmedizin. 1990;19:178-182.
25. Seltzer AP. Minimizing post-operative edema and ecchymoses by the use of an oral enzyme preparation (bromelain): a controlled study of 53 rhinoplasty cases. Eye Ear Nose Throat Mon. 1962;41:813-817.
26. Blonstein JL. Control of swelling in boxing injuries. Practitioner . 1969;203:206. 26. Zatuchni GI, Colombi DJ. Bromelains therapy for the prevention of episiotomy pain. Obstet Gynecol. 1967;29:275-278.
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33. 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.
36. Cameron IW. An investigation into some of the factors concerned in the surgical removal of the impacted lower wisdom tooth, including a double blind trial of chymoral. Br J Oral Surg. 1980;18:112-124.
40. Gylling U, Rintala A, Taipale S, et al. The effect of a proteolytic enzyme combinate (bromelain) on the postoperative oedema by oral application. A clinical and experimental study. Acta Chir Scand. 1966;131:193-196.
41. Tilscher H, Keusch R, Neumann K. Results of a double-blind, randomized comparative study of Wobenzym-placebo in patients with cervical syndrome [translated from German]. Wien Med Wochenschr. 1996;146:91-95.
49. Martin T, Uhder K, Kurek R, et al. Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial. Radiother Oncol. 2002;65:17-22.
50. Kerkhoffs GM, Struijs PA, De Wit C, et al. A double blind, randomised, parallel group study on the efficacy and safety of treating acute lateral ankle sprain with oral hydrolytic enzymes. Br J Sports Med. 2004;38:431-435.
51. Klein G, Kullich W, Schnitker J, et al. 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. 2006;24:25-30.
53. Akhtar NM, Naseer R, Farooqi AZ, et al. Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee—a double-blind prospective randomized study. Clin Rheumatol. 2004;23:410-415.
54. Klein G, Kullich W, Schnitker J, et al. 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. 2006;24:25-30.
55. Dorr W, Herrmann T. Efficacy of Wobe-Mugos® E for reduction of oral mucositis after radiotherapy : results of a prospective, randomized, placebo-controlled, triple-blind phase III multicenter study. Strahlenther Onkol. 2007;183:121-127.
56. Beck TW, Housh TJ, Johnson GO, et al. Effects of a protease supplement on eccentric exercise-induced markers of delayed-onset muscle soreness and muscle damage. J Strength Cond Res. 2007;21:661-667.
Last reviewed April 2009 by EBSCO CAM Review Board
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