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The Role of Enzyme Supplementation in Digestive Disorders Mario Roxas, ND

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The Role of Enzyme Supplementation in Digestive Disorders Mario Roxas, ND Alternative Medicine Review Volume 13, Number 4 2008 Review Article The Role of Enzyme Supplementation in Digestive Disorders Mario Roxas, ND Advantages of microbe-derived enzymes are that they may be used at a lower dosage and possess a broader pH range of activity than animal-based counterparts. Plant- based enzymes, such as bromelain from pineapple and papain from papaya, have proteolytic activity. Studies Abstract combining pancreatic enzymes and fungal enzymes or This article reviews various forms of enzyme supplementation bromelain have reported synergistic effects. used clinically in digestive and absorption disorders. Enzyme Digestive enzyme supplementation can aid in supplementation plays an integral role in the management of the breakdown of fats, proteins, and carbohydrates and various digestive disorders, particularly with regard to exocrine may provide benefit in disorders in which compromised pancreatic insufficiency. However, application of enzymes digestion may be involved. may also be beneficial for other conditions associated with poor digestion including lactose intolerance. Historically, porcine and bovine pancreatic enzymes have been the The Pancreas: A Review preferred form of supplementation for exocrine pancreatic The pancreas is comprised of an endocrine and insufficiency. Use of microbe-derived lipase has shown an exocrine portion. The endocrine portion consists of promise with studies indicating benefit similar to pancreatic the islets of Langerhans, which are responsible for the enzymes, but at a lower dosage concentration and with a secretion of insulin, glucagon, and somatostatin. Pan- broader pH range. Safety and efficacy of enzymes derived creatic exocrine tissues (the acini) produce digestive from microbial species in the treatment of conditions such enzymes that are mixed with sodium bicarbonate from as malabsorption and lactose intolerance is promising. Plant- the ductules connecting the acini to the pancreatic duct. based enzymes, such as bromelain from pineapple, serve as This pancreatic “juice” flows through the pancreatic duct, effective digestive aids in the breakdown of proteins. Synergistic connecting with the hepatic duct, and ultimately empty- 1 effects have been observed using a combination of animal- ing into the duodenum via the sphincter of Oddi. The based enzymes and microbe-derived enzymes or bromelain. digestive enzymes in the pancreatic juice break down (Altern Med Rev 2008;13(4):307-314) carbohydrates, proteins, and fats (Table 1). Sodium bi- carbonate neutralizes the acidic chyme that will make its way from the stomach to mix with the juice in the Introduction duodenum and start the enzyme-activating process. Animal-based pancreatic enzymes are the ac- Problems can occur when there is a dysfunc- cepted form of supplementation for exocrine pancre- tion in the ability of the pancreas to produce enzymes atic insufficiency, providing benefit to some individuals or the body’s demand for enzymes exceeds the supply. with gastrointestinal disorders. Studies report microbe- derived lipase has shown promising activity, similar to porcine and bovine pancreatic enzymes. The safety and Mario Roxas, ND – Technical Advisor, Thorne Research; Associate Editor, efficacy of these enzymes in the treatment of malabsorp- Alternative Medicine Review; private practice in Sandpoint, Idaho, with an emphasis on clinical nutrition and botanical medicine. tion and lactose intolerance continues to be researched. E-mail: [email protected] Page 307 Copyright © 2008 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission. Alternative Medicine Review Volume 13, Number 4 2008 Review Article Table 1. Pancreatic Enzymes in Digestion Enzyme Optimal pH Range Action Enterokinase (actually secreted 5.2-6.0 Transforms trypsinogen into trypsin in the small intestine) in duodenum Proteolytic Enzymes: 7.9-9.7 Tr ypsin and chymotrypsin break down Tr ypsinogen (trypsin) proteins into polypeptides and Chymotrypsinogen (chymotrypsin) dipeptides; carboxypolypeptidase Carboxypolypeptidase splits peptides into individual amino Also various elastases and acids nucleases Amylolytic Enzymes: 6.7-7.2 Hydrolyzes starches, glycogen, and Pancreatic amylase other carbohydrates (other than cellulose) into disaccharides and some trisaccharides Lipolytic Enzymes: 8.0 Lipase hydrolyzes fats into fatty Lipase acids and monoglycerides; phospho- Phosphalipase A1, A2 lipases split fatty acids from phos- Esterase pholipids; esterase hydrolyzes cholesterol esters This dysfunction can occur for a variety of reasons, in- animal’s species, age and sex, as well as husbandry prac- cluding genetic predisposition, illness, injury/trauma, tices. The physiology of hogs, especially the pancreas, excessive exercise, aging, toxic exposure, or a combina- is more similar to humans than any other animal spe- tion thereof. A deficiency of pancreatic enzymes could cies.6 Enzymatic activity levels from pork sources are potentially contribute to the development of numerous approximately 30- to 50-percent higher than beef illnesses and degenerative conditions. sources. While porcine pancreas is particularly rich in amylase and lipase, bovine pancreas is rich in proteolytic Pancreatic Enzyme Supplementation enzymes but substantially lower in amylase and lipase. Chymotrypsin, trypsin, pancreatin, and pan- Sow glands are high in lipase, whereas butcher hogs crelipase, either individually or in combination, are the (young male hogs up to 90 kg in weight and six months key components of most common pancreatic supple- of age) are high in protease. Enzyme levels in beef cows ments used in health care and are primarily extracted and bulls differ significantly from those found in steers from porcine or bovine sources.2 Lipase may also be or heifers. synthesized from microbial sources, such as Aspergillus oryzae and Rhizopus arrhizus.3-5 Plant-Based Enzyme Preparations U.S. Pharmacopoeia (U.S.P.) grade chymotrypsin As the name implies, plant-based enzyme and trypsin are crystallized from ox pancreas gland extract, preparations are derived from plant sources, such as pancrelipase is derived from hog pancreas, and pancreatin pineapple and papaya. Bromelain is a general name for is extracted from both hog and ox sources.2 the family of sulfhydryl-containing, proteolytic enzymes The activity and concentration of these en- from the pineapple fruit and stem. Bromelain also con- zymes are determined by multiple factors, including the tains a peroxidase, acid phosphatase, several protease Page 308 Copyright © 2008 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission. Alternative Medicine Review Volume 13, Number 4 2008 Digestive Enzymes A. oryzae has traditionally been used in the fermentation process of soybeans to Table 2. Generally Accepted Industry Methods for Deter- produce soy sauce, tamari, and miso. mining Enzymatic Activity of Microbe-Derived Enzymes Varieties of lipase, amylase, pro- tease, and lactase have been made from Enzyme Activity Units microbial species and have been used in the management of enzyme deficiencies. Table Amylase SKB units (Sandstedt, Keen and Blish, Cereal 2 provides generally accepted standards for Chemistry 12, 172, 1939); based on the diges- microbe-derived enzyme activity. Benefit tion of starch over time has also been reported on the use of fungal- Protease HUT units (Hemoglobin Units); based on based enzymes in the treatment of chroni- 15-19 enzymatic hydrolysis of denatured hemoglobin cally obstructed arteries. Lipase LU (Lipase Units, Food Chemicals Codex (FCC)); Clinical Applications based on lipolytic activity utilizing olive oil Malabsorption Cellulase GD (Guar Gum or Methylcellulose Hydrolysis); Enzyme supplementation is an reduced viscosity flow time against hydrolysis established method to treat a number of digestive conditions. For example, pancre- Lactase FCC units (Food Chemicals Codex). Based on atic enzyme supplementation is the thera- liberation of o-nitrophenol py of choice for management of exocrine pancreatic insufficiency (EPI). Abdominal pain, maldigestion, steatorrhea (fat in the inhibitors, and organically-bound calcium. Bromelain stool), and weight loss due to nutrient ma- is commonly used as a supplement to aid digestion of labsorption are typical EPI symptoms. protein. In addition, benefit has been reported with its A common cause of EPI is chronic pancreati- use in wound debridement7,8 and as an anti-inflamma- tis, which can impair the ability of the pancreas to pro- tory agent, particularly with soft tissue trauma.9-12 duce the enzymes necessary for proper digestion of nu- Different designations are used to indicate the trients, particularly fats. At least 70 percent of chronic activity of bromelain. Gelatin dissolving units (g.d.u.) and pancreatitis cases stem from chronic alcohol abuse;20 milk clotting units (m.c.u.) are the most commonly used hence, EPI is often observed in alcoholics. measures of activity. One gram of bromelain standard- EPI often occurs in individuals with cystic fi- ized to 2,000 m.c.u. would have 1,200 g.d.u. of activity. brosis (CF), a genetic disorder that affects approximate- Papain is the dried and purified latex from the ly 30,000 children and adults in the United States.21 papaya fruit. It is a complex of several enzymes that have EPI also occurs in diabetes, which plagues approxi- proteolytic, amylolytic, and weak lipolytic activity.13 Like mately 23.6 million children and adults in the United bromelain, papain is commonly
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