The Role of Enzyme Supplementation in Digestive Disorders

Review ArticleAlternative Medicine Review Volume 13, Number 4 2008Table 1. Pancreatic Enzymes in DigestionEnzymeEnterokinase (actually secretedin the small intestine)Proteolytic Enzymes:Trypsinogen (trypsin)Chymotrypsinogen (chymotrypsin)CarboxypolypeptidaseAlso various elastases andnucleasesAmylolytic Enzymes:Pancreatic amylaseLipolytic Enzymes:LipasePhosphalipase A1, A2EsteraseOptimal pH Range5.2-6.07.9-9.76.7-7.28.0ActionTransforms trypsinogen into trypsinin duodenumTrypsin and chymotrypsin break downproteins into polypeptides anddipeptides; carboxypolypeptidasesplits peptides into individual aminoacidsHydrolyzes starches, glycogen, andother carbohydrates (other thancellulose) into disaccharides andsome trisaccharidesLipase hydrolyzes fats into fattyacids and monoglycerides; phospholipasessplit fatty acids from phospholipids;esterase hydrolyzescholesterol estersThis dysfunction can occur for a variety of reasons, includinggenetic predisposition, illness, injury/trauma,excessive exercise, aging, toxic exposure, or a combinationthereof. A deficiency of pancreatic enzymes couldpotentially contribute to the development of numerousillnesses and degenerative conditions.Pancreatic Enzyme SupplementationChymotrypsin, trypsin, pancreatin, and pancrelipase,either individually or in combination, are thekey components of most common pancreatic supplementsused in health care and are primarily extractedfrom porcine or bovine sources. 2 Lipase may also besynthesized from microbial sources, such as Aspergillusoryzae and Rhizopus arrhizus. 3-5U.S. Pharmacopoeia (U.S.P.) grade chymotrypsinand trypsin are crystallized from ox pancreas gland extract,pancrelipase is derived from hog pancreas, and pancreatinis extracted from both hog and ox sources. 2The activity and concentration of these enzymesare determined by multiple factors, including theanimal’s species, age and sex, as well as husbandry practices.The physiology of hogs, especially the pancreas,is more similar to humans than any other animal species.6 Enzymatic activity levels from pork sources areapproximately 30- to 50-percent higher than beefsources. While porcine pancreas is particularly rich inamylase and lipase, bovine pancreas is rich in proteolyticenzymes but substantially lower in amylase and lipase.Sow glands are high in lipase, whereas butcher hogs(young male hogs up to 90 kg in weight and six monthsof age) are high in protease. Enzyme levels in beef cowsand bulls differ significantly from those found in steersor heifers.Plant-Based Enzyme PreparationsAs the name implies, plant-based enzymepreparations are derived from plant sources, such aspineapple and papaya. Bromelain is a general name forthe family of sulfhydryl-containing, proteolytic enzymesfrom the pineapple fruit and stem. Bromelain also containsa peroxidase, acid phosphatase, several proteasePage 308Copyright © 2008 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission.

Review ArticleAlternative Medicine Review Volume 13, Number 4 2008or pH-protected to ensure activity in the small intestine.Pancreatic lipase is a relatively fragile enzyme and becomesirreversibly inactivated at a lumen pH

Review ArticleAlternative Medicine Review Volume 13, Number 4 2008Lactose as a Supplement DiluentLactose is used as a diluent in numerouspharmaceutical and nutritional preparations, includingin bromelain, papain, pepsin, and pancreatin. The U.S.Pharmacopoeia states that each milligram of NationalFormulary (N.F.) or U.S.P. pepsin should digest between3,000 and 3,500 times its weight of coagulated eggalbumin. When a pepsin with higher digestive activityis used it is mixed with lactose to reduce its digestivepotency to the official standard.* Lactose is also theprimary substance used to dilute U.S.P. pancreatin.Each milligram of U.S.P. pancreatin is standardized tocontain no less than 25 U.S.P. units of amylase activity,2.0 U.S.P. units of lipase activity, and 25 U.S.P. units ofprotease. Both pepsin and pancreatin preparations ofhigher digestive power are labeled as a whole numbermultiple (e.g., 2X, 3X).* Manufacturer analysis of rawpancreatin indicates the pure product displays notless than 9X of the U.S.P. value. Thus, one gram of purepancreatin contains approximately 235,000-275,000units of amylase activity, 220,000-270,000 units ofprotease activity, and 18,000-40,000 units of lipaseactivity.*The United States Pharmacopeia (22nd revision),The National Formulary (17th ed), United StatesPharmacopeial Convention, Inc.: Rockville, MD;1990.The 27 lactose-intolerant children were then given the enzymepreparations with whole milk. Both K. lactis- andA. oryzae-derived enzymes significantly reduced hydrogenbreath excretion (p

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Bromelain: a literature review and discussionof its therapeutic applications. Altern Med Rev1996;1:243-257.Page 314Copyright © 2008 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission.