Verdauungsenzyme

What are digestive enzymes?

From a scientific perspective, enzymes are proteins that are capable of accelerating or catalyzing the rate of a biological reaction in the body. In the world of bodybuilding and sports nutrition, the term enzyme generally refers to a group of digestive aids that can be added to supplements to improve their digestibility.

Where do digestive enzymes come from?

Enzymes are naturally produced in the body by different organs. Amylases are a group of digestive enzymes used in carbohydrate digestion and are produced by the salivary glands and pancreas. Proteases are responsible for the digestion of protein and are present in different parts of the digestive system such as the stomach and small intestine. Lipases are responsible for lipid or fat digestion and can be produced by the liver and pancreas. There is also a wide range of other digestive enzymes that can be extracted from animal or microbial sources, as well as plant-derived digestive enzymes, including bromelain, a protein digestive enzyme found in pineapples.

Summary of the mechanisms of action

Digestive enzymes can improve digestion through the following mechanisms:

• Increasing the absorption of fats and proteins and breaking down complex carbohydrates
• Improving lactose digestion in people who suffer from lactose intolerance
• Breaking down gliadin, a component of gluten, which can help people with coeliac disease

They can help with irritable bowel syndrome and ulcerative colitis by reducing

• Relieving symptoms of bloating, constipation and painful bowel movements
• Reducing the levels of inflammatory markers (CD44, IFN-y, TNF-alpha, GM-CSF) involved in irritable bowel syndrome
• Increase the amount of good intestinal bacteria (bifidobacteria)

In addition to this, digestive enzymes could help fight infections by

• Inhibiting the growth of gut bacteria that cause infections around the stomach and intestines and helping to kill yeast and viruses
• By destroying biofilms - a sticky mass of bacteria that is resistant to common treatments

The ability of natural digestive enzymes to fight infection and reduce a variety of digestive problems explains their use in functional medicine. They are often prescribed for problems such as a permeable intestinal wall and fungal infections. In addition to this, some enzymes can also relieve joint discomfort, reduce pain and inflammation and improve heart health. However, these benefits depend on the individual enzyme. For example, only bromelain supports weight loss and only amylase helps prevent diabetes.

Potential health benefits of digestive enzymes

Digestive enzymes may be helpful for pancreatic insufficiency In exocrine pancreatic insufficiency, the pancreas does not work properly and does not produce adequate amounts of digestive enzymes (proteases, amylases and lipases).

Causes of this condition include inflammation of the pancreas (pancreatitis), pancreatic cancer, cystic fibrosis or pancreatic surgery. Symptoms include digestive problems, stomach pain, bloating, weight loss and fat in the stool. In several clinical studies of over 750 adults and children with pancreatic insufficiency, supplementation with prescription digestive enzymes resulted in increased fat and protein absorption, less fat in the stool, reduced bloating and abdominal pain, improved stool consistency and better quality of life (1, 2). However, it should be noted that prescription digestive enzyme products are far more effective than over-the-counter supplements and that pancreatic insufficiency should never be self-medicated without medical supervision.

Digestive enzymes can help with digestive disorders

Specific enzymes can help with lactose intolerance, coeliac disease and other causes of indigestion. In several clinical studies involving over 100 adults and children with lactose intolerance, lactase supplements were able to increase lactose digestion and relieve symptoms such as cramps, nausea, pain and bloating (3). In an eleven-week study of 51 subjects with digestive disorders, a combination of bromelain with essential oils, baking soda and sodium alginate improved bowel movements and overall digestion and reduced bloating (4). In clinical studies with over 80 subjects with increased protein intake, protease supplements were able to increase protein absorption and improve blood lipid levels (5). In addition, actinidin from kiwi fruit improved the digestion of dietary proteins (beef protein, gelatin, soy protein isolate and gluten) in rats (6). In addition, nattokinase and papain have been shown to break down parts of gliadin - a component of gluten - in cell studies, suggesting potential for use by people with celiac disease (7).

Digestive enzymes can help with inflammation of the gut

Digestive enzymes can reduce digestive problems such as constipation, diarrhea, stomach pain and bloating associated with irritable bowel syndrome, Crohn's disease and ulcerative colitis. They can also reduce inflammatory markers and increase the amount of good gut bacteria (8, 9). In clinical studies involving over 570 patients with irritable bowel syndrome, Crohn's disease, ulcerative colitis or chronic gastritis, digestive enzyme supplements improved the symptoms of gastritis.

Digestive enzyme supplements improved symptoms such as heartburn, flatulence, constipation, painful bowel movements, bloating and stomach pain and reduced inflammation (10, 11) The following enzymes were used:

• Pancrelipase
• actinidin
• papain
• amylase
• lipase
• maltase

In a 60-day study of 34 women, banana amylase reduced flatulence and increased the amount of healthy gut bacteria (bifidobacteria) (12). In addition, papain and pepsin relieved stomach pain and vomiting in 100 autistic children. The scientists emphasized a possible connection between the gut and the brain (13). In cell studies and animal studies, bromelain, pepsin, alpha-amylase and cellulase have been shown to kill harmful bacteria that cause stomach and intestinal infections and may contribute to irritable bowel syndrome (14, 15). In mice with irritable bowel syndrome, bromelain reduced CD44 production, which may reduce intestinal inflammation and the incidence and severity of ulcerative colitis. It also prevented intestinal cramps. In cell studies, it reduced inflammatory markers (IFN-y, TNF-alpha, GM-CSF) involved in irritable bowel syndrome (16, 17).

Digestive enzymes could help against microbial infections

Digestive enzymes such as amylases and trypsin and proteases such as nattokinase and serrapeptase protect against infections. They prevent new biofilms from forming and destroy existing colonies. Biofilms are a mass of difficult-to-eliminate bacteria that form on surfaces in the body (18). Some enzymes could also help with dengue fever - a viral disease transmitted by mosquito bites. In clinical trials involving over 700 subjects with dengue fever, a papaya extract increased red blood cell and platelet counts and reduced the length of stay in hospital (19, 20). In 60 children with sepsis, trypsin, bromelain and rutin reduced fever after 21 days and reduced symptoms compared to a placebo (21).

Surprisingly, certain enzymes can improve vaginal health. In a three-year study of 62 women with vaginal yeast infections, a supplement containing papain, bromelain and rutin reduced symptoms and recurrence of infection over the next 3 years (22).

In cell studies and animal studies, trypsin, alpha-amylase, cellulase, pepsin and papain were able to destroy biofilm colonies and block the growth of subsequent microbes (23, 24, 25):

• Bacteria that cause food poisoning and gastrointestinal infections
• Staphylococci (respiratory and skin infections)
• Bacteria that cause infections in burn wounds
• E. Coli
• Salmonella
• Helicobacter pylori (bacteria that cause stomach ulcers)
• Yeast infections

For these reasons, digestive enzymes can potentially help prevent infections of the skin, urinary tract, respiratory tract and intestines.

Digestive enzymes could help with pain and swelling

In several clinical trials involving over 400 patients who had undergone surgery, supplementation with digestive enzymes (bromelain, chymotrypsin, pancreatin, papain, trypsin, serrapeptase) reduced pain and swelling, as well as the need for painkillers (26). In 192 people with cold sores (herpes zoster), supplementation with digestive enzymes reduced pain as effectively as the drug acyclovir (27). In addition, supplementation with digestive enzymes (trypsin, papain, lipase, chymotrypsin, bromelain, amylase) reduced muscle pain and soreness and prevented muscle pain after exercise in studies (28, 29).

Digestive enzymes can be helpful for joint problems

In several studies involving more than 1,000 subjects with osteoarthritis of the shoulder or knee, digestive enzyme supplements reduced joint pain, swelling and joint stiffness while improving the quality of life and function of the affected joints (30, 31, 32).

The following enzymes were used:

• Pancreatin
• trypsin and chymotrypsin
• papain
• Lipase and amylase

In further studies on patients with damaged or herniated discs, chymotrypsin and trypsin were able to reduce the intake of painkillers and improve the ability to move the legs by reducing swelling in the nerves compared to a placebo (33). However, the study situation on these effects is mixed. Among others, there is a 16-week study with 30 patients with knee osteoarthritis in which bromelain did not improve the symptoms (knee pain, function and stiffness) (34).

Digestive enzymes may promote heart health

Some digestive enzymes may protect the heart by lowering blood lipid levels and reducing platelet clumping.

Bromelain is promising in this regard, but probably only works well in combination with the protein nattokinase. Nattokinase is known to reduce excessive blood clotting and both compounds are often combined in supplements (35, 36). In clinical studies, bromelain normalized platelet counts, reduced platelet clumping and prevented excessive blood clotting, thereby reducing the risk of heart disease (37). However, in a study of 68 diabetics, bromelain did not reduce risk factors for heart disease (high blood lipid levels and high blood pressure) (38). In cell studies and animal studies, bromelain, actinidin and nattokinase were able to reduce platelet clumping. Bromelain also increased the survival rate of heart cells and protected them from poor blood flow (39, 40).

Digestive enzymes could reduce side effects of cancer and chemotherapy

Based on preliminary results, digestive enzymes may help reduce some of the side effects of cancer treatments, reduce inflammation and improve digestion (41, 42). In clinical trials involving a total of 2,500 cancer patients, digestive enzyme supplementation improved cancer-related digestive tract disorders, mental problems, breathing difficulties, headaches, pain, appetite problems, skin problems and infections. They also reduced the side effects of chemotherapy and radiation treatments (43, 44).

Digestive enzymes could reduce inflammation

Digestive enzymes can reduce levels of pro-inflammatory compounds and block pro-inflammatory enzymes and pathways. They may also help to break down dead cells and tissue, which helps to remove harmful substances from the site of inflammation. They are often combined with other enzymes such as serrapeptase to achieve these effects (45). In clinical trials with subjects with inflamed sinuses, bromelain and serrapeptase relieved symptoms such as nasal congestion, sinus tension, pain and runny nose. This therapy worked better than other alternative therapies. Bromelain was also able to alleviate allergic asthma in mice (46, 47). In a study with 130 test subjects, proteases (papain, bromelain, trypsin and chymotrypsin) were also able to reduce TGF-beta levels and thus also inflammation (48). In addition, digestive enzymes were able to reduce symptoms in a three-month study of 27 children with bronchitis (49).

Finally, chymotrypsin, trypsin and serrapeptase reduced swelling and inflammation in mice and rats and were more effective than non-steroidal anti-inflammatory drugs (50).

Digestive enzymes could promote wound healing

Digestive enzymes (trypsin, chymotrypsin, papain, bromelain in combination with serrapeptase) promote wound healing by breaking down the fibrin barrier and improving blood flow in the wound area. They also remove dead tissue and cells and increase the production of collagen (51). In a study of 192 subjects with herpes blisters, supplementation with digestive enzymes reduced skin wounds and redness just as effectively as the drug acyclovir (52). In clinical trials with volunteers with burns, chymotrypsin and trypsin reduced the levels of pro-inflammatory cytokines (IL-1 and IL-6) and oxidative stress and prevented tissue damage (53). In another clinical study of 75 patients undergoing orthopaedic surgery, trypsin and chymotrypsin reduced wound redness, tenderness, swelling and discharge more than bromelain or serrapeptase (54). In rats and pigs, papain and bromelain applied to the skin removed dead cells and tissue, accelerated wound closure and reduced inflammatory markers (55).

Digestive enzymes could be helpful in Alzheimer's disease

Amyloid-beta plaques contribute to the onset of Alzheimer's disease. In animals and cell studies, different digestive enzymes (trypsin, bromelain, nattokinase, serrapeptase and alpha-chymotrypsin) increased the degradation of amyloid beta and reduced acetylcholinesterase levels, whose overactivity can worsen cognition (56, 57).

Diabetes

Of more than 2,000 people, those with low amylase levels had an increased incidence of type 2 diabetes and metabolic syndrome. However, clinical studies have not yet investigated the benefits of digestive enzymes in diabetes prevention. However, some cell studies and animal studies indicate some potential of papain (58). In diabetic rats, papain reduced blood glucose levels, triglyceride levels and cholesterol levels and prevented damage to the pancreas and liver. In rat cells, a papaya extract blocked key enzymes (α-amylase, α-dlucosidase) associated with type 2 diabetes (59).

Effects on weight control

Although digestive enzymes are popular in weight loss programs, there are practically no studies to support this. Only a few cell-based studies suggest that bromelain has the potential to increase fat burning.

In one cell study, bromelain blocked the formation of fat by reducing proteins and enzymes (PPARy, adiponectin, fatty acid synthase and others) involved in the storage of fat (60).

Disadvantages and side effects

The use of digestive enzymes is generally considered safe and harmless. The use of digestive enzymes is widespread in the medical field for patients suffering from digestive disorders. Excessive doses of digestive enzymes can result in temporary indigestion, which disappears as soon as the intake is stopped.

Possible side effects are mild and include

• Diarrhea
• constipation
• nausea
• stomach pain
• flatulence
• headache
• exhaustion
• skin rashes
• Blood sugar fluctuations

There is a case report of intestinal inflammation after taking a high dose of pancreatic enzyme supplements. Care should be taken if you are allergic to any of the sources from which the digestive enzymes are derived. For example, people who are allergic to pineapple should avoid bromelain supplements. People who are allergic to papaya or latex should not use papain supplements. Unripe or semi-ripe papayas can be dangerous for pregnant women as they can stimulate uterine contractions. For this reason, papain may not be safe for pregnant women. In male rats and mice, papaya extracts reduced sperm motility and female fertility.

Interactions with medications

Blood thinners

People taking blood thinners such as heparin, aspirin or warfarin should avoid bromelain, papain, nattokinase and serrapeptase as they may increase the risk of bleeding.

Antibiotics

Bromelain may increase the absorption of the following antibiotics:

• Penicillin
• Tetracycline (antibiotics that fight bacterial infections)

It is possible that bromelain could also reduce their side effects.

Diabetes medication

Papain may lower blood sugar levels, so it should not be taken with diabetes medication, as there may be a risk of low blood sugar levels. Acarbose and miglitol are diabetes medications that lower blood sugar levels by blocking alpha-glucosidases. For this reason, alpha-amylases, maltase and pancreatin could reduce the effect of these drugs and result in high blood glucose levels.

Recommended dosage

The recommended dosage of digestive enzymes varies greatly depending on the source of the digestive enzymes, their activity factor, the application and the type of digestive enzymes. Clinically, 200 to 2000 mg of bromelain, 25,000 - 40,000 IU of porcine lipase and 18,750 - 30,000 IU of funallipase per day have been shown to be effective for people suffering from digestive problems.

As digestive enzymes are designed to aid digestion, timing of intake is important. They should be consumed immediately before or together with a meal or supplement.

Digestive enzyme supplements

Digestive enzymes can be found in the form of digestive support supplements containing only digestive enzymes, as well as an ingredient in a wide range of other supplements. Most commonly, digestive enzymes are added to all types of protein powders to either pre-digest the protein to some degree or to aid the digestive process after the protein has been consumed. Digestive enzymes are also found in some antioxidant supplements. When looking for digestive enzymes, keep in mind that there are many different types of digestive enzymes that are used to aid in the digestion of carbohydrates, protein and fat. These include:

• Digestive enzymes for protein: bromelain, pepsin, protease I, protease II, protease III
• Digestive enzymes for carbohydrates: amylase, amylase II, cellulase, galactosidate, glucoamylase, invertase, lactase, maltase, pectinase, phytase, xylanase
• Digestive enzymes for fats: lipase

Combinations with other supplements

Digestive enzymes can be combined with all foods and macronutrient-based supplements.

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