Enzyme Supplements – Pros and Cons

Consumers are increasingly turning to over-the-counter (OTC) enzyme supplements based on the belief that they can aid digestion and improve overall health. However, as with most supplements, research has demonstrated minimal positive results when compared to anecdotal data. In clinical settings, enzyme supplements are prescribed for individuals suffering from issues that impact digestive function, such as pancreas dysfunction. Conversely, OTC enzymes such as bromelain or papain (derived from pineapples and papaya respectively) are readily consumed by healthy individuals.

The mechanism(s) of action associated with OTC enzyme use is not well understood. Clinical investigations have demonstrated mixed results and present varying theories. For example, bromelain has been shown to be both pro- and anti-inflammatory in nature, while papain seems to have the potential to expedite damaging free radical activity via stimulation of select cells that regulate immune function. The true effectiveness of OTC enzyme supplements is currently unknown as the only reputable studies investigating their use have included prescription-based compounds.

The limited research on OTC enzyme use has been recently summarized in the Mayo Clinic Proceedings:

Pros

1. Risks are considered minimal when taking OTC at the suggested dosage
2. Prescription supplements have been found to decrease bloating when taken before and after a fatty meal
3. OTC enzymes may be able to reduce joint pain from ailments such as rheumatoid arthritis or osteoarthritis
4. Some reports suggest a possible capacity to improve recovery in patients suffering from multiple myeloma
   • Myeloma is a type of cancer that impacts blood plasma cells and can lead to bone tumors/lesions

Cons

1. Gastrointestinal cramping and/or diarrhea
2. The possibility of esophageal perforation when very large doses are ingested
   • This critical condition can create an actual opening in the esophagus that allows food to pass into the upper thoracic cavity
   • Enzyme supplements appear to have the rare potential to create severe esophageal tissue irritation/breakdown in some individuals
3. Some individuals experience allergic and/or anaphylactic reactions (relatively rare)
4. Some OTC compounds appear to expedite pro-inflammatory reactions by acting upon select cells that regulate immune function
5. Like many unregulated dietary supplements, OTC enzymes may contain potentially-harmful contaminants such as arsenic
6. OTC enzymes may increase systemic amylin concentrations; having a negative impact sugar regulation and satiety
7. OTC enzymes are generally metabolized in the acidic environment of the stomach (unless combined with specific pharmaceuticals); rendering them useless as they fail to enter circulation in an active state
8. It has been found that children with cystic fibrosis who take large dosages of certain digestive enzymes can develop fibrosing colonopathy (severe digestive pathology that mimics symptoms seen with intestinal blockage)

Until research is able to provide conclusive data on the safety/effectiveness of OTC enzyme supplement use, one must approach the topic with caution. For personal trainers with clients who ask about taking OTC enzyme supplements; consulting the above pros and cons and educating the client as appropriate would be an effective and responsible response.