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Product Review: Digestive Enzyme Supplements
 

Initial Posting: 4/25/15  Last Update: 1/14/17Digestive Enzyme Supplements Reviewed by ConsumerLab.com

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Summary: What You Need to Know About Digestive Enzyme Supplements
  • Digestive enzyme supplements can help you digest specific foods when you do not naturally produce enough enzymes. (See "What They Are" for a list of enzymes and the foods they break down.) They may also have other beneficial effects.
  • Choose a digestive enzyme supplement that lists enzyme activity units (such as PU, HUT, FIP, etc.), not just the amount of enzyme (such as milligrams) since that won't tell you how potent the enzyme is (See "What They Do"). Also, check that ConsumerLab.com or another reputable independent 3rd party has verified the enzyme activity. As found in this Review, some products don't provide what they list (see (See "What CL Found")
  • See the top choices of products "Approved" by ConsumerLab.com.
  • Digestive enzymes are generally well-tolerated but people with allergies to a specific enzyme source, certain medical conditions, or who are taking medications such as blood-thinners or diabetes drugs may need to avoid specific enzymes (See "Concerns and Cautions").

What They Are:
Digestive enzymes break down specific parts of food (such as fats or carbohydrates) to make them available for absorption. These enzymes are named by the part of the food which they break down, as shown in the table below. For example, proteases break down protein, lipases break down lipids (fats), lactase breaks down lactose, and alpha-galactosidase breaks down complex sugars in foods like beans and broccoli. Some, like cellulase, break down parts of cell walls in plant-based foods. Pancreatin, which is produced in the pancreas, is a combination of amylase, lipase and protease enzymes. 

The body naturally secretes enzymes throughout the gastrointestinal tract during digestion. Nutrients which we can't absorb (such as plant fiber) are often fermented by the bacteria in our guts, creating gas which can lead to abdominal discomfort. Most of the supplements tested in this review are digestive enzyme blends, which contain a combination of enzymes to help break down multiple components of a meal. These enzymes may be animal-derived (such as pancreatin (from pigs or cows) or from plants (such as the proteases bromelain (from pineapple) and papain (from papaya)), bacteria, or fungi.

Enzyme Breaks down: Unit to Look For on Label Effective Serving Size

(Maximum Dose)
1
Protease (peptidase, dipeptidyl-peptidase, nattokinase, papain, bromelain) Protein HUT, DPP, PU, PC, SAP, USP (if referring to pancreatin), GDU (1 GDU = 15,000 PU) Bovine or porcine protease: 15,625 - 150,000 USP per day1
Bromelain: 1,200 GDU
Fungal protease: 675,000 HUT or 6,825 SAP
Bacterial protease: 490,000 PC1

(Papain: 2,400,000 PU per dose, 7,200,000 per day; bromelain (fruit): 10,125,000 PU per dose, 20,250,000 per day; not to exceed 7,200,000 PU in products containing both papain and bromelain)
Lipase Fat (in butter, rich sauces) FIP, LU, USP(if referring to pancreatin) Bovine or porcine derived lipase: 5,000 - 40,000 USP1
Fungal derived lipase: 18,750-30,000 LU

(29,700 LU per dose, 112,500 LU per day)
Amylase, glucoamylase Starch (in beans, lentils, grains, bread, corn) DU, AGU, USP (if referring to pancreatin) Bovine or porcine derived amylase: 16,600 - 149,400 USP1

(Amylase: 34,000 DU per dose, 150,000 DU per day; glucoamylase: 300 AGU per day)
Invertase Table sugar (sucrose) SU, INVU (4,200 SU or 3,000 INVU per day)
Alpha-galactosidase Complex sugars (found in grains, beans, nuts and certain vegetables like broccoli and cabbage) GALU 240 — 1,200 GALU
Lactase (See Review of Lactase Enzyme Supplements) Milk sugar (lactose) ALU 3,000 — 6,000 ALU
Cellulase, hemicellulase Plant fiber (in fruits and vegetables) CU, HCU (110,000 CU or 45,000 HCU per day)
Pectinase Plant fiber PGU (180 endo-PG per day)
Xylanase Plant fiber XU (3,300 XU per day)
Beta-glucanase Plant fiber BGU (210 BGU per day)
Phytase Phytic acid (in wheat and other grains, beans, nuts, seed oils) FTE,FTU 20 - 75 FTU

(75 FTU per day)
1Effective dose or maximum dose in activity units established by Health Canada

What They Do:
For people with medical conditions which prevent them from normally producing certain digestive enzymes, taking medication or supplements which provide digestive enzymes can certainly help. For example, people with pancreatic disease or impaired pancreatic function due to cystic fibrosis do not produce sufficient pancreatin. In these cases, animal-derived pancreatin is helpful, particularly for the digestion of fats.

Digestive discomfort
Some studies have found that the body's own production of pancreatic enzymes such as amylase, lipase and chymotrypsin may decrease with age; however, the evidence for this is mixed (Keller, Gut 2005). Similarly, some, but not all, studies have shown that digestive enzymes can improve digestive symptoms in people without pancreatic disease. For example, a small clinical study of healthy men and women found that taking one capsule of a prescription animal-derived pancreatin containing lipase (10,000 USP), amylase (33,200 USP), and protease (37,500 USP) enzymes (Creon, Solvay Pharmaceutical) immediately before a high fat, high calorie meal, and two more capsules immediately after the meal, significantly reduced bloating, gas and fullness compared to placebo (Suarez, Dig Dis Sci 1999). On the other hand, another study found that pancreatic enzymes did not improve symptoms of indigestion (Kleveland, Scand J Gastroenterol 1990). Be aware that some supplements include a combination of amylase, lipase and protease enzymes from plant or fungal sources and refer to this as "pancreatin alternative "or "vegetarian pancreatin analog."

Lactase has been shown to improve the digestion of lactose (milk sugar) and decrease the symptoms of lactose intolerance such as gas, bloating and diarrhea (Gao, Nagoya J Med 2002; Lami, Am J Gastr 1988). A dose between 3,000 and 6,000 ALU can help those with lactose intolerance digest about 20 grams of lactose from milk (Lin, Dig Dis Sci 1993). See the Review of Lactase Enzymes and Lactose-Free Milks for more information and our tests and reviews of products.

A small clinical study found that a dose of 1,200 GALU of alpha-galactosidase taken during a meal rich in fermentable carbohydrates (420 grams of cooked beans) significantly reduced the severity of flatulence compared to placebo (Stefano, Dig Dis Sci 2007). Measures of bloating, abdominal discomfort and pain were also lower in the group taking alpha-galactosidase but did not reach statistical significance. A clinical study of a branded supplement (Beano) containing alpha-galactosidase derived from Aspergillus niger found that a lower dose of alpha-galactosidase (240 GALU from 8 drops of the supplement) also significantly reduced flatulence compared to placebo (Ganiats, J Fam Pract 1994). Another small study of men and women with type 2 diabetes (average age 56) who were taking the glucose-lowering drug acarbose found that 15 drops of Beano taken with a test meal significantly reduced self-reported measures of flatulence compared to eating a test meal without the enzyme supplement (Lettieri, Clin Ther 1998). However, the supplement also appeared to reduce the effectiveness of acarbose (See Cautions and Concerns for more about this).

A very small clinical study found that 160 mg of a patented enzyme blend of carbohydrases derived from Aspergillus niger and Aspergillus oryzae and containing amylase, cellulase and hemicellulase (Carbogen, Triarco Industries) taken with a meal replacement bar (providing approximately 50 grams of carbohydrate) significantly increased glucose levels compared to ingestion of the meal replacement bar without the enzyme, which could be useful for athletes during training or competition when they need to quickly replenish glucose (Frank, Int J Sport Nutr Excer Metabol 2002).

Supplementation with bromelain was reported to decrease diarrhea and other symptoms in two women with ulcerative colitis who were taking medication but still experiencing significant symptoms, (Kane, Ann Intern Med 2000) — although dosage and enzyme activity were not described. There is one report of papain supplementation (one 1,800 mg enteric coated tablet taken with each meal) improving nutrient absorption and eliminating loose stools in a patient with celiac disease (Messer, Lancet 1976).
See the Encyclopedia articles about Proteases (including papain) and Bromelain for more information about these enzymes.

If you feel that you are having trouble digesting particular foods, it may be best to choose a supplement that provides an enzyme or enzymes specific to the food causing your digestive symptoms. For example, if you find you feel too full or have gas or bloating after a high-fat meal, choose a supplement with higher lipase activity. If protein seems to cause symptoms, choose a supplement with more protease activity.

Nutrient absorption
In addition to reducing digestive discomfort, by breaking down foods into absorbable nutrients, enzymes increase your absorption of nutrients in foods.

Phytates, a component in many grains, beans, nuts and certain potatoes, can inhibit the absorption of minerals like iron and zinc. A review of clinical studies found that a dose between 20 and 320 FTU significantly improved iron absorption from consumption of flour (100 grams)(Troesch, Food Nutr Bull 2013).

Preliminary studies with a product containing lipase, amylase, protease, cellulase and lactase derived from Aspergillus niger and bromelain (AbsorbAid, Nature's Sources) suggest that it may reduce stool frequency and water content in patients with short bowel syndrome and that one teaspoon of AbsorbAid added four times daily to an enteral feeding solution given to elderly nursing home patients increased protein absorption compared to giving the same solution without the enzyme blend (Glade, Nutrition 2001). According to its label, AbsorbAid contains lipase 381 FIP, amylase 2772 SKB/DU, protease (from bromelain) 12 GDU, cellulase 99 CU, and lactase 300 ALU per two-capsule serving; however, it's not known whether the same formulation with the same activity units were used in the studies above.

A small clinical trial found that the addition of 2.5 to 5 grams (activity units not identified) of a patented blend of proteases derived from Aspergillus niger and Aspergillus oryzae (Aminogen, Triarco Industries) taken with 50 grams of whey protein concentrate significantly increased serum amino acid levels in young healthy men compared to the same amount of whey protein ingested without added proteases (Oben, J Int Soc Sports Nutr 2008).

Inflammation/muscle pain/bruising
Proteases, like bromelain, have been promoted to reduce inflammation or pain in muscles and joints, although the evidence for this is mixed and far from convincing.

Osteoarthritis:
A 3 month clinical study of 400 mg bromelain taken twice daily found no benefit in moderate-to-severe osteoarthritis of the knee compared to placebo (Brien, QJM 2006). However, a study of an enteric coated combination product, Wobenzyme (Mucos Pharma), found that taking two
tablets 3 times daily on an empty stomach for 3 months significantly reduced pain in men and women with knee osteoarthritis compared to placebo. This treatment also worked as well as 150 mg of diclofenac sodium (a prescription NSAID) to reduce pain, but only diclofenac produced a significant improvement in stiffness and joint function, although patients taking Wobenzyme reported less heartburn, stomach pain and nausea (Bolten, Arthritis 2014). The six tablets of Wobenzyme provided 540 mg bromelain, 288 mg trypsin (from porcine or bovine pancreas) - units of enzyme activity not listed - and 600 mg rutoside trihydrate (which is not an enzyme). A study in Germany among 90 men and women (average age 52) with osteoarthritis of the hip found that the same daily dose of the same formula (sold as Germany as Phlogenzym) taken for six weeks reduced pain and stiffness, and improved function just as well as a daily dose of diclofenac sodium (100 gm).  Both treatments had similar tolerability, with the most common side effect reported for each being gastrointestinal complaints (Klein, Clin Exp Rheumatol 2006). One weakness of this study, however, was the lack of a placebo control.

Muscle Pain:
There have been mixed results with proteases for delayed onset muscle pain. One study found no decrease in muscle pain when 300 mg of bromelain was taken 3 times daily following weight lifting exercises (Stone Clin J Sport Med 2002).  Interestingly, in this study,
ibuprofen also had no effect on muscle pain. However, a small study found that supplementation with two protease tablets (each providing 325 mg pancreatic enzymes, 75 mg trypsin, 50 mg papain, 50 mg bromelain, 10 mg amylase, 10 mg lipase, 10 mg lysozyme, 2 mg chymotrypsin — activity units not given) (Enzymatic Therapy Corporation) taken four times a day 1 day before a downhill running test and for 3 days after the running test, significantly reduced self-reported soreness in young healthy men compared to placebo (Miller, J Sport Sci 2003). The supplement was taken on an empty stomach, at least 30 minutes before a meal, with an 8 oz. glass of water. Another small study investigating the effects of a branded enzyme blend (DigeZyme, Sami Labs) in healthy men found those who took one capsule (providing 1,200 DU alpha-amylase, 55 CU cellulose, 200 FIP lipase, 200 ALU lactase and 300 PC protease) three times daily, one day before a treadmill running test and for two days after the running test, significantly reduced self-reported pain and tenderness 3 days after the test, compared to placebo (Majeed, Sports Nutr Ther 2016). No adverse events were noticed in the study.

Protease enzymes have also been proposed for reducing inflammation in a number of other conditions such as sinusitis, recovery from surgery and bruising — see the Proteolytic Enzymes article in the encyclopedia.

Lowering blood pressure:
In men and women with untreated high systolic blood pressure (130 to 159 mmHg) one capsule containing 2,000 FU nattokinase taken daily for 8 weeks was shown to reduce systolic and diastolic blood pressure, by 5.55 mmHg and 2.84 mmHg, respectively (Kim, Hypertens Res 2008).

Quality Concerns and What CL Tested for:
Neither the Food and Drug Administration (FDA) nor any other federal or state agency routinely tests supplements for quality prior to sale. In order to help consumers identify products of better quality, ConsumerLab.com purchased and tested digestive supplements to determine whether they contained their labeled amount of enzyme activity for amylase, lipase, and protease. As the FDA only requires supplements to list the amounts of enzyme ingredients, for products listing only amounts and not enzyme activity, activity levels were determined by ConsumerLab.com. Tablets were tested for their ability to properly break apart (disintegrate) in solution. Products were also tested for potential contamination with lead, cadmium, and arsenic.

See How Products Were Evaluated for more information on testing.

Update:
(4/29/15): A CL member complained to a supplement maker that its digestive enzyme supplement was "Not Approved" in this report. We've posted the response from the company and we point out that the company remains incorrect in how it labels the enzyme activity of the product. For details, see the "Update" near the top of the full report.
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