Teresa Tsui

Why do we need enzymes?

We are what we eat – perhaps we are how and what we digest? Enzymes are important chemical messengers that assist with digestive function, enabling the breakdown of important nutrients such as proteins, carbohydrates and fats. The pancreas is a major organ in the body that produces enzymes, namely proteases, amylase, and lipase (Whitecomb, 2007).

Health Canada’s Dietary Reference Intakes establish nutrient reference values for healthy populations, outlining key nutrient intakes to prevent deficiencies and lower the risk of chronic disease (Health Canada, 2005). Approximately 10-35% of daily energy intake is protein (Health Canada, 2005), where proteases assist with protein breakdown into peptides and amino acids, constituents easily assimilated by the body. Amylases are key enzymes that digest carbohydrates into simple sugars such as glucose, where carbohydates make up approximately 45-65% of the daily dietary intake. Lipases are the fat-digesting enzymes, breaking down approximately 100 g of dietary fat each day (< 25% of total energy) about into triglycerides and phospholipids.

Loss of pancreatic function and resulting enzyme production occurs in disease of the pancreas, including chronic pancreatitis, cystic fibrosis, tumors in the pancreas, Celiac’s disease, and surgical removal of the pancreas (Dominguez-Munoz, 2011; Giuliano 2011). Signs and symptoms are debilitating – namely, nausea, bloating, pain, inadequate nutrient absorption, steatorrhea, diabetes mellitus, weight loss (Giuliano, 2011). Enzyme replacement therapy provides a viable option to mimic the lost physiological secretions of the pancreas (Dominguez-Munoz, 2011).

How to select a good enzyme product?

Randomized controlled trials have investigated combination enzyme products that typically include protease, lipase, and amylase, in amounts of 30,000-100,000 USP, 5,000-112,500 USP, and 750-99,600 USP, respectively (Suarez 1999; Borowitz 2006).

Suarez et al. conducted a double-blind, cross over single-dose study to determine whether microencapusulated pancreatic enzymes reduce postprandial symptoms experienced by healthy volunteers (N = 18, 13 females; ages 25-52 years) after ingestion of a high calorie, high fat meal (Suarez 1999). The enzyme profile in the test product consisted of a total of 30,000 USP lipase, 112,500 USP protease, 99,600 USP amylase. At 7am of the test date, 18 subjects ingested 185 g of cookies (1196 calories and 72 g of fat) with three pancreatic enzyme capsules or placebo. The severity of gastrointestinal symptoms and flatus passages were recorded for 15-17 hours, and end-alveolar samples were obtained every hour for 10 hours. The authors found that ingestion of pancreatic supplements was associated with a significant reduction in bloating over the entire recording period, and with significant reductions in bloating, gas, and fullness during the dinner to bedtime period (p = 0.049). The authors did not report any side effects. These findings are important because they reduce postprandial symptoms in healthy subjects, suggesting that these pancreatic enzyme supplements might also be beneficial to individuals with irritable bowel syndrome (Suarez 1999).

In another one-month randomized, double-blind, parallel dose-ranging study (N = 117, mean age 20.9-22.2 years in the 4 groups), individuals with pancreatic insufficiency secondary to cystic fibrosis investigated three doses of pancreatic enzyme replacement therapy on nitrogen and fat absorption, markers of pancreatic function (Borowitz, 2006). The three pancreatic enzyme doses provided pancreatic lipase at 5,000, 25,000, and 100,000 units of lipase and a corresponding amount of protease and amylase at a 1:1:0.15 ratio (lipase:protease:amylase) on a daily basis. The authors found that fat absorption was significantly greater in the mid and high dose groups compared with the low dose group (P = 0.0229 and p = 0.0041, respectively). There were no significant differences in nitrogen absorption between the three groups. The largest increase in fat absorption (31%) occurred in the participants receiving the mid and high doses who had the lowest baseline fat absorption values (<40%). The adverse events reported in all three treatments groups were generally mild digestive-related concerns. There were no statistically-significant differences between all three groups. Overall, the findings of this study suggests that supplementing with at least 25,000 units of lipase, 25,000 units of protease and 3,730 units of amylase is efficacious at improving fat malabsorption for individuals with pancreatic insufficiency (Borowitz, 2006).

The importance of supplementing with pancreatic enzymes for maintaining healthy digestive function is an area of active study. Emerging research on the safe and effective use of pancreatic enzymes containing lipase, protease and amylase is reassuring for those who live with pancreatic insufficiency.

References

Borowitz D, Goss CH, Limauro S, Konstan MW, Blake K, Casey S, Quittner AL, Murray FT. Study of a novel pancreatic enzyme replacement therapy in pancreatic insufficient subjects with cystic fibrosis. J Pediatr. 2006 Nov;149(5):658-662.

Domínguez-Muñoz JE. Pancreatic exocrine insufficiency: diagnosis and treatment. J Gastroenterol Hepatol. 2011 Mar;26 Suppl 2:12-6.

Giuliano CA, Dehoorne-Smith ML, Kale-Pradhan PB. Pancreatic enzyme products: digesting the changes. Ann Pharmacother. 2011 May;45(5):658-66. Epub 2011 May 3.
Health Canada – Dietary Reference Intakes, 2005. Accessed: May 27, 2011. URL: http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_macronutr_tbl-eng.php
Suarez F, Levitt MD, Adshead J, Barkin JS. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Dig Dis Sci. 1999 Jul;44(7):1317-21.
Whitcomb DC, Lowe ME. Human pancreatic digestive enzymes. Dig Dis Sci. 2007 Jan;52(1):1-17. Epub 2007 Jan 5. Review