Proteolytic Enzymes Overview

Proteolytic enzymes (proteases) help you digest the proteins in food. Although your body produces these enzymes in the pancreas, certain foods also contain proteolytic enzymes.

Papaya and pineapple are two of the richest plant sources, as attested by their traditional use as natural "tenderizers" for meat. Papain and bromelain are the respective names for the proteolytic enzymes found in these fruits. The enzymes made in your body are called trypsin and chymotrypsin.

The primary use of proteolytic enzymes is as a digestive aid for people who have trouble digesting proteins. However, proteolytic enzymes may also be absorbed internally to some extent and may reduce pain and inflammation.

You don't need to get proteolytic enzymes from food, because the body manufactures them (primarily trypsin and chymotrypsin). However, deficiencies in proteolytic enzymes do occur, usually resulting from diseases of the pancreas (pancreatic insufficiency). Symptoms include abdominal discomfort, gas, indigestion, poor absorption of nutrients, and passing undigested food in the stool.

For use as a supplement, trypsin and chymotrypsin are extracted from the pancreas of various animals. You can also purchase bromelain extracted from pineapple stems and papain made from papayas.

When you purchase an enzyme, the amount is expressed not only in grams or milligrams but also in activity unitsor international units.These terms refer to the enzyme's potency (specifically, its digestive power).

Recommended dosages of proteolytic enzymes vary with the form used. Because of the wide variation, we suggest following label instructions.

Proteolytic enzymes can be broken down by stomach acid. To prevent this from happening, supplemental enzymes are often coated with a substance that doesn't dissolve until it reaches the intestine. Such a preparation is called enteric coated.

Most of the studies described in this section used combination products containing various proteolytic enzymes plus other substances, such as the bioflavonoid rutin.

Osteoarthritis and Other Forms of Chronic Musculoskeletal Pain

Several studies provide preliminary evidence that proteolytic enzymes might be helpful for various forms of chronic pain, including neck pain and osteoarthritis.

Neck Pain

A double-blind, placebo-controlled trial of 30 people with chronic neck pain found that use of a proteolytic enzyme mixture modestly reduced pain symptoms as compared to placebo. ¹

Osteoarthritis

Studies enrolling a total of more than 400 people compared proteolytic enzymes to the standard anti-inflammatory drug diclofenac for the treatment of osteoarthritis -related conditions of the shoulder, back, or knee. ² The results generally showed equivalent benefits with the supplement as with the medication. However, all of these studies suffered from various flaws that limit their reliability; the most important was the absence of a placebo group .

Shingles *(Herpes Zoster)*

Herpes zoster( shingles ) is an acute, painful infection caused by the varicella-zoster virus, the organism that causes chickenpox. Proteolytic enzymes have been suggested as treatment. However, there is little evidence to support their use.

A double-blind study of 190 people with shingles compared proteolytic enzymes to the standard antiviral drug acyclovir. ³ Participants were treated for 14 days and their pain was assessed at intervals. Although both groups had similar pain relief, the enzyme-treated group experienced fewer side effects. However, since acyclovir offers minimal benefit at most, these results don't mean very much.

Similar results were seen in another double-blind study in which 90 people were given either an injection of acyclovir or enzymes, followed by a course of oral medication for 7 days. ⁴

Sports Injuries

Several small studies have found proteolytic enzyme combinations helpful for the treatment of sports injuries . However, the best and largest trial by far failed to find benefit.

A double-blind, placebo-controlled study of 44 people with sports-related ankle injuries found that treatment with proteolytic enzymes resulted in faster healing and reduced the time away from training by about 50%. ⁵ Based on these results, a very large (721-participant), double-blind, placebo-controlled trial of people with sprained ankles was undertaken. ⁶ Unfortunately, this study failed to find benefit with rutin, bromelain, or trypsin, separately or in combination.

Three other small, double-blind studies, involving a total of about 80 athletes, found that treatment with proteolytic enzymes significantly speeded healing of bruises and other mild athletic injuries as compared to placebo. ^{7 8} In another double-blind trial, 100 people were given an injection of their own blood under the skin to simulate bruising following an injury. Researchers found that treatment with a proteolytic enzyme combination significantly speeded up recovery. ⁹ In addition, a double-blind, placebo-controlled trial of 71 people with finger fractures found that treatment with proteolytic enzymes significantly improved recovery. ¹⁰ However, these studies were performed decades ago and are not quite up to modern standards.

Surgery

Numerous studies have evaluated various proteolytic enzymes as an aid to recovery from surgery , but the results have been mixed. Again, most of these studies are not up to modern standards.

A double-blind, placebo-controlled trial of 80 people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling. ¹¹ Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in 80 individuals undergoing oral surgery. ¹² The results showed reduced pain, inflammation, and swelling in the treated group as compared to the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery, ¹³ as well as in one study involving only bromelain. ¹⁴ A double-blind, placebo-controlled study of 204 women receiving episiotomies during childbirth found evidence that a mixed proteolytic enzyme product can reduce inflammation. ¹⁵ Bromelain was also found helpful for reducing inflammation following episiotomy in one double-blind, placebo-controlled trial of 160 women, ¹⁶ but a very similar study found no benefit. ¹⁷ Other double-blind, placebo-controlled studies have found that bromelain reduces inflammation and pain following nasal surgery, ¹⁸ cataract removal, ¹⁹ and foot surgery. ²⁰ However, a study of 154 individuals undergoing facial plastic surgery found no benefit. ²¹ A small double-blind, placebo-controlled trial of 24 people having surgical extraction of third molars found serrapeptase given during the procedure reduced postoperative pain and swelling (significant differences on days 2, 3 and 7). ²²

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3. Billigmann VP. Enzyme therapy—an alternative in treatment of herpes zoster. A controlled study of 192 patients [translated from German]. Fortschr Med. 1995;113:43-48.
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13. Cameron IW. An investigation into some of the factors concerned in the surgical removal of the impacted lower wisdom tooth, including a double blind trial of chymoral. Br J Oral Surg. 18(2):112-24.
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18. SELTZER AP. Minimizing post-operative edema and ecchymoses by the use of an oral enzyme preparation (bromelain). A controlled study of 53 rhinoplasty cases. Eye Ear Nose Throat Mon. 41():813-7.
19. Spaeth GL. The effect of bromelains on the inflammatory response caused by cataract extraction: a double-blind study. Eye Ear Nose Throat Mon. 47(12):634-9.
20. Frank SC. Use of chymoral as an anti-inflammatory agent following surgical trauma. J Am Podiatr Assoc. 1965;55:706-709.
21. Gylling U, Rintala A, Taipale S, Tammisto T. The effect of a proteolytic enzyme combinate (bromelain) on the postoperative oedema by oral application. A clinical and experimental study. Acta Chir Scand. 131(3):193-6.
22. Al-Khateeb TH, Nusair Y. Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg. 37(3):264-8.