Enzyme supplements available without a prescription are becoming increasingly popular, but should everyone add them to their shopping list? Brent Bauer, M.D., director of the Mayo Clinic Complementary and Integrative Medicine Program, is co-author of a new paper in the medical journal Mayo Clinic Proceedings on the pros and cons of over-the-counter enzymes. Here, Dr. Bauer answers some common questions about these dietary supplements:
What's the issue?
Dr. Bauer: "They've become so popular. Like so many dietary supplements, patients are looking for something to help their health, so they're reading about over-the-counter enzymes as one of those many dietary supplements, and all of a sudden we're seeing sales go through the roof. A huge challenge with dietary supplements is that most haven't been tested as most drugs are. We have a lot of information, but we don't have definitive information. So our patients hear a lot of positive things, but they do not always hear the negatives or the side effects. So we're trying to be very evidence-based. We don't want to say no, there's no reason to ever take an over-the-counter enzyme. By the same token, we don't want to just rush out and buy it because we heard somebody say something positive on TV."
What are some of the reasons people take enzyme supplements?
Dr. Bauer: "We have a lot of natural enzymes in our bodies. They help us digest food. There are clearly medical reasons to use enzymes. If a patient's pancreas isn't working, for example, that patient may need to take a medically prescribed enzyme supplement. That's a little different story from a healthy person who wants to use over-the-counter bromelain, or papain -- the enzymes that come from the pineapple and the papaya -- or trypsin, or chymotrypsin. The reasons people might use those center around digestion: Maybe they're getting older, they're having more gas and bloating, so they think if they take an enzyme it will help their digestion. There are also some anti-inflammatory effects, so some people will use those enzymes to try to reduce inflammation, maybe help with osteoarthritis. And there's a long history of these being used as anti-cancer agents. The challenge from a physician standpoint is that the evidence for each of those is pretty limited. We just don't have the data to say, `No, it doesn't work. Yes, it does work.' We're stuck."
What if I want to try over-the-counter enzymes? Are there any side effects?
Dr. Bauer: "Fortunately, for most over-the-counter enzymes, unless you're taking super-high doses, the risks are pretty minimal. Some people get gastrointestinal upset or some irritation. So I'll have that conversation with my patients: If they want to try enzymes, I want them to understand the risks, the potential benefits, the limited amount of evidence. And then if we're going to use it, I try to do it in a short trial period, use it for two or three weeks. If you notice a big improvement, it doesn't mean it works, but it means maybe for you it's something you might want to continue with. If it's not working, don't just keep taking more and hoping for something magical to happen."
Is there anyone who shouldn't take these?
Dr. Bauer: "Bromelain, the enzyme from the pineapple, may have anti-platelet activity. So for people taking blood thinners or who have anti-platelet activity, theoretically there could be increased risk of bleeding. For children with cystic fibrosis, there have been a couple of bad adverse reactions where those taking prescription enzymes can get a bad colon disorder called fibrosing colonopathy."
How can consumers judge advertising claims?
"If you look at some of the bold headlines on dietary supplements -- 'Use our enzymes, we can help prevent cancer' -- there's probably a grain of truth in a lot of the advertising, but it's hyped and it's made to sound unbelievably good. As soon as you hear that type of hype, those types of overblown promises, it's time to step back and say `Wait a minute, what am I investing my money in?' And then it's a good time to do a little research, then it's even a better time to go and talk to your physician and ask whether there are any risks and any interactions with the medications you are taking."
- Jithinraj Edakkanambeth Varayil, Brent A. Bauer, Ryan T. Hurt. Over-the-Counter Enzyme Supplements: What a Clinician Needs to Know. Mayo Clinic Proceedings, 2014; DOI: 10.1016/j.mayocp.2014.05.015
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