What Are Digestive Enzymes?

How do they impact digestion and inflammation? Read on!

Digestive Enzyme capsules and tablets

Verywell / Anastasia Tretiak

Food fuels your body. Digestive enzymes (proteins in the body) help break down your food into smaller parts so your body can easily integrate the nutrients. Usually, digestive enzymes are produced in different parts of the body, like the mouth (where digestion begins), stomach, pancreas, and small intestine. These digestive enzymes are endogenous (made in the body).

For some people, the body doesn't make enough of these enzymes or can't use them properly due to health conditions. Being unable to break food down can lead to nutrient deficiencies and can cause other conditions (ex., osteoporosis).

A healthcare provider may prescribe prescription enzyme replacement therapy (ERT) after a diagnosis relating to an enzyme deficiency. However, this article will focus on major over-the-counter (OTC) digestive enzyme supplements, not prescription enzyme replacement therapy products (ex., pancreatic enzyme replacement therapy (PERT)).

The following are examples of digestive enzymes that occur naturally in the body. Some of these are also available as supplements or prescription products.

Digestive enzymes that break down carbohydrates (and where they're found):  

  • Amylase (in saliva and the pancreas) breaks down complex carbohydrates and starches in grains, beans, and starchy vegetables. 
  • Lactase (small intestine) breaks down lactose, a sugar in dairy products.
  • Maltase (saliva, pancreas) breaks down maltose, a sugar in grains.
  • Sucrase (small intestine) digests sucrose, a sugar found in fruit, nuts (in small amounts), and veggies.

A digestive enzyme that breaks down fat: Lipase (pancreas).

Digestive enzymes that break down proteins:  

  • Chymotrypsin (pancreas)
  • Pepsin (stomach)
  • Peptidase (stomach, pancreas, small intestine)
  • Protease (pancreas)
  • Trypsin (small intestine)

A digestive enzyme that breaks down multiple nutrients: Elastase (pancreas) helps digest carbohydrates, fats, and proteins.

Oral digestive enzyme supplements made from plants:

  • Bromelain (from pineapple) digests proteins
  • Papain (from papaya) also digests proteins

This is not an exhaustive list of endogenous digestive enzymes and/or available OTC supplements or products.

OTC enzymes have been studied in people with autism, arthritis pain, celiac disease, Crohn's disease, irritable bowel syndrome, muscle soreness, and more. It's important to discuss any digestive symptoms with your healthcare provider.

OTC digestive enzyme supplements are not meant to treat life-threatening medical conditions. Please discuss any concerning symptoms with your healthcare provider.

Dietary supplements are not regulated like drugs in the United States, meaning the Food and Drug Administration (FDA) does not approve them for safety and effectiveness before products are marketed. Choose a supplement tested by a trusted third party, such as USP, ConsumerLab, or NSF, when possible. However, even if supplements are third-party tested, that doesn't mean they are necessarily safe for all or effective in general. Therefore, talking to your healthcare provider about any supplements you plan to take and checking in about potential interactions with other supplements or medications is important.

Supplement Facts

  • Active Ingredient(s): Alpha-d-galactosidase (Beano), amylase, bromelain*, chymotrypsin, elastase, lactase (Lactaid), lipase, maltase, papain*, pepsin, peptidase, protease, sucrase, trypsin
  • Alternate Names(s): Amylolytic enzymes, lipolytic enzymes, proteolytic enzymes
  • Legal Status: Over-the-counter (OTC) supplements (United States), food additives (select enzymes), GRAS (select enzymes).
  • Suggested Dose: Dosage depends on the condition.
  • Safety Considerations: Prescription blood thinners, children (people under 18), pregnancy, and breastfeeding.

Uses of Digestive Enzymes

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist, pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.

Digestive enzymes help break down the food you eat so your body can get the most nutrients. When this process is disrupted, you may experience discomfort (ex., bloating, gas). In more severe conditions where digestive enzymes aren’t produced or used efficiently, your body could become malnourished as it also can’t use nutrients from your food. Over time, this can cause issues like osteoporosis. People with more severe conditions (ex., exocrine pancreatic insufficiency (EPI), pancreatitis, surgical removal of the pancreas, cystic fibrosis) will likely need prescription enzyme replacement therapy (ERT).

Over-the-counter (OTC) supplements may be used in other conditions (lactose intolerance, trouble breaking down carbohydrates in beans). OTC digestive enzyme supplements have been studied for use in inflammatory bowel disease (Crohn’s, ulcerative colitis), irritable bowel syndrome (with FODMAP intolerance), lactose intolerance (due to aging, premature digestive systems in babies, injury, or disease like celiac), trouble digesting carbohydrates, and more. This article covers these conditions.

Be sure to discuss your symptoms and use of digestive enzymes with your healthcare provider.

Digestive Symptoms in Autism

Eating a balanced diet is part of an overall approach to health. However, eating a wide variety of foods can be challenging for some people with autism spectrum disorder (ASD). People with ASD may have special dietary needs, including help slowly introducing foods that otherwise may cause them to experience sensory overwhelm (issues with integrating the mouth-feel, taste, or smell of food). They may also experience digestive upset, which may contribute to the rejection of certain foods and also different behaviors.

If you or a loved one are having issues or concerns in the area of eating and ASD, or you find yourself needing support, consider speaking with your or your child's healthcare provider about working with a food therapy specialist (e.g., an occupational therapist or a registered dietitian nutritionist with food therapy training).

Note: digestive enzymes are not a cure for autism. Please discuss digestive enzymes before using them with your or your child's healthcare provider.

Reports suggest anywhere from nine to 70% of people with autism spectrum disorders (ASD) experience gastrointestinal problems. Abdominal discomfort, gassiness, loose stools, or constipation (which may contribute to limiting food variety) have been reported. Some studies have suggested enzyme deficiencies - in lactase, maltase, sucrase, alatinase, and glucoamylase - may contribute to digestive discomfort, which may, in turn, contribute to big feelings and behaviors that seem challenging. These behaviors are trying to communicate something important.

One study of 199 children and adults (ages 33 months to 28 years) with ASD looked at digestive enzyme activity, specifically lactase, maltase, and sucrase. The researchers suggested that boys under five years with ASD were more likely to have lactase deficiency than girls with ASD. Other digestive enzyme deficiencies they noted were sucrase and maltase. Only 6% of the participants had small intestine (duodenum) inflammation.

An investigation of different ways to support digestive health in children with ASD has been suggested. However, research on using digestive enzymes (or any supplements) for gut issues in children with ASD is mixed.

In one placebo-controlled study of 92 children (three to nine years) with ASD, 47 were given digestive enzymes (Neo-Digestin; papain 0.08 grams (g) and pepsin 0.04 grams (g) per 5 milliliters (mL) solution) three times daily (for a total of papain 0.24 grams and pepsin 0.12 grams per 15 milliliters solution daily) before meals for three months. The children who took enzymes had improvements in emotional response and general behavior. They also had improvements in the following:

  • Abdominal pain
  • Food variety (selective eating may be seen in children with ASD)
  • Quality of stools
  • Vomiting

In a study of 29 children with ASD, a combination supplement with caso-glutenase 10,000 AU; bromelain 230 BTU; acid-fast protease 100 SAPU; lactase 330 LacU; phytase 125 U; and galactose 100 milligrams was taken with each meal for twelve weeks. Guardians, parents, teachers, or therapists evaluated thirteen health and behavior parameters. Socialization and hyperactivity improved by 90% and 80%, respectively. Stimming and speech improved the least.

However, several other studies using a different enzyme combination found no similar effects.

More research is needed. Talk to your child's healthcare provider (ex., pediatrician) before giving them digestive enzymes or other supplements.

Cancer Treatment Complications

A review showed mixed results for using digestive enzymes to treat cancer or cancer treatment complications.

While some studies suggested OTC enzymes improved the quality of life for people with colorectal cancer or increased survival in people with multiple myeloma also receiving standard treatment, other studies reported conflicting results.

More research is needed. Talk to your healthcare provider before taking any supplements or over-the-counter medications due to possible interactions, especially during cancer treatment.

Celiac Disease

Enzymes have been studied for celiac disease (an autoimmune disease). A review highlighted studies using gluten-degrading enzymes like cysteine proteases, prolyl endopeptidases, and subtilisin. Some of these enzymes are being studied for drug development. However, the review suggests that gluten-degrading enzymes could potentially increase or decrease the body’s immune response to gluten, potentially worsening symptoms. Other studies using other enzymes for celiac were inconclusive.

Enzymes alone should not be used to manage or treat celiac disease. Follow the guidance of your healthcare provider (ex., registered dietitian nutritionist, gastroenterologist) and your body.

Fermentable Carbohydrate Digestion

Some people have trouble digesting specific carbohydrates in beans. Studies have suggested an alpha-galactosidase supplement (ex., Beano) reduced gastrointestinal symptoms (ex., abdominal discomfort, bloating).

Functional Dyspepsia

Researchers conducted a randomized, double-blind, placebo-controlled study of 40 people (32 people assigned female at birth, eight assigned male at birth) with symptoms of functional dyspepsia (including indigestion). Fifty milligrams of a combination enzyme product (α-amylase, protease, cellulase, lactase, and lipase) were used twice daily for 60 days. The researchers reported that the treatment reduced indigestion symptoms compared to the placebo.

Of note, the study's authors were founders or employees of the company that manufactured and marketed the enzyme product used in this study. This could introduce bias in study results and needs to be considered when interpreting the findings. Further study is required to confirm any of these results.

Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) includes ulcerative colitis (bowel disease) and Crohn’s disease (inflammation anywhere in the digestive tract, even the mouth). The use of digestive enzymes has been suggested as a potential treatment option for IBD, though conflicting evidence exists. It’s also been suggested that people with IBD may not make enough lactase or use it effectively, leading to dairy intolerance.

A few case studies in humans suggested bromelain may help symptoms in people with colitis.

Digestive enzymes have also been studied for combined inflammatory bowel disease with irritable bowel syndrome (IBD-IBS). IBD-IBS syndrome is an inflammatory bowel disease (IBD) with irritable bowel syndrome (IBS) symptoms, such as abdominal pain and diarrhea. In a study, people with IBD-IBS (including those with Crohn’s disease or ulcerative colitis) were given Asacol (mesalamine) (an anti-inflammatory drug) with Biointol (a combination product with digestive enzymes, inositol, and beta-glucan) for four weeks. The control group received Asacol only.

After four weeks, those who received Asacol and Biointol said they had less abdominal pain. They also said they had less bloating and flatulence. Those who took only Asacol slightly improved fecal urgency (sudden need for a bowel movement). 

While these effects may seem promising, more studies are needed to confirm the results.

Irritable Bowel Syndrome (IBS)

Digestive enzymes have been studied in people with irritable bowel syndrome (IBS). One study discussed in a review used Essential Enzymes 500 (Source Naturals, Scotts Valley, CA, USA), a combination product containing protease (4,375 USP units), lipase (375 USP units), a-amylase (2,614 USP units), as well as amyloglucosidase, cellulase, hemicellulase, and lactase in people with diarrhea associated with IBS. Of the 86 people in follow-up (those who finished the study), 71 (82.5%) experienced improved or eliminated IBS-D symptoms. 

It’s important to note that this study used a combination product. It would be challenging to understand which ingredients were most effective over time. Further studies are needed to confirm these results.

Lactose Malabsorption and Intolerance

People with trouble digesting dairy (ex., lactose malabsorption, lactose intolerance) may take OTC digestive enzymes like lactase.

Lactase digests lactose. Lactose is the primary sugar in milk and other dairy products (ex., buttermilk, condensed and evaporated milk, yogurt, ice cream, and cheese). Lactase supplements can help prevent indigestion in people who have trouble digesting lactose. Secondary lactose intolerance can arise in people with IBD (Crohn’s, ulcerative colitis) and other diseases like celiac. This is due to potential intestinal damage and, thus, decreased lactase production in the body.

Lactase malabsorption and intolerance must be addressed to prevent diseases like osteoporosis. Speak with your healthcare provider if you have any questions or concerns.

Muscle Soreness

Studies have also looked into OTC enzymes as a treatment for sore muscles. In a placebo-controlled study, 20 people assigned male at birth were given protease (breaks down proteins) supplements containing 325 milligrams (mg) of pancreatic enzymes, 75 milligrams of trypsin, 50 milligrams of papain, 50 milligrams of bromelain, 10 milligrams of amylase, 10 milligrams of lipase, 10 milligrams of lysozyme, and two milligrams of chymotrypsin. After intense downhill running, the supplement reduced pain in this group.

A study using a different product (300 milligrams of bromelain, twice daily) on elbow pain soreness after exercise showed no difference between the bromelain group, 400 milligrams of Advil (ibuprofen) twice daily, placebo, and control groups.

These studies are small and not enough to make a firm recommendation for digestive enzymes for muscle soreness. Further study is needed.


Researchers have studied the effects of bromelain on osteoarthritis (OA) pain. It's been suggested that bromelain works by reducing inflammation.

A review of studies on supplements in OA found evidence that bromelain may ease OA pain. The authors noted, however, that many of the studies had a suboptimal design, meaning the study designs weren't great, so they may not necessarily capture useful information.

Another study of 150 people with moderate-to-severe knee OA compared Voltaren (diclofenac) with Wobenzym.

Voltaren is a prescription non-steroidal anti-inflammatory (NSAID) pain reliever. In the suggested daily dose, Wobenzym contains milligrams of trypsin (an enzyme derived from pig or cow pancreas that breaks down proteins), 540 milligrams of bromelain (from pineapple), and 600 milligrams of rutoside trihydrate (rutin, an antioxidant derived from the Japanese pagoda tree, Sophora japonica). After 12 weeks, people taking Wobenzym had less joint pain and improved knee function (walking ability and knee flexibility) compared to the NSAID group. The effects of the individual enzymes on arthritis are unclear. A study with a similar supplement suggested only minor improvements in pain.

Based on the current research, it's challenging to know how effectively individual enzymes may improve OA symptoms, especially when using combination products that contain more than just enzymes. Larger, high-quality studies are needed before these results can be confirmed.

Digestive Enzyme Deficiency

In the body, most digestive enzymes are made by the pancreas, small intestine, and mouth (saliva). These are called endogenous digestive enzymes. These enzymes help your body break down fats, proteins, and carbohydrates from food.

When your body doesn't make enough enzymes, it can't break down food as easily. That means it cannot absorb the nutrients from those foods easily. This can cause malabsorption.

Malabsorption can lead to nutritional deficiencies and uncomfortable symptoms, like:

What Causes a Digestive Enzyme Deficiency?

Diseases that cause digestive enzyme insufficiency include but are not limited to the following:

These conditions may require prescription enzyme replacement therapy (ERT). Prescription products are different from over-the-counter products. 

Other conditions that may cause inefficient production or use of digestive enzymes include the following:

How Do I Know If I Have a Digestive Enzyme Deficiency?

Your healthcare provider will diagnose a digestive enzyme deficiency and can determine whether you need a prescription product or if an over-the-counter product will suffice. 

Symptoms of enzyme deficiency may includethe following:

  • Abdominal pain
  • Bloating
  • Diarrhea
  • Constipation
  • Disease due to long-term deficiency (ex., osteoporosis)

Keep track of when you experience these symptoms and the foods you consume before experiencing symptoms. Consult your healthcare provider if you experience any of these symptoms.

What Are the Side Effects of Digestive Enzymes?

Most digestive enzyme supplements are safe at doses recommended by the manufacturer. Side effects are generally mild. However, the risk of severe side effects does exist.

The risk of an allergic reaction is present for all digestive enzyme supplements, particularly if you have a known allergy to them or the products from which they are derived (for example, an allergy to papaya or pineapple).

Common Side Effects

Common side effects of digestive enzyme oral supplementation are primarily gastrointestinal upset, such as:

  • Allergic reactions
  • Diarrhea
  • Loose stools
  • Nausea
  • Stomach pain
  • Vomiting

Side effects, when applied to the skin, include:

  • Redness and swelling

Severe Side Effects

Severe side effects of digestive enzymes are rare. Each supplement can have different effects. Severe side effects include but aren't limited to the following:

  • Pain and burning when applied to the skin (trypsin)
  • Severe irritation (papain latex)
  • Perforated esophagus (papain in high amounts)--this is rare.
  • Severe allergic reactions like anaphylaxis (chymotrypsin)--this is rare.


Some digestive enzyme products are derived from animals (ex., cattle, pigs). If you’re following a specific diet that avoids animal products, please be aware of the origin of your enzymes. 

Avoid use if allergic to any ingredient in your supplement (ex., ingredients in fruit latex, pineapple, papaya). Ask your pharmacist or review the product label for a complete list of ingredients. 

Use caution when using bromelain if you take blood thinners. If you take blood thinners or have low platelets, using bromelain may increase your risk of bleeding.

If pregnant or breastfeeding, consult a healthcare provider before taking digestive enzymes.

Digestive enzyme capsules
Verywell / Anastasia Tretiak

Dosage: How Much Digestive Enzymes Should I Take?

Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage are appropriate for your individual needs.

Dosing for digestive enzyme supplements differs for each enzyme and different conditions. The following has been suggested:

  • Bromelain: up to 400 milligrams (mg) per day by mouth.
  • Chymotrypsin: up to 100,000U USP four times daily by mouth.
  • Papain: up to 1,500 milligrams per day by mouth.
  • Trypsin: up to 50 milligrams; combined with bromelain.

Digestive enzymes are usually taken before meals.

As a general rule, never take more than the recommended dose. Follow instructions on product labels and include your healthcare provider and pharmacist in your decisions. Look for supplements certified by a third party if purchasing in a store.

What Happens If I Take Too Much Digestive Enzymes?

A standard dose for over-the-counter digestive enzyme supplements is lacking. Follow the instructions on your supplement package. Consult with your healthcare provider for further guidance.

In rare cases, excess digestive enzyme supplementation has resulted in esophageal perforation (torn esophagus).


Digestive enzyme supplements may interact with blood-thinning medicines like:

Digestive enzymes, specifically bromelain, may interact with other supplements with blood-thinning effects. These include:

  • Garlic (high amounts)
  • Ginger
  • Gingko biloba
  • Ginseng
  • Fish oil
  • Vitamin E
  • Willow

Bromelain may impact absorption and the body's use of medications such as:

  • Antibiotics (ex., amoxicillin, tetracycline)
  • Blood pressure medication/ACE inhibitors (ex., Capoten (captopril), Zestril (lisinopril))
  • Chemotherapy drugs (ex., 5-fluorouracil, vincristine)

Papain may impact how the body absorbs amiodarone, levothyroxine, diabetes medications, and warfarin.

It is essential to carefully read a supplement's ingredient list and nutrition facts panel to know which ingredients and how much of each ingredient is included. Please review this supplement label with your healthcare provider to discuss potential interactions with foods, other supplements, and medications.

How to Store Digestive Enzymes

Store digestive enzymes in a cool, dry place. Keep digestive enzymes away from direct sunlight. Follow the manufacturer’s guidance on your digestive enzyme packaging.

Similar Supplements

Select foods contain digestive enzymes, like pineapple and papaya. Pineapple contains bromelain, and papaya contains papain.

Papain is a proteolytic enzyme found in papaya and is believed to aid digestive issues. However, eating papaya has the same benefits as taking papain as an oral supplement.

While probiotics and prebiotics are used for digestion, they have different mechanisms of action (they work differently) than digestive enzymes.

Frequently Asked Questions

  • What’s prescription enzyme replacement therapy?

    People with conditions like cystic fibrosis, pancreatitis, and pancreatic cancer are prescribed prescription enzyme replacement therapy, usually in the form of pancreatic enzyme replacement therapy (PERT). Prescription PERT products include Creon, Pancreaze, Ultresa, Viokace, and Zenpep. Prescription PERT is different from over-the-counter products.

  • Should you take digestive enzymes before or after you eat?

    While digestive enzymes are typically taken before meals, read the manufacturer’s suggestions. Ask a healthcare provider if you have any questions.

  • Is Lactaid a digestive enzyme?

    Lactaid is an over-the-counter product that contains the digestive enzyme lactase. Lactase breaks down lactose (a sugar) in dairy products. It helps people with lactose intolerance.

Sources of Digestive Enzymes & What To Look For

Digestive enzymes are typically found naturally in the body. They are also sold as supplements and can be found in foods like pineapple and papaya.

Food Sources

The digestive enzyme bromelain can be found in the core and stem of the pineapple. Papain can be found in papaya. While digestive enzymes exist in these plants, it's unclear whether you'll get extra digestive enzymes by eating the fruit of these plants. They're typically more concentrated in dietary supplements derived from these plants.

Some food products also contain enzymes, like Lactaid milk which contains lactase.


Digestive enzymes are widely available online and in stores. They typically come in capsule form. They may have different amounts of enzymes and sometimes contain other ingredients like prebiotics or probiotics. Speak with your healthcare provider before using digestive enzymes, particularly if you’re having trouble with digestion.


Digestive enzymes have been studied for several health conditions, like IBS, IBD, symptoms of autism, and more. The evidence is mixed regarding whether or not they’re useful for some of these conditions. Digestive enzymes are readily available over-the-counter for issues like lactose intolerance and for help with digesting other carbohydrates. Some digestive enzymes may have mild side effects. Since digestive symptoms can also be connected with more severe conditions, discuss your symptoms and concerns with your healthcare provider.

39 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Diabetes and Digestive and Kidney Diseases. Your digestive system & how it works.

  2. NIH National Center for Complementary and Integrative Health (NCCIH). Bromelain.

  3. LactMed. Papaya.

  4. Varayil JE, Bauer BA, Hurt RT. Over-the-counter enzyme supplements: what a clinician needs to know. Mayo Clin Proc. 2014;89(9):1307-12. doi:10.1016/j.mayocp.2014.05.015

  5. Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. Digestive enzyme supplementation in gastrointestinal diseasesCurr Drug Metab. 2016;17(2):187–193. doi:10.2174/138920021702160114150137

  6. Wasilewska J, Klukowski M. Gastrointestinal symptoms and autism spectrum disorder: links and risks - a possible new overlap syndrome. Pediatric Health Med Ther. 2015 Sep 28;6:153-166. doi: 10.2147/PHMT.S85717. PMID: 29388597; PMCID: PMC5683266.

  7. Adams JB, Audhya T, Geis E, et al. Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial. Nutrients. 2018 Mar 17;10(3):369. doi: 10.3390/nu10030369

  8. Kushak RI, Lauwers GY, Winter HS, Buie TM. Intestinal disaccharidase activity in patients with autism: effect of age, gender, and intestinal inflammation. Autism. 2011;15(3):285-294. doi:10.1177/1362361310369142

  9. Sanctuary MR, Kain JN, Angkustsiri K, German JB. Dietary Considerations in Autism Spectrum Disorders: The Potential Role of Protein Digestion and Microbial Putrefaction in the Gut-Brain Axis. Front Nutr. 2018;5:40. Published 2018 May 18. doi:10.3389/fnut.2018.00040

  10. Sathe N, Andrews JC, McPheeters ML, Warren ZE. Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review. Pediatrics. 2017;139(6):e20170346. doi:10.1542/peds.2017-0346

  11. Saad K, Eltayeb AA, Mohamad IL, et al. A randomized, placebo-controlled trial of digestive enzymes in children with autism spectrum disorders. Clin Psychopharmacol Neurosci. 2015;13(2):188. doi:10.9758/cpn.2015.13.2.188

  12. Brudnak MA, Rimland B, Kerry RE, et al. Enzyme-based therapy for autism spectrum disorders -- is it worth another look?. Med Hypotheses. 2002;58(5):422-428. doi:10.1054/mehy.2001.1513

  13. Munasinghe SA, Oliff C, Finn J, et al. Digestive enzyme supplementation for autism spectrum disorders: a double-blind randomized controlled trial. J Autism Dev Disord. 2010;40:1131–1138. doi:10.1007/s10803-010-0974-2

  14. Popiela T, Kulig J, Hanisch J, Bock PR. Influence of a complementary treatment with oral enzymes on patients with colorectal cancers–an epidemiological retrolective cohort study. Cancer Chemother Pharmacol. 2001;47(1):S55-63.

  15. Sakalova A, Bock PR, Dedik L, et al. Retrolective cohort study of an additive therapy with an oral enzyme preparation in patients with multiple myeloma. Cancer Chemother Pharmacol. 2001;47(suppl):S38-S44.

  16. Martin T, Uhder K, Kurek R, et al. Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial. Radiother Oncol. 2002;65:17-22.

  17. Wei G, Helmerhorst EJ, Darwish G, Blumenkranz G, Schuppan D. Gluten Degrading Enzymes for Treatment of Celiac Disease. Nutrients. 2020 Jul 15;12(7):2095. doi: 10.3390/nu12072095. PMID: 32679754; PMCID: PMC7400306.

  18. Janssen G, Christis C, Kooy-Winkelaar Y, et al. Ineffective degradation of immunogenic gluten epitopes by currently available digestive enzyme supplementsPLoS One. 2015;10(6):e0128065. Published 2015 Jun 1. doi:10.1371/journal.pone.0128065

  19. Di Stefano M, Miceli E, Gotti S, Missanelli A, Mazzocchi S, Corazza GR. The effect of oral alpha-galactosidase on intestinal gas production and gas-related symptoms. Dig Dis Sci. 2007;52(1):78-83. doi:10.1007/s10620-006-9296-9

  20. Majeed M, Majeed S, Nagabhushanam K, Arumugam S, Pande A, Paschapur M, Ali F. Evaluation of the Safety and Efficacy of a Multienzyme Complex in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. J Med Food. 2018 Nov;21(11):1120-1128. doi: 10.1089/jmf.2017.4172

  21. Onken JE, Greer PK, Calingaert B, Hale LP. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro. Clin Immunol. 2008;126(3):345-352. doi:10.1016/j.clim.2007.11.002

  22. Ratajczak AE, Rychter AM, Zawada A, Dobrowolska A, Krela-Kaźmierczak I. Lactose intolerance in patients with inflammatory bowel diseases and dietary management in prevention of osteoporosis. Nutrition. 2021;82:111043. doi:10.1016/j.nut.2020.111043

  23. Kane S, Goldberg MJ. Use of bromelain for mild ulcerative colitis. Ann Intern Med. 2000;132(8):680. doi:10.7326/0003-4819-132-8-200004180-00026

  24. Spagnuolo R, Cosco C, Mancina RM, et al. Beta-glucan, inositol and digestive enzymes improve quality of life of patients with inflammatory bowel disease and irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2017;21(2 Suppl):102-107.

  25. Graham DY, Ketwaroo GA, Money ME, Opekun AR. Enzyme therapy for functional bowel disease-like post-prandial distress. J Dig Dis. 2018;19(11):650-656. doi:10.1111/1751-2980.12655

  26. Money ME, Camilleri M. Review: Management of postprandial diarrhea syndromeAm J Med. 2012;125(6):538-544. doi:10.1016/j.amjmed.2011.11.006

  27. Alkalay MJ. Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders. Nutrients. 2021 Dec 21;14(1):2. doi: 10.3390/nu14010002.

  28. Miller PC, Bailey SP, Barnes ME, Derr SJ, Hall EE. The effects of protease supplementation on skeletal muscle function and DOMS following downhill running. J Sports Sci. 2004;22(4):365-72. doi:10.1080/02640410310001641584

  29. Stone MB, Merrick MA, Ingersoll CD, Edwards JE. Preliminary comparison of bromelain and ibuprofen for delayed onset muscle soreness management. Clin J Sport Med. 2002;12(6):373-8.

  30. Akhtar N, Haqqi TM. Current nutraceuticals in the management of osteoarthritis: a review. Ther Adv Musculoskelet Dis. 2012;4(3):181-207. doi:10.1177/1759720X11436238

  31. Bolten WW, Glade MJ, Raum S, Ritz BW. The safety and efficacy of an enzyme combination in managing knee osteoarthritis pain in adults: a randomized, double-blind, placebo-controlled trial. Arthritis, 2015. doi:10.1155/2015/251521

  32. Wood VK. Is phlogenzym effective in reducing moderate to severe osteoarthritis pain in adults? PCOM Physician Assistant Studies Student Scholarship. 2013;139.

  33. Catanzaro R, Sciuto M, Marotta F. Lactose intolerance: An update on its pathogenesis, diagnosis, and treatment. Nutr Res. 2021;89:23-34. doi:10.1016/j.nutres.2021.02.003

  34. Montalto M, Nucera G, Santoro L, et al. Effect of exogenous β-galactosidase in patients with lactose malabsorption and intolerance: a crossover double-blind placebo-controlled study. European Journal of Clinical Nutrition. 2005;59(4):489.

  35. Dighe N, Pattan SR, Merekar AN, et al. Bromelain A Wonder Supplement: A Review. Pharmacologyonline. 2010;1:11-18.

  36. Stanger MJ, Thompson LA, Young AJ, Lieberman HR. Anticoagulant activity of select dietary supplements. Nutr Rev. 2012;70(2):107-117. doi:10.1111/j.1753-4887.2011.00444.x

  37. Oketch-Rabah HA, Marles RJ, Jordan SA, Low Dog T. United States Pharmacopeia Safety Review of Willow Bark. Planta Med. 2019;85(16):1192-1202. doi:10.1055/a-1007-5206

  38. Chakraborty AJ, Mitra S, Tallei TE, et al. Bromelain a Potential Bioactive Compound: A Comprehensive Overview from a Pharmacological Perspective. Life (Basel). 2021 Apr 6;11(4):317. doi: 10.3390/life11040317

  39. MedlinePlus. Papaya.

Additional Reading

By Regina C. Windsor, MPH, RDN
Listen to yourself. Connect the dots. Find your people. Go have fun.

Originally written by Cathy Wong
Cathy Wong

Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health.

Learn about our editorial process