Pancreatic Enzymes

Pancreatic enzymes help break down proteins, fats and carbohydrates. When the pancreas doesn’t produce enough enzymes to break down food, enzyme supplements become necessary. It’s very common for people who have pancreatic cancer to be deficient in pancreatic enzymes. Malabsorption is an issue for individuals who have had the Whipple procedure to surgically remove a pancreatic tumor since fat absorption can’t be completely restored to normal.

Supplemental Pancreatic Enzymes

Supplemental pancreatic enzymes are available in prescription formulations only. Because early pancreatic enzyme preparations were in use before the passage of the Federal Food, Drug and Cosmetic Act of 1938, they were exempt from the review and approval set down by the act. Initially both prescription and non-prescription products were available, but in 1995 because of concerns over therapeutic failure and adverse affects with high doses the non-prescription products were outlawed. The FDA required all new products to submit a NDA or New Drug Application. They allowed the marketing of prescription products while they identified requirements for the NDA. While the requirements were under review some manufacturers were making generic products even though they violated the ruling. In 2004, the Food and Drug Administration mandated that all pancreatic insufficiency drugs in the United States obtain a NDA by April 2008. Because of their life sustaining nature pancreatic enzymes are allowed to be manufactured, while manufacturers conduct studies and prepare applications. The FDA’s desire is to standardize the enzyme activity and ensure correlation between the stated potency and the bioavailability of the enzymes.

In recommending enzymes, the type and dosage needs to be individualized for each person. As with any other supplement, when a person finds something that works for him he should stick with that brand. In general most people start by taking one tablet or capsule with snacks and two with meals and then increase or decrease until the proper dose is established. Any questions should be addressed when talking to your doctor or dietician.

Prescription Enzymes

All prescription pancreatic enzymes are from a porcine source. Individuals who are allergic to pork need to find alternative products by talking to their doctor or dietitian. Prescription preparations are said to contain pancrelipase, which is a combination of the three enzyme; protease, lipase and amylase. These enzymes digest protein, fat and sugars.

Creon® Capsule
Pancrease® Capsules
Zenpep® Capsules

Important Points To Know When Taking Pancreatic Enzyme

  • To improve the effectiveness of pancreatic enzymes, because acid inhibits the enzymes, an acid-reducing medication may be prescribed. These medications include histamine2 blockers such as Tagamet ®, Zantac® and Pepcid® or proton pump inhibitors such as Prilosec®, Prevacid®, and Nexium®. The disadvantage to the proton pump inhibitors is that once you start taking them you must continue doing so, as your body will require them. If you desire to stop you must wean yourself off, which requires that you decrease the dose slowly then switch over to a histamine2 blocker before stopping.
  • Always take enzymes with every meal or snack especially when eating meat, dairy or sweets.
  • When starting enzymes always start with the smallest dose necessary and adjust according to need.
  • Always take pancreatic enzymes before a meal or snack. They don’t work well if taken after the meal. If taking multiple enzymes take them at the beginning, middle and end of the meal.
  • Always swallow tablets whole with a glass of water. Some enzyme supplements are enteric coated to prevent them from being dissolved in the stomach. Crushing or chewing them will destroy the coating. Only crush or chew tablets if instructed to do so by your pharmacist or physician.
  • Some enzymes present in pancrelipase can begin to digest the oral mucosa if retained in the mouth, which can lead to ulceration of the tongue, cheeks and lips. If swallowing a capsule is difficult you can open it and place the tiny enteric coated microspheres in a spoonful of soft food such as applesauce or pureed banana. You might try this trick to swallow the capsule: after placing the capsule in your mouth and taking a big drink of water tilt your head down and swallow. By doing this, the natural buoyancy of the capsule in the water causes it to go down your throat.
  • Don’t mix opened capsules with milk, custard, pudding, ice cream or other dairy products, because they have a higher pH. The higher pH may dissolve the microspheres and destroy enzyme activity before the capsule is consumed.
  • Calcium or magnesium supplements or antacids, which contain these minerals, shouldn’t be taken within 2 hours of the enzymes as they may reduce the effectiveness.

Why Pancreatic Enzymes Might Be Needed

Doctors will prescribe digestive enzymes, which include pancreatic enzymes, to help improve digestion and absorption of food in conditions that cause poor absorption. These conditions are:

  • Pancreatic Insufficiency
  • Following a total pancreatectomy ( total removal of the pancreas)
  • Following the Whipple procedure
  • Pancreatic or duodenal tumors
  • Cystic fibrosis
  • Blockage or narrowing of the pancreatic or biliary duct (the tubes that carry pancreatic juice or bile)

The inability of the pancreas to secrete the enzymes needed for digestion is called pancreatic insufficiency. Mild forms of insufficiency are common, especially in older adults. Insufficiency may play a role in food allergies. It’s also common in pancreatic cancer patients. This will cause feelings of indigestion, bloating with large amounts of gas, cramping after eating, frequent and loose stools, foul smelling gas or stools and floating and greasy or fatty stools.

The Whipple procedure is the most commonly utilized surgery for the removal of pancreatic tumors. About twenty-five percent of patients will suffer from malabsorption and decreased fat absorption and it usually can’t be restored to normal. In these patients the goal is to restore adequate nutrition, and prevent diarrhea and weight loss. To achieve this goal a dose of lipase, 30,000 to 40,000 units, before each meal can be given.

In patients with advanced cancer located in the head of the pancreas, which can’t be surgically removed, obstruction of the duct is common. To treat these patients and prevent weight loss, a combination of pancreatic enzyme replacement, drainage of the bile duct and nutritional counseling can be used.

Uses of Pancreatic Enzymes

Physicians use symptoms as well as laboratory tests to assess pancreatic function. Common symptoms include indigestion, gas with abdominal bloating and discomfort, and passing undigested food in the stools. Most nutrition-orientated physicians use the comprehensive stool and digestive analysis for laboratory diagnosis. Intestinal overgrowth of the yeast Candida albicans is another indicator of pancreatic insufficiency. Parasites of the small intestine, which include bacteria, protozoa, and intestinal worms as well as the yeast, may also indicate insufficiency. Proteases in addition to digesting protein, in conjunction with other digestive secretions, are responsible for keeping the small intestine free of these parasites.

Proteases are very important in preventing tissue damage during the inflammatory process and in preventing the formation of fibrin clots. They cause an increase in the breakdown of fibrin, a process known as fibrinolysis. Fibrin’s role in inflammation is to form a wall around the area of inflammation, which results in the blockage of blood and lymph vessels and it leads to swelling. It can also cause blood clots to develop and these blood clots can become dislodged causing heart attacks or strokes.

Both pancreatic enzymes and preparations containing protease have been shown to be useful in treating many acute and chronic inflammatory conditions such as rheumatoid arthritis, tendonitis, and sports injuries. They have also been shown to be useful in treating thrombophebitis, which is a disease where blood clots develop in veins. These blood clots become inflamed and can dislodge resulting in a heart attack or stroke.

It appears that how they benefit in improving inflammation in these acute and chronic conditions is that they help the body to breakdown immune complexes that are formed between antibodies and the antigens they bind to. Diseases, which are associated with high levels of immune complexes in the blood, are referred to as “autoimmune”. Autoimmune diseases include lupus, multiple sclerosis, scleroderma and rheumatoid arthritis. These higher levels of immune complexes are also seen in diseases like Crohn’s disease, ulcerative colitis and AIDS.

Practitioners who specialize in alternative cancer treatments have promoted enzymes as a cancer treatment for years. These include Max Gerson M.D., William Kelley DDS and Nicholas Gonzalez M.D. Several clinical studies have shown pancreatic enzymes as being beneficial in improving the quality and prolonging the life of cancer patients.

Potentially pancreatic enzymes may be useful in treating viral illnesses such as hepatitis C, herpes simplex and herpes zoster (shingles). One study showed that treating herpes zoster patients with acyclovir and pancreatic enzymes was more effective than treatment with acyclovir alone. Another study showed treating hepatitis C patients with pancreatic enzymes and alpha-interferon was slightly better than treatment with the interferon alone.