Proteolytic-pancreatic enzyme therapy (PpET) [IM4update]
This was not included in Inflammation Mastery 4th Edition for the following 3 reasons
Proteolytic-pancreatic enzyme therapy (PpET) is an important therapy for a wide range of conditions, and yet I did not include it in Inflammation Mastery 4th Edition, even though I had actually published a summary in a separate article in 2005.
The reasons that this information was not included are as follows:
The original versions of Integrative Orthopedics (2004) and Integrative Rheumatology (2006) which eventually matured into Inflammation Mastery (2016) were written mostly for chiropractic and naturopathic students and clinicians, who are already trained in the use of enzyme therapy.
Oversight due to time pressure.
The prescription of enzyme therapy is somewhat complicated due to different units ranging from milligrams to milk-clotting units.
The section that follows is slightly updated from the original Nutritional Perspectives publication in 2005—the PDF is provided below with the original citations to research.
Admittedly, the article is somewhat of a polemic as I was a chiropractic cheerleader at the time—more on that later
Proteolytic-pancreatic enzyme therapy (PpET): Oral administration of proteolytic/pancreatic enzymes (such as pancreatin, bromelain, papain, trypsin and alpha-chymotrypsin) for therapeutic purposes is well established on physiologic, biochemical, and clinical grounds, and a brief review of their historical use is provided here. One of the first experimental studies was published by Beard in 1906 in the British Medical Journal wherein he showed that proteolytic enzymes significantly inhibited tumor growth in mice with implanted tumors[1] and a year later in that same journal, Cutfield[2] reported tumor regression and other objective improvements in a patient treated with proteolytic enzymes. In the American research literature, anti-cancer effects of proteolytic enzymes were reported during this same time in the Journal of the American Medical Association in anecdotal case reports of patients with fibrosarcoma[3], breast cancer[4], and head and neck malignancy[5]—all of whom responded positively to the administration of proteolytic enzymes; no adverse effects were seen. Although nearly a century would pass before Beard’s study and results were replicated with modern techniques[6],[7], by now research has established that orally administered proteolytic enzymes are well absorbed from the gastrointestinal tract into the systemic circulation[8],[9] and that the anti-tumor, anti-metastatic, anti-infectious, anti-inflammatory , analgesic, and anti-edematous actions result from synergism between a variety of mechanisms of action, including the dose-dependent stimulation of reactive oxygen species production and anti-cancer cytotoxicity in human neutrophils[10], a pro-differentiative effect[11], reduction in PG-E2 production[12], reduction in substance P production[13], modulation of adhesion molecules and cytokine levels[14], fibrinolytic effects and an anti-thrombotic effect mediated at least in part by a reduction in 2-series thromboxanes.[15] Unfortunately, enthusiasm for the enzyme treatment of cancer waned prematurely when trypsin was judged to not be a “miracle cure”, when the mechanism of action could not be determined, and as enthusiasm surrounding drug and radiation treatments grabbed the attention of allopaths.[16] However, modern controlled clinical trials in cancer patients have established the value of enzyme therapy, which produces important clinical benefit (e.g., symptom reduction and prolonged survival) for little cost and with negligible adverse effects.[17],[18],[19] Research in other clinical applications for proteolytic enzymes has consistently shown benefit when properly formulated and manufactured preparations are administered appropriately in the treatment of cellulitis, diabetic ulcers, sinusitis, and bronchitis.[20] For example, in a double-blind placebo-controlled trial with 59 patients, Taub[21] documented that oral administration of bromelain significantly promoted the resolution of congestion, inflammation, and edema in patients with acute and chronic refractory sinusitis; no adverse effects were seen in any patient.
Chiropractic and naturopathic physicians today use these enzymes mostly for the treatment of inflammatory and injury-related disorders. Reporting from the Tulane University Health Service Center, Trickett[22] reported that a papain-containing preparation benefited 40 patients with various injuries (e.g., contusions, sprains, lacerations, strains, fracture, surgical repair, and muscle tears); no adverse effects were seen. In a recent open trial of patients with knee pain, Walker et al[23]found a dose-dependent reduction in pain and disability as well as a significant improvement in psychological well-being in patients consuming bromelain orally. Most of the studies reviewed by Brien et al[24] were suggestive of a positive benefit in patients with knee osteoarthritis, but inadequate dosing clearly prohibited the attainment of optimal results. Bromelain also attenuates experimental contraction-induced skeletal muscle injury[25] reduces production of hyperalgesic PG-E2 and substance P, is generally effective in the amelioration of trauma-induced injury, edema, and inflammation, and is practically non-toxic. Although bromelain may be used in isolation, enzyme therapy is generally delivered in the form of polyenzyme preparations containing pancreatin, bromelain, papain, trypsin and alpha-chymotrypsin.
