Enzyme Therapy

***Disclaimer: This blog is not meant to be used as legal or medical advice.  It is written as my person perspective on how medical professionals could blend western medicine with other modalities***

A growing number of people are developing sensitivity to gluten without having celiac disease.  Is there something they can do to improve these negative symptoms?  This week on the Integrated Pharmacist Podcast, we're talking about Enzyme Therapy.  This approach to health recognizes that foods we eat can affect overall health.  Enzymes throughout the body can help certain chemical processes happen.  If the right ones are administered, food can potentially be digested even better.  This could lead to healthier guts and bodies.  We already practice this in western medicine.  We have medications that are concentrated pancreatic enzymes.  These are typically given to patients whose pancreas does not work optimally such as in cystic fibrosis or pancreatic cancer.
One branch of enzyme therapy came about from cat studies that show that raw foods contain enzymes within themselves that can help break itself down.  Because we cook our food and that destroys the enzymes, they hypothesize that this causes our pancreas to work harder than it should and drain other internal resources of the building blocks our body needs to built its own enzymes.  In order to combat this, some people promote a raw-food diet while others propose we supplement our diet with plant-based enzymes.

The number of people who have a sensitivity to gluten is on the rise.  Gluten is a protein that gets broken down in the digestive tract into peptides and then amino acids.  However, one peptide in gluten called gliadin is not well broken down in humans.  This peptide typically doesn't bother most people, but it can cause problems specifically in people with Celiac Disease.  Researchers wanted to see if using plant-based enzymes targeted at breaking down gliadin would help patients with gluten sensitivity that do not directly have Celiac Disease.  A total of 30 patients who demonstrated non-celiac gluten sensitivity were randomized into 2 groups.  One group got a placebo while the other received a treatment of 4 enzymes which included 3 derived from aspergillus and penicillium fungi and 1 from the papaya.  These enzymes were specifically selected because of their ability to breakdown gliadin into parts more digestible to humans.
Each participant was given instruction to maintain a gluten free diet for a short period.  Then they were to add 1 slice of bread to each meal.  There was a washout period of gluten-free meals again, and then the subjects were crossed over to the other arm.  Data recorded included gluten-sensitive responses, side effects, and inflammatory biomarkers.  Significant findings included fewer reported issues with bowel evacuation, headaches, and bloating in the study arm compared to placebo.  No negative side effects were reported from enzyme use and inflammatory biomarkers indicated that even under gluten challenge, these patients do not exhibit the same inflammation as patients with celiac disease.  This trial demonstrates that appropriate enzyme therapy can help with non-celiac gluten intolerance for some patients.  This might be a liberating concept for people who have had to restrict their diets away from some of their favorite foods.
As clinicians, it makes sense to understand enzyme therapy and be able to make informed decisions

about what products might be useful to patients.  As with all over-the-counter supplements, it's wise to refer to products that have been cleared through companies like Consumer Labs and USP.  These seals ensure good manufacturing practices and that the product has what the bottle says it has.  Gluten enzymes can be purchased from $10-30 a bottle containing 60 to 120 capsules each.
Thank you all for listening.  It's nice to be back to my usual mode of podcast.  I hope you enjoyed the episode.  If you'd like to reach out to me, you can email me at integratedpharmacist@gmail.com.  Please join us again next week on the Integrated Pharmacist Podcast.

Reference:
Ido H, Matsubara H, Kuroda M, et al. Combination of Gluten-Digesting Enzymes Improved Symptoms of Non-Celiac Gluten Sensitivity: A Randomized Single-blind, Placebo-controlled Crossover Study. Clin Transl Gastroenterol. 2018;9(9):181. Published 2018 Sep 19. doi:10.1038/s41424-018-0052-1